Human Resources Are Critical to Universal Health Coverage
It is a universal truth that there will be no health service without a health workforce (World Health Organization [WHO ] 2014).
But in many geographies, the demand for health exceeds the supply of people who can provide it. This is in spite of a workforce of over 40 million and spending on healthcare worldwide of US$7.2 trillion, equating to 10.6% of global gross domestic product (Deloitte 2015).
A convergence of forces has had a dramatic effect on the balance of demand and supply. Amongst these are social and demographic change (Girasek et al. 2016); the consequences of ageing; the growing risk of non-communicable diseases and a broader definition of what is understood by the meaning of health, which now refers to the totality of human welfare, extending beyond a ânarrowâ biomedical view (Salomon et al. 2003). In its contemporary form, health is a âstate of complete physical, social and mental well-being, and not merely the absence of disease or infirmityâ (WHO 2016) and satisfies the demands of a life commensurate with age, culture, and personal responsibility (Bircher 2005). It relates to everyday life, not just the object of living, and is a fundamental human right that is recognised in the Universal Declaration of Human Rights.
The context for health services worldwide is therefore set by these factors together with pressures on health budgets and a growing demand for a return on investment in health. The fact that health services are now seen as vital to national economies contributing to development, growth and stability adds further weight to their importance. Undoubtedly, continuing progress in human longevity (Gratton and Scott 2016) and a broader definition will necessitate not only step changes in technology for health but a significant increase in the number of talented health professionals.
To address the human resource challenges, the WHO , the Global Health Workforce Alliance and others have called for macro, interconnected efforts and innovative approaches to workforce planning and management (WHO 2013): broadening the recruitment pool, creating targets for producing larger numbers of health workers, and offering greater career opportunities and flexibility in health systems (Maeda et al. 2014: 42; Girasek et al. 2016).
Healthcare HR Is at a Crossroads
Such targets are also framed in the context of affordability and sustainability compounded by change in the sector which is not happening in small incremental steps but in quantum leaps impacting on a wide range of organisational drivers from technology infrastructure to finance and business processes (Kabene 2010; Hopper 2015). In addition, since quality care begins with quality people, there is a dynamic to make sure that human resources decisions support both immediate organisational goals and the long-term aims of staffing with highly qualified individuals (Fried and Fottler 2008; Pynes and Lombardi 2011). On the one hand, this means training, education and development in each of the professional specialisms such as doctors, nurses or allied health professionals (Sambrook and Stewart 2007); on the other, it means strategic management of human resources as a whole to ensure that qualified, motivated personnel are available to staff the full portfolio of health units (Hernandez and OâConnor 2010). In all cases, health service human resources are key determinants of health service performance (Dubois et al. 2005).
Solutions to health challenges are categorised under the heading of âhuman resources for healthâ and take place in a cycle of macro geopolitical and geosocial initiatives influenced by labour market economics and principles of ethics and morality (in transnational recruitment, for example). At a micro level, the challenge facing regional and local health sector organisations is how to integrate laudable global aspirations into their own specific objectives and operationalise them in day-to-day practice. The role of the health organisation human resource professional is often more complex than that of counterparts in other sectors. It is a role that includes common goals across the sector but often competing priorities within it (Deloitte 2015). Talent and talent management feature heavily in their sphere of interest.
Reframing the Concept of Health Increases the Demand for Health Sector Talent
Health workforce shortages are forecast to be significantâup to 15 million workers (Liu et al. 2016)âcaused by not only demand-side issues as outlined above but supply-side ones since not enough people are entering the health professions. Regional imbalances and the migration of healthcare workers exacerbate the problem. For example, whilst over time the number of doctors per 1000 population is expected to remain virtually the same, the unequal distribution of health workers means that there will be large regional differences. The USA had 3.3 doctors per 1000 population in 2013âbut still faces challenges in renewing and refreshing the clinical workforceâwhilst countries in Africa and South East Asia have struggled to recruit and retain enough skilled medical staff to come anywhere near these ratios (Deloitte 2015). Furthermore, the numbers donât reflect demand and supply, as exemplified by the position in Sub-Saharan Africa, in which the disease burden is not matched by a commensurate proportion of health workers (Celletti et al. 2011).
The need to increase the numbers in the health profession has focused on low- and middle-income countries on the one hand, where it is a critical issue and where a shallow pool of those qualified to meet the demand for healthcare and the movement of healthcare workers from countries with scarce resource to areas of resource abundance âpresents a complex set of decisions and relationships that affect the development of international health care systemsâ (Karan and DeUgarte 2016: 665; Maeda et al. 2014; Maurer 2015: 1). But, on the other hand, there is the challenge in high-income countries to recruit enough people to train for key health sector roles in the face of an increase in the demand for healthcare (Maeda et al. 2014; Maurer 2015: 1). The Association of American Medical Colleges, for example, has noted that under every scenario, the USA will face a shortage of physicians over the next decade (Association of American Medical Colleges 2016). The attraction, management, development and retention of talent into health are therefore not confined to one region or country. Instead, they are worldwide issues. A shortage of healthcare workers in Africa on the one hand and healthcare workers in China on the other; a âsilver tsunamiâ caused by retiring baby-boomer nursing workforce in the USA on the one hand (Moore 2015) to an undersupply of general practitioners and medical specialists in the UK on the other. Talent shortages in health are ubiquitous.
These factors have a significant effect on what might be termed point-of-care organisations and mean that the criticality of effective talent management has rarely been as important to success as it is today, nor more challenging. In addition, internal forces such as those caused by workforce demographics have reshaped health organisations, whilst global mobility, multi-generational and more diverse, empowered employees have changed their character. Traditional skills remain in demand, but new ones emerge for both clinical and technical or managerial roles. Success in this area therefore requires that organisations have a focus on more than just the numbers of talented employees. Instead, human resources and talent management will require insights into âcompetencies, quality, motivation and performanceâ (WHO 2013: ix).
Talent Management in Health Takes Place in a Complex, Contested Economic Environment
Many of the factors that influence health, and the quality and quantity of the health workforce, transcend any one nation or organisation, which means that effective talent management is becoming a supranational and national priority âbound up in a complex and contested political economy, where the place, role, skills, aptitudes and mobility of health workers are central to health delivery, access, inequality, utilisation and outcomesâ (Connell and Walton-Roberts 2016: 168). There is recognition of the important role of human resources for health in national priorities and international goals (WHO 2013: 2). But there is also recognition that health sector organisations, such as those at the community, hospital or health unit level, will need an equally strong focus on human resources and talent management. The observation that âhealth care delivery cries out for a strategy, given the stakes, the scale and the sheer complexity of the taskâ (Porter and Teisberg 2006: 151) could apply equally to both international and local health organisations.
The unique context of health means that talent management is framed not only by the demographic and economic forces that pertain to other sectors but by ethical and moral issues such as those in recruitment that potentially pit south against north, nation against nation, and organisation against organisation in the quest to meet the increasing demand for health sector talent. The relatively free movement of health workers, whilst providing benefits for some countries, has also brought in its wake regional imbalances. Organisational talent strategies have this consideration in addition to the other factors.
Investing in the Health Workforce Can Create Economic Growth
Balancing global initiatives against local circumstances is therefore one of the stand-out features of talent management in the health sector.
How organisations define talent and talent management and how they establish talent strategies that are the best fit for their own contexts will be covered in detail in later chapters. But as a general statement, talent management includes, inter alia, the attraction, recruitment, management, retention and development of a broad range of clinical, technical and managerial health professionals.
The strength of interest has come about because there is a belief that âthe development of employment in the health and social sector is not only an imperative of international public health. It constitutes a major economic and social opportunity to promote inclusive economic growth and creation of decent jobs, especially f...