Why does it take a crisis to understand that
health workers are our health system? By Ivy Bourgeault, Sarah Simkin and Caroline Chamberland-Rowe n country after country, members of the public are clapping from their doorways and balconies to show their appreciation of health workers. It is becoming clearer than ever that our health system is largely our health workers. Ventilators do not work without health workers; testing does not happen without health workers. All forms of care required to respond to this crisis will require health workers. Health system capacity – of which health workers are a key component – is often represented as a flat line on epidemic curves. The main aim of flattening the curve is to keep demand below the upper limit of health system capacity. This flat line gives the impression that health system capacity is static. It is not. Social distancing is a way for us to help moderate the demand side of the equation, but how are we to bolster the capacity side of the equation to keep ahead of that curve? Ongoing analyses of health system capacity are modelling increased capacity of physical resources. What is unclear is whether these analyses are modelling health workforce capacity, and if so, how. Health workforce capacity is not simply the number of doctors, nurses, respiratory therapists or other essential health workers that are actively registered. What health workers are allowed to do (their scopes of practice) and how they do it (their practice patterns) can vary substantially, depending on the populations they
I
care for, the settings in which they work and the regulations by which they are governed. But health workforce modelling should not only model how work is typically done. In times of crisis, when systems are called upon to demonstrate resilience, responsiveness, and surge capacity, models need to take into consideration how work could be done and demonstrate what capacity could be mobilized through more optimal use of available resources. That is, how could we better utilize the whole of the health workforce to turn the capacity line upwards? Responding to this crisis will require shifting tasks and leveraging the full scope of skills available within the health workforce. These innovations are often employed in low resource settings, out of necessity, but even high-income countries are quickly shifting tasks and redeploying available human resources. In the UK, for example, anyone with skills in sedation, including dental nurses who are part of the National Health Service are being recalled to help respond to the COVID crisis. In Australia, physiotherapists are similarly being redeployed to work in acute respiratory teams. Additional pools of health workers, such as trainees and retirees, are being mobilized. To best accomplish this, we need to know who is in the health workforce, where they are, and what skills they have. Sounds straightforward – and yet, in Canada, these basic data are often fragmented, out of date or hard to access. Continued on page 13
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