How safe is skill mix in dentistry?

A look ahead to the ADI Team Congress 2022

Nurse staffing and patient-perceived quality of nursing care: a cross-sectional analysis of survey and administrative data in German hospitals

ObjectiveTo examine the impact of nurse staffing on patient-perceived quality of nursing care. We differentiate nurse staffing levels and nursing skill mix as two facets of nurse staffing and use a multidimensional instrument for patient-perceived quality of nursing care. We investigate non-linear and interaction effects.SettingThe study setting was 3458 hospital units in 1017 hospitals in Germany.ParticipantsWe contacted 212 554 patients discharged from non-paediatric, non-intensive and non-psychiatric hospital units who stayed at least two nights in the hospital between January and October 2019. Of those, 30 174 responded, yielding a response rate of 14.2%. Our sample included only those patients. After excluding extreme values for our nurse staffing variables and removing observations with missing values, our final sample comprised 28 136 patients ranging from 18 to 97 years of age (average: 61.12 years) who had been discharged from 3458 distinct hospital units in 1017 hospitals.Primary and secondary outcome measuresPatient-perceived quality of nursing care (general nursing care, guidance provided by nurses, and patient loyalty to the hospital).ResultsFor all three dimensions of patient-perceived quality of nursing care, we found that they significantly decreased as (1) nurse staffing levels decreased (with decreasing marginal effects) and (2) the proportion of assistant nurses in a hospital unit increased. The association between nurse staffing levels and quality of nursing care was more pronounced among patients who were less clinically complex, were admitted to smaller hospitals or were admitted to medical units.ConclusionsOur results indicate that, in addition to nurse staffing levels, nursing skill mix is crucial for providing the best possible quality of nursing care from the patient perspective and both should be considered when designing policies such as minimum staffing regulations to improve the quality of nursing care in hospitals.

Informing the increasing production of the health workforce in Bangladesh: evidence from a mapping exercise of health professional education institutions

This study aimed to evaluate the trend of production (2007-2016) and associated factors of seven health professionals i.e. physicians, dentists, diploma nurses, bachelor nurses, midwives, medical assistants and medical technologists in Bangladesh. The study team adopted a mapping approach to geographically locate all the health professional education institutions recognized by the Ministry of Health and Family Welfare (MOHFW). This was supported by a mixed-method design combining qualitative (e.g. group discussions and key informant interviews) and quantitative (questionnaire survey) methods. From 2007 to 2016, a total of 107,406 students graduated from all seven professional categories. Out of the total, about 40% belonged to the MBBS physician, 6% dentists, 15% medical assistants, 18% medical technologists, 21% nurses, and only 1% to the midwives. So, a skill-mix imbalance exists at the production level. Though the production had been on rising last 10 years, the production of the physicians was higher than any other professional categories. Feminization of the workforce is prominent as there was an average 14% increase of the female doctors than the male. The increasing production of health professionals needs to be supported by proper planning and policy interventions in order to avoid distortion of skill mix. Growing feminization of the workforce is also another area that requires special attention on the development of gender-sensitive employment conditions. Bangladesh Journal of Medical Education Vol.12(2) July 2021: 30-46

Size, composition and distribution of health workforce in India: why, and where to invest?

Background Investment in human resources for health not only strengthens the health system, but also generates employment and contributes to economic growth. India can gain from enhanced investment in health workforce in multiple ways. This study in addition to presenting updated estimates on size and composition of health workforce, identifies areas of investment in health workforce in India. Methods We analyzed two sources of data: (i) National Health Workforce Account (NHWA) 2018 and (ii) Periodic Labour Force Survey 2017–2018 of the National Sample Survey Office (NSSO). Using the two sources, we collated comparable estimates of different categories of health workers in India, density of health workforce and skill-mix at the all India and state levels. Results The study estimated (from NHWA 2018) a total stock of 5.76 million health workers which included allopathic doctors (1.16 million), nurses/midwives (2.34 million), pharmacist (1.20 million), dentists (0.27 million), and traditional medical practitioner (AYUSH 0.79 million). However, the active health workforce size estimated (NSSO 2017–2018) is much lower (3.12 million) with allopathic doctors and nurses/midwives estimated as 0.80 million and 1.40 million, respectively. Stock density of doctor and nurses/midwives are 8.8 and 17.7, respectively, per 10,000 persons as per NHWA. However, active health workers’ density (estimated from NSSO) of doctor and nurses/midwives are estimated to be 6.1 and 10.6, respectively. The numbers further drop to 5.0 and 6.0, respectively, after accounting for the adequate qualifications. All these estimates are well below the WHO threshold of 44.5 doctor, nurses and midwives per 10,000 population. The results reflected highly skewed distribution of health workforce across states, rural–urban and public–private sectors. A substantial proportion of active health worker were found not adequately qualified on the one hand and on the other more than 20% of qualified health professionals are not active in labor markets. Conclusion India needs to invest in HRH for increasing the number of active health workers and also improve the skill-mix which requires investment in professional colleges and technical education. India also needs encouraging qualified health professionals to join the labor markets and additional trainings and skill building for already working but inadequately qualified health workers.

Planning the Future Oral Health Workforce: A Rapid Review of Supply, Demand and Need Models, Data Sources and Skill Mix Considerations

Over the last decade, there has been a renewed interest in oral health workforce planning. The purpose of this review is to examine oral health workforce planning models on supply, demand and needs, mainly in respect to their data sources, modelling technique and use of skill mix. A limited search was carried out on PubMed and Web of Science for published scientific articles on oral health workforce planning models between 2010 to 2020. No restrictions were placed on the type of modelling philosophy, and all studies including supply, demand or needs based models were included. Rapid review methods guided the review process. Twenty-three studies from 15 countries were included in the review. A majority were from high-income countries (n = 17). Dentists were the sole oral health workforce group modelled in 13 studies; only five studies included skill mix (allied dental personnel) considerations. The most common application of modelling was a workforce to population ratio or a needs-based demand weighted variant. Nearly all studies presented weaknesses in modelling process due to the limitations in data sources and/or non-availability of the necessary data to inform oral health workforce planning. Skill mix considerations in planning models were also limited to horizontal integration within oral health professionals. Planning for the future oral health workforce is heavily reliant on quality data being available for supply, demand and needs models. Integrated methodologies that expand skill mix considerations and account for uncertainty are essential for future planning exercises.

Size, composition and distribution of health workforce in India: why, and where to invest?

BACKGROUND: Investment in human resources for health not only strengthen the health system but also generates employment and contributes to economic growth. India can gain from enhanced investment in health workforce in multiple ways. This study in addition to presenting updated estimates on size and composition of health workforce, identifies areas of investment in health workforce in India.METHODS: We analyzed two sources of data: i) National Health Workforce Account (NHWA) 2018 and ii) Periodic Labour Force Survey 2017-18 of the National Sample Survey Office (NSSO). Using the two sources we collated comparable estimates of different categories of health workers in India, density of health workforce and skill-mix at the all India and state levels.RESULTS: The study estimated (from NHWA 2018) a total stock of 5.76 million health workers which included allopathic doctors (1.16 million), nurses/midwives (2.34 million), pharmacist (1.20 million), dentists (0.27 million), and traditional medical practitioner (AYUSH 0.79 million). However, the active health workforce size estimated (NSSO2017-18) is much lower (3.12 million) with allopathic doctors and nurses/midwives estimated as 0.80 million and 1.40 million respectively. Stock density of doctor and nurses/mid-wives are 8.8 and 17.7 respectively per 10,000 persons as per NHWA. However, active health workers’ density (estimated from NSSO) of doctor and nurses/mid-wives are estimated to be 6.1 and 10.6 respectively. The numbers further drop to 5.0 and 6.0 respectively after accounting for the adequate qualifications. All these estimates are well below the WHO threshold of 44.5 doctor, nurses and midwives per 10,000 population. The results reflected highly skewed distribution of health workforce across states, rural-urban and public-private sectors. A substantial proportion of active health worker were found not adequately qualified on the one hand and on the other more than 20% of qualified health professionals are not active in labour markets.CONCLUSION: India needs to invest in HRH for increasing the number of active health workers and also improve the skill-mix which requires investment in professional colleges and technical education. India also needs encouraging qualified health professionals to join the labour markets and additional trainings and skill building for already working but inadequately qualified health workers.