Health workforce strategies in response to major health events: a rapid scoping review with lessons learned for the response to the COVID-19 pandemic

Background The early weeks of the COVID-19 pandemic brought multiple concurrent threats—high patient volume and acuity and, simultaneously, increased risk to health workers. Healthcare managers and decision-makers needed to identify strategies to mitigate these adverse conditions. This paper reports on the health workforce strategies implemented in relation to past large-scale emergencies (including natural disasters, extreme weather events, and infectious disease outbreaks). Methods We conducted a rapid scoping review of health workforce responses to natural disasters, extreme weather events, and infectious disease outbreaks reported in the literature between January 2000 and April 2020. The 3582 individual results were screened to include articles which described surge responses to past emergencies for which an evaluative component was included in the report. A total of 37 articles were included in our analysis. Results The reviewed literature describes challenges related to increased demand for health services and a simultaneous decrease in the availability of the workforce. Many articles also described impacts on infrastructure that hindered emergency response. These challenges aligned well with those faced during the early days of the COVID-19 pandemic. In the published literature, the workforce strategies that were described aimed either to increase the numbers of health workers in a given area, to increase the flexibility of the health workforce to meet needs in new ways, or to support and sustain health workers in practice. Workforce responses addressed all types and cadres of health workers and were executed in a wide range of settings. We additionally report on the barriers and facilitators of workforce strategies reported in the literature reviewed. The strategies that were reported in the literature aligned closely with our COVID-specific conceptual framework of workforce capacity levers, suggesting that our framework may have heuristic value across many types of health disasters. Conclusions This research highlights a key deficiency with the existing literature on workforce responses to emergencies: most papers lack substantive evaluation of the strategies implemented. Future research on health workforce capacity interventions should include robust evaluation of impact and effectiveness.

Patterns of Human Capital Formation

The main goal of the article is to identify the basic patterns of the formation of human capital (HC). An especially valuable and scarce resource of the modern economy is becoming a creative skilled worker capable of generating ideas, as well as creating and implementing new technological solutions and products. The development of the economy leads to significant transformations in the generation of resource potential, and changes in the role of individual resources. Human capital begins to play a dominant role in the resource hierarchy. It is the HC that sets in motion the production processes and determines the efficiency of using the entire resource potential. The methods of aspect analysis and of apperception used in this study made it possible to identify modern patterns peculiar to the formation of human capital in the economy, and to emphasize its objective importance and ability to significantly influence the development of society. During the research, the authors proved that human capital acquires the status of the main resource in the economy, the quantitative characteristics of the workforce capacity give way to the role of qualitative characteristics, and the development of STP requires a new employee formation to dominate the intellectual component.

Responding to COVID-19 by building health workforce capacity across eleven countries in Sub-Saharan Africa

Background: The global spread of the SARS-CoV-2 virus highlights both the importance of frontline healthcare workers (HCW) in pandemic response and their heightened vulnerability during infectious disease outbreaks. Adequate preparation, including the development of human resources for health (HRH) is essential to an effective response. ICAP at Columbia University (ICAP) partnered with Resolve to Save Lives and MOHs to design an emergency training initiative for frontline HCW in 11 African countries, using a competency-based backward-design approach and tailoring training delivery and health facility selection based on country context, location and known COVID-19 community transmission. Methods: Pre and Post-test assessments were conducted on participants completing the COVID-19 training. Parametric and non-parametric methods were used to examine average individual-level changes from pre- to post-test, and compare performance between countries, cadres, sex and facility types. A post evaluation online training survey using Qualtrics was distributed to assess participants’ satisfaction and explore training relevance and impact on their ability to address COVID-19 in their facilities and communities. Results: A total of 8,797 HCW at 945 health facilities were trained between June 2020 and October 2020. Training duration ranged from 1 to 8 days (median: 3days) and consisted of in person, virtual or self guided training. Of the 8,105 (92%) HCW working at health facilities, the majority (62%) worked at secondary level facilities as these were the HF targeted for COVID-19 patients. Paired pre- and post-test results were available for 2,370 (25%) trainees, and 1,768 (18%) participants completed the post-evaluation training survey. On average, participants increased their pre- to post-test scores by 15 percentage points (95% CI: 0.14, 0.15). While confidence in their ability to manage COVID-19 was high following the training, respondents reported that lack of access to testing kits (55%) and PPE (50%), limited space in the facility to isolate patients (45%), and understaffing (39%) were major barriers. Conclusion: Ongoing investment in health systems and focused attention to health workforce capacity building is critical to outbreak response. The success of our short-term IPC training initiative was due both to the speed, rigor and flexibility of its design and delivery, and to the pre-existing systems, resources, and partnerships that enabled its rapid implementation

Trends in training progression: response to the study by Silkens et al

Recruitment and retention are of major concern to all in medicine. Improvement in recruitment to UK speciality training programmes does not directly translate into senior workforce capacity, which remains dependent on trainee progression. In 2021, Silkens et al undertook a mixed-methods study to investigate this and described a trainee-driven shift away from conventional training pathways and expectations. These findings suggest a need for a broad change in approach to careers, underpinned by commitment to reducing differential attainment, acknowledgment that trainees may have a range of unique needs, and development of a culture of equality, diversity and inclusion.

Increasing doctors working in specific rural regions through selection from and training in the same region: national evidence from Australia

Background ‘Grow your own’ strategies are considered important for developing rural workforce capacity. They involve selecting health students from specific rural regions and training them for extended periods in the same regions, to improve local retention. However, most research about these strategies is limited to single institution studies that lack granularity as to whether the specific regions of origin, training and work are related. This national study aims to explore whether doctors working in specific rural regions also entered medicine from that region and/or trained in the same region, compared with those without these connections to the region. A secondary aim is to explore these associations with duration of rural training. Methods Utilising a cross-sectional survey of Australian doctors in 2017 (n = 6627), rural region of work was defined as the doctor’s main work location geocoded to one of 42 rural regions. This was matched to both (1) Rural region of undergraduate training (< 12 weeks, 3–12 months, > 1 university year) and (2) Rural region of childhood origin (6+ years), to test association with returning to work in communities of the same rural region. Results Multinomial logistic regression, which adjusted for specialty, career stage and gender, showed those with > 1 year (RRR 5.2, 4.0–6.9) and 3–12 month rural training (RRR 1.4, 1.1–1.9) were more likely to work in the same rural region compared with < 12 week rural training. Those selected from a specific region and having > 1-year rural training there related to 17.4 times increased chance of working in the same rural region compared with < 12 week rural training and metropolitan origin. Conclusion This study provides the first national-scale empirical evidence supporting that ‘grow your own’ may be a key workforce capacity building strategy. It supports underserviced rural areas selecting and training more doctors, which may be preferable over policies that select from or train doctors in ‘any’ rural location. Longer training in the same region enhances these outcomes. Reorienting medical training to selecting and training in specific rural regions where doctors are needed is likely to be an efficient means to correcting healthcare access inequalities.

Health Workforce Strategies in Response to Major Health Events: A Rapid Scoping Review with Lessons Learned for the Response to the COVID-19 Pandemic

Background: The early weeks of the COVID-19 pandemic brought multiple concurrent threats – high patient volume and acuity and, simultaneously, increased risk to health workers. Healthcare managers and decision-makers needed to identify strategies to mitigate these adverse conditions. This paper reports on the health workforce strategies implemented in relation to past large-scale emergencies (including natural disasters, extreme weather events, and infectious disease outbreaks).Methods: We conducted a rapid scoping review of health workforce responses to natural disasters, extreme weather events, and infectious disease outbreaks reported in the literature between January 2000 and April 2020. The 3582 individual results were screened to include articles which described surge responses to past emergencies for which an evaluative component was included in the report. A total of 37 articles were included in our analysis.Results: The reviewed literature describes challenges related to increased demand for health services and a simultaneous decrease in the availability of the workforce. Many articles also described impacts on infrastructure that hindered emergency response. These challenges aligned well with those faced during the early days of the COVID-19 pandemic. In the published literature, the workforce strategies that were described aimed either to increase the numbers of health workers in a given area, to increase the flexibility of the health workforce to meet needs in new ways, or to support and sustain health workers in practice. Workforce responses addressed all types and cadres of health workers and were executed in a wide range of settings. We additionally report on the barriers and facilitators of workforce strategies reported in the literature reviewed. The strategies that were reported in the literature aligned closely with our COVID-specific conceptual framework of workforce capacity levers, suggesting that our framework may have heuristic value across many types of health disasters.Conclusions: This research highlights a key deficiency with the existing literature on workforce responses to emergencies: most papers lack substantive evaluation of the strategies implemented. Future research on health workforce capacity interventions should include robust evaluation of impact and effectiveness.

Workforce Capacity Development and the Digital Extended Specimen

As we look to the future of natural history collections and a global integration of biodiversity data, we are reliant on a diverse workforce with the skills necessary to build, grow, and support the data, tools, and resources of the Digital Extended Specimen (DES; Webster 2019, Lendemer et al. 2020, Hardisty 2020). Future “DES Data Curators” – those who will be charged with maintaining resources created through the DES – will require skills and resources beyond what is currently available to most natural history collections staff. In training the workforce to support the DES we have an opportunity to broaden our community and ensure that, through the expansion of biodiversity data, the workforce landscape itself is diverse, equitable, inclusive, and accessible. A fully-implemented DES will provide training that encapsulates capacity building, skills development, unifying protocols and best practices guidance, and cutting-edge technology that also creates inclusive, equitable, and accessible systems, workflows, and communities. As members of the biodiversity community and the current workforce, we can leverage our knowledge and skills to develop innovative training models that: include a range of educational settings and modalities; address the needs of new communities not currently engaged with digital data; from their onset, provide attribution for past and future work and do not perpetuate the legacy of colonial practices and historic inequalities found in many physical natural history collections. Recent reports from the Biodiversity Collections Network (BCoN 2019) and the National Academies of Science, Engineering and Medicine (National Academies of Sciences, Engineering, and Medicine 2020) specifically address workforce needs in support of the DES. To address workforce training and inclusivity within the context of global data integration, the Alliance for Biodiversity Knowledge included a topic on Workforce capacity development and inclusivity in Phase 2 of the consultation on Converging Digital Specimens and Extended Specimens - Towards a global specification for data integration. Across these efforts, several common themes have emerged relative to workforce training and the DES. A call for a community needs assessment: As a community, we have several unknowns related to the current collections workforce and training needs. We would benefit from a baseline assessment of collections professionals to define current job responsibilities, demographics, education and training, incentives, compensation, and benefits. This includes an evaluation of current employment prospects and opportunities. Defined skills and training for the 21st century collections professional: We need to be proactive and define the 21st century workforce skills necessary to support the development and implementation of the DES. When we define the skills and content needs we can create appropriate training opportunities that include scalable materials for capacity building, educational materials that develop relevant skills, unifying protocols across the DES network, and best practices guidance for professionals. Training for data end-users: We need to train data end-users in biodiversity and data science at all levels of formal and informal education from primary and secondary education through the existing workforce. This includes developing training and educational materials, creating data portals, and building analyses that are inclusive, accessible, and engage the appropriate community of science educators, data scientists, and biodiversity researchers. Foster a diverse, equitable, inclusive, and accessible and professional workforce: As the DES develops and new tools and resources emerge, we need to be intentional in our commitment to building tools that are accessible and in assuring that access is equitable. This includes establishing best practices to ensure the community providing and accessing data is inclusive and representative of the diverse global community of potential data providers and users. Upfront, we must acknowledge and address issues of historic inequalities and colonial practices and provide appropriate attribution for past and future work while ensuring legal and regulatory compliance. Efforts must include creating transparent linkages among data and the humans that create the data that drives the DES. In this presentation, we will highlight recommendations for building workforce capacity within the DES that are diverse, inclusive, equitable and accessible, take into account the requirements of the biodiversity science community, and that are flexible to meet the needs of an evolving field.

PP26 Stepping up: interviews with student paramedics and lecturers about a scheme to increase workforce capacity within an English ambulance service during the first wave of the COVID-19 pandemic

BackgroundDuring the UK’s first wave of the COVID-19 pandemic in early 2020, ambulance services acted to increase capacity rapidly. One English ambulance service recruited existing supernumerary student paramedics into a new, paid, hybrid role, working as one half of a double-crewed ambulance team.MethodsTen student paramedics and two university lecturers were interviewed remotely in one-to-one sessions with a single interviewer. Students participated from 3 of 4 partner universities, and lecturers from 2 of the 4. Their responses were transcribed and coded into a framework of the four processes of organisational entry: analysis, recruitment, selection, and induction.ResultsThe participants described barriers and facilitators to the success of the scheme in all four processes. Analysis: job descriptions and working conditions were not always clear to interviewees. Recruitment: some students described feeling under pressure to take part. Lecturers criticised communications, particularly around some of their student paramedics who had withdrawn from study. Selection: students were critical of some aspects of physical assessment being omitted for this new role, but later reinstated for subsequent paramedic recruitment events. Induction: most students praised the initial training and their induction onto ambulance stations, but many felt they should have been given driver training. Lecturers raised concerns that students at risk of failing in placement may not be supported adequately in this new role. Almost all participants praised the scheme’s intentions and overall delivery, and some suggested a similar role bears consideration for future business-as-usual university placements.ConclusionsParticipants were broadly positive about this scheme, with some suggesting that elements of this hybrid role could feature in a post-pandemic student paramedic programme. Limitations include recall bias and response bias, particularly in that students who declined to take part in the scheme also declined to take part in this interview study.

A new bottom-up method for the standard analysis and comparison of workforce capacity in mental healthcare planning: Demonstration study in the Australian Capital Territory

The aims of this study are to evaluate and describe mental health workforce and capacity, and to describe the relationship between workforce capacity and patterns of care in local areas. We conducted a comparative demonstration study of the applicability of an internationally validated standardised service classification instrument—the Description and Evaluation of Services and Directories—DESDE-LTC) using the emerging mental health ecosystems research (MHESR) approach. Using DESDE-LTC as the framework, and drawing from international occupation classifications, the workforce was classified according to characteristics including the type of care provided and professional background. Our reference area was the Australian Capital Territory, which we compared with two other urban districts in Australia (Sydney and South East Sydney) and three benchmark international health districts (Helsinki-Uusima (Finland), Verona (Italy) and Gipuzkoa (Spain)). We also compared our data with national level data where available. The Australian and Finnish regions had a larger and more highly skilled workforce than the southern European regions. The pattern of workforce availability and profile varied, even within the same country, at the local level. We found significant differences between regional rates of identified rates of psychiatrists and psychologists, and national averages. Using a standardised classification instrument at the local level, and our occupational groupings, we were able to assess the available workforce and provide information relevant to planners about the actual capacity of the system. Data obtained at local level is critical to providing planners with reliable data to inform their decision making.