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Ivy Lynn Bourgeault
Professor at the School of Sociological and Anthropological Studies at the University of Ottawa and Director of the Canadian Health Workforce Network
That was the situation before the pandemic. With COVID-19, we are seeing levels of stress, overwork and exhaustion in the health sector that have never been imagined before.
Even if they are useful, downstream expressions of benevolence and free access to psychotherapy services are palliative solutions at best. We should rather look upstream, that is to say towards the factors at the origin of the crisis.
Health worker burnout is directly linked to poor workforce planning. It is incredible to think that we can continue to run our health care system while remaining ignorant of the basics about its main resource – its workforce.
Health workers form more than 10% of the workforce in Canada. It accounts for more than two-thirds of health costs, not counting the personal and public expenses related to the training of its members. In 2019, this represented a sum of 175 billion dollars, or almost 8% of the GDP.
To make the best possible decisions about this invaluable resource, health workforce research (and the research data infrastructure necessary to support it) is essential. It must be given the means to develop without delay.
Canada lags behind other peer countries in the OECD, including the United Kingdom, Australia and the United States, in big data analytics and implementation a digital research infrastructure. Yet this would provide us with vital information for workforce planning. Our significant knowledge gaps have resulted in serious systemic risks that health planners have had to contend with throughout this health crisis.
Without relevant and up-to-date data, decision-makers are unable to optimally and timely deploy the necessary workforce to the areas that need it most. Planning activities across Canada remain ad hoc, sporadic, and isolated, resulting in significant inefficiencies and costs. The consequences range from underutilization of the workforce to poor population health outcomes to staff burnout.
What data is currently available to us?
These are data specific to each profession that tell us little about the role of healthcare providers within the teams called upon to intervene throughout the patient’s clinical journey in the “real world”. In addition, data collection varies across jurisdictions, so cross-sectoral analyzes are not easy. In particular, there is a lack of information on providers of eldercare and mental health care – two sectors heavily affected by the pandemic.
To support inter-professional and inter-sectoral planning, we would need consistent data on a wider range of health workers.
Ideally, data collection would be done in a consistent fashion taking into account diversity (racial, Indigenous, and gender identity in a broader perspective) as well as practice characteristics (delivery setting, scope of practice and service capacity, for example). In addition, this information would be associated with relevant data on patients, in particular on the use of services and the evolution of their state of health.
Robust data would give us a better idea of the range of health workers and their characteristics, the type of care they provide, and the outcomes.
Right now we are making decisions blindly, without relying on essential data such as that which has been available for years in most other developed countries.
How did we get there ?
To coordinate data collection, analytics and research on the health workforce, Canada needs a strong and centralized infrastructure. This would make it possible to fill a gap that has caused us to fall behind and that the appearance of COVID-19 has made even more evident.
Impossible to claim to have been caught off guard. As early as 2010, the House of Commons Standing Committee on Health recommended establishing a mechanism dedicated to human resources in health, a proposal supported by all parties and by several organizations that testified before its members at the time. Things have hardly changed since.
Added to the dispersion of governance responsibilities inherent in a federated health system, the lack of coordination of data integration, analytics and planning activities has the effect of blurring the lines of responsibility and the efforts of even more ineffective collaboration.
Other countries have succeeded in overcoming these challenges. Since the pandemic clearly revealed the need, Canada has no more excuses.
The federal ministers of health, labor and innovation must make the establishment of a data management infrastructure for the health workforce a top priority. The pandemic could well be the boost that will allow important progress to be made on this issue.
To show our support for our caregivers, applauding is not enough – we need to get down to the task of planning for better working conditions for them. Let us make improved research on the health workforce an important legacy to bequeath to these essential workers.
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