Assessing the status of health workforces in operational environments

Facilitator guide

Table of Contents

The 5 Domains of Workforce Classification

Background

Overview of the tool

Preparation

The Facilitator

Scope

Initial data collection

Choosing focus group participants

Preparing participants

Individual workforce rating

The focus group meeting

Introduction

Discussion

Summary

Follow-up

Domain definitions

Service need

Public profile

Supply

Operational flexibility

Operational capacity

Appendix 1 Scoring Matrix for Health Workforce Classification Framework

Appendix 2 Template report initial data collection template

Appendix 3 Information for participants

Appendix 4 Copy of online survey.

Appendix 5 Template Report Workforce assessment status

The 5 Domains of Workforce Classification

Background

In order to write an effective collective employment negotiations bargaining strategy there is an need to consider a number of intersecting elements such as fiscal constraints, current and future service delivery need and workforce issues.

This workforce tool was developed in response to a need for an evidenced based approach to assessing and categorising the level of need of workforce. It has been used to support the collective DHB employment negotiations processes. It has formed the baseline data gathering for operational information on specific workforces and has helped identify where further investigation into particular workforce issues is required.

There were two key drivers that have lead to the development of this tool. The first was a need to assess and classify health workforces whilst taking cognisance of the wider contextual factors which impact on the New Zealand health system. The second driver was a desire to have an evidence-based method for District Health Boards (DHBs) to review their workforces as part of developing a bargaining strategy for collective employment agreements. Previous assessments of the health workforce were been anecdotal and lacked a whole of systems approach. They did not provide a logical framework to enable a comparison of workforces. It is intended this tool will benefit the wider health system by providing a framework for evidential discussion to occur.

Use of the tool relies on consensus view of an expert focus group who agree on a workforce classification and where required make suggestions for further investigation.

The tool is time dependent so only provides information at the particular point in time in which the process is undertaken. There is however the ability to repeat the process at a later date in order to review any changes or other such trends

Overview of the tool

This qualitative assessment tool has been specifically designed to identify workforce pressures that may have an impact on the capacity to deliver services. Its key purpose is to identify areas of operational pressure for the particular workforce being examined. It is recommended that this tool be used along side other assessment tools in evaluating a workforce.

This workforce assessment tool is a qualitative process that uses 5 factors (figure 1) to guide a facilitated focus group discussion on the identified workforce. The need to have a diverse group of both operational and professional viewpoints is imperative as it enables views to be challenged and strong rationale to be developed to support the final categorisation.

The first step of the process is to identify the scope of the assessment to be performed. Generally this is for an occupational group but it could also be further refined to review a particular speciality for region.

Having defined the scope, the next stage is to gather all readily available background information/data on this workforce to help inform the group discussion and ensure the facilitator is adequately prepared for the focus group process. Data can include relevant operational DHB information on the workforce, regulatory workforce data and strategic workforce information from Health Workforce New Zealand

This information is shared with the focus group participantsat the beginning of the process. The information will assist the participants to complete an individual assessment of the workforce and enable informed discussion on each of the 5 domains.

During the focus group the facilitator keeps the groupfocused on discussing the rating, andrationale,for the workforce in each domain. Having rated each domain the scores are totalled and the workforce is assigned to one of four classifications based on the level of intervention required. This classification is indicative only and provides a rationale for further investigation to occur.

Stable Occupation
WATCHING BRIEF /
Transitional Occupation
SOME INTERVENTION RECOMMENDED /
Transitional/ Occupation Under Pressure
INTERVENTION REQUIRED /
Occupation Under Pressure
INTERVENTION IMPERATIVE /

Preparation

The Facilitator

Each workforce assessment requires a leader or facilitator who is responsible for managing the process and facilitating the focus group discussion. This includes:-

  • Identifying the scope of the assessment
  • Organising and collating the initial data collection
  • Theselection and invitation of focus group participants,
  • Ensuring participants have the resources required to fully participate.
  • Summarise the focus group discussions and overall findings.
  • Managing any follow up investigation that may be required.

The facilitator needs to be familiar with the process and have some skills in facilitation of group process.

It is important that the facilitator fully understands the five factors and their purpose, so as to correctly guide discussion within the group. There is often a tendency for focus group members to digress into other topics, relevant to the workforce, not required for the purpose of the exercise. The facilitator must keep a tight handle on the topic of discussion and ensure that valuable time is not spent on superfluous items.

The facilitator must also ensure that they are able to manage more vocal focus group members and ensure that a consensus is gained to weighting. They need to encourage feedback from quieter group members and ensure that all views are able to be represented. They must also pose challenges in the form of reflection questions if they feel that the group of particular members have started to focus on issues or areas of interest which are not relevant for the tool discussion.

In summary the facilitator must take a ‘helicopter’ view of the topic and ensure that the focus group stays on task and topic. They must work to ensure all discussion remains centred around the tool and that issues of relevance are explored as able.

Scope

The first step of the assessment tool process is to identify the scope of the assessment to be performed. Usually this will be reviewing a workforce as a whole as is defined in the coverage clause of a particular employment agreement. Consideration may also be given to other workforce scopes such as

  • Whole of workforce: general consideration of a specific workforce e.g. nursing,midwifery etc
  • Professional Groupings: specific practice areas relevant to a particular work group
  • Specialities and sub-specialties: e.g. nursing such as medical, surgical, ED, Critical Care, operating theatre etc
  • Geographic: rural /urban; across regions
  • Service /deployment based: medical, surgical, mental health etc
  • Patient categories: hi dependency; low dependency

The most common use of the tool is for a profession specific review.

Initial data collection

The aim of this step is to gather readily available background information/data on this workforce to help inform the group discussion and ensure the facilitator is adequately prepared for the focus group process.

Data can include relevant operational DHB information on the workforce, regulatory workforce data and strategic workforce information from Health Workforce New Zealand. It should also include any indications of changes to service delivery models which may be considered in DHBs or within the MoH.

The SER data team will coordinate the collection and preparation of this report using the template attached as appendix two.

Choosing focus group participants

Getting the right people involved is critical to this qualitative process as its validity is dependant on the quality of the discussion and group reaching consensus.

Ideally a focus group should have a minimum of 10 and a maximum of 20 participants in the focus group. In deciding the participants the following needs to be considered.

  • the workforce being discussed
  • other occupational groups
  • service delivery
  • geographic
  • strategic and operational workforce views

The facilitator is responsible for developing this group by sending out a request for volunteers through the led DHBs groups and by asking HWNZ,NHB and relevant professional groups if they would like to be involved. Depending on the group it may also be valuable to engage the training organisations.

Preparing participants

Because of the qualitative nature of this process it is essential that participants have all the information they need to ensure full and active participation.

Participantsmust:-

  1. Be clear on the scope of the workforce assessment
  2. Understand the Health Workforce Classification Assessment tool and the importance of their role to the process
  3. Have time to review the data that has been collected
  4. First individually rate the workforce and send to the facilitator prior to focus group

This is achieved by the facilitator sending out the participants hand book and the initial data collection report. Appendix three provides template email to participants.

A follow-up phone call prior to the focus group to ensure understanding may also be useful.

Individual workforce rating

The first stage of the workforce assessment process is for the individual to decide an initial rating of the workforce. This is achieved through completion of an online survey. Once the facilitator has identified the focus group participants DHBSS admin staff will prepare the online survey and send a link to each of the participants. It will be the facilitators responsibility to follow up with participants to ensure they complete the survey. Participants are encouraged to provide the reasoning for the ratings they give.

The results of the survey will be summarised and returned to the participants to use during the focus group meeting.

The focus group meeting

This meeting may be held both face to face or via a teleconference. The decision for which will be based on cost and practicality. It is useful to note that the process works equally well in either mode. Adequate time should be allocated to the teleconference/ meeting and approximately 60-90 minutes issufficient to conduct the process.

Introduction

The meeting commences with the facilitator

  1. Introducing the purpose of the meeting including the scope of the workforce being discussed
  2. Introducing the group participants or enabling them to introduce themselves
  3. Providing a reminder of the Health Workforce Classification Framework. This should include definitions of the five domains, the rating scale and final classifications. The scoring matrix (appendix 1) provides a prompt for this discussion and includes descriptions of the final classification.

Discussion

The focus group will spend most their timeconcentrating on completing the scoring matrix. This is the area of the tool which allows for group debate and for the cumulative scoring that results in the final classification.The facilitator will lead the group discussion on each dimension of the framework. This starts with service need and worksacross the matrix to end with operational capacity.

The facilitator encourages the group to discuss which score the workforce in question should be given between 1 and 4, as well as rationale why. The need to have a diverse group of both operational and professional viewpoints is imperative here as it allows views to be challenged and strong rationale to be given in order to reach the final score. The facilitator skill here is the most important as they work withthe group to achieve consensus on the final score. The group must reach agreement on the score (1-4) of each dimension before moving to the next dimension.

Once each factor has been scored and the totaltallied, the corresponding number should be found in the scoring table at the bottom of the matrix. This should be confirmed by the facilitator and the group asked to confirm they endorse the final classification reached.

As the group works through the 5 domains the facilitator should take notes and ensure that areas which arise and are not covered by the 5 domains are noted for further investigation if warranted. The facilitator should also keep a record of the scoring of each of the 5 domains so as to tally the completed score to reach the overall classification.

The final score out of each of the 5 domains will add up to a total overall score which in turn will determine which classification is reached. The total score should be matched to the table underneath the scoring matrix.

Summary

To complete the screening tool assessment process the facilitator should reconfirm the final classification reached. They should also reiterate any additional issues which have arisen from group discussion that require further investigation as part of any ER/IR processes. This classification then provides a basis from which other discussions can be generated and also helps to provide direction on what areas are causing pressure or particular issues to the workforce being reviewed.

Follow-up

Confirmation of the findings – a summary of written notes from the facilitator plus the final score and rationale should be emailed to all group members within a week of teleconference / meeting completion. Any follow up work from these findings should be agreed at this point also.

All focus group members are required to review the sent items and send back any corrections to the facilitator within the space of 5-10 working days. Further analysis is now undertaken, on additional items which arose out of the focus group but were not particularly relevant to the workforce assessment tool. These are areas that can be expanded on and further investigated in the final operational analysis that is completed for the BSG.

Domain definitions

Service need

This domain includes factors such as:-

  • Service stabilityincluding changes to service demand which may be driven by population or purchasing changes.
  • Operational deployment and intensity of use. Is this a seven day 24 hour service or Monday to Friday business hours (is this capacity)
  • Clinical processes/models of care influence on occupational requirements for example nurse/doctor led

Rating / Description / Example
1 / Service is stable and there are no anticipated major changes to service delivery or demand in the short term / Current demand does not exceed supply and service picture has no particular issues.
2 / Some instances of demand pressure on service but stable overall / Occasional instances of increased demand but majority of time is stable.
3 / Service demand progressively increasing impacting on service level or peak demand periods increasing / Increasing demand impacting on supply.
4 / Service operating at full capacity Peaks in service demand driving instability in service delivery. / Demand exceeds supply.

Key Questions to support and encourage discussion:

What is the current demand picture?

Has the service changed significantly? Or is it about to?

What is the current service picture?

Public profile

This domain includes factors such as:-

  • Public confidence: does the lack of a readily available workforce pose potential public confidence issues if the service cannot be delivered as required?
  • Political /policy context: political mandate/drivers for particular workforces
  • Labour market positioning: relative strength in the labour market

Rating / Description / Example
1 / No current issue of public confidence or political/policy factors. / Low public profile in that there are relatively few instances where the workforce would gain increased political / public interest
2 / Some Public confidence issues/policy issues appearing which may impact on the workforce / Occasional confidence issues which may be emerging, but workforce is till relatively low in regards to gaining public or political attention i.e. clinical perfusionists
3 / Public confidence/political context/policy change is directly impacting on the workforce / Where a workforce is being impacted on by political / public changes but also where workforce is impacting on public and political environment i.e. by way of strike that impacts on service provision i.e. MRTs
4 / Public/political confidence in services is being actively impacted by absence of the workforce/or disruption to availability / This is usually for inherently political workforces i.e. RMOs, SMOs, Midwives, and Medical Physicists. More common in autonomous than delegated workforce roles.

Key Questions to support and encourage discussion:

How politically sensitive is this workforce?

Is it currently a high government priority?

What are the current public sensitivities around this workforce?

Supply

This domain includes factors such as:-

  • Community / population health requirements: Are there sufficient numbers of this occupational grouping within the system (via education and immigration)? Inward and outward flows balanced?
  • Distribution: is there a general distribution issue or a specific local/regional mal-distribution?
  • Gender/ethnicity/age: Is an aging workforce an additional risk factor? For example, is there adequate Maori and Pacific representation to meet needs of specific communities?

Rating / Description / Example
1 / No major distribution or supply issues / Stable supply pattern
2 / Some Distribution issues emerging and wider issues with supply / May be with particular specialities, rather than entire workforce
3 / Distribution and supply issues increasingly impacting on wider system.
Issues with overall size of workforce available. / Often related to geographic distribution issues – must ask group are these pure supply issues or a maldistribution issue occurring?
4 / Significant distribution and or supply issues currently occurring, problems with small size of available workforce. / Real issues with supply pipeline of professional group i.e. we need to import greater than 50% of entire workforce - medical physicists an example

Key Questions to support and encourage discussion: