The pandemic exposes critical gaps in Canada’s health workforce planning

Health workers in Canada experience endemic levels of burnout directly related to understaffing and work overload. Leaves of absence from work for mental health and stress-related issues are 1.5 times higher among health workers than the rest of the population. Increasingly, health workers are significantly reducing their hours worked, just to cope, or leaving their jobs altogether.

That was before the pandemic.  With COVID-19, we are witnessing levels of stress, overload, and burnout among health workers previously unimaginable.

Downstream responses of mindfulness and free access to psychotherapy, albeit helpful, are at best band-aid solutions. We have to look upstream to the source of the crisis.

Health worker burnout is directly linked to poor health workforce planning. That we continue to operate our health system blindfolded to very basic data about our system’s key resource – its health workers – is remarkable.

Health workers account for more than 10 percent of all employed Canadians and over two-thirds of all health care spending, not including the personal and public costs for their training.  This amounts to $175 billion (2019), or nearly eight percent of Canada’s total GDP.

Health workforce science – and the data research infrastructure necessary to support it — is critical to making the best decisions about this essential human resource.  We need to advance health workforce science in Canada now.

Canada lags behind comparable OECD countries, including the U.K., Australia, and the U.S. on big data analytics and a digital research infrastructure that would give us vital information for health workforce planning.  Significant gaps in our knowledge have caused serious systemic risks for planners to manage during this health crisis.

Absent timely and relevant health workforce data, decision-makers cannot optimally deploy health workers to where, when, and how they are most needed.  As a result, health workforce planning activities across Canada remain ad hoc, sporadic, and siloed, generating significant costs and inefficiencies.  The consequences include everything from sub-optimal health workforce utilization and poor population health outcomes to health worker burnout.

What data do we have?

The data we have are profession-specific and say little about how health workers function as teams in “real world” patient care pathways.  The data are also collected differently by various stakeholders, so are not easy to analyze across jurisdictions. Notable absences are workers in older adult care and mental health care – two sectors heavily impacted by the pandemic.

What we need are a standard set of data across a broader range of health workers in support of interprofessional and inter-jurisdictional planning.

Ideally, these data would be collected uniformly, include diversity (racial, Indigenous, and more inclusive gender identity), and address practice characteristics (e.g., setting, scope and service capacity).  These data should also be linked to relevant patient information, including health care utilization and outcome data.

Robust data would allow us to better understand the range and characteristics of health workers caring for patients, the types of care they provide, and the outcomes experienced by patients.

Right now, we are making decisions in the dark, without using essential data that most other developed nations have had for years.

So how do we get there?

Canada needs a more robust and centrally coordinated health workforce data, analytics and science infrastructure.  This would address a critical gap that has held us back, and which has become only more apparent since COVID-19.

We can’t claim to have been blindsided.  Already in 2010, the Parliamentary Standing Committee recommended a designated health workforce agency, and this call was endorsed across all parties and by several stakeholder organizations that provided testimony to the committee.  Since then, almost nothing has happened on this front.

The absence of a central coordination and implementation of integrated health workforce data, analytics, and planning activities, combined with diffuse governance responsibilities inherent in a federated health system leaves us with blurred lines of responsibility and poorly coordinated efforts.

Other countries have managed to overcome these challenges.  Now that the pandemic has made the need crystal clear, Canada no longer has any excuse.

The Federal Ministers of Health, Labour and Innovation need to make the health workforce data infrastructure a top priority.  The pandemic may be the impetus that enables us to make necessary significant advances in health workforce data infrastructure.

We need to stop simply clapping our hands in support of health workers — and start planning to create better workforce conditions for them.  Let’s make improved health workforce science in Canada a key legacy in support of our health care workers.

Ivy Lynn Bourgeault is a professor of sociological and anthropological studies, University of Ottawa, and the lead, Canadian Health Workforce Network.

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