Despite established research clearly demonstrating paths forward towards better health workforce planning, health systems have been slow to adapt these techniques. We believe this is due to the gap between the theoretical and the practical: while published literature covers the theoretical 'what' few if any material available demonstrate the subsequent 'how', indicating a widespread lack of experience in practical health workforce planning transformation.
This is exacerbated by an absence of industry tools which has to-date suffered from an absence of focus on the administrative side of health workforce / HHR planning - focusing instead on either clinical-patient experiences (automated triaging, EHR/EMR systems) or frontline operations (scheduling, payroll, time management).
As always, if you have any questions regarding this content or wish to discuss any of this in more detail, please contact us at info@someplumconsulting.com.
Stock-Flow Modeling
Stock-flow provider supply modeling enables decision-makers to both understand the current composition of their specific health workforce, as well as anticipate and predict the future supply of healthcare providers based on current levels and their changes overtime. Provider recruitment/inflow and attrition/outflow must be understood, as they are influenced by factors like retirements, new graduates, migration, and changes in work patterns.
This modeling approach allows healthcare planners to anticipate potential shortages or surpluses of healthcare professionals by accounting for the dynamic nature of the workforce. By understanding these trends, a health system can make informed decisions on recruitment, training, and policy interventions to ensure that healthcare services are adequately staffed in the future, thereby maintaining or improving the quality and accessibility of care.
Health workforce data is critical to the accuracy and effectiveness of stock-flow provider modeling in healthcare planning. This data includes detailed information on the number, distribution, demographics, qualifications, and employment patterns of healthcare professionals. Accurate and up-to-date health workforce data allows for precise calculations of the current "stock" of providers, while also enabling reliable predictions of "flows," such as incoming graduates, retirements, and migration patterns.
Steps to Building Stock-Flow Modeling Capacity
1. Define Provider Types
Define what provider types your organization currently employs and needs to track. This could include both registered providers as well as unregistered, back office, and/or support staff.
2. Define Provider Locations
Regions, Locations, Facilities, and even Units may be tracked, trended, managed, and planned separately for. Each location comes with its own set of environmental factors which may need to be considered in a model.
3. Define Provider Status
Provider specific statuses must be identified and tracked with reporting – including statuses such as fulltime, part time, casual, relief, on-call, and others.
4. Build Current State Workforce Reporting
Once the above has been identified preliminary reporting exercises can now occur that collect current-state workforce details pertaining to the above. It is critical that this information be both comprehensive and representative.
5. Build Historical Reporting
Build access to workforce data specific to the above – both currently, then historically, at intervals determined for tracking and forecasting (either monthly or quarterly).
6. Build Demographics Reporting
Conduct a deeper dive into workforce data to understand key rates such as tenure and retirement rates, attrition trends related to age, tenure, position, and location, and other insights capable of generating a better understanding of your current and future workforce trends.
7. Build Workforce Stock-Flow Models
Assemble stock-flow models based on 1) current state workforce levels, 2) historical and projected inflow and outflow rates and 3) incorporate demographic insights and trends into future state assumptions.
8. Validate Stock-Flow Outputs
Solicit input from clinical and operational leads across categories and locations for input to logic and reasonability. Often, rates of inflow and outflow are not well tracked at local levels, so sharing this information may be both enlightening and result in very specific dialogue.
9. Establish Governance, Update & Sharing Frequency Process
Stock-flow models must be maintained, updated, and tracked to be useful planning tools. This involves regularly accessing updated data, updating stock-flow actuals compared to projected numbers, and comparing them to determine where variance is occurring.
Clinical Services Utilization
Calculating clinical services utilization among populations involves gathering and analyzing data related to the use of healthcare services by individuals within a specific group. Here are general steps to help you calculate clinical services utilization:
1. Define the Population of Interest
Clearly define the population you are studying. This could be a specific demographic group, a geographic area, or individuals with certain health conditions.
2. Identify Relevant Clinical Services
Determine the types of clinical services you want to measure. These may include doctor visits, hospitalizations, emergency room visits, preventive screenings, and other healthcare interventions.
3. Data Collection
Gather data from relevant sources including Electronic Health Records (EHR), Claims Data, Surveys, and Public Health Records.
4. Calculate Utilization Rates
Utilization rates are measures of how often a particular service is used within a specified time period. Common utilization rates include:
- Utilization Rate (%) = (Number of Service Users / Total Population) x 100
- Visit Rate = (Number of Visits / Total Population) x 100
5. Adjust for Age and Other Demographic Factors
To make fair comparisons, adjust utilization rates for age and other demographic factors using age-standardization techniques or other relevant adjustments.
6. Geographic Considerations
If your population is spread across different geographic regions, consider calculating utilization rates for each region separately to identify variations.
7. Comparison and Benchmarking
Compare your utilization rates to either internal, adjacent, or other jurisdictional benchmarks or standards to assess whether utilization is at, higher, or lower than expected.
Population Health Workforce / HHR Needs
This process builds on the preceding steps to analytically measure the number of health human resources (HHR) / health workforce needed to meet clinical and operational services needs. Here are general steps to help guide you through this calculation:
1. Define Clinical Service Needs
Clearly identify the clinical services that need to be provided. Consider the range of healthcare services required to meet the needs of the population.
2. Determine Workforce Requirements
Specify the types of healthcare professionals needed to deliver the identified services, including physicians, nurses, allied health professionals, support staff, and administrative personnel.
3. Assess Service Delivery Models
Consider different models of service delivery, such as team-based care, telehealth, or community health worker programs.
4. Calculate Staffing Ratios
Determine the optimal staffing ratios for each type of healthcare professional based on industry standards, best practices, and the specific needs of the population.
5. Adjust for Population Characteristics
Consider the unique characteristics of the population, such as age, health status, and socioeconomic factors.
6. Project Future Needs
Anticipate changes in the population's healthcare needs over time. Consider factors such as population growth, aging, and the prevalence of specific health conditions.
Public Health Utilization Indicators
Public health utilization indicators provide insights into the use of healthcare services and the overall health status of the population. Common indicators include:
Healthcare Access
- Primary Care Utilization: Frequency of visits to primary care providers
- Emergency Room Visits: Number of emergency department visits
Preventive Services
- Immunization Rates: Percentage of population receiving recommended vaccinations
- Cancer Screening Rates: Utilization of cancer screening programs
Chronic Disease Management
- Chronic Disease Monitoring: Utilization of services for managing chronic conditions
- Rehabilitation Services: Access to rehabilitation services
Maternal and Child Health
- Prenatal Care: Utilization of prenatal care services
- Child Health Check-ups: Frequency of well-child visits and vaccinations
Mental Health Services
- Mental Health Service Utilization: Use of counseling, therapy, and psychiatric care
- Substance Abuse Treatment: Access to treatment for substance use disorders
These indicators help policymakers, public health officials, and researchers understand the strengths and challenges of the public health system. Regular monitoring allows for evidence-based decision-making and the development of strategies to improve population health and healthcare delivery.