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Journal of Primary Health Care Journal of Primary Health Care Society
Journal of The Royal New Zealand College of General Practitioners
RESEARCH ARTICLE (Open Access)

Disrupting the present to build a stronger health workforce for the future: a three-point agenda

Robin Gauld
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- Author Affiliations

1 University of Otago, Otago Business School, New Zealand

Correspondence to: Robin Gauld, University of Otago, Otago Business School, New Zealand. Email: robin.gauld@otago.ac.nz

Journal of Primary Health Care 10(1) 6-10 https://doi.org/10.1071/HC17083
Published: 29 March 2018

Journal Compilation © Royal New Zealand College of General Practitioners 2018.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Abstract

The health professional workforce in high-income countries is trained and organised today largely as it has been for decades. Yet health care professionals and their patients of the present and future require a different model for training and working. The present arrangements need a serious overhaul: not just change, but disruption to the institutions that underpin training and work organisation. This article outlines a three-point agenda for this, including: the need to reorganise workforce and care systems for multimorbidity; to reorient workforce training to build genuine inter-professionalism; and to place primary care at the apex of the professional hierarchy.

KEYWORDS: Health workforce; health professionals; medical professionals; disruption; institutions


References

[1]  Barnett K, Mercer SW, Norbury M, et al. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet. 2012; 380 37–43.
Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.Crossref | GoogleScholarGoogle Scholar |

[2]  Marengoni A, Angleman S, Melis R, et al. Aging with multimorbidity: a systematic review of the literature. Ageing Res Rev. 2011; 10 430–9.
Aging with multimorbidity: a systematic review of the literature.Crossref | GoogleScholarGoogle Scholar |

[3]  Tinetti ME, Fried TR, Boyd CM. Designing health care for the most common chronic condition—multimorbidity. JAMA. 2012; 307 2493–4.
Designing health care for the most common chronic condition—multimorbidity.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC38XhtVCkurfJ&md5=42abbbfe72070559a0a31669165af569CAS |

[4]  Huntley AL, Johnson R, Purdy S, et al. Measures of multimorbidity and morbidity burden for use in primary care and community settings: a systematic review and guide. Ann Fam Med. 2012; 10 134–41.
Measures of multimorbidity and morbidity burden for use in primary care and community settings: a systematic review and guide.Crossref | GoogleScholarGoogle Scholar |

[5]  Boult C, Reider L, Leff B, et al. The effect of guided care teams on the use of health services. Arch Intern Med. 2011; 171 460–6.
The effect of guided care teams on the use of health services.Crossref | GoogleScholarGoogle Scholar |

[6]  Boyd  CMBoult  CShadmi  Eet al.2007 Guided care for multimorbid older adults.Gerontologist47 697704.

[7]  Coleman K, Austin BT, Brach C, Wagner EH. Evidence on the chronic care model in the new millennium. Health Aff (Millwood). 2009; 28 75–85.
Evidence on the chronic care model in the new millennium.Crossref | GoogleScholarGoogle Scholar |

[8]  Bodenheimer T, Chen E, Bennett HD. Confronting the growing burden of chronic disease: can the US health care workforce do the job? Health Aff (Millwood). 2009; 28 64–74.
Confronting the growing burden of chronic disease: can the US health care workforce do the job?Crossref | GoogleScholarGoogle Scholar |

[9]  Friedman A, Hahn KA, Etz R, et al. A typology of primary care workforce innovations in the United States since 2000. Med Care. 2014; 52 101–11.
A typology of primary care workforce innovations in the United States since 2000.Crossref | GoogleScholarGoogle Scholar |

[10]  Organisation for Economic Co-operation and Development (OECD). The Looming Crisis of the Health Workforce. How Can OECD Countries Respond? Paris: OECD; 2008.

[11]  Ono T, Schoenstein M, Buchan J. Geographic Imbalances in Doctor Supply and Policy Responses. OECD Health Working Papers No. 69. Paris: OECD; 2014.

[12]  Organisation for Economic Co-operation and Development (OECD). Health Systems Institutional Characteristics. A Survey of 29 OECD Countries. Paris: OECD; 2010.

[13]  Mossialos E, Wenzl M, Osborn R, Sarnak D, editors. International Profiles of Health Care Systems, 2015. New York: The Commonwealth Fund; 2016.

[14]  Stokes J, Checkland K, Kristensen SR. Integrated care: theory to practice. J Health Serv Res Policy. 2016; 21 282–5.
Integrated care: theory to practice.Crossref | GoogleScholarGoogle Scholar |

[15]  Room G. Complexity, Institutions and Public Policy: Agile Decision-Making in a Turbulent World. Cheltenham: Edward Elgar; 2011.

[16]  Wilsford D. Path dependency, or why history makes it difficult but not impossible to reform health systems in a big way. J Public Policy. 1994; 14 251–83.
Path dependency, or why history makes it difficult but not impossible to reform health systems in a big way.Crossref | GoogleScholarGoogle Scholar |

[17]  Tuohy CH. Accidental Logics: The Dynamics of Change in the Health Care Arena in the United States, Britain and Canada. New York: Oxford University Press; 1999.

[18]  Olson M. The Logic of Collective Action: Public Goods and the Theory of Groups. Cambridge, MA: Harvard University Press; 1965.

[19]  Gauld R. The New Health Policy. Maidenhead: Open University Press; 2009.

[20]  Irvine D. GMC and the future of revalidation: patients, professionalism, and revalidation. BMJ. 2005; 330 1265–8.
GMC and the future of revalidation: patients, professionalism, and revalidation.Crossref | GoogleScholarGoogle Scholar |

[21]  Freidson E. Professionalism: The Third Logic. Cambridge: Polity Press; 2001.

[22]  Pedersen A, Hack TF. Pilots of oncology health care: a concept analysis of the patient navigator role. Oncol Nurs Forum. 2010; 37 55–60.
Pilots of oncology health care: a concept analysis of the patient navigator role.Crossref | GoogleScholarGoogle Scholar |

[23]  Attström K, Niedlich S, Sandvliet K, et al. Mapping and analysing bottleneck vacancies in EU labour markets. Brussels: European Commission; 2014.

[24]  Scheffler RM, Liu JX, Kinfu Y, Dal Poz MR. Forecasting the global shortage of physicians: an economic-and needs-based approach. Bull World Health Organ. 2008; 86 516–23.
Forecasting the global shortage of physicians: an economic-and needs-based approach.Crossref | GoogleScholarGoogle Scholar |

[25]  Osterman P. How common is workplace transformation and who adopts it? ILR Review. 1994; 47 173–88.
How common is workplace transformation and who adopts it?Crossref | GoogleScholarGoogle Scholar |

[26]  Stokes T, Tumilty E, Doolan-Noble F, Gauld R. Multimorbidity, clinical decision making and health care delivery in New Zealand Primary care: a qualitative study. BMC Fam Pract. 2017; 18 51
Multimorbidity, clinical decision making and health care delivery in New Zealand Primary care: a qualitative study.Crossref | GoogleScholarGoogle Scholar |

[27]  Darlow B, Coleman K, McKinlay E, et al. The positive impact of interprofessional education: a controlled trial to evaluate a programme for health professional students. BMC Med Educ. 2015; 15 98
The positive impact of interprofessional education: a controlled trial to evaluate a programme for health professional students.Crossref | GoogleScholarGoogle Scholar |

[28]  Thomas EJ. Improving teamwork in healthcare: current approaches and the path forward. BMJ Qual Saf. 2011; 20 647–50.
Improving teamwork in healthcare: current approaches and the path forward.Crossref | GoogleScholarGoogle Scholar |

[29]  Bodenheimer T, Ghorob A, Willard-Grace R, Grumbach K. The 10 building blocks of high-performing primary care. Ann Fam Med. 2014; 12 166–71.
The 10 building blocks of high-performing primary care.Crossref | GoogleScholarGoogle Scholar |

[30]  Petterson SM, Liaw WR, Phillips RL, et al. Projecting US primary care physician workforce needs: 2010–2025. Ann Fam Med. 2012; 10 503–9.
Projecting US primary care physician workforce needs: 2010–2025.Crossref | GoogleScholarGoogle Scholar |