1. Making the right decisions in a complex world
WHO seminar, Geneva
12thDecember, 2014
Dr. Graham WillisHead of Research and Development, CfWI
Matt EdwardsHead of Horizon scanning and International, CfWI
8. Robust workforce planning
Understand the system
Explore the future
Simulate the possibilities
Make robust
decisions
Focal question
Transparent and participatory
12. Scenario generation workshop
Population
GDP growth
Energy usage
Carbonemissions
High
Low
C
A
B
Consistency analysis
13. Scenario generation workshop
Vary across different futures
Formal elicitation protocol
Monte Carlo simulation
Probability
Value
Quantify critical parameters
20. What about the rest of the system?
Health
Public health
Social care
2%
98%
Workforces not yet
modelled
Workforces modelled to date
21. What about the rest of the system?
Health
Public health
Social care
10%
Other health and support
21%
Paid adult care and support
24%
Volunteer adult care and support
43%
Unpaid adult care and support
2%
Workforces modelled to date
22. Not just workforce numbers
What skills and competences are needed?
Competences
Skills
Facilitation
Leadership
Wellbeing
Knowledge
Personal
Types of skill
Level of skill
Low to High
Quantitative skills
Qualitative skills
23. Not just the skills
What drives the demand?
Demand for skills
Long-term
conditions
Infectious
diseases
Births
One-off
events
24. Not just the skills
What drives the supply?
Supply of skills
Up or down
skilling
Education &
training
Workforce
supply
Capacity
to learn
25. Population
Learning disabilities
Oral health
Singular demand for service
Maternal and perinatal
Infectious disease
Mental long-term conditions
Physical long-term conditions
Skill level: 12 3 4 5
We need a new framework
Prevent
Enable
Assess
Plan
Treat
Rehabilitate
Relieve
Link
Unpaid adult social care workforce
Nurses
Dentists
Medical generalists
Medical specialists
Volunteer care and support workforce
Other workforce groups
Horizon 2035 workforce groups
Increasing concentration and experience
26. A new challenge: Horizon 2035
What skills and competences do we have?
What might we need in future?
27. Future demand for skills
Skill hours/Year
(Billions)
2012201620202024202820322036
Time (Year)
Probability: 80% 100%
Central estimate:
28. 5 Skill levels
4
3
2
1
Super-specialist
Specialist
Generalist
Increasing length of training
Skill dimensions
Visualising the system
Learning disabilities
Oral health
Singular demand for service
Maternal and perinatal
Infectious disease
Mental long-term conditions
Physical long-term conditions
Demand sources
Medical Specialist
29. Visualising the system
Learning disabilities
Oral health
Singular demand for service
Maternal and perinatal
Infectious disease
Mental long-term conditions
Physical long-term conditions
Demand sources
Super-specialist
Specialist
Generalist
Up-skilling targets
Midwife
30. Super-specialist
Specialist
Generalist
Up-skilling targets
Visualising the system
Learning disabilities
Oral health
Singular demand for service
Maternal and perinatal
Infectious disease
Mental long-term conditions
Physical long-term conditions
Demand sources
Paid care and support
33. EU Joint Action
Work packages
Objectives
Increased knowledge
Improved tools
Higher effectiveness
Horizon scanning
and qualitative
Quantitative
Data, migration
and mobility
Coordination
Dissemination
Evaluation
Sustainability
69 partners
Funded by the Health Programme of the European Union
34. Work package 6 –Horizon scanning
Horizon scanning
and qualitative
Qualitative
methods
Pilot
study
Future skills
35. User guidelines –qualitative methods
Published 27 November 2014
www.euhwforce.euwww.horizonscanning.org
Examples of methods in use across EU e.g. scenarios, surveys, Delphi
Helps deal with inherent complexity and uncertainty of workforce planning
Descriptions of health workforce planning and forecasting approaches for Belgium, Finland, Germany, Hungary, Netherlands, Spain and the United Kingdom
Qualitative methods
1
2
3
36. User guidelines –qualitative methods
Published 27 November 2014
www.euhwforce.euwww.horizonscanning.org
Use alongside quantitative methods to achieve integrated approaches across Europe
Recommends taking into account the different useful approaches for different contexts
Methods can be used to systematically investigate different workforce futures and deal with uncertainty
4
5
6
Qualitative methods
37. Future drivers and skills across Europe?
Provide an estimation of the future needs of skills and competencies needed in the health workforce and their distribution.
Drivers and trends
Report on Future Skills and Competencies
38. Future drivers and skills across Europe?
54
Horizon scanning interviews
264
Drivers collected
and grouped
Megatrends under investigation
Wellbeing skills
39. Visual key
Van der Heijden (2005) Scenarios –the art of conversation
Different environments of influence
7 indicative causal loop diagrams
These guide the identification of megatrends.
Focal
Skills and
competence of the health workforce
in 2035.
40. 1. Connecting and enabling technology
Enable. Effective engagement with engaged ‘consumers’. Patient engagement/partnership/ empowerment. Interpretation of data/statistics. Interpersonal and communication skills.
Availability
of health
information
System
performance
data
Patient
empowerment
Policy and
regulation
Professional
interpretation
Remote
consultations
Connectivity
between
patients and
professionals
Health and
care data
Remote
monitoring
ICT
Population
health
literacy
‘Big Data’
+
+
+
+
+
+
+
+
+
+
+
+
+
+
Working
Transactional
Contextual
Focal
41. 2. Demographic demand
Relieve. Enable. Link. Chronic disease management/supported self-management. Coordination/linking skills. Multidisciplinary coordination and team working allied with generalist skills. Long-term care skills. Challenge to single disease framework. Communication skills.
Working
Transactional
Contextual
Focal
Multi-morbidity
Chronic
conditions
EU fertility
rate
Healthy
cohort of older
people
Prevention
EU life
expectancy
+
=
+
+
‘Age’ of the
population
+
=
+
-
Economic
and social
inequality
+
42. 2. Demographic demand
Working
Transactional
Contextual
Focal
Multi-morbidity
Chronic
conditions
EU fertility
rate
Healthy
cohort of older
people
Prevention
EU life
expectancy
+
+
=
+
‘Age’ of the
population
+
=
+
-
Economic
and social
inequality
+
Attach indicators which describe the current state or trend
43. 2. Demographic demand
Working
Transactional
Contextual
Focal
Multi-morbidity
Chronic
conditions
EU fertility
rate
Healthy
cohort of older
people
Prevention
EU life
expectancy
+
‘Age’ of the
population
+
+
Economic
and social
inequality
+
< 5
10 - 14
20 - 24
30 - 34
40 - 44
50 - 54
60 - 64
70 - 74
80 - 84
2035
2010
Source: Eurostat
Source: Barnett et al, 2012
44. 3. Mobility
Education, registration, licensing and regulation of skills. Workforce planning skills. Health system and workforce system incentives.
Working
Transactional
Contextual
Focal
Mobile health
professionals
National skills
distribution
European skills
distribution
Health
outcomes
National skills
requirements
Mobile
patient
‘consumers’
+
+
+
European
health market
for skills
+
Freedom of
movement
+
45. 4. Productivity
Enable. Self-care and self-management. Task allocation. Leadership skills. Productive teams.
Working
Transactional
Contextual
Focal
Location of care
GDP allocated
to ‘healthcare’
Skill mix
Resistanceto change
Complex
comorbidities
Public health
expenditure
Health system
efficiency
Patient/public
expectations
Gross
Domestic
Product
Access to care
Quality
of care
+
-
-
46. 5. Personalisation
Assess. Enable. Treat. Communication of risk. Shared decision making. Translation of research developments. Task allocation.
Working
Transactional
Contextual
Focal
Workforce
productivity
Behavioural
sciences
Population health literacy
Personalised care
Innovation
genomics,
Pharmaco- genetics
Diagnostics
Decision aids
Industrialinnovation
Risk
stratification
+
+
Therapeutics
+
+
+
+
+
+
+
+
Data
collected by
individuals
+
47. 6. Future patients
Assess. Enable. Prevent. Communication skills. Coaching skills. Broader skill base and competence of healthcare in the population. Mobility. Role changes or partnerships. Defensive medicine.
Working
Transactional
Contextual
Focal
Proportion
of types of
care
Ageing
populations
Complex
demand
Diverse
populations
Proportion
of generalists
to specialists
Climate
change
+
+
+
Disease
profiles
+
+
Patient
empowerment
Informed
patients
+
+
48. 7. Supply
Link. Cooperation. Task allocation. Supply of skills and competences. Workforce planning skills. Leadership skills. Multidisciplinary teams/integration. Workforce flexibility. Skill mix. Task shifting.
Working
Transactional
Contextual
Focal
Mobile healthprofessionals
Workforce
roles
Health
workforce
headcount
Attractiveness
of career
Labour force
Work-life
balance
expectations
Age of the
population
-
-
Induced
demand
-
Workforceinteraction
Quality of care
49. 7. Supply
Working
Transactional
Contextual
Focal
Mobile healthprofessionals
Workforce
roles
Health
workforce
headcount
Attractiveness
of career
Labour force
Work-life
balance
expectations
Age of the
population
-
-
Induced
demand
-
Workforceinteraction
Quality of care
50. Demand is increasing and accelerating
(World Bank)
Global population
Global and national imbalances of workforces
6.9Bn
9.5Bn
20102050
51. World population by 2100
UN Population Division (UNPD) projects an 80 percent probability that the world’s population will be between 9.6 and 12.3 billion by 2100.
www.sciencemag.org/content/ 346/6206/234.abstract
http://www.newsecuritybeat.org/2014/10/refines- population-projections-80-percent-probability-10-12- billion-people-2100/
World population (Billions)
2010202020302040205020602070208020902100
13
12
11
10
9
8
7
6
UNPD and IIASA Projections, 2010-2100
IIASA SSP2 medium variant
UN medium variant
UN 80% upper probability
UN 80% lower probability
52. Key shifts and possible solutions?
Integrated care
24/7 and tech enabled working
24/7
Care model shifts
Secondary Care
Patient and service user empowerment / self- management
53. New workforce roles and prototyping
Prototyping and discovering
New roles and skills
54. Key points
What if the future is not what we expect?
Consider many futures
Transparent and participatory approach
56. Acknowledgements
Thanks to Jim Campbell, the WHO and GHWA for the invitation and hosting of this session.
Dr DelanyoDovlofor chairing.
Also to acknowledge the continued support from the EU Commission, EU Joint Action, the Department of Health, UK and our national and international partners and advisors for participating in our research.
57. Contact details
Dr Graham WillisHead of Research and DevelopmentCfWI, England
@
+44(0)7812 340 405
graham.willis@cfwi.org.uk
www.cfwi.org.uk| www.horizonscanning.org.uk
Matt EdwardsHead of Horizon Scanning & InternationalCfWI, England
+44(0)7834 800 393
matt.edwards@cfwi.org.uk
Questions welcomed…
