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Showing papers on "Workforce published in 2005"


Posted Content
TL;DR: The authors assesses the effects of pathways into teaching in New York City on the teacher workforce and on student achievement, finding that teachers who enter through new routes, with reduced coursework prior to teaching, are more or less effective at improving student achievement.
Abstract: We are in the midst of what amounts to a national experiment in how best to attract, prepare, and retain teachers, particularly for high-poverty urban schools. Using data on students and teachers in grades 38, this study assesses the effects of pathways into teaching in New York City on the teacher workforce and on student achievement. We ask whether teachers who enter through new routes, with reduced coursework prior to teaching, are more or less effective at improving student achievement. When compared to teachers who completed a university-based teacher education program, teachers with reduced coursework prior to entry often provide smaller initial gains in both mathematics and English language arts. Most differences disappear as the cohort matures, and many of the differences are not large in magnitude, typically 2 to 5 percent of a standard deviation. The variation in effectiveness within pathways is far greater than the average differences between pathways.

549 citations


Journal ArticleDOI
TL;DR: The cost associated with performance based work loss or “presenteeism” greatly exceeded the combined costs of absenteeism and medical treatment combined for all chronic conditions studied.
Abstract: Objective:The objective of this study was to determine the prevalence and estimate total costs for chronic health conditions in the U.S. workforce for the Dow Chemical Company (Dow).Methods:Using the Stanford Presenteeism Scale, information was collected from workers at five locations on work impair

527 citations


Journal ArticleDOI
TL;DR: The purpose of this paper is to describe four directions in which the existing workforce can change: diversification; specialisation and vertical and horizontal substitution, and to discuss the implications of these changes for the workforce.
Abstract: The healthcare professions have never been static in terms of their own disciplinary boundaries, nor in their role or status in society. Healthcare provision has been defined by changing societal expectations and beliefs, new ways of perceiving health and illness, the introduction of a range of technologies and, more recently, the formal recognition of particular groups through the introduction of education and regulation. It has also been shaped by both inter-professional and profession-state relationships forged over time. A number of factors have converged that place new pressures on workforce boundaries, including an unmet demand for some healthcare services; neo-liberal management philosophies and a greater emphasis on consumer preferences than professional-led services. To date, however, there has been little analysis of the evolution of the workforce as a whole. The discussion of workforce change that has taken place has largely been from the perspective of individual disciplines. Yet the dynamic boundaries of each discipline mean that there is an interrelationship between the components of the workforce that cannot be ignored. The purpose of this paper is to describe four directions in which the existing workforce can change: diversification; specialisation and vertical and horizontal substitution, and to discuss the implications of these changes for the workforce.

508 citations


Journal ArticleDOI
TL;DR: This paper used data from the British Labour Force Survey (BLSV) to investigate the effect of immigration on the labour market outcomes of native-born workers in Britain, and found no strong evidence that immigration has overall effects on aggregate employment, participation, unemployment and wages but some differences according to education.
Abstract: Using data from the British Labour Force Survey this article provides an empirical investigation of the way immigration affects labour market outcomes of native born workers in Britain, set beside a theoretical discussion of the underlying economic mechanisms. We discuss problems arising in empirical estimation, and how to address them. We show that the overall skill distribution of immigrants is remarkably similar to that of the native born workforce. We find no strong evidence that immigration has overall effects on aggregate employment, participation, unemployment and wages but some differences according to education.

484 citations


Journal ArticleDOI
TL;DR: In this paper, a review of programs that work to diversify engineering is presented, with research and evaluation-based findings applied to education and workforce practice, with the goal of assisting current and future practitioners in becoming culturally competent.
Abstract: Engineering, education to workplace, is not just about technical knowledge. Rather, who becomes an engineer and why says much about the profession. Engineering has a “diversity” problem. Like all professions, it must narrow the gap between practitioners on the one hand, and their clientele on the other; it must become “culturally competent.” Given the current composition of the engineering faculty and the profession's workforce more generally, it behooves engineering education to diversify while assisting current and future practitioners in becoming culturally competent. Programs that work to diversify engineering are reviewed, with research and evaluation-based findings applied to education and workforce practice.

382 citations


Journal ArticleDOI
TL;DR: In this paper, the authors used data from the US National Study of the Changing Workforce (a nationally representative sample of working adults) to test the hypothesis that employees with time-flexible work policies reported less stress, higher levels of commitment to their employer, and reduced costs to the organization because of fewer absences, fewer days late, and fewer missed deadlines.
Abstract: Data from the US National Study of the Changing Workforce (a nationally representative sample of working adults) were used to test the hypothesis that employees with time-flexible work policies reported less stress, higher levels of commitment to their employer, and reduced costs to the organization because of fewer absences, fewer days late, and fewer missed deadlines. The model provides persuasive findings for the hypothesized relationship and offers important suggestions to employers who can translate reduced illness into savings and increased commitment into better employees. Contrary to expectations, there were no gender differences in how employees responded to flexible work policies, showing that gender-neutral work policies make financial sense. By showing that time-flexible work policies provide employer benefits, we can hasten the change to a new worker model—one that is family and employer friendly. The business case for family-friendly work policies may prove to be the best tool we have in changing how we live and work. Copyright © 2005 John Wiley & Sons, Ltd.

330 citations


Journal ArticleDOI
TL;DR: The Blue Ribbon Committee on Surgical Education was charged with examining the multitude of forces impacting health care and making recommendations regarding the changes needed in surgical education to enhance the training of surgeons to serve all the surgical needs of the nation, and to keep training and research in surgery at the cutting edge in the 21st Century.
Abstract: American surgical education has a rich heritage, and its programs produce some of the best trained and most competent surgeons. Although surgery residency training has changed little since its formulation by Halsted at the beginning of the last century, surgery residency and fellowship programs continue to maintain high standards because they are highly structured, monitored, evaluated, and credentialed. At the dawn of the 21st Century, however, numerous forces for change are impacting medical education in general and surgical training in particular. On the one hand, the explosion of knowledge from the advances of science, systems, and information technology provide new opportunities to improve our training programs. On the other hand, as the public has become increasingly better informed about its healthcare needs and safety, its expectation has shifted and now increasingly demands advanced and specialized care. Contrary to earlier predictions of excess physicians by 2010, we appear to be on the threshold of a shortage in physician workforce. This impending shortage should be viewed in the context of Association of American Medical Colleges (AAMC) data, which show that the number of applicants to medical schools in the United States has declined by 25% since 1996. Now, nearly 50% of students entering medical school are women. The average U.S. medical student now graduates with a debt in excess of $100,000. Students of both genders are increasingly selecting specialties with more controllable lifestyles than general surgery. Furthermore, general surgery residencies experience an attrition rate of nearly 20%, primarily because of lifestyle concerns of residents. Major changes have occurred and more are foreseen in the practice of surgery. Much clinical care has moved from the inpatient hospital setting to the outpatient, and the length of stay for inpatients has significantly decreased. These shifts have resulted in a significant impact on both undergraduate and graduate medical/surgical education. Surgical care is moving from discipline-based to disease-based practice in which surgeons will increasingly practice within a team of experts. How do we train surgeons to be leaders of such multidisciplinary teams? Recognizing the multitude of changes taking place, and spearheaded by the Presidential Address at the 2002 annual meeting of the American Surgical Association (ASA), the ASA Council in partnership with the American College of Surgeons (ACS), the American Board of Surgery (ABS), and the Resident Review Committee for Surgery (RRC-S), established a Blue Ribbon Committee on Surgical Education in June 2002. The Committee was charged with examining the multitude of forces impacting health care and making recommendations regarding the changes needed in surgical education to enhance the training of surgeons to serve all the surgical needs of the nation, and to keep training and research in surgery at the cutting edge in the 21st Century. This report is based on the work done and consultations obtained by the ASA Blue Ribbon Committee over a 2-year period. The Committee quickly recognized the complexity of its tasks and how any major recommendation for change could provoke controversy among many stakeholders, including members of the committee itself. Gradually, however, the committee was able to arrive at a consensus. On a separate track, the ABS has come to similar conclusions on how to restructure the surgery training program. The Committee recognizes that its recommendations are just recommendations, but sincerely hopes that they will serve as an impetus for a concerted effort by the ACS, ABS, and the RRC to further refine and implement them. What is being recommended here is no less than a new surgical education system but one that takes place in the context of patient care. This will require major redesign of surgery residency training and allocation of sufficient resources to achieve the desired outcomes. Given that such an education system is essential not only for producing the next generation of highly trained surgeons, but also for enhancing the quality of the most advanced patient care in the nation's teaching hospitals and clinics, appropriate strategies need to be developed at the national level to implement the recommendations. The report is presented under the following headings: Surgical/Medical workforce Medical student education in surgery Resident workhours and lifestyle in surgery Residency education in surgery The structure of surgical training Education support and faculty development Training in surgical research Continuous professional development The Executive Summary highlights the conclusions and recommendations of the Committee.

295 citations


Journal ArticleDOI
TL;DR: It is suggested that higher nurse staffing and richer skill mix (especially of registered nurses) are associated with improved patient outcomes, although the effect size cannot be estimated reliably and the association appears to show diminishing marginal returns.
Abstract: The relationship between quality of care and the cost of the nursing workforce is of concern to policymakers. This study assesses the evidence for a relationship between the nursing workforce and patient outcomes in the acute sector through a systematic review of international research produced since 1990 involving acute hospitals and adjusting for case mix. Twenty-two large studies of variable quality were included. They strongly suggest that higher nurse staffing and richer skill mix (especially of registered nurses) are associated with improved patient outcomes, although the effect size cannot be estimated reliably. The association appears to show diminishing marginal returns.

278 citations


Report SeriesDOI
TL;DR: In order to resolve nurse shortages, the paper compares and evaluates policy levers that decision makers can use to increase flows of nurses into the workforce, reduce flows out of the workforce and improve nurse retention rates.
Abstract: There are reports of current nurse shortages in all but a few OECD countries. With further increases in demand for nurses expected and nurse workforce ageing predicted to reduce the supply of nurses, shortages are likely to persist or even increase in the future, unless action is taken to increase flows into and reduce flows out of the workforce or to raise the productivity of nurses.This paper analyses shortages of nurses in OECD countries. It defines and describes evidence on current nurse shortages, and analyses international variability in nurse employment. Additionally, a number of demand and supply factors that are likely to influence the existence and extent of any future nurse shortages are examined. In order to resolve nurse shortages, the paper compares and evaluates policy levers that decision makers can use to increase flows of nurses into the workforce, reduce flows out of the workforce, and improve nurse retention rates.Although delayed market response may have been ...

240 citations


Book
15 Mar 2005
TL;DR: Huselid et al. as discussed by the authors presented a Workforce Scorecard that identifies and measures the behaviors, competencies, mind-set, and culture required for workforce success and reveals how each dimension impacts the bottom line.
Abstract: In a marketplace fueled by intangible assets, anything less than optimal workforce success can threaten a firm's survival. Yet, in most organizations, employee performance is both poorly managed and underutilized. The Workforce Scorecard argues that current management and human resources practices hinder employees' ability to contribute to strategic goals. To maximize the power of their workforce, organizations must meet three challenges: view their workforce in terms of contribution rather than cost; replace benchmarking metrics with measures that differentiate levels of strategic impact; and make line managers and HR professionals jointly responsible for executing workforce initiatives. Building on the proven model outlined in their best-selling book The HR Scorecard, Mark Huselid, Brian Becker, and co-author Richard Beatty show how to create a Workforce Scorecard that identifies and measures the behaviors, competencies, mind-set, and culture required for workforce success and reveals how each dimension impacts the bottom line. Practical and timely, The Workforce Scorecard offers crucial lessons for leveraging human capital to achieve strategic success.

225 citations



Journal ArticleDOI
TL;DR: Geographic access to physicians has continued to improve over the past two decades, although some smaller specialties have not diffused to the most rural areas, and current measures of geographic access overstate the extent of maldistribution.
Abstract: While views on the adequacy of the national physician workforce vary widely and fluctuate over time (Council on Graduate Medical Education [COGME] 1998; Cooper et al 2002; Grumbach 2002a; Grumbach 2002b; Weiner 2002; Blumenthal 2004 most seem to agree that physicians are geographically maldistributed, with too few in rural areas The COGME, for example, concluded that: Geographic maldistribution of health care providers and service is one of the most persistent characteristics of the American health care system Even as an oversupply of some physician specialties is apparent in many urban health care service areas across the country, many inner city and rural communities still struggle to attract an adequate number of health professionals to provide high-quality care to local people This is the central paradox of the American health care system: shortages amid surplus COGME 1998) Government policies to increase the diffusion of physicians across underserved areas have been in place for decades and continue to evolve Most recently, the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 increased and expanded fee enhancements for physicians who provide services to enrollees in underserved areas Medicare has included such additional payments for rural physicians since 1987, when Congress enacted the Medicare Payment Incentive Program Similarly, designated Rural Health Clinics have historically been eligible for cost-based reimbursement under Medicare and Medicaid The federal government also reinforces the health workforce directly in underserved areas through the National Health Services Corps and a wide variety of grant-making programs operated through the Health Resources and Services Administration Medical schools have attempted to address health workforce shortages by recruiting and training individuals committed to practice in underserved areas (Adkins et al 1987; Brazeau, Potts, and Hickner 1990; Rabinowitz et al 1999) Despite the wide array of policies and programs to address the issue, some reports have suggested that undersupply of primary care physicians (PCPs) is worsening in rural areas (Institute of Medicine 1996; Ricketts, Hart, and Pirani 2000) Physician-to-population ratios calculated at the county level are commonly relied upon as indicators of such worsening and are used in part to target government programs, including the subsidy enacted as part of the recent Medicare legislation A number of published analyses, however, have suggested that this measure of disparity is misleading as an indicator of access because it assumes that residents only seek care in their own county, contrary to patient origin studies (Kleinman and Makuc 1983; Newhouse 1990) While the potential importance of patient travel to providers in adjacent areas is considered informally in designating underserved areas for the purpose of Federal policy, no systematic method has been proposed to incorporate such considerations into access measures There is an extensive literature that deals with modeling the diffusion of physicians and other health care resources across geographic areas and measures of geographic accessibility of physician services (Knox 1979; Joseph and Bantock 1982; Wing and Reynolds 1988; Kwan and Weber 2003; Guagliardo 2004) Several recent reviews synthesize current findings and methods in the context of a literature that dates to the nineteenth century (Kwan and Weber 2003; Guagliardo 2004) Both reviews concur as to the deficits of both provider-to-population ratios and distance models (also known as travel impedance models) for ascertaining spatial availability of physician services The major criticism of these approaches relates to their failure to portray accurately the set of accessible physicians from the individual's point of view and to weigh each in proportion to their availability along the geospatial (and temporal) continuum Substantial progress to this end has been made using gravity models, which quantify accessibility as the weighted sum of physician resources within a given radius, with the weights given by a distance decay function (see, inter alia, Knox 1979) The more sophisticated versions of the gravity model also account for differences in patient demand facing each physician (Joseph and Bantock 1982) More recently, investigators at the University of New Mexico, Division of Government Research have been working on a “compound” gravity model, which accounts for the spatial distribution of potential patients and physicians at the zip-code level and derives an implied population-to-physician ratio (New Mexico Health Policy Commission 2004) We note as well that there is a growing literature that goes well beyond the methods applied here to account for not just geospatial but temporal patterns of accessibility, particularly in urban areas These efforts take advantage of sophisticated Geographic Information System capabilities to model with much greater precision the location of physicians and populations, as well as features such as roads and transportation options (Kwan et al 2003) Related issues have also been explored in the context of an effort to establish more realistic market area definitions for pediatric and primary care using insurance billing data to approximate patient travel patterns (Goodman et al 2003; Guagliardo et al 2004) These service areas are defined to include the plurality of providers used by residents and thus represent more rational markets than geopolitical units such as counties While service areas represent a more logical locus of measurement and intervention for primary care workforce issues than counties, they do not greatly improve measures of access as a substantial share of care received by residents is obtained outside of the service area (roughly one-third, based on the studies) To shed further light on disparities in geographic access to physicians, we updated earlier research to see how the distribution of physicians has changed in light of the large increase in overall supply In a new analysis, we measure geographic access by estimating caseloads of physicians serving communities across the urban–rural spectrum, and we compare simulated PCP caseloads with thresholds established for designating Health Professional Shortage Areas (HPSAs) Our caseload analysis, which is akin to the compound gravity model described above, allows for explicit modeling of patient preferences with regard to travel distance to a physician and takes into account the availability of nearby alternatives in measuring access to care at the population level

Journal ArticleDOI
TL;DR: A larger surgical workforce will be needed to provide the breadth of services encompassed by the primary components of general surgery, as the phenomenon of progressive specialization evolves.
Abstract: Background Although most general surgeons receive comparable training leading to Board certification, the services they provide in practice may be highly variable. Progressive specialization is the voluntary narrowing of scope of practice from the breadth of skills acquired during training; it occurs in response to patient demand, rapid growth of medical knowledge, and personal factors. Progressive specialization is increasingly linked to fellowship training, which generally abruptly narrows a surgeon's scope of practice. This study examines progressive specialization by evaluating trends in fellowship training among general surgeons. Study design Because no database exists that tracks trainees from medical school matriculation through entrance into the workforce, data from multiple sources were compiled to assess the impact of progressive specialization. Trends in overall number of trainees, match rates, and proportion of international medical graduates were analyzed. Results The proportion of general surgeons pursuing fellowship training has increased from > 55% to > 70% since 1992. The introduction of fellowship opportunities in newer content areas, such as breast surgery and minimally invasive surgery, accounts for some of the increase. Meanwhile, interest in more traditional subspecialties (ie, thoracic and vascular surgery) is declining. Conclusions Progressive specialization confounds workforce projections. Available databases provide only an estimate of the extent of progressive specialization. When surgeons complete fellowships, they narrow the spectrum of services provided. Consequently, as the phenomenon of progressive specialization evolves, a larger surgical workforce will be needed to provide the breadth of services encompassed by the primary components of general surgery.

Journal ArticleDOI
TL;DR: The authors found that work-family conflict has increased during this period, particularly for men, and marital, parental, and spouse's employment status proved to be consistently important predictors of work family conflict.
Abstract: Although many observers assume that balancing the often-competing demands of work and family has become increasingly difficult in recent decades, little research has explicitly examined this proposition. This study examines this question by drawing on data from the 1977 Quality of Employment Survey and the 1997 National Study of the Changing Workforce. The author found that work-family conflict has increased during this period, particularly for men. In addition, marital, parental, and spouse’s employment status prove to be consistently important predictors of work-family conflict. Future research focusing on men’s experiences of conflict, examining conflict from the perspective of the family unit, and exploring the effects of workplace policies is suggested.

Journal Article
TL;DR: In this article, a detailed profile for 5 nursing workforce destination countries: Australia Ireland Norway the United Kingdom and the United States is presented. And a comparative analysis made possible by each country's high-quality health system infrastructure and valid nursing workforce data is performed.

Journal ArticleDOI
Soonhee Kim1
TL;DR: In this article, a survey questionnaires were sent to IT employees working in the central IT departments of two state governments to analyze how job characteristics, work environment, and human resource management practices influenced their turnover intentions.
Abstract: Electronic government expansion is creating the complex challenges of managing an effective information technology (IT) workforce in the public sector. Survey questionnaires were sent to IT employees working in the central IT departments of two state governments to analyze how job characteristics, work environment, and human resource management practices influence their turnover intentions. Results show that work exhaustion, an emphasis on participatory management, and opportunities for advancement were statistically significant variables affecting state government IT employee turnover intentions, and that salary satisfaction was not a statistically significant factor. Suggestions are offered for improving IT employee retention rates in government agencies.

Journal ArticleDOI
17 Mar 2005-BMJ
TL;DR: To meet the growing global demands of caring for the increasing numbers of patients with chronic conditions, there needs to be a new approach to training to include a new set of core competencies that prepare 21st century health workers to manage today's most prevalent health problems.
Abstract: To meet the growing global demands of caring for the increasing numbers of patients with chronic conditions, we need to develop a new approach to training Chronic conditions currently account for more than half of the global disease burden and are a primary challenge for 21st century healthcare systems.1 This is a dramatic shift from the health concerns of the 20th century, when acute infectious diseases were the primary focus in every country. While the world is experiencing a rapid transition from acute diseases to chronic health problems, training of the healthcare workforce, however, relies on early 20th century models that emphasise diagnosis and treatment of acute diseases. Educational leaders, health professional bodies, and the World Health Organization recognise such models as inadequate for health workers caring for a growing population of patients with health problems that persist across decades or lifetimes.2–5 Training should be restructured to include a new set of core competencies (knowledge, skills, abilities, personal qualities, experience, or other characteristics)—new “tricks” that prepare 21st century health workers to manage today's most prevalent health problems. The global crisis in the healthcare workforce has attracted much attention in recent years.6–10 There is a global imbalance of human resources for health and, in particular, a shortage of healthcare workers in developing countries.11 Clearly, the scarcity of healthcare workers is cause for concern. Unchecked migration of the workforce from rural to urban areas and from poor to wealthy countries has dire consequences for the health of those living in abandoned communities. The sole focus on the quantity of healthcare workers, however, has obscured a second but equally troubling issue: the quality of the training and preparation of the workforce. There is an obvious mismatch between the most prevalent health problems (that is, chronic …

Journal ArticleDOI
TL;DR: In this paper, the authors review quantitative and qualitative research on the impact of IT on economic performance in developed and developing countries and find evidence of a strong positive correlation between IT and economic performance, as well as IT-induced changes in workforce composition in favor of highly skilled or educated workers.

Journal ArticleDOI
TL;DR: Issues related to geriatric dentistry and concerns about access to dental care include the increasing diversity of the older adult population, concerns about the degree to which the dental workforce is prepared to meet the oral health needs of older patients, and the adequacy of the future workforce.
Abstract: Oral health is essential to an older adult's general health and well-being. Yet, many older adults are not regular users of dental services and may experience significant barriers to receiving necessary dental care. This literature review summarizes national trends in access to dental care and dental service utilization by older adults in the United States. Issues related to geriatric dentistry and concerns about access to dental care include the increasing diversity of the older adult population, concerns about the degree to which the dental workforce is prepared to meet the oral health needs of older patients, and the adequacy of the future workforce, including concern about training opportunities in gerontology and geriatrics for dental and allied dental practitioners.

Journal ArticleDOI
TL;DR: The roles of health professionals will need to change and workforce planning needs to place a stronger emphasis on issues of workforce substitution, that is, a different mix of responsibilities.
Abstract: The Australian health workforce has changed dramatically over the last 4 years, growing in size and changing composition. However, more changes will be needed in the future to respond to the epidemiological and demographic transition of the Australian population. A critical issue will be whether the supply of health professionals will keep pace with demand. There are current recorded shortages of most health professionals, but this paper argues that future workforce planning should not be based on providing more of the same. Rather, the roles of health professionals will need to change and workforce planning needs to place a stronger emphasis on issues of workforce substitution, that is, a different mix of responsibilities. This will also require changes in educational preparation, in particular an increased emphasis on interprofessional work and common foundation learning.

Book
01 Dec 2005
TL;DR: This book discusses the challenges of transition in CEE and the NIS of the former USSR, and proposes a strategic framework for the development of the health care workforce in Europe.
Abstract: Foreword Human resources for health in Europe Analysing trends, opportunities and challenges Migration of health workers in Europe: policy problem or policy solution? Changing professional boundaries Structures and trends in health profession education in Europe Managing the performance of health professionals Health care managers as a critical component of the health care workforce Incentives in health care: the shift in emphasis from the implicit to the explicit Enhancing working conditions Reshaping the regulation of the workforce in European health care systems The challenges of transition in CEE and the NIS of the former USSR The impact of EU law and policy Moving forward: building a strategic framework for the development of the health care workforce Index

Journal ArticleDOI
TL;DR: The structural position of black and minority ethnic workers (BME) and migrant workers in the UK labour market is relatively well known as discussed by the authors, but what it is like to work in these increasingly segmented sections of the economy where white workers have abandoned jobs in favour of (slightly) more lucrative work is less well known.
Abstract: The structural position of black and minority ethnic workers (BME) and migrant workers in the UK labour market is relatively well known. Many workers in these groups find themselves in low-paid, low-skilled jobs primarily because of their ethnicity and regardless of their skills. This racialization of the labour market has been well documented - particularly since the ‘large-scale’ BME immigration in the post-war period. What is less well known is what it is like to work in these increasingly segmented sections of the economy where white workers have abandoned jobs in favour of (slightly) more lucrative work. Adopting a case-study approach, this article follows a trade union’s attempt to organize a sandwich factory of 500 workers, where most of the workforce was made up of BME migrant workers.

Journal ArticleDOI
Delanyo Dovlo1
TL;DR: Suggestions that the way human resources for health are trained and deployed in Africa does not enhance productivity and that countries are unable to realize the full potential expected from the working life of their health workers are illustrated.
Abstract: Sub-Saharan Africa faces a human resources crisis in the health sector. Over the past two decades its population has increased substantially, with a significant rise in the disease burden due to HIV/AIDS and recurrent communicable diseases and an increased incidence of noncommunicable diseases. This increased demand for health services is met with a rather low supply of health workers, but this notwithstanding, sub-Saharan African countries also experience significant wastage of their human resources stock. This paper is a desk review to illustrate suggestions that the way human resources for health (HRH) are trained and deployed in Africa does not enhance productivity and that countries are unable to realize the full potential expected from the working life of their health workers. The paper suggests data types for use in measuring various forms of "wastage". "Direct" wastage – or avoidable increases in loss of staff through factors such as emigration and death – is on the rise, perhaps as a result of the HIV/AIDS epidemic. "Indirect" wastage – which is the result of losses in output and productivity from health professionals' misapplied skills, absenteeism, poor support and lack of supervision – is also common. HIV/AIDS represents a special cause of wastage in Africa. Deaths of health workers, fear of infection, burnout, absenteeism, heavy workloads and stress affect productivity. The paper reviews strategies that have been proposed and/or implemented. It suggests areas needing further attention, including: developing and using indicators for monitoring and managing wastage; enhancing motivation and morale of health workers; protecting and valuing the health worker with enhanced occupational safety and welfare systems; and establishing the moral leadership to effectively tackle HIV/AIDS and the brain drain.

Journal ArticleDOI
TL;DR: Despite changes in the workforce, the world of work is still largely organized for a family model that is increasingly rare--one with a stay-at-home caregiver.
Abstract: Demographic data show that major changes have been occurring in the everyday lives of families over the last generation, with the majority of mothers of young children in the workforce and an increasing number of men and women assuming caregiving responsibilities for older relatives. Thus, the 2 primary identities of most adults, defined by their multiple family and work roles, need to be coordinated in ways that promote positive family outcomes, returns on investments for employers, and societal values. Despite changes in the workforce, the world of work is still largely organized for a family model that is increasingly rare--one with a stay-at-home caregiver. Recommendations based on psychological and other social science research are offered to align the needs of working families and employers.

Journal ArticleDOI
TL;DR: It is hypothesized that the rural areas of the United States are relatively undersupplied with general surgeons, and steps to reverse this trend are needed to preserve the viability of health care in many parts of rural America.
Abstract: Background General surgeons form a crucial component of the medical workforce in rural areas of the United States. Any decline in their numbers could have profound effects on access to adequate health care in such areas. Hypothesis We hypothesize that the rural areas of the United States are relatively undersupplied with general surgeons. Design and Setting The American Medical Association’s Physician Masterfile was used to identify all clinically active general surgeons as well as their locations and characteristics. Their geographic distribution was examined using the ZIP code version of the Rural-Urban Commuting Areas. Surgeons were classified as practicing in urban areas, large rural areas, or small/isolated rural areas. Results There are currently 17 243 general surgeons practicing in the United States. Nationally, the number of general surgeons per population of 100 000 varies from 6.53 in urban areas to 7.71 in large rural areas and 4.67 in small/isolated rural areas. Only 10.6% of the nation’s general surgeons are female. Wide variations in numbers of general surgeons were found between and within individual states. General surgeons in the smallest rural areas are more likely than those in urban areas to be male (92.7% vs 88.3%, P P P Conclusions The overall size of the rural general surgical workforce has remained static over the last decade, but its demographic characteristics suggest that numbers will decline. Many rural residents have limited access to surgical services. Steps to reverse this trend are needed to preserve the viability of health care in many parts of rural America.

Journal ArticleDOI
TL;DR: The authors examined child care policies in three countries-France, Sweden, and the United States-to explore the links between labor markets and social policy and to probe the applicability of the "varieties of capitalism" literature to the human services.
Abstract: This article examines child care policies in three countries-France, Sweden, and the United States-to explore the links between labor markets and social policy and to probe the applicability of the “varieties of capitalism” literature to the human services. Countries differ in the extent to which they subsidize early childhood care and education programs, reflecting, in part, the nature of the child care workforce. In liberal market economies such as the United States, a low-skill, low-wage workforce has enabled a private market of child care to develop, letting federal and state governments off the hook from having to subsidize these programs. In the more coordinated market economies of Western Europe, by contrast, higher labor market regulations, wages, and rates of unionization raise the cost of labor and impede the growth of a private child care market. As a result, governments aiming to promote women’s employment or assure the education of young children will feel pressed to provide extensive public subsidies for these services. While these differences reflect long-standing variations in labor market skill regimes, strong public sector unions also shape diverging trajectories in the “production” of child care services.



Journal ArticleDOI
TL;DR: A systematic analysis of the current status of emerging CBLTC systems in Shanghai, China covers several domains of the system: service delivery, workforce, financing, and quality of care management.
Abstract: China's rapid economic reforms, coupled with the changes in age composition of the demographic structure, have greatly affected the traditional family support system. In response to these changes, efforts to develop new models of community-based long-term care (CBLTC) for elders in China have received growing attention. This paper provides a systematic analysis of the current status of emerging CBLTC systems in Shanghai, China. It covers several domains of the system: service delivery, workforce, financing, and quality of care management. Several main issues involved in the development of the emerging system are addressed, and relevant policy implications are presented in the paper.

Journal ArticleDOI
TL;DR: It is concluded that a newly strengthened public health infrastructure must be sustained in the future through a balancing of the values inherent in the federal system.
Abstract: Threats to Americans' health-including chronic disease, emerging infectious disease, and bioterrorism-are present and growing, and the public health system is responsible for addressing these challenges. Public health systems in the United States are built on an infrastructure of workforce, information systems, and organizational capacity; in each of these areas, however, serious deficits have been well documented. Here we draw on two 2003 Institute of Medicine reports and present evidence for current threats and the weakness of our public health infrastructure. We describe major initiatives to systematically assess, invest in, rebuild, and evaluate workforce competency, information systems, and organizational capacity through public policy making, practical initiatives, and practice-oriented research. These initiatives are based on applied science and a shared federal-state approach to public accountability. We conclude that a newly strengthened public health infrastructure must be sustained in the future through a balancing of the values inherent in the federal system.