Showing papers on "Workforce published in 2008"

Motivation and retention of health workers in developing countries: a systematic review.

Abstract: A key constraint to achieving the MDGs is the absence of a properly trained and motivated workforce. Loss of clinical staff from low and middle-income countries is crippling already fragile health care systems. Health worker retention is critical for health system performance and a key problem is how best to motivate and retain health workers. The authors undertook a systematic review to consolidate existing evidence on the impact of financial and non-financial incentives on motivation and retention.

Orthopaedic surgeon workforce and volume assessment for total hip and knee replacement in the United States: preparing for an epidemic.

Abstract: The demand for health-care services in general, and musculoskeletal care in particular, is expected to increase substantially in the United States because of the growth of the population, aging of the population, public expectations, economic growth, investment in health-care interventions, and improved diagnosis and treatment. The impact of an aging population is demonstrated by the fact that, in 2000, the eleven most costly medical conditions in the United States were far more prevalent among the elderly, and the population of elderly Americans is increasing. It is not clear that the future supply of physicians will be sufficient to meet the increasing demand for health care. The supply of American physicians is limited by the aging and retirement of current physicians, medical school graduation class size of allopathic medical doctors and osteopathic physicians, and United States immigration policies, which limit the number of physicians entering the country. Furthermore, among active physicians, the “effective physician supply” is limited by gender and generational differences, lifestyle choices, changing practice patterns, and variability in physician productivity. At current physician production levels, the ratio of physicians to population will peak between 2015 and 20201. Between 2000 and 2020, the demand for orthopaedic services in this country will increase by 23% while the supply of orthopaedic surgeons will increase by only 2% during the same interval2. During the next few decades, the demand for total joint arthroplasties in the United States may not be met because of an inadequate supply of total joint arthroplasty surgeons. This hypothesis or concern is based on data and trends associated with the prevalence of total joint arthroplasty, projected volumes of total joint arthroplasty, workforce trends in total joint arthroplasty, and reimbursement for total joint arthroplasty. The purposes of this paper are to evaluate the validity of this …

Incentives for retaining and motivating health workers in Pacific and Asian countries.

Abstract: This paper was initiated by the Australian Agency for International Development (AusAID) after identifying the need for an in-depth synthesis and analysis of available literature and information on incentives for retaining health workers in the Asia-Pacific region. The objectives of this paper are to: 1. Highlight the situation of health workers in Pacific and Asian countries to gain a better understanding of the contributing factors to health worker motivation, dissatisfaction and migration. 2. Examine the regional and global evidence on initiatives to retain a competent and motivated health workforce, especially in rural and remote areas. 3. Suggest ways to address the shortages of health workers in Pacific and Asian countries by using incentives. The review draws on literature and information gathered through a targeted search of websites and databases. Additional reports were gathered through AusAID country offices, UN agencies, and non-government organizations. The severe shortage of health workers in Pacific and Asian countries is a critical issue that must be addressed through policy, planning and implementation of innovative strategies – such as incentives – for retaining and motivating health workers. While economic factors play a significant role in the decisions of workers to remain in the health sector, evidence demonstrates that they are not the only factors. Research findings from the Asia-Pacific region indicate that salaries and benefits, together with working conditions, supervision and management, and education and training opportunities are important. The literature highlights the importance of packaging financial and non-financial incentives. Each country facing shortages of health workers needs to identify the underlying reasons for the shortages, determine what motivates health workers to remain in the health sector, and evaluate the incentives required for maintaining a competent and motivated health workforce. Decision-making factors and responses to financial and non-financial incentives have not been adequately monitored and evaluated in the Asia-Pacific region. Efforts must be made to build the evidence base so that countries can develop appropriate workforce strategies and incentive packages.

Health System Reform in China 5 China's human resources for health: quantity, quality, and distribution

Abstract: In this paper, we analyse China’s current health workforce in terms of quantity, quality, and distribution. Unlike most countries, China has more doctors than nurses—in 2005, there were 1·9 million licensed doctors and 1·4 million nurses. Doctor density in urban areas was more than twice that in rural areas, with nurse density showing more than a three-fold diff erence. Most of China’s doctors (67·2%) and nurses (97·5%) have been educated up to only junior college or secondary school level. Since 1998 there has been a massive expansion of medical education, with an excess in the production of health workers over absorption into the health workforce. Inter-county inequality in the distribution of both doctors and nurses is very high, with most of this inequality accounted for by within-province inequalities (82% or more) rather than by between-province inequalities. Urban–rural disparities in doctor and nurse density account for about a third of overall inter-county inequality. These inequalities matter greatly with respect to health outcomes across counties, provinces, and strata in China; for instance, a cross-county multiple regression analysis using data from the 2000 census shows that the density of health workers is highly signifi cant in explaining infant mortality.

Forecasting the global shortage of physicians: an economic- and needs-based approach

Abstract: OBJECTIVE: Global achievements in health may be limited by critical shortages of health-care workers. To help guide workforce policy, we estimate the future demand for, need for and supply of physicians, by WHO region, to determine where likely shortages will occur by 2015, the target date of the Millennium Development Goals. METHODS: Using World Bank and WHO data on physicians per capita from 1980 to 2001 for 158 countries, we employ two modelling approaches for estimating the future global requirement for physicians. A needs-based model determines the number of physicians per capita required to achieve 80% coverage of live births by a skilled health-care attendant. In contrast, our economic model identifies the number of physicians per capita that are likely to be demanded, given each country's economic growth. These estimates are compared to the future supply of physicians projected by extrapolating the historical rate of increase in physicians per capita for each country. FINDINGS: By 2015, the global supply of physicians appears to be in balance with projected economic demand. Because our measure of need reflects the minimum level of workforce density required to provide a basic health service that is met in all but the least developed countries, the needs-based estimates predict a global surplus of physicians. However, on a regional basis, both models predict shortages for many countries in the WHO African Region in 2015, with some countries experiencing a needs-based shortage, a demand-based shortage, or both. CONCLUSION: The type of policy intervention needed to alleviate projected shortages, such as increasing health-care training or adopting measures to discourage migration, depends on the type of shortage projected.

The US dermatology workforce: A specialty remains in shortage

Abstract: Introduction Since 1999, multiple surveys have documented a stable undersupply of dermatologic services in the United States. Factors contributing to the imbalance include changes in the demographics of the physician workforce, increased demand for services, and a limited number of training positions for new physicians. In response to the demand, there has also been a substantial influx of nonphysician clinicians into dermatology offices. Methods We sought to follow up the large data set collected by the American Academy of Dermatology in 2002; the survey was repeated in 2005 and 2007. Response rates ranged from 30% to 35% and included more than 1200 respondents each year. Results Few changes were noted in the metrics used to assess the balance of supply and demand in the US dermatology workforce between 2002 and 2007. Mean wait times for new patient appointments decreased slightly from 36 to 33 days. One third of practices continue to seek additional dermatologists. In 2007, 23% of practices reported employing a physician assistant and 10% a nurse practitioner (up from 15% and 8% in 2002). In 2007, typical dermatologists continued to spend the bulk of their direct patient care time in medical dermatology (23.9 hours, 63%), followed by surgery (10.2 hours, 27%), and then cosmetic dermatology (3.8 hours, 10%). A substantial subset of dermatologists (29%) spent half or more of their time in surgical and cosmetic dermatology combined. Although female dermatologists worked fewer total hours, they spent equal time caring for patients with medical dermatologic conditions, less time in surgical dermatology, and more time in cosmetic dermatology. Limitations The survey is potentially subject to inaccurate self-report and response bias. Although the results shed light on patient access and the dermatology workforce, they do not establish or quantify any impact on patients' health. Conclusions Between 2002 and 2007, despite continued increases in the number of nonphysician clinicians in US dermatology offices, there were only small changes in the overall metrics commonly used to assess workforce balance. These findings suggest persistent unmet demand, but, given divergent trends of ongoing increases in surgical and cosmetic dermatology, growth in the use of physician assistants and nurse practitioners, and an aging and expanding US population, the future balance of supply and demand remains difficult to predict. Nevertheless, careful workforce planning and deliberative consideration of the risks and benefits of rapidly emerging changes in the delivery of dermatologic care are essential to ensure access to high-quality care for patients with skin disease.

Implementing lean production systems: barriers to change

Abstract: Purpose – The purpose of this paper is help understand why implementing continuous improvement (CI) strategies can be difficult at times. It also addresses the problem of resistance to change within even those firms whose CEO is most fully committed to implementation of CI programs.Design/methodology/approach – The study focuses on a Fortune 500 manufacturing plant located in the Eastern USA. A survey was distributed to both salaried and unionized hourly employees.Findings – Results from the survey show that the problem lies primarily with an aging and high seniority hourly workforce and a lack of committed leadership at this research site. For example, salaried employees consistently provided higher positive ratings of CI initiatives. In addition, higher seniority was directly correlated with negative ratings. Finally, the study found that employees do not feel valued when they contribute to the improvement processes and that 100 per cent of the hourly male employees disagreed that “The Company considers...

A Life Beyond Work? Job Demands, Work-Life Balance, and Wellbeing in UK Academics

Abstract: SUMMARY Research findings from several countries suggest that academic work has become comparatively stressful, with potentially serious consequences for the workforce and the quality of higher education. This article reports the findings of a study that examined work demands, work-life balance and wellbeing in UK academic staff. Job demands and levels of psychological distress were high and working during evenings and weekends was commonplace. Most academics surveyed, however, were at least moderately satisfied with their jobs. Work-life balance was generally poor and most respondents wished for more separation between their work and home lives. Academics who reported more work-life conflict and perceived a greater discrepancy between their present and ideal levels of work-life integration tended to be less healthy, less satisfied with their jobs, and more likely to have seriously considered leaving academia. On the whole, academics that perceived more control over their work, more schedule flexibility a...

The Future of the Nursing Workforce in the United States: Data, Trends and Implications

Abstract: The Future of the Nursing Workforce in the United States: Data, Trends and Implications provides a timely, comprehensive, and integrated body of data supported by rich discussion of the forces shaping the nursing workforce in the US. Using plain, jargon free language, the book identifies and describes the key changes in the current nursing workforce and provide insights about what is likely to develop in the future. The Future of the Nursing Workforce offers an in-depth discussion of specific policy options to help employers, educators, and policymakers design and implement actions aimed at strengthening the current and future RN workforce. The only book of its kind, this renowned author team presents extensive data, exhibits and tables on the nurse labor market, how the composition of the workforce is evolving, changes occurring in the work environment where nurses practice their profession, and on the publics opinion of the nursing profession.

A Retrospective View of Corporate Diversity Training From 1964 to the Present

Abstract: Although its effectiveness has been questioned, over the past 30 years diversity training has become common practice in the corporate arena, as a myriad of workforce differences has gained increasi...

Managerial Talent, Motivation, and Self-Selection into Public Management

Abstract: The quality of public management is a recurrent concern in many countries. Calls to attract the economy's best and brightest managers to the public sector abound. This paper studies self-selection into managerial and non-managerial positions in the public and private sector, using a model of a perfectly competitive economy where people differ in managerial ability and in public service motivation. We find that, if demand for public sector output is not too high, the equilibrium return to managerial ability is always highest in the private sector. As a result, relatively many of the more able managers self-select into the private sector. Since this outcome is efficient, our analysis implies that attracting a more able managerial workforce to the public sector by increasing remuneration to private-sector levels is not cost-efficient.

Intensification of workplace regimes in British horticulture: the role of migrant workers

Abstract: In Britain, international migrants have very recently become the major workforce in labour-intensive agriculture. This paper explores the causes of the dramatic increase since the 1990s in the employment of migrant workers in this sub-sector. It locates this major change in a general pattern of intensification in agricultural production related to an ongoing process of concentration in retailer power, and in the greater availability of migrant workers, shaped in part by state initiatives to manage immigration. However, within this narrative of change at the national scale, the paper also finds continuing diversity in agricultural workplace regimes. The paper draws on concepts developed in the US literature on agrarian capitalism. It then uses case histories from British agriculture to illustrate how growers have directly linked innovations involving intensification through labour control to their relationships with retailers. Under pressure on ‘quality’, volume and price, growers are found to have ratcheted up the effort required from workers to achieve the minimum wage through reducing the rates paid for piece work, and in some cases to have changed the type of labour contractor they use to larger, more anonymous businesses. The paper calls for further, commodity-specific and spatially-aware research with a strong ethnographic component.

Talent Management in the Era of the Aging Workforce: The Critical Role of Knowledge Transfer

Abstract: Organizations have been confronting many of the demographic changes occurring in the workforce, such as increasing racial and ethnic diversity along with greater numbers of women workers. The workf...

Contract Labour: The ‘Achilles Heel’ of Corporate Codes in Commercial Value Chains

Abstract: Codes of labour practice implemented by corporate buyers in their global production networks are one dimension of corporate social responsibility (CSR). Research indicates the benefits of codes for workers are limited and they fail to reach the most vulnerable workers, particularly those employed by labour contractors who face the worst employment conditions. This contribution argues that the commercial dynamics of global production networks provides an opening for civil society organizations to pressure for codes, but simultaneously drives the use of a vulnerable and insecure workforce that is the ‘Achilles Heel’ of codes. Whilst codes have a role to play, inherent tensions underpinned by a commercial logic mean they should only ever be viewed as one strand in broader strategies that address the rights of the most vulnerable workers in global production.

Child Welfare Worker Characteristics and Job Satisfaction: A National Study

Abstract: The education, recruitment, training, and retention of a quality child welfare workforce is critical to the successful implementation of public policy and programs for the nation's most vulnerable children. Yet, national information about child welfare workers has never been collected. The National Survey of Child and Adolescent Well-Being is a study of children who are investigated for child maltreatment that also offers information about the child welfare workers (unweighted N = 1,729) who serve them in 36 states and 92 counties. These cases represent the national population of child welfare workers, estimated at more than 50,000, serving children approximately 12 months after a case was opened. Child welfare workers having any graduate or social work degree in a nonurban setting were more satisfied than their peers. Regression results indicate that worker satisfaction is associated with quality of supervision and urban setting but does not have a clearly independent relationship with having a degree in social work. Practice implications are discussed.

Beyond the Self-expressive Creative Worker An Industry Perspective on Entertainment Media

Abstract: Evidence from industry reports, labor union data, and interviews with producers and union officials indicates that while the demand for media products and the number of productions continues to rise, much of the increase in demand is in low-budget features and extremely low-budget production for cable networks. In this production environment, the conglomerates are pressuring producers to reduce labor costs and produce a larger number of low-cost products. Producers are using various strategies to reduce costs, including requiring more flexibility from the production workforce with respect to the length of workdays and working conditions. This article examines how production trends, influenced by conglomerate domination of production and distribution, are affecting the media workforce. In particular I look at three tendencies. The first is a widening split between core workers and peripheral workers employed in industry projects. The second is a change in professional and craft identities as a result of te...

Will the stork return to Europe and Japan? Understanding fertility within developed nations.

Abstract: We seek to explain the differences in fertility rates across high-income countries by focusing on the interaction between the increasing status of women in the workforce and their status in the household, particularly with regards to child care and home production. We observe three distinct phases in women's status generated by the gradual increase in women's workforce opportunities. In the earliest phase, characteristic of the 1950s and 1960s in the United States, women earn low wages relative to men and are expected to shoulder all of the child care at home. As a result, most women specialize in home production and raising children. In an intermediate stage, women have improved (but not equal) labor market opportunities, but their household status lags. Women in this stage are still expected to do the majority of child care and household production. Increasing access to market work increases the opportunity cost of having children, and fertility falls. Female labor force participation increases. Working women in this phase of development have the strongest disincentives to having additional children since the entire burden of child care falls on them. In the final phase of development, women's labor market opportunities begin to equal those of men. In addition, the increased household bargaining power that comes from more equal wages results in much higher (if not gender-equal) male participation in household production. Female labor force participation is higher than in the intermediate phase. The increased participation of men in the household also reduces the disincentives for women to have additional children, and fertility rates rise compared to the intermediate phase. The intermediate, low-fertility phase might describe Japan, Italy, and Spain in the present day, while the Scandinavian countries, the Netherlands, and the modern-day United States may be entering the final phase. After presenting the empirical evidence, we predict that high-income countries with the lowest fertility rates are likely to see an increase in fertility in the coming decades.

The neglect of the global surgical workforce: experience and evidence from Uganda.

Abstract: Africa’s health workforce crisis has recently been emphasized by major international organizations. As a part of this discussion, it has become apparent that the workforce required to deliver surgical services has been significantly neglected. This paper reviews some of the reasons for this relative neglect and emphasizes its importance to health systems and public health. We report the first comprehensive analysis of the surgical workforce in Uganda, identify challenges to workforce development, and evaluate current programs addressing these challenges. This was performed through a literature review, analysis of existing policies to improve surgical access, and pilot retrospective studies of surgical output and workforce in nine rural hospitals. Uganda has a shortage of surgical personnel in comparison to higher income countries, but the precise gap is unknown. The most significant challenges to workforce development include recruitment, training, retention, and infrastructure for service delivery. Curricular innovations, international collaborations, and development of research capacity are some of the initiatives underway to overcome these challenges. Several programs and policies are addressing the maldistribution of the surgical workforce in urban areas. These programs include surgical camps, specialist outreach, and decentralization of surgical services. Each has the advantage of improving access to care, but sustainability has been an issue for all of these programs. Initial results from nine hospitals show that surgical output is similar to previous studies and lags far behind estimates in higher-income countries. Task-shifting to non-physician surgical personnel is one possible future alternative. The experience of Uganda is representative of other low-income countries and may provide valuable lessons. Greater attention must be paid to this critical aspect of the global crisis in human resources for health.

Beyond diversity training: A social infusion for cultural inclusion

Abstract: Contemporary organizations, in an effort to reap the benefits of a diverse workforce, continue to spend millions of dollars on diversity training despite the tendency of such training to either fail or result in less than desired outcomes. We introduce an alternative, strategic approach to organizational diversity designed to create a more inclusive “culture of diversity.”This long-term, relational approach emphasizes an attitudinal and cultural transformation, requiring managers to “break barriers” by moving away from “managing diversity” toward “managing for diversity” to capitalize on the unique perspectives of a diverse workforce. © 2008 Wiley Periodicals, Inc.

Current and Future State of the US Nursing Workforce

Abstract: DESPITE A RECENT STRENGTHENING OF THE REGIStered nurse (RN) workforce, the US health care delivery system needs to prepare for an aging population of RNs and a coming wave of retirements. Over the next 20 years, the average age of RNs will increase, and the size of the workforce will plateau as large numbers of RNs retire. Because the demand for RNs is expected to increase steadily during this same period, a large and prolonged shortage of RNs is expected to develop in the latter half of the next decade, threatening access and quality and increasing health care costs. The question looming over the nursing profession, employers, nursing educators, physicians, other health professionals, and health care policy makers is what can be done to mitigate these developments.

Reflections from employers on the disabled workforce: Focus groups with healthcare, hospitality, and retail administrators

Abstract: Historically, employment rates for people with disabilities have been low. Despite legislation that prohibits the discrimination of this group in work settings, employers are reluctant to hire people with disabilities. The purpose of this qualitative study was to explore the experiences of employers with workers with disabilities. Three focus groups were conducted with 21 administrators from three business sectors (i.e., healthcare, hospitality, and retail). Content analysis indicated five primary themes: (1) importance of disability employment agencies and disability advocates; (2) persistence of manager bias; (3) lack of promotion opportunities; (4) costs associated with having workers with disabilities; and (5) benefits associated with having workers with disabilities. Implications include the need for intervention studies that address the challenges experienced by individuals with disabilities, particularly during hiring and promoting phases of employment, and educational efforts to inform administrators and managers of the few costs and numerous benefits associated with having workers with disabilities.

Nurses in Australian general practice: implications for chronic disease management

Abstract: Aims. The purpose of this study was to describe the demographic and employment characteristics of Australian practice nurses and explore the relationship between these characteristics and the nurses’ role. Background. Nursing in general practice is an integral component of primary care and chronic disease management in the United Kingdom and New Zealand, but in Australia it is an emerging specialty and there is limited data on the workforce and role. Design. National postal survey embedded in a sequential mixed method design. Methods. 284 practice nurses completed a postal survey during 2003–2004. Descriptive statistics and factor analysis were utilized to analyse the data. Results. Most participants were female (99%), Registered Nurses (86%), employed part-time in a group practice, with a mean age of 45·8 years, and had a hospital nursing certificate as their highest qualification (63%). The tasks currently undertaken by participants and those requiring further education were inversely related (R2 = −0·779). Conversely, tasks perceived to be appropriate for a practice nurse and those currently undertaken by participants were positively related (R2 = 0·8996). There was a mismatch between the number of participants who perceived that a particular task was appropriate and those who undertook the task. This disparity was not completely explained by demographic or employment characteristics. Extrinsic factors such as legal and funding issues, lack of space and general practitioner attitudes were identified as barriers to role expansion. Conclusion. Practice nurses are a clinically experienced workforce whose skills are not optimally harnessed to improve the care of the growing number of people with chronic and complex conditions. Relevance to clinical practice. Study data reveal a need to overcome the funding, regulatory and interprofessional barriers that currently constrain the practice nurse role. Expansion of the practice nurse role is clearly a useful adjunct to specialist management of chronic and complex disease, particularly within the context of contemporary policy initiatives.

Internationalization and the Spaces of Temporary Labour: The Global Assembly of a Local Workforce

Abstract: An increasing number of low-status consumer service jobs in the UK are undertaken by economic migrants, who are often recruited through the aegis of employment agencies. This article explores the use of migrant agency workers by a London hotel and a hospital, looking at the ways in which such a labour force is recruited and assembled in parts of the service sector in Greater London. It argues that even in the most locally-based of service-sector jobs, typically involving face to face interactions, new sets of transnational connections are producing a globalized labour force.

Globalization, Women's Migration, and the Long-Term-Care Workforce

Abstract: With the aging of the world's population comes the rising need for qualified direct long-term-care (DLTC) workers (i.e., those who provide personal care to frail and disabled older adults). Developed nations are increasingly turning to immigrant women to fill these needs. In this article, we examine the impact of three global trends-population aging, globalization, and women's migration-on the supply and demand for DLTC workers in the United States. Following an overview of these trends, we identify three areas with embedded social justice issues that are shaping the DLTC workforce in the United States, with a specific focus on immigrant workers in these settings. These include world poverty and economic inequalities, the feminization and colorization of labor (especially in long-term care), and empowerment and women's rights. We conclude with a discussion of the contradictory effects that both population aging and globalization have on immigrant women, source countries, and the long-term-care workforce in the United States. We raise a number of policy, practice, and research implications and questions. For policy makers and long-term-care administrators in receiver nations such as the United States, the meeting of DLTC worker needs with immigrants may result in greater access to needed employees but also in the continued devaluation of eldercare as a profession. Source (supply) nations must balance the real and potential economic benefits of remittances from women who migrate for labor with the negative consequences of disrupting family care traditions and draining the long-term-care workforce of those countries.