Healthcare Quarterly
Health Quality 5.0: The Global Health Workforce Crisis – First Things First
Abstract
The future of quality is personal. Health Quality 5.0 moves people-centred, integrated health and social care systems to the forefront of our post-COVID-19 agenda – and that cannot happen without addressing our global workforce crisis. Building back a stronger, healthier workforce is the first of the five big challenges we address in our special series. Starting with the global health workforce crisis is fitting, given it is the most fundamental and formidable barrier to health and quality today. As we put the pieces of the Health Quality 5.0 puzzle together, a picture of a more resilient health system will emerge and a new leadership agenda to get there will take shape.
Introduction
There is no quality of care without a healthy, competent workforce. So, when healthcare leaders and workers worldwide unequivocally concur that we are in the midst of a workforce crisis, we know that addressing it is universally and uniquely urgent. Every one of my recent conversations with health providers, organizational leaders, academics, patients and policy makers across multiple countries has reflected and reinforced that. My survey may not be scientific, but the voices are authentic and the views are rooted in reality.
Commissioned reports by provincial, national and international bodies back this up. Media headlines capture the pervasive and personal consequences of the crisis. Members of the health workforce, weakened by the pandemic and its aftermath, are struggling to do the job they love. That means shift shortages, longer wait times, clinical errors, mistakes in judgement and negative effects on patients. At the same time, when workforce warnings and calls for help go unheeded and harm happens, providers become more distressed psychologically and morally and their trust in leadership wanes. All this makes healthcare practitioners more likely to leave their place of work – or quit their profession entirely.
Two things strike me about this: (1) no one is surprised by where we find ourselves and (2) we keep coming up with the same types of recommendations that we failed to act on in the first place and yet, somehow, we expect different responses. Why is it so hard to make progress? How are we to understand, account for and alter this stasis? Where are the bright lights to beckon us onward? And what, if anything, can leaders do today to help turn things around?
These are some of the questions we set out to address in this second installment of our series, “It is Time for Health Quality 5.0: Are You Ready?” The global health workforce crisis is the first of the five big challenges we examine in this series – a fitting choice, given it is the most fundamental and formidable barrier to health and quality today. In our introductory article, we highlighted a handful of daunting issues facing global leaders today and laid out our case for change: create a new agenda that responds to changing realities and ushers in a new era for health quality (Thompson 2023). The commentary seemed to speak to people, many of whom appreciated the self-declared optimistic bias in looking to the future. Thank you for taking the time to read it and for sharing your feedback and positive comments.
Trying to tackle such complex issues – the workforce crisis, planetary health, equity, co-production and the retreat on quality – is ambitious. It calls for diverse input, big-picture perspectives, prudent leaps of faith and practical problem solving. We could also really benefit from inventive strategies to build on promising initiatives from the past and bring them to fruition. This is not a solo mission; we need teams of teams, partners and new networks to make collective action happen and succeed. Let us get started. Step one is understanding the problem and how it became the crisis it is today.
Understanding the Problem
In 2009, the World Health Organization (WHO) described the serious health workforce shortage as “one of the most critical constraints to the achievement of health and social development goals” (WHO 2009).
For those of us who spent the previous two decades implementing cutbacks and layoffs and leaning out a healthcare system that was deemed unaffordable, this was a reckoning. Workforce supply problems had been growing for years; the signs were all there but they went unheeded. The opportunity to tackle the tough issues head on, with an eye to the future, was lost (along with seats in medical and nursing schools). Short-sighted decision making and quick fixes, viewed as more valuable, won. The seeds of today's crisis found fertile soil.
Three seminal reports (Kruk et al. 2018; World Health Organization et al. 2018; National Academies of Sciences, Engineering, and Medicine et al. 2018) published about a decade later revealed the consequences of that short-sighted approach, including negative impacts on critical priorities such as patient safety. The reports called for better working conditions, national workforce strategies and updated competency and curriculum requirements. While the authors acknowledged that the recommendations were not new, they warned that failing to act on them would seriously compromise the resilience and sustainability of healthcare systems, putting patient safety more at risk.
Two years later, the COVID-19 pandemic hit and, as we all know, the compounding effect on an already vulnerable system was crushing. The pandemic exposed the fault lines in our health systems and across society. It exacerbated existing workforce challenges and produced new ones with unprecedented levels of risk, including higher threats for increased infection, physical and psychological harm and death. Despite all this, healthcare workers showed up – and then some. That took its toll on the workforce. Over the past several years, workforce retention rates have worsened while early retirements, medical leaves, mental health struggles and suicide rates have increased. The next wave of the crisis is right around the corner. The demand for healthcare workers is projected to rise to 80 million by 2030 (WHO 2016, 2017). The WHO (2016, 2017) also predicts a worldwide shortage of 18 million health workers by 2030, which will result in a shortfall of more than 20% of the people we will need (Britnell 2019; Refsum and Britnell 2023).
The estimated gap is concentrated more in low- and middle-income countries, raising issues related to cross-border recruitment and the migration of healthcare workers to higher-income countries. It appears that it is harder to help when your own house is on fire. The Organisation for Economic Co-operation and Development (OECD) issued yet another call for greater global collaboration and planning to address the workforce crisis in early February 2023 (OECD 2023a).
The heightened attention to “healthcare heroes” (Cox 2020) so evident during the pandemic has now faded, but the challenges facing the health workforce – and the health system that relies on it – clearly have not. The pre-pandemic complacency around health workforce issues has no place in the world today.
So where do we go from here? It's easy to be discouraged, but sitting on the sidelines is unacceptable. Waving our hands and saying, “I told you so,” or demanding that other people act is not leadership. Each of us must stand up, step in, try new strategies and test new approaches, and when things do or do not work, learn from that. We keep going until measurable improvements are made – ones that healthcare workers can see and experience in the short and long term. It will be a long journey but as the following sections show, we are on the way.
The Challenge: Context
The following points may be patent, but they are pivotal to understanding and resolving the global health workforce crisis:
- The workforce crisis is global, but we need local solutions that fit the context and capabilities of each country, province or community.
- This workforce crisis is like no other. The sheer number, size, severity and complexity of the problems mean old solutions are not fit for purpose.
- The pandemic's impact on the physical and mental health of healthcare providers cannot be underestimated or sustained. This inhibits people from coming to the table to collaborate on solutions. Healthcare workers' trust in the system has been shaken, and the public's confidence is also in steep decline.
- The healthcare system does not exist in a silo (although it often works in them); it is affected by trends in other industries and world affairs at large. Boundaries between sectors are increasingly blurred, which makes designing solutions for complex, adaptive systems even more complex.
- Facing facts means having access to data that are timely, relevant and transparent. Without data, we are working in the dark again, destined to repeat historic mistakes.
A recent OECD (2023b) report on lessons learned from the COVID-19 pandemic calls out three major vulnerabilities weakening the resilience of health systems: health systems were unprepared, understaffed and underinvested when the pandemic hit. It will take all healthcare stakeholders working together to identify, design, implement, coordinate and evaluate the investments, interventions, reforms and cultural shifts that the health workforce needs to recover, rebuild and reorient itself toward a rapidly evolving healthcare future. To do that, we will need to be properly prepared, equipped with the right resources, infrastructure, tools and competencies, including leadership skills. With that in mind, I interviewed two leaders with national and international mandates for workforce change – supporting the healthcare workforce through this crisis and strengthening it for the future.
Deborah (“Deb”) Gordon is a registered nurse, with years of experience in front-line practice and change leadership, and the recently appointed interim chief executive officer (CEO) of Health Workforce Canada (HWC). The newly created independent agency aims to strengthen health workforce data and long-term planning, working with experts and partners in the field. She shared her early aspirations for the agency and what we could expect to see over the coming months. She has taken on this position with an optimism stemming from the deep respect and confidence she has for the people who – despite the obstacles they face – make healthcare happen every day.
Her message to the members of the healthcare workforce is as follows:
We know how hard you work and saying thanks is not enough. You need leaders to mobilize to support you in real and influential ways in the work you do. (Deborah Gordon, personal communication, January 16, 2024)
Pedro Delgado, vice-president (VP) of the Institute for Healthcare Improvement (IHI), provided his international insights into what strengthens and weakens the health workforce. Delgado serves as the IHI lead in Europe and Latin America. After hearing him speak at the 2023 International Hospital Federation's (IHF's) 46th World Hospital Congress (IHF 2023), I wanted to explore the tension I saw between his focus on the joy in work and the realities facing healthcare workers today (see “A Conversation with Pedro Delgado”).
True to the Health Quality 5.0 era of personalization, both leaders see healthcare as an endeavour that is fundamentally human – or “humane” to use Delgado's word – requiring a people-centred lens for every action and issue. The leaders agree on the need for new leadership competencies (and a renewed emphasis on some old ones), different management styles and more comprehensive health human resource (HHR) planning – efforts that are long overdue. Rather than shying away from difficult issues, they are drawing people together to solve them, focusing on everything from front-line improvements earmarked for early implementation to big-picture policy changes and targeted strategies to achieve better regional and population health outcomes.
Solutions: Where to Look and What to Look for
The health workforce crisis is multi-faceted, international and interconnected. It requires cross-jurisdictional responses, shared resources and efforts that are aligned or, at least, not at cross-purposes. We need interventions targeted to all levels and levers, strategies for every challenge and early and inclusive input into solutions. The answers are not all at hand. The ongoing impact of the pandemic and other unfortunate factors affecting the workforce have made the issues more difficult to resolve, especially by a healthcare community whose energy and resources need replenishing.
The report Ready for the Next Crisis? Investing in Health System Resilience (OECD 2023b) lays out six policy recommendations to reduce the risk and impact of future shocks and to strengthen health system resiliency. I like the focus on resilience because it is about future proofing the system. The full report is worth a read. Each policy recommendations is relevant to the way Health Quality 5.0 is taking shape. Addressing all of them would positively impact workforce issues. The recommendations outlined in the report's Executive Summary (OECD 2023b: 16–20) follow:
- Promote the health of the population: Vulnerable populations make for vulnerable health systems.
- Promote workforce retention and recruitment: Staff are the key to making systems resilient.
- Promote data collection and use: Without the right data, decision makers are flying blind.
- Promote international co-operation: Responses will be better together than alone.
- Promote supply chain resilience: Getting products and services to where and when they are needed.
- Promote governance and trust: Without trust, whole-of-society approaches are less effective.
What does this mean for Canada? While we do not yet have a well-articulated action plan and solutions, we do have key elements of these recommendations in motion that can help generate and sustain successful results. While that is cause for some optimism, there is still a long journey ahead.
First, we need a pipeline of healthcare workers well prepared with competency profiles that are fit for purpose in a changing health system. We have many strong institutions with expertise in education, training and curriculum development to ensure that we have a future workforce ready and able to function in current, and changing, work environments.
The CanMEDS Framework (Thoma et al. 2023) – identifying and describing attributes that physicians require to meet the needs of the people they serve – is world-renowned. Competency profiles of other professions are taking similar shape. Accreditation Canada engages with regulators, professional associations and academic institutions while fulfilling its role as the accreditor for post-secondary colleges and university programs for 18 professions. This article is not about the education sector, but we will never meet the demand for high-quality graduates in Canada and beyond, without addressing supply-side issues.
Once students graduate and enter the workforce, we need to ensure that they have the skills to thrive and practise to their full potential. Health workforce shortages have a profound impact on healthcare delivery and on the lives of individuals, which our systems are intended to protect.
We need solutions for the health workforce crisis that are supported by good data (good data, not perfect data). Canada has work to do on that front – which is why we wholeheartedly welcome the HWC and its timely mandate. We need to secure the kind and quality of data that can spur targeted actions to bring the healthcare workforce – in all its diversity – out of crisis. With HWC's work underway, Canada could join other countries presenting national perspectives and putting approaches in place to support local efforts.
HWC's CEO says she considers accessible, understandable baseline data to be an essential starting point for progress and the key to building trust among the many stakeholders instrumental to driving change. The agency is working in partnership with the Canadian Institute for Health Information to release updated HHR data in early 2024 as a foundation for identifying opportunities for change. Stakeholders will be brought together to help interpret the data and identify priorities for action.
This is a positive step – if we do not get caught in a swirl of data analysis while problems persist and grow. Supply and demand data and HHR statistics are useful, but they need to be married with the authentic voice of healthcare workers.
Amplifying and listening to the voices of healthcare workers
Research has established a clear and close association between staff well-being, patient outcomes and an organization's safety culture – an association well supported by several studies. A recent commentary (Kapur 2023) called for a stronger focus on staff well-being in the “NHS 2023 Long Term Workforce Plan,” noting that it is needed to avoid negative impacts on recruitment and retention, financial liability and workload.
If staff well-being is negatively impacted, patient care will suffer as a result and vice-versa. (Kapur 2023: 1911)
The finding is significant, underscoring the value of capturing the voices and views of the healthcare workforce to prompt improvements in workplace safety culture, staff well-being and patient outcomes. We also know from leading Canadian researchers that while safety efforts have increased significantly, safety has not improved (Sauro et al. 2021). We need to tease out the interconnected issues to understand why. Better data on the relationship between the well-being of the workforce and safety in its broadest sense – physical, psychological and cultural – can help.
Health Standards Organization (HSO) and Accreditation Canada have developed a new workforce safety survey that is the only tool that ties worker well-being to safety culture. The HSO Global Workforce Survey (GWS)1 gathers, evaluates and benchmarks health and social services workforce perceptions on a range of issues, generating meaningful, actionable data for improvement. Findings from the GWS can provide a more precise picture of an organization's health workforce and a better understanding of the views, feelings and needs of healthcare workers.
High participation rates within individual organizations can allow data to be assessed by profession, province/country, type of setting, age of workers and more. HSO looks forward to working with HWC, clients and other partners to capture and amplify the voice of healthcare workers in a way never done before.
Questions from the GWS are being used in a longitudinal evaluation of 150 Canadian hospitals, which is part of a new Canadian Institutes of Health Research study that identifies hospital-level factors impacting patient safety called “HARM Evaluated: Hospital characteristics & Adverse event Rate Measurement” (Parshuram et al. 2023). The GWS questions explore factors associated with safety culture, including safety strategies, staffing, volume and capacity. This instrument was chosen because it is considered the most comprehensive and integrated workforce assessment tool available for worker well-being and safety.
During the early testing phase, more than 10,000 responses were gathered from direct and non-direct care staff, including physicians, across 300 locations that covered most sectors and provinces. Findings indicate high rates of burnout, insufficient time to complete job expectations, lack of positive recognition, limited trust in senior managers/executives and work environments that are not psychologically healthy and safe.
HWC's CEO says that trust makes quality improvement, workforce satisfaction and engagement possible. It would be a serious mistake, she says, and a strategic error to take the focus off the needs of the health workforce and the support and changes they need.
People say, “Well, it's not about them (health providers).” Well, it is! Unless we have staff and doctors [who] can do their jobs, we have no healthcare. (Deborah Gordon, personal communication, January 16, 2024)
Healthcare workers need to be assured that they can answer truthfully and provide input without backlash for speaking truth to power. Likewise, only opportunities for input that are real, well-designed and respectful of people's time, efforts and ideas will prompt change. Without genuine, informed and actionable engagement with the healthcare workforce, no amount of infrastructure or investment will get to the issues keeping the workforce crisis alive and well. We need that kind of engagement to build trust, which should be a top priority for all health leaders. That trust can open the door to hope – for better workplaces, better health and better systems for all.
With those conditions met, we can uncover thoughts and feelings that explain stalled progress or point out more promising avenues for success. Misconceptions and attitudes can get aired, adjusted and corrected – or simply acknowledged – making it more likely that people will come together to work on resolving the identified problems.
Shaping the leadership agenda
A thorough understanding of the realities and dynamics of the workforce crisis can help build a more resilient health system and better prepare leaders for the future. That may mean monitoring how the workforce is adapting to technological trends or anticipating the need for new competency requirements or new workplace supports. The questions that follow are meant to prompt leaders to think ahead about how they can support and strengthen today's workforce while anticipating the needs of future workforces.
- Do we have quality data to identify and understand who our workforce is, and how they think, feel and perform?
- Are we making it possible for healthcare workers to share their views freely?
- Are we hearing what they say – and heeding it? Every voice matters. Every action we undertake to respond to what we hear matters. To build trust and solve problems together, we must listen, hear and act.
- How do we help leaders strengthen their abilities to handle tough issues fairly and confidently – especially when results are unexpected or unduly negative?
- Are we working inclusively, engaging with everyone who can contribute to improvements in health and care? Are we aware of the barriers to change – and are we addressing them?
- What outcomes and impact do we observe from our organization's focus on workforce well-being and safety culture? What can we learn from others?
- Are we partnering and co-creating solutions with our own workforce and others? How do we avoid reinventing the wheel?
- Are we helping shape healthcare's future and the healthcare workforce? How?
- Are there new, potentially promising leads that we should pursue but prudently? How do we know if we are solving one problem but creating another?
It helps to be calm, curious and open-minded when answering these questions, as well as genuinely interested in understanding and accepting what we hear. It also takes courage to stay the course when conversations get challenging or emotional. It is easy to become defensive or drawn into political blame games when reviewing the data and sorting through the why.
These are not easy issues; we instinctively avoid any possibility of conflict. But when more people commit to discovering what the data really mean to people and engage meaningfully with healthcare workers who know that they are being heard, we can help make change happen. Simple questions can be powerful; do not overcomplicate things. Think about the disarmingly straightforward inquiry that Pedro Delgado (personal communication, December 14, 2023), IHI's VP, puts to a broad range of people working in healthcare organizations: “What are the pebbles in your shoes, and how can I help you get rid of them?”
Conclusion and Next Up: Co-Design/Co-Production and Health Quality
Good data, combined with objective, independent analysis and transparent sharing of results can provide a solid foundation for meaningful engagement with the people who first raised their voices. Engagement can point to areas for improvement, but it can also build on identified areas of strength. When our words and deeds demonstrate that we value and respect the voices of the workforce, we help make change happen. When we strengthen our support to leaders navigating difficult times and issues, we accelerate the pace of change and sustain its results.
There are many layers wound around the healthcare workforce crisis; we have unpacked only some. Four other drivers of quality are integral to our vision for Health Quality 5.0. The whole notion of co-production, for instance, which depends on the joint engagement of staff and patients, is a natural topic for us to explore next. Like a healthy, competent workforce, co-production is essential for Health Quality 5.0.
Our next article sets out the key components of co-design/co-production, reviewing recent research findings and looking at innovations that are faring well – or faltering – and finding out why. Naturally enough, patient perspectives will be embedded into our examination of the issue.
Meanwhile, we would love to hear from you. Tell us if this article resonated with you or missed the mark; weigh in on our first article's (Thompson 2023) case for change – for Health Quality 5.0; and share your experience with co-design and co-production. Your voice matters.
A CONVERSATION WITH PEDRO DELGADO Leslee J. Thompson (LT) talks with Pedro Delgado (PD), the vice-president of the Institute for Healthcare Improvement (IHI). The IHI lead in Europe and Latin America, Delgado is based in England and spoke with us from Ireland late in 2023 (the following has been edited for length and clarity). |
LT: Reflecting on the realities of health provider burnout -the sheer stress - and the lack of autonomy and other difficulties, one could question whether speaking about joy in work is out of touch. How do you reconcile that and make joy feel real and possible? PD: That dissonance can create distance as opposed to proximity - exactly what we do not want. People say, “Enjoy work? What are you talking about? Don't call and tell me about joy when I'm barely surviving.” So, you're right. … [With the IHI Framework for Improving Joy in Work] we've opted to bring opportunities to improve health and healthcare into challenging conversations, framing them with a question that pertains to all of us: “So what matters to you?” The question provides a platform to have a conversation about the possibility of improving what matters to them (Perlo et al. 2017). LT: There is no quality without a healthy, confident and engaged workforce. Does this premise resonate with you? PD: We talk about quality improvement being a contact sport. It is a humane endeavour, a beautiful privilege. But it is also physically, intellectually and emotionally demanding. We feel empathy and compassion but also tiredness and burnout. For the healthcare workforce to give empathy and compassion and leverage their intellectual power, we all need to be healthy. So, absolutely, there is no healthcare without healthy staff. LT: People talk about resiliency as a personal and professional characteristic and as the ultimate quest for health systems - resiliency increases your chances of achieving the goals and outcomes associated with quality. How do joy and the healthcare workforce relate to the notion of resiliency? PD: Joy and resilience are interconnected concepts - both dynamic. We pursue resilience, joy and safety as a daily occurrence and as a daily opportunity. We know our work around resilience and joy will never be done. It is the work of every single day - how we look at each other, speak to each other, demonstrate commitment to each other, how we create psychological safety and so on (Perlo et al. 2017). LT: HSO has a new instrument for measuring workforce well-being that is tied to the culture of safety. In last year's survey of 10,000 participants from across all sectors of the healthcare system, 25% said that their work area (direct care) is not psychologically healthy and safe. Are these findings about psychological safety common in countries around the world? PD: Absolutely, I see the same and higher. Psychological safety starts with how we train healthcare professionals. Our education systems invite us to either pass or fail, be either right or wrong, to live in the black or the white. [With] healthcare, there is often a grey area and we do not have the answer. It is going to be impossible to find solutions that are scientifically sound and humanely possible unless we listen to the people we serve. LT: What competencies and capabilities do the workforce and educators of the future need? How do we help the next generation develop them? Can they be hardwired into the curriculum and training to prepare people appropriately for the future? Are there things we can do on that front? PD: Yes, 100%. There are three or four things I would highlight. Start early; include humility, curiosity, teamwork, psychological safety and so on, early on; and commit to co-production and co-design from the very start. … Recognize that we know a lot but don't know it all. Be curious and learn to ask good questions and listen with empathy. Accept that this job, healthcare, is not a superhero's job. It is not about one individual, profession or gender. It is always about teamwork. Commit to co-design and co-production; ingrain it as value. Once the patient becomes an integral part of the conversation, you create a dynamic that is a lot healthier for professionals too. |
About the Author(s)
Leslee J. Thompson, BScN, MScN, MBA, ICD, is the chief executive officer at Health Standards Organization and Accreditation Canada in Ottawa, ON. She works as an executive-in-residence at the Rotman School of Management in the University of Toronto in Toronto, ON, and focuses on strategy and change leadership. A passionate champion of people-centred care, Leslee began her career as an intensive care unit nurse and has 30 years of experience as a senior executive in hospitals, health systems, the government and a global MedTech company. She has served on multiple public and private sector boards, including the International Society for Quality in Health Care. Leslee can be reached by e-mail at leslee.thompson@healthstandards.org.
Acknowledgment
The author would like to acknowledge the contributions of Sine MacKinnon whose writing skills and public policy knowledge helped frame and produce this commentary.
References
Britnell, M. 2019. Human: Solving the Global Workforce Crisis in Healthcare. Oxford University Press.
Cox, C.L. 2020. ‘Healthcare Heroes’: Problems with Media Focus on Heroism from Healthcare Workers during the COVID-19 Pandemic. Journal of Medical Ethics 46(8): 510–13. doi:10.1136/medethics-2020-106398.
International Hospital Federation (IHF). 2023, December 21. Elevating Employee Wellbeing in Healthcare - Insights from WHC 2023 Plenary Session 2. Retrieved February 12, 2024. <https://ihf-fih.org/news-insights/elevating-employee-wellbeing-in-healthcare-%e2%88%92-insights-from-whc-2023-plenary-session-2/>.
Kapur, N. 2023. The NHS Workforce Plan Needs a Wellbeing Focus. BMJ 382: 1911. doi:10.1136/bmj.p1911.
Kruk, M.E., A.D. Gage, C. Arsenault, K. Jordan, H.H. Leslie, S. Roder-DeWan et al. 2018. High-Quality Health Systems in the Sustainable Development Goals Era: Time for a Revolution. Executive Summary. The Lancet Global Health Commission 6(11): E1196–52. doi:10.1016/S2214-109X(18)30386-3.
National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Health Care Services; Board on Global Health; Committee on Improving the Quality of Health Care Globally. 2018. Crossing the Global Quality Chasm: Improving Health Care Worldwide. National Academies Press.
Organisation for Economic Co-operation and Development (OECD). 2023a, February 23. Boosting investment in Health Systems Will Be Essential to Deal with Future Shocks, Says OECD. Retrieved February 12, 2024. <https://www.oecd.org/health/boosting-investment-in-health-systems-will-be-essential-to-deal-with-future-shocks.htm>.
Organisation for Economic Co-operation and Development (OECD). 2023b. Ready for the Next Crisis? Investing in Health System Resilience. OECD Health Policy Studies. OECD Publishing. doi:10.1787/1e53cf80-en.
Parshuram, C.S., R.G. Baker, K.M. Sauro and G.A Tomlinson. 2023. HARM Evaluated: Hospital Characteristics & Adverse Event Rate Measurement. Retrieved February 4, 2024. <https://webapps.cihr-irsc.gc.ca/decisions/p/project_details.html?applId=408734&lang=en>.
Perlo J, B. Balik S. Swensen A. Kabcenell J. Landsman and D. Feeley. 2017. IHI Framework for Improving Joy in Work. IHI White Paper. Institute for Health Improvement.
Refsum, C. and M. Britnell. 2023. The Missing Millions: Leadership and the Global Workforce Crisis. In N. Chambers, ed., Research Handbook on Leadership in Healthcare (pp. 75–99). Edward Elgar Publishing Limited.
Sauro, K.M., G.R. Baker, G. Tomlinson and C. Parshuram. 2021, November 23. The Role of Hospital Characteristics in Patient Safety: A Protocol for a National Cohort Study. CMAJ 9(4): E1041–47. doi:10.9778/cmajo.20200266.
Thoma, B., C. Abbott and L. Snell. 2023, March 21. The Future of the CanMEDS Physician Competency Framework. Canadian Medical Education Journal 14(1): 1–3. doi:10.36834/cmej.77098.
Thompson, L.J. 2023. It Is Time for Health Quality 5.0: Are You Ready? Healthcare Quarterly 26(3): 27–30. doi:10.12927/hcq.2023.27218.
World Health Organization (WHO). 2009, June 24. Health Workforce: The Health Workforce Crisis. Retrieved October 30, 2023. <https://www.who.int/news-room/questions-and-answers/item/q-a-on-the-health-workforce-crisis>.
World Health Organization (WHO). 2016. Global Strategy on Human Resources for Health: Workforce 2030. Retrieved February 12, 2024. <https://iris.who.int/bitstream/handle/10665/250368/9789241511131-eng.pdf?sequence=1>.
World Health Organization (WHO). 2017, November 16. Dublin Declaration on Human Resources for Health: Building the Health Workforce of the Future. Retrieved October 30, 2023. <https://www.who.int/publications/i/item/dublin-declaration-on-human-resources-for-health--building-the-health-workforce-of-the-future>.
World Health Organization, Organisation for Economic Co-operation and Development and The World Bank. 2018. Delivering Quality Health Services: A Global Imperative for Universal Health Coverage. Retrieved February 6, 2024. <https://iris.who.int/bitstream/handle/10665/272465/9789241513906-eng.pdf?sequence=1>.
Footnotes
1 The HSO GWS will be launched and available in the fall of 2024.
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