What Do Workforce Issues Have To Do With Patient Safety? Can You Help Control Some Health Care Costs by Improving Patient Safety? Ed Salsberg, M.P.A. Executive Director Center For Health Workforce Studies School of Public Health Univeristy of Albany,-SUNY Rensselaer, NY

The Health Workforce: A Basic Premise Health workers are cornerstone of the health care delivery system Health workers are cornerstone of the health care delivery system Health care system is only as good as its workforce Health care system is only as good as its workforce Workforce directly affects quality, cost and access Workforce directly affects quality, cost and access System wide high turnover, difficulty recruiting, worker dissatisfaction are signs of a systemic problem System wide high turnover, difficulty recruiting, worker dissatisfaction are signs of a systemic problem

How Health Workforce Issues Affect Patient Safety Health workforce shortages Health workforce shortages Basic education and training Basic education and training Continuing professional education Continuing professional education Supervision and feedback Supervision and feedback Job Satisfaction Job Satisfaction Turnover and retention Turnover and retention Job design Job design Inadequate information systems Inadequate information systems Lack of diversity Lack of diversity

Addressing Workforce Issues That Impact Patient Care Assure an adequate supply of workers Assure an adequate supply of workers Create a work environment responsive to the workforce: Listen to workers Create a work environment responsive to the workforce: Listen to workers Provide feedback to workers on their performance Provide feedback to workers on their performance Assure appropriate education and continuing education Assure appropriate education and continuing education Design jobs to meet worker needs Design jobs to meet worker needs Invest in information systems Invest in information systems Support for training of managers and supervisors Support for training of managers and supervisors

Workforce Shortages Affect Many Professions Nurses, nurse aides, home health aides, lab workers, rad techs, pharmacists, dentists, and more Nurses, nurse aides, home health aides, lab workers, rad techs, pharmacists, dentists, and more Hospitals; nursing homes, home health agencies Hospitals; nursing homes, home health agencies Urban, rural and suburban areas Urban, rural and suburban areas

How Health Workforce Shortages Affect Patient Safety Stress and burnout Stress and burnout Rushed care and less attention to individual patient needs Rushed care and less attention to individual patient needs Use of temporary staff with less knowledge of facility, other staff and patients Use of temporary staff with less knowledge of facility, other staff and patients Turnover and loss of expertise and knowledge Turnover and loss of expertise and knowledge Substitution of less qualified workers Substitution of less qualified workers

Factors Contributing to Health Workforce Shortages Short term factors Short term factors – Competition for workers – Educational system response lags Long Term factors Long Term factors – Increase in demand due to aging of nation, growing wealth and new interventions – Aging of workforce – Changing racial/ethnic mix – Career choices for women Workplace factors Workplace factors – Physically and emotionally demanding work – Non-competitive wages and benefits – Job design, working conditions and paperwork – Poorly trained managers

States Responses to Health Worker Shortages

“In Our Hands- How Hospital Leaders Can Build a Thriving Workforce” April 2002 Recommendations from AHA Commission on the Workforce for Hospitals and Health Systems Foster Meaningful Work Foster Meaningful Work Improve the Workplace Partnership Improve the Workplace Partnership Broaden the Base Broaden the Base Collaborate with Others Collaborate with Others Build Societal Support Build Societal Support

Crisis as Opportunity Better quality of care Better quality of care Adequate supply of health workers Adequate supply of health workers Increased worker satisfaction Increased worker satisfaction More effective delivery system More effective delivery system More cost effective care More cost effective care Information systems that work Information systems that work More culturally diverse workforce More culturally diverse workforce Increased enrollment in health professions schools Increased enrollment in health professions schools