Context

1. Promoting evidence-based health policy making: The European Observatory on Health Systems & Policies(in association with the University of Pennsylvania)

2. Context • Common health system challenges • Cross country learning potential • Transference of models and ideas • Limited availability of evidence about impact • Reforms rich in ideology but poor in knowledge • Transitory fashions • When available does not reach policy makers

3. Mission The European Observatory on Health Systems and Policies supports and promotes evidence-based health policy-making through comprehensive and rigorous analysis of the dynamics of health care systems in Europe

4. Principles • Working in partnership with governments to comprehensively describe health care systems and the changes they undergo • Comparative analysis of existing evidence • Bridging the gap between scientific evidence and the needs of policy makers • Development of practical lessons and options in health policy making

5. Partners • WHO Regional Office for Europe • 8 governments (Belgium, Finland, Greece, Norway, Slovenia, Spain, Sweden, Veneto Region of Italy), • European Investment Bank, World Bank • Open Society Institute • London School of Hygiene & Tropical Medicine, London School of Economics & Political Science, CRP-Santé Luxembourg

6. Health Care Systems in Transition (HiT) country profiles • Analytical description of health care system and of reform initiatives in progress or under development • Covers (almost) all 52 Member States of WHO European Region (European Union, central and eastern Europe, former Soviet Union, South-East Europe, Turkey, Israel etc.) plus Mongolia

8. 2. Comparative analysis / studies

9. 2. Comparative analysis / studies

10. www.observatory.dk

11. The health workforce:From today’s newspaper Jobs shortage for new doctorsBMA chief warns that thousands trained in Britain may need to emigrate The Observer, 25th June 2006

12. Who is in charge? • “in four days my bedding was only changed once although soiled by blood, IV fluids, and a leaky catheter” • “despite high fever and being constrained by attachment to an IV, my sheets were never even straightened” • “a cannula was replaced at one point but the old one was not removed for three hours because the nurses and the phlebotomist could not agree whose responsibility this was” • “three staff nurses remarked in a 10 minute period on how I was due for paracetamol but none returned to give me the tablet” Anonymous: Four days in a strange place. J Health Serv Res Pol 2006

13. … to put it mildly • “perhaps the most telling example, though, was the struggle over my attempt to get discharged. … the only reason for detaining me was that I was receiving IV antibiotics. I pointed out firmly and repeatedly that this was absurd, since I could easily come and get these as an outpatient… junior clinicians told me it was organisationally impossible, but the consultant let slip that the problem was that they would have to ask the nurses to do them a favour by agreeing to manage the infusion”

14. The problem… • “Care was being delivered by a group of professional and semi-professional workers, each of whom occupied their own silo, occasionally picking up information from others to initiate some action, or acting in ways that triggered actions by others, but who were unable to see how they formed part of a whole system”

15. Moving ahead • Supply strategies • Need for vastly improved forecasting methods • … which take account of the unknowable • Education and training strategies • Adapting training to needs • Life long learning • Working environment strategies • Creating places where people want to work

16. The unknowable “there are known knowns; there are things we know we know. We also know there are known unknowns; that is to say we know there are some things we do not know. But there are also unknown unknowns, the ones we don’t know we don’t know. And … it is the latter category that tend to be the difficult ones.”

17. Moving ahead • Supply strategies • Need for vastly improved forecasting methods • … which take account of the unknowable • Education and training strategies • Adapting training to needs • Life long learning • Working environment strategies • Creating places where people want to work

18. “OK, we’ll vote. How many say the heart has four chambers?” … Trained staff don’t appear overnight … as does a trained workforce

19. Moving ahead • Supply strategies • Need for vastly improved forecasting methods • … which take account of the unknowable • Education and training strategies • Adapting training to needs • Life long learning • Working environment strategies • Creating places where people want to work

20. A happy workforce makes a difference • 39 hospitals defined prospectively as providing a good nursing environment; • matched with 195 controls with similar characteristics in other areas; • after adjustment for severity; magnet hospitals had a 4.6% lower mortality rate • board certification, technology etc.. not relevant Source: Aiken & Sloane

21. Further reading

22. What are the critical gaps in the health workforce • What are the critical challenges facing the health care workforce in the 21st century? • Nigel Edwards • What are the critical skills that we will need (and who will have them) to meet those challenges? • Bonnie Sibbald • What are the regulatory challenges to closing these critical workforce gaps? • Carl Ardy Dubois • Discussion • Julie Sochalski