Royal College – National Specialty Societies 2018 Human Resources for Health Dialogue

Author: Lisa Little

January 08, 2019

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1 Overview

On December 11, 2018, the Royal College held its eight annual National Specialty Societies

(NSS) Human Resources for Health (HRH) Dialogue. This year’s dialogue focused on aligning

quality health workforce data, research and analysis to decision making.

Objectives:

Learning and establishing actions about:

1. advancing effective workforce research methodologies and metrics

2. identifying and addressing the health needs of populations

3. identifying and integrating system factors into workforce planning

The event was attended by 70 participants representing 47 member organizations

comprised of:

29 NSSs

7 medical organizations/groups

6 data holder organizations

2 research groups

2 government organizations

1 learner organization

A list of participants can be found in Appendix A.

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Bridging the Divide Between Data and Decision

Making Keynote Presentation

Dr. Jennifer Zelmer, President and CEO of the Canadian Foundation for Healthcare

Improvement launched the day by providing her

perspective as someone who has experience in a

number of health workforce aspects spanning data,

research and planning. She noted that healthcare

decisions are informed by a myriad of people and

organizations. Canada is fortunate to have a wide

range of data sources available to it. However,

information deluge is both an opportunity and a

challenge. How do we manage all this data? Dr. Zelmer noted that if attendees read 1

hr/day, 15 mins/article, they would have read only 0.3% of articles produced in that year.

Most important are the threads and connections between the data sets.

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Promoting evidence-informed decision-making is a key lever for healthcare improvement

and is impacted by a number of considerations which she highlighted. Data collection and

decision making in healthcare is also impacted by a changing landscape which includes

interprofessional collaborative practice, e-patients and big data analytics. Dr. Zelmer

challenged participants to ask themselves how ready they were for this change.

This presentation generated discussion among the participants on:

physicians as chief information officers

how to move from crisis oriented data needs on urgent issues to creating long term

data infrastructure through capacity building when opportunities arise and building

relationships to develop coalition for change

the importance of visualization of data for decision makers

the importance of patient privacy with the goal of improved patient care.

3 Health Needs: Connecting the Dots Panel Discussion to explore how specialists can better address health needs of the population

Ms Carolyn Canfield, Founding member, Patient Advisors Network (Patient Perspective) and

first patient safety champion and Adjunct Professor at University of British Columbia Faculty

of Medicine

Ms Canfield spoke of the need to bridge the gap between data and the patient experience.

Patients now have access to data and understanding how they use this data is key - whether

online or in person with a healthcare provider. She noted that Canadians are hungry for

information about their healthcare system - what will it look like when they need it. There is

a growing appetite by citizens to not only understand data but also generate data in the

form of patient expectations and health literacy levels. Ms Canfield noted that it is difficult

cfhi-fcass.ca | @cfhi_fcass.ca 7

Decision Considerations: Examples

1 2 3 4 5 6

Knowledge

about data/

analysis

varies

greatly

Speed

Is key when

decision

timescales

are short

Cost

of access

and analysis,

in $ or time

Use

depends on

context,

relationship,

culture,

timing

Quality

of data

including

perceived

relevance

New models

of care affect

data needs &

interpretation

Source: CFHI 2018

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for the public to learn about the health system. There are numerous barriers including

limited access to conferences, cost of health journals, etc. She suggested there are

numerous roles for patients. She shared her experiences in the Strategy for Patient-

Oriented Research (SPOR) to ensure projects are patient focused/sensitive, in planning by

sitting on various committees, and in teaching in undergraduate medical education. She

encouraged participants to consider how to involve citizens in what matters to them.

Dr. Cory Neudorf, Chief Medical Health Officer, Saskatoon Population & Public Health

Services, also associate professor at University of Saskatchewan

Dr. Neudorf shared his experience in examining data at a smaller geographical area. He

noted that the way we are analyzing and reporting data can lead to short comings in

accurately identifying health needs and subsequently providing appropriate healthcare

services. Enhanced data, such as educational levels and Indigenous status, is needed to

describe unique patient experiences. Huge variation in health outcomes is seen based on

Canadians’ socioeconomic status; it is the root of all other patient outcomes and is driving

changes in patient behaviour and how patients access the healthcare system. Dr. Neudorf

suggested that we continue to improve care for those who access healthcare, but what

about those who never access healthcare? Prevention programming is not getting to those

that need the highest level of care. There is a need to involve citizens in designing health

care that is meaningful and culturally relevant. He encouraged participants to consider how

we work differently together with the patient and examine the cultural context to provide

culturally appropriate care. He suggested there is a greater need to examine the social

determinants of health, and that examining the enablers of health may lead to a different

health team composition.

This panel presentation generated discussion among the participants on:

trust between providers and patients is key

listening is a first step in patient led care and that is not something we do well

when you listen to patients, you understand social inequities and the interplay with

health and social policy/care

how do we structure and build the system to be meaningful and relevant to

patients/citizens?

an appropriate level of detail on patient context and demographics needs to be

collected, especially in EMR, to enable a systems approach

too often we try to control, rather than focus, on the factors that are driving health

status

need to enhance patient data - averages mask important differences

what would you do to reduce the need for each specialty; what are things in the

health system that create demand?

maps are visualizations that move people and enable granularity

infographics are now an important way of conveying information quickly

patient stories are powerful data

specialties still siloed and don’t communicate with other specialties to enhance the

patient journey; use patients to structure connections across those specialties.

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4 The Current State World Café

In preparation for the afternoon breakout sessions, featured researchers and subject matter

experts rotated though groups of participants to start identifying actions and solutions

relating to the following four topics. Background documents and discussion questions for

each group topic were distributed in advance to all participants.

Group 1 Data collection and standards

Mr. Geoff Ballinger, Manager, Physicians Information, Canadian Institute for Health Information

(CIHI)

Group 2 Full-time equivalent (FTE) methodologies Dr. Evert Tuyp, President, BC Section of Dermatology and Clinical Assistant Professor, University of

British Columbia

Group 3 Expanding and building on needs based planning Mrs. Danielle Fréchette, Executive Director, Office of Health Systems Innovation and External

Relations, Royal College

Group 4 Exploring solutions related to employment of newly certified specialists

Dr. Allison Fox-Robichaud, President of the Canadian Critical Care Society

Dr. Paola Fata, President of the Canadian Association of General Surgeons

5 Tackling the Current State Concurrent Sessions

Participants contributed to one of the four groups to discuss and advance the actions and solutions

identified during the previous World Café session. Each group was asked to identify key takeaways,

actions and key stakeholders. The following are the results presented by each group.

In their words: Group 1 Data collection and standards

Key

Tak

eaw

ays Designing data for use

for future policy change.

Most information is on supply side, need to start looking at population health needs side (e.g. CIHI;s Population Health Grouper).

Integrate models of care into workforce planning, include qualitative data.

Data should be accessible and scalable in a timely and transparent fashion.

Act

ion

s Build capacity to educate stakeholders about current data sources/tools and how to work with that data including gaps.

Review and modify minimum data set to provide to regulatory bodies (e.g. equity indicators, FTE, retirement).

Press upon regulatory bodies the importance of data.

Key

Sta

keh

old

ers

Regulatory bodies

Patient advisors

Researchers

Data holders

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In their words: Group 2 Full-time equivalent (FTE) methodologies

In their words: Group 3 Expanding and building on needs based planning

Key

Tak

eaw

ays Current CIHI definition is

irrelevant to some specialties, regions and facilities ( payment information gaps and various professional roles).

Step back and ask “How do we define an FTE. What info do we need to get out of FTE?”.

-What FTE requirement is needed to deliver services to a population/community?

-What does an average or reasonable FTE look like for a particular specialty group (e.g., X ER visits per day, X slides read per week, X hours of work per week, etc)?

The specialty specific approach could result in a loss of comparability. We still need an FTE measure that can be used to talk with policy makers.

Act

ion

s Conduct an environmental scan to build on the working paper that was started for this meeting, leading to a repository/drop box of existing resources, studies, etc (InfoCentral, Research Gate).

NSS need to develop a definition of FTE for their specialty, looking at other NSS approaches for best practices.

Review current FTE metrics to see which specialties they reflect well and what new methods exist or might be created to improve measurement for other specialties for which they don’t work.

Key

Sta

keh

old

ers

NSS

Governments (P/T)

CIHI and data holders

Universities

Patients

Health economists

ImagineCanada

Key

Tak

eaw

ays

Don't boil the ocean: planning is complex, jurisdiction owned so make actions meaningful/have impact.

Pick 1-2 things that will have a real impact.

Pick what and who you’re trying to influence/inform.

Act

ion

s Inform students upstream about employability by specialty, geography (current & what should be).

- Geospatial mapping, partnerships with geographers to provide information to faculties of medicine

Common voice that health resource planning is socially accountable.

- Engagement with citizen patients to reflect those voices in planning

Specialty Workforce Collaborative (SWC) as a resource to government with informed opinions & facts about planning.

Key

Sta

keh

old

ers

Citizen patients

Policy/decision makers

Medical Schools

Future Physicians/ Learners

Specialty Workforce Collaborative

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In their words: Group 4 Exploring solutions related to employment of newly certified specialists

6 Priority Actions Next Steps

Participants undertook a prioritization exercise using Poll Everywhere to identify the top 5

actions from the list of actions generated from the four groups. The following actions were

the highest rated:

1. Increase robust data predicting health workforce needs (work with NSS to extract

data).

2. NSS need to develop a definition of FTE for their specialty, looking at other NSS

approaches or best practices.

3. Emphasize the importance or data to regulatory bodies and others.

4. Inform students upstream about employability by specialty and geography (current

and what should be).

5. Strive for national licensing for trainees (more complicated for certified specialists).

7 Closing Remarks

Mrs. Fréchette concluded the day by stating the Royal College will support the Coordinating

Group of the Specialty Workforce Collaborative to define next steps. She also emphasized

that active participation of NSS and others will be critical to moving these actions forward.

She thanked theme leads, speakers, the Coordinating Group, and everyone present for their

contribution to moving from problems to action.

Key

Tak

eaw

ays What is the minimal

data set that we need to move forward to identify gaps in your specialty HRH planning?

How do we make it easier for trainees to move between regulatory colleges?

Facilitating transitioning into and out of practice (*in areas of need) via a mentoring program system.

Act

ion

s Increase robust data predicting health workforce needs (work with NSS to extract data).

Strategy around governance of a region.

Central repository of jobs.

National licensing for trainees (more complicated for certified specialists).

Royal College to define a community rotation.

Key

Sta

keh

old

ers Regulatory bodies

Medical school (i.e. undergraduate program directors, deans)

Governments (P/T) NSS

Physician Resources Planning Advisory Committee (specific governmental group based on actual data)

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Appendix A Participant List

FIRST NAME

Peter

LAST NAME

Anderson*

ORGANIZATION

Canadian Urological Association

Inika Anderson Canadian Society of Endocrinology and Metabolism

Henry Annan Canadian Federation of Medical Students

Geoff Ballinger Canadian Institute for Health Information

Geoff Barnum Canadian Post-M.D. Education Registry (CAPER)

Rob Beanlands University of Ottawa Heart Institute

Ivy Bourgeault University of Ottawa

Jennifer Brunet-

Colvey*

Canadian Ophthalmological Society

Carolyn Canfield University of British Columbia

Caroline Chamberland University of Ottawa

Tara S. Chauhan Canadian Medical Association

Lindsay Cherpak Canadian Association of Radiologists

Essandoh Dankwa Labrador - Grenfell Health

Jana Davidson BC Children's Hospital

Isabelle De Bie Centre universitaire de santé McGill

Shanna DiMillo Royal College of Physicians and Surgeons of Canada

Heather Dow Events & Management Plus Inc.

Mary Jean Duncan Canadian Society of Plastic Surgeons

Bryce Durafourt Resident Doctors of Canada

Paola Fata* McGill University Health Centre

Pamela Forsythe* Canadian Psychiatric Association

Alison Fox-

Robichaud*

Canadian Critical Care Society

Danielle Fréchette Royal College of Physicians and Surgeons of Canada

Colleen Galasso HealthCareCAN

John Gallinger Canadian Resident Matching Service

Irving Gold Resident Doctors of Canada

B.J. Hancock University of Manitoba/ Canadian Association of

Paediatric Surgeons

Desiree Hao Tom Baker Cancer Centre

Katie Hardy* Canadian Psychiatric Association

Douglas Hedden Royal College of Physicians and Surgeons of Canada

David Henderson Canadian Society of Palliative Care Physicians

Caroline Herzberg Canadian Dermatology Association

Tanya Horsley Royal College of Physicians and Surgeons of Canada

Casey Hurrell Canadian Association of Radiologists

Carole Jacob Royal College of Physicians and Surgeons of Canada

Suzanne Joyal Canadian Dermatology Association

Karen Kieley Royal College of Physicians and Surgeons of Canada

Greg Killough Royal College of Physicians and Surgeons of Canada

Jon Kimball Association of Faculties of Medicine of Canada

Chad Leaver Canada Health Infoway | Inforoute Santé du Canada

Robert Lee Canadian Resident Matching Service

Francine Lemire College of Family Physicians of Canada

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Myuri Manogaran Royal College of Physicians and Surgeons of Canada

Raymond Maung Royal Inland Hospital

Colin McCartney The Ottawa Hospital/University of Ottawa

Jill McEwen* Canadian Association of Emergency Physicians

Dolores McKeen Dalhousie University

Frank Molnar* The Ottawa Hospital

Cordell Oren Neudorf University of Saskatchewan

Julia Niles The Canadian Association of Radiologists

Barry Pakes University of Toronto

Bojan Paunovic Winnipeg Regional Health Authority/

University of Manitoba

Jasmine Pawa University of Toronto

Carolyn Pullen Canadian Cardiovascular Society

Cheryl Ripley Canadian Ophthalmological Society

Artem Safarov College of Family Physicians of Canada

Leah Salvage Public Health Physicians of Canada

Sarah Simkin University of Ottawa

Steve Slade Royal College of Physicians and Surgeons of Canada

Christine Smith Royal College of Physicians and Surgeons of Canada

Caroline St. Denis Royal College of Physicians and Surgeons of Canada

Debra Thomson Canadian Anesthesiologists' Society

Paul Tomascik Royal College of Physicians and Surgeons of Canada

Evert Tuyp* Canadian Dermatology Association

Elizabeth Waite Canadian Academy of Child and Adolescent Psychiatry

Joel Campbell Watts Royal Ottawa Mental Health Centre

Jessica Widdifield Canadian Rheumatology Association

Dawn Wilson* Canadian Association of General Surgeons

Homer Yang London Health Sciences Centre /

Schulich School of Medicine & Dentistry

Jennifer Zelmer Canadian Foundation for Healthcare Improvement

*members of the Coordinating Group of the Specialty Workforce Collaborative.

Additional Group members not in attendance at the 2019 Dialogue include:

Shanna Scarrow, Canadian Association of Emergency Physicians

Jasmin Lidington, Canadian Association of General Surgeons

Geneviève Moineau, Physician Resources Planning Advisory Committee

Sandra Allison, Public Health Physicians of Canada

Yvonne Buys, Canadian Ophthalmologic Society