Good afternoon and thank you for the opportunity to meet with the committee.
I have prepared a brief opening statement to provide context for the nature of our work and some of the lessons that we have learned.
Health Intelligence has undertaken related work with a team of four, constituted by a project lead, a health statistician, a software engineer and a project manager. Each of us has consulted in health care for 20 years or more, with the major thrust over the past 10 years being resource and clinical services planning. With varying degrees of scope and intensity, we've completed resources and services plans in nine provinces and territories.
I do believe that a fundamental aspect of your mandate in this committee is, in fact, this type of planning, particularly in the domains of recruitment and retention efforts, which inevitably founder in the absence of the ability to recruit to a plan.
Health care systems that are unplanned rarely, if ever, reach full potential. Human resources for health are, intrinsically, the health care system. Without question, technology, beds and pharmaceuticals are vital to its functioning, but the ultimate quality of care received by the people it serves starts and ends with the quality of its human resources for health.
Planning human resources for health addresses the challenge of balancing supply, demand and need in a highly labour-intensive delivery system. Understanding the complexity of the workforce, the contributing roles of supply and demand in generating shortages, demographic trends and working conditions are additive in assessing the current and long-term pressures on the workforce.
Resource planning and related policy initiatives are dysfunctional without coordination across the workforce. In the absence of health workforce planning as the basis of health system planning, policy and implementation, the status quo will prevail. Across Canada, the status quo means a largely demand-based system of growth and change in health workforce needs.
On the other hand, clinical services forecasting is a forward-looking projection based on assumptions regarding key determinants of population need and workforce supply. Resource and services planning is the process of shaping the future forecast according to organizational strategy, policy and objectives. As I'm sure you're well aware, the work of such planning is neither formulaic nor necessarily intuitive. Rather, it is navigational, both seeking information and responding to it.
The methodology that we've used for a little over a decade is an adjusted population needs-based model, or APNM, which utilizes a primary model that is population-needs based, but has specific adjustments and modifications to compensate for known inherent weaknesses. The elements and variables in our model constitute the anchor to underpin the complexity of a rolling 10-year plan with a constant repopulation of the data and the qualitative components as well. The outcoming care is equitable, sustainable and based on population health needs.
This patient-centred care, as was referenced earlier, cannot be achieved in the absence of a collaborative, team-based care, which is characterized particularly by the role optimization of all providers in the system with measured outcomes, mutual respect and a shared responsibility for quality.
The methodology itself, as it's evolved over the past dozen years, follows a sequence. It begins with comprehensive data acquisition, collation and analytics followed by comprehensive qualitative inputs based on significant stakeholder engagement and an updating of our literature database. We assess determinants of need and determinants of supply. All of these come together to evolve into a preliminary data catalogue and from there, into a data compendium. The data compendium evolves into an environmental scan and the environmental scan evolves into the genesis of innovative models of care.
Integrating the final qualitative and quantitative elements of need and supply uses our software and the APNM to generate a forecasting model, including scenarios and simulations that are translated into a base case, a low case and a high case in the construct of a rolling 10-year plan.
With this context and summary of our approach as the backdrop, the following is a non-prioritized list of lessons and key points that, if nothing else, have been constants throughout our work.
First of all, if it's not being done for the patient, then why is it being done? We have survived and are coming out of a provider-centric care system. Hopefully, it'll be a patient-centric system.
Recruitment and retention of health professionals are unquestionably bolstered when there is a resource and services plan in place. Recruitment and retention are, however, best addressed as separate entities, since the drivers differ and are distinct.
Rural and remote care benefits from jurisdictional programs, but requires support with the modern tools of digital health.
Recurrent themes across jurisdictions have been collaborative care, mental health and addictions, palliative care, vulnerable populations, public health, maternal and child health, and care of the older adult. These rise to the top in every jurisdiction where we work.
As referenced—and it's important to stress—to be successful, a resource and services plan needs to be navigational, not prescriptive. Planning must be customized to jurisdictional priorities and a needs assessment. For all providers, it's essential to work by using clinical FTEs, including an academic mandate.
The models of care need to be developed with role optimization of all provider disciplines and a shared responsibility for quality. Failure to achieve advances in models of care perpetuates the status quo and marginalizes non-physician providers.
There also needs to be a much greater focus on generalism. That is one of the keys to health care transformation.
Finally, Mr. Chair, this planning that's been described is absolutely not an end, but a beginning.
Thank you.