22nd June 2018, Volume 131 Number 1477

Gareth H Rees, Peter Crampton, Robin Gauld, Stephen MacDonell

Recently, concerns have been raised over the sufficiency, distribution and sustainability of New Zealand’s medical workforce, with competing views being offered on the responses that should be taken.1,2 The arguments…

Subscriber content

The full contents of this page is only available to subscribers.

To view this content please login or subscribe

Summary

New Zealand has recurring shortages of medical professionals, yet many of the solutions implemented have failed to sustainably address the problem. The article suggests that by broadening the range of methods, future workforces could be configured and skilled to meet future expected health needs. By embracing these methods, policy makers can be better equipped to develop options which are more likely to represent future workforce conditions and needs. Including this approach within planning will contribute to the design of more sustainable workforce policies.

Abstract

Concerns over New Zealand’s health workforce sufficiency, distribution and sustainability continue. Proposed solutions tend to focus on supplying medical professionals to meet predicted numbers or to resolve distributional problems. This is despite quantitative forecasts being known to have poor reliability. A recent study on New Zealand’s health workforce planning, which focused less on medical workforce numbers and more on the system’s organisation and constituent interrelations, highlights the use of complementary methods to define the problems and design a range of policy responses. Core to deciding on suitable interventions is the use of analysis tools, such as judgement-based approaches, which are commensurate with the actual levels of uncertainty being experienced, and which complement quantitative predictive forecasting.

Author Information

Gareth H Rees, Profesor Contratado, ESAN University, Peru;
Peter Crampton, Pro-Vice-Chancellor Division of Health Sciences & Dean of Otago Medical School, University of Otago; Robin Gauld, Pro-Vice-Chancellor of Commerce & Dean Otago Business School, University of Otago; Stephen MacDonell, Department of Information Science, Otago Business School, University of Otago.

Correspondence

Gareth H Rees, Profesor Contratado, ESAN University, Alonso Molina 1652, Montericco Chico, Surco, Lima 100, Peru.

Correspondence Email

grees@esan.edu.pe

Competing Interests

Dr Rees reports grants from Health Workforce New Zealand, University of Otago and Freemasons New Zealand during the conduct of the study. Dr MacDonell reports grants from Ministry of Health outside the submitted work.

References

  1. Crampton P. Does New Zealand need a third medical school? New Zealand Medical Journal. 2017; 130:11–16.
  2. Lawrenson R, Town I, Strasser R, et al. The proposal for a third medical school in New Zealand: a community-engaged graduate entry medical program. New Zealand Medical Journal. 2017; 130:63–70.
  3. Bloom G, Standing H. Future health systems: Why future? Why now? Social Science & Medicine. 2008; 66:2067–2075.
  4. Gorman DF. The disposition and mobility of medical practitioners in New Zealand. New Zealand Medical Journal. 2011; 124:11–13.
  5. Poole P. Nature and nurture: shaping New Zealand’s medical workforce. New Zealand Medical Journal. 2016; 129:6–8.
  6. Atmore C. The role of medical generalism in the New Zealand health system into the future. New Zealand Medical Journal. 2015; 128:50–55.
  7. Gorman DF. Developing health care workforces for uncertain futures. Academic Medicine. 2015; 90:400–403.
  8. Raymont A, Simpson J. Projections of surgical need in New Zealand: Estimates of the need for surgery and surgeons to 2026. New Zealand Medical Journal. 2008; 121:11–18.
  9. Nana G, Stokes F, Molano W, Dixon H. New Zealand Nurses: Workforce planning 2010–2035. Wellington: BERL, 2013.
  10. The GP Workforce. The Royal New Zealand College of General Practitioners. http://www.rnzcgp.org.nz/RNZCGP/Publications/The_GP_workforce/RNZCGP/Publications/GP_workforce.aspx?hkey=a7341975-3f92-4d84-98ec-8c72f7c8e151&iSession=c93ca3a1e6e447bc8b7f902cf493aca8 http://www.mcnz.org.nz/news-and-publications/workforce-statistics/
  11. Workforce Statistics. Medical Council of New Zealand.
  12. Gorman DF, Brooks PM. On solutions to the shortage of doctors in Australia and New Zealand. Med J Aust. 2009; 190:152–156.
  13. Health Workforce Advisory Committee. Fit for purpose and practice: a review of the medical workforce in New Zealand. Wellington: Health Workforce Advisory Committee. 2005.
  14. Gorman DF. Towards a sustainable and fit-for-purpose health workforce - lessons from New Zealand. Medical Journal of Australia - Open. 2012; 1:32–36.
  15. Rees GH. Editorial: Addressing inadequate health workforce intelligence. Intern Med J. 2015; 45:887–889.
  16. Imison C, Buchan J, Xavier S. NHS Workforce planning: Limitations and possibilities. London: The Kings Fund. 2009.
  17. Ono T, Lafortune G, Schoenstein M. Health workforce planning in OECD countries: A review of 26 projection models from 18 countries. OECD Health Working Papers, No 62. Paris: OECD Publishing. 2013.
  18. Roberfroid D, Leonard C, Stordeur S. Physician supply forecast: Better than peering in a crystal ball? Human Resources for Health 7: 1–13.
  19. National Health Workforce Planning and Research Collaboration. Alternative approaches to health workforce planning: Final report. Adelaide: Health Workforce Australia. 2011.
  20. Slaughter RA. From forecasting and scenarios to social construction: changing methodological paradigms in futures studies. foresight. 2002; 4:26–31.
  21. Gordon A. The boundaries of quantitative forecasting methods: respecting the limits of determinism. Foresight: The International Journal of Applied Forecasting. 2010:9–15.
  22. Hurst K, Kelley Patterson D. Health and social care workforce planning and development–an overview. International journal of health care quality assurance. 2014; 27:562–572.
  23. Navarro J, Hayward P, Voros J. How to solve a wicked problem? Furniture foresight case study. foresight. 2008; 10:11–29.
  24. Rittel HW, Webber MM. Dilemmas in a general theory of planning. Pol Sci. 1973; 4:155–169.
  25. Vartiainen P. Health care management in Finland: an analysis of the wickedness of selected reforms. Review of Business. 2008; 28:41–55.
  26. Martin G. Do we need a leadership 2.0 in healthcare? A commentary. In: Skills for Health, (ed.). Tomorrow’s workforce: Commentaries on the future of skills and employment in the UK’s health sector. Bristol, UK: Skills for Health. 2009 pg 35–50.
  27. Rickards L, Wiseman J, Edwards T, Biggs C. The problem of fit: scenario planning and climate change adaptation in the public sector. Environ Planning C: Govt Pol. 2014; 32:641–662.
  28. Veenman SA. Futures studies and uncertainty in public policy: A case study on the ageing population in the Netherlands. Futures. 2013; 53:42–52.
  29. van Asselt MBA, van’t Klooster SA, Veenman SA. Coping with policy in foresight. Journal of Futures Studies. 2014; 19:53–76.
  30. Ackoff RL. Transforming the systems movement. 3rd International Conference on Systems Thinking in Management (ICSTM 2004). Philadelphia. 2004.
  31. Enserink B, Kwakkel JH, Veenman SA. Coping with uncertainty in climate policy making: (Mis)understanding scenario studies. Futures. 2013; 53:1–12.
  32. Armstrong JS. Introduction. In: Armstrong JS, (ed.). Principles of Forecasting: A Handbook for Researchers and Practitioners. Boston, MA: Kluwer Academic Publishers. 2001 pg 1–12.
  33. Popper R. How are foresight methods selected? foresight. 2008; 10:62–89.
  34. Costanzo LA, MacKay RB. Introduction. In: Costanzo LA and MacKay RB, (eds.). Handbook of research on strategy and foresight. Cheltenham, UK: Edward Elgar Publishing Ltd. 2009 pg 1–12.
  35. Bradfield R, Cairns G, Wright G. Teaching scenario analysis—An action learning pedagogy. Technological Forecasting and Social Change. 2015; 100:44–52.
  36. Gregory WL, Duran A. Scenarios and acceptance of forecasts. In: Armstrong JS, (ed.). Principles of Forecasting: A Handbook for Researchers and Practitioners. Boston: Kluwer Academic Publishers. 2001 pg 519–540.
  37. Meadows DH. Places to intervene in a system (in increasing order of effectiveness). Whole Earth. 1997; 91:78–84.
  38. Maruthappu M, Hasan A, Zeltner T. Enablers and barriers in implementing integrated care. Health Systems & Reform. 2015; 1:250–256.
  39. Minister of Health. New Zealand Health Strategy: Future direction. Wellington: Ministry of Health, 2016.

Download

The downloadable PDF version of this article is only available to subscribers.

To view this content please login or subscribe