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Summary Report of the Health Human Resources Symposium

Table of Contents

Executive Summary

On May 10th and 11th, 2022, Health Canada hosted a Health Human Resources (HHR) Symposium to convene stakeholders, across provinces and territories, to align on the need for shared action as it relates to Canada’s HHR crisis, further exacerbated by the COVID-19 pandemic, and discuss potential pan-Canadian solutions to address the crisis. Multidisciplinary participants across federal and provincial / territorial governments, thought leaders, regulators, professions, and educators participated in the Symposium.

The Symposium was grounded in the key takeaways from the HHR Stakeholder and provincial/territorial Roundtables, which were held between April 4th and 8th, 2022 to gather perspectives on the key challenges (“areas of focus”), opportunities, and real examples of change against the key challenges, with an aim to align on the imperative for action. The areas of focus that framed the discussion were as follows:

Figure 1

Figure1

Figure 1 - Text description

A cluster map illustrating the five key and interrelated areas of focus for addressing HHR challenges in Canada’s health system. These include:

  • Recruitment for future needs
  • Retention of healthcare workers
  • Workforce mental health and well-being
  • Data to support effective workforce planning and management
  • Productivity and models of care

These areas of focus were leveraged to develop a shared vision for HHR in Canada, as well as generate potential pan-Canadian solutions in Day One. After robust discussion, participants identified attributes of a shared vision for HHR in Canada, which were later captured in a vision statement, created post-Symposium, as follows:

Together, we will create the equitable, compassionate, and sustainable conditions for health care workers to serve Canada’s patients and health system, now and in the future. This requires a pan-Canadian approach to health human resources planning, where our actions are driven by data and every stakeholder is accountable to advance collaborative change.

Participants also aligned on a set of overarching principles and themes relevant to all of the solutions that were generated – which included a need to intentionally embed perspectives of equity deserving groups that have been marginalized in HHR conversations, provide clarity in leadership and accountability, and acknowledge that change to Canada’s HHR crisis will be advanced over the long-term. In all solutions, collaboration amongst all key stakeholders will be required – including federal and provincial / territorial government bodies, regulators, professional bodies, educators, pan-Canadian health organizations, unions, and system-leaders.

To advance change related to Canada’s HHR crisis, participants brainstormed on potential solutions in breakout groups during Day One and aligned on a set of prioritized solutions in plenary. The prioritized solutions formed the basis for discussion in Day

Two – where participants considered what each solution would look like, what actions would need to take place in the short-term, mid-term, and long-term, and what stakeholders might be involved in developing, generating, and sustaining momentum. It was reinforced through the conversation that further discussion would be required to refine the ideas, proposed actions, and timing – and that these ideas would be a starting point for further conversation.

Key highlights on the prioritized solutions, which appear below in no particular order
Proposed Solutions Highlights

Create a pan-Canadian health workforce data strategy to align health system priorities and HHR actions

With acknowledgement that the current state of data on Canada’s health workforce is impeding HHR planning efforts, this solution would centralize accountability for development of a coordinated, pan-Canadian data strategy to enable evidence-based planning moving forward.

Enable innovative, team-based models of care

This solution considers a fundamental reimagining of Canada’s current models of care – with a focus on enabling collaborative team-based care models which support providers in working to their optimal scope and meeting patients’ needs.

Create positive workplace culture and practice environments

While well-being could be improved in part through addressing systemic challenges facing the health workforce, focused efforts are required to support the development of physically and psychologically safe work environments, particularly given the impacts of the pandemic on workers’ well-being.

Create a health workforce retention strategy

All jurisdictions require an aligned strategy to address burnout and professional departures and coordinate cross- jurisdictional recruitment among health workers in order to retain the current workforce through demonstrating greater responsiveness to workers’ needs.

Increase representation of equity deserving groups (Indigenous, Black, 2SLGBTQ+) in health workforce initiatives

This solution proposes an intentional commitment to embedding equity deserving groups in workforce planning efforts – with the outcomes of this focused effort integrated into the path forward for all solutions.

Coordinate a pan- Canadian approach to post-secondary education and programs and leveraging IEHWs

This solution was developed with acknowledgement that a pan-Canadian approach to align on the competencies required, for both domestic students and internationally educated health workers (IEHWs), could reduce recruitment and mobility barriers.

While the Symposium brought together many stakeholders together to provide their different points of view on tangible solutions, there was clear consensus that collaboration amongst all stakeholders will be required to advance an aligned, pan- Canadian approach to addressing Canada’s HHR crisis.

Introduction

The health human resources (HHR) crisis is one of the greatest challenges facing Canada’s healthcare system today. Domestically and globally, health workforces today are facing unprecedented challenges – including a dwindling supply of healthcare workers, low retention, and workplace conditions that place undue pressure on workers. These challenges have been further exacerbated by COVID-19, where high patient workloads, resource scarcity, and fear for personal safety have led to unprecedented levels of burnout, absences, and turnover.

It is well-understood that the path forward must address the root causes of the HHR crisis, in order to build a resilient health workforce to meet current and future demand. The scale of the Canada’s HHR crisis today will require transformative and innovative solutions to problems that have existed for years – with new and different levels of collaboration required across all stakeholders.

KPMG Canada was procured by Health Canada, through the Government of Canada tendering process, to provide objective facilitation for a two-phased, action-oriented set of dialogues:

Ahead of these discussions, Health Canada prepared a primer document, summarizing the key challenges that underpin the current state of Canada’s health workforce. These challenges were leveraged to frame both the Stakeholder Roundtables and Symposium and are summarized at a high-level below. Further details on the Stakeholder Roundtables, as well as these challenges, are available in Key Challenges & The Opportunity for Action.

Summary of the key challenges that underpin the current state of Canada's health workforce
Area of Focus Details on the Challenges
Recruitment for Future Needs

Health system usage trends and an aging population are increasing demand for care, particularly in long-term care and home care settings, where the total cost of care is estimated to rise from $29.7 billion in 2019, to $58.5 billion in 2031.Footnote 1 Presently, the World Health Organization projects a shortage of 15 million healthcare workers by 2030, increasing demand for talent globally.Footnote 2
Retention of Healthcare Workers

A 2021 survey by the RNAO found that 15.6% of nurses shared that they were likely to leave nursing for a new occupation post-pandemicFootnote 3, and a similar Canadian study found that 50% of PSWs leave the health care sector after less than 5 years.Footnote 4
Workforce Mental Health and Well- Being

Multiple Canadian studies, including a study conducted by the Ontario Science Advisory Table, indicated that severe emotional exhaustion in Canadian healthcare workers has increased to 60% by mid-2021 (up from an estimated 30-40% in mid-2020).Footnote 5

Data to Support Effective Workforce Planning & Management

Canada falls behind OECD comparators such as the US, UK, and Australia on the robustness of health workforce data, as well as the availability of said data to support workforce planning.Footnote 6
Productivity and Models of Care

OECD estimates that 79% of nurses and 76% of physicians perform tasks that they are overqualified for, providing an opportunity to examine task suitability.Footnote 6 Canada’s traditional approach to care delivery has led to unintended consequences – including limitations to workforce productivity, and workers not being optimized to the top of their scope.

Discussion and validation of these challenges at the Stakeholder Roundtables served as a jumping off point for the subsequent Symposium participants’ forward-looking, action-oriented dialogue.

Key Challenges & The Opportunity for Action

The Stakeholder Roundtables hosted ahead of the Symposium were focused on the following core objectives:

The outputs from the Stakeholder Roundtables were used as the starting point to frame discussion at the Symposium. A What We Heard report was circulated to all Symposium participants ahead of the discussion – providing a common understanding of the key challenges, and opportunities for action.

The Key Challenges

Across the Stakeholder Roundtables, there was general alignment that the five challenge areas captured in the primer document (visually depicted below) represent the most important HHR challenges facing Canada’s health system today – and that they are mutually reinforcing, such that change in one challenge area may lead to benefits in another.

Participants underscored the importance of taking a collaborative, pan-Canadian approach to addressing these challenges. It was also suggested that solutions should not anchor to the current state of Canada’s healthcare system, but rather build towards an aspirational vision for what HHR in Canada could look like in future.

Figure 2

Figure2

Figure 2 - Text description

A cluster map illustrating the five key and interrelated areas of focus for addressing HHR challenges in Canada’s health system. These include:

  • Recruitment for future needs
  • Retention of healthcare workers
  • Workforce mental health and well-being
  • Data to support effective workforce planning and management
  • Productivity and models of care

The Opportunity for Action

Across the challenge areas, participants discussed potential opportunities to address five key challenges – and agreed that opportunities should be collaborative and pan- Canadian, build towards a brighter future for HHR in Canada, and inspire “acting locally, thinking nationally”.

Area of Focus Opportunities Raised at the Stakeholder Roundtables

Recruitment for Future Needs

There is an opportunity to re-imagine the approach to recruitment to be needs-based and coordinated nationally. Innovation in education, and building infrastructure and capacity, are required to train the next generation of healthcare workers to meet the health system’s needs.

Retention of Healthcare Workers

Clarifying career pathways within professions and addressing lifestyle factors were shared as opportunities to enhance retention. Retention incentives should be coordinated nationally and focus on enhancing respect and work-life flexibility and attracting needed workers to communities in need.
Workforce Mental Health and Well-Being

To seize all other opportunities for change, healthcare workers’ well-being must become a system-level priority. This will require responsiveness to improve the at-work experience and needed supports, and a commitment to rebuild trust with equity-seeking communities and demonstrate to the broad health workforce that workers’ safety is being prioritized.

Data to Support Effective Workforce Planning & Management

A pan-Canadian data strategy was seen as critical to close data gaps, drive accountability, and inform planning efforts. This includes greater coordination in planning and accountability, development of minimum data standards, and development of a national HHR database.

Productivity and Models of Care

The time is now to build an HHR strategy grounded in the models of care we need for the future. Building competencies and capacity to deliver team-based care, creating common education standards, and simplifying licensure and registration were viewed as key priorities.

In discussing the opportunities for action, participants also discussed key barriers to acting on these opportunities, and potential roles that their organization could assume in advancing them.

With respect to key barriers, there was alignment that a pan-Canadian approach to HHR will require innovation in Canada’s current health system structures – with greater emphasis on accountability, creating pan-Canadian solutions, and reducing provincial/territorial silos – as well as greater investment in priority areas such as data management and education.

As it relates to potential roles, participants were aligned on the urgency to act, and shared examples of how their organization could be involved – from supporting advocacy, to developing bridging strategies for the progression of health professionals and advancing actions on specific opportunities (e.g., collection of data, creation of standards). Generally, these roles aimed to amplify organizations’ existing strengths versus taking on new roles to lead the HHR path forward across disciplines and professions.

Key Takeaways for the Symposium

The Stakeholder Roundtables reinforced the urgency for action related to Canada’s HHR crisis – and confirmed that the challenge areas from the primer represent the most important areas of focus in moving forward with pan-Canadian action.

In moving beyond the Stakeholder Roundtables, it was clear that further dialogue with multidisciplinary stakeholders was required to address the following questions:

The Symposium provided the starting point to explore these questions with multidisciplinary stakeholders and begin to generate concrete actions which build towards a shared vision for HHR in Canada. The objectives of the Symposium were as follows:

The Shared Vision for HHR in Canada

Shared Vision

With a shared understanding of the key challenges and opportunities for action underpinning the current state of Canada’s HHR crisis, Day One of the Symposium focused on aligning to a shared vision for health human resources in Canada.

The Honourable Jean-Yves Duclos, Canada’s Minister of Health, provided opening remarks to set the stage for Day One, commending the participants’ commitment to collaborating on a shared vision to address Canada’s HHR crisis. To build a resilient health workforce for the future, Minister Duclos encouraged the Symposium participants to act decisively to strengthen Canada’s health human resources – the backbone of a quality public health system.

Following Minister Duclos’ remarks, participants discussed key elements of a shared vision for HHR in Canada as a basis for the future state solutions that the Symposium would generate. The following “word cloud” was developed by participants based on their aspirations for health human resources in Canada:

Figure 3

Figure3

Figure 3 - Text description

A word cloud image depicting participant input into what aspirations they held for the future of health human resources in Canada.

Clear attributes of the shared vision emerged during the “word cloud” generation. Among participants, there was agreement that the future of health human resources in Canada should be:

These attributes helped to inform the following proposed shared vision statement for the future of Canada’s health workforce. This vision statement was created post- Symposium, based on the identified attributes of a shared vision for HHR in Canada.

Together, we will create the equitable, compassionate, and sustainable conditions for health care workers to serve Canada’s patients and health system, now and in the future. This requires a pan-Canadian approach to health human resources planning, where our actions are driven by data and every stakeholder is accountable to advance collaborative change.

Key Considerations

In discussing the shared vision as it relates to HHR in Canada, the following considerations were raised to keep top of mind as we consider “what it will take” to act on the solutions:

The Path Forward: Solutions for Action

Proposed Solutions

Following the visioning discussion, participants had a clearer idea of the attributes that the collective sought to embed in the shared vision and potential solutions for the future of Canada’s health workforce. With these attributes in mind, participants were divided into groups, and tasked with generating pan-Canadian solutions across the five areas of focus that could help to advance the shared vision.

Participants acknowledged that change to Canada’s HHR crisis would require investment in shared action over the long-term to address – with near-term investment required in priority areas (i.e., data, retention, models of care) to help in realizing our shared vision, and proportionately more effort was focused in these areas relative to other areas (e.g., recruitment). Furthermore, across all solutions, it was acknowledged that we must intentionally embed perspectives of equity deserving groups that have been marginalized in HHR conversations. In all solutions, collaboration amongst all key stakeholders will be required, with clarity in leadership and accountability for action.

The comprehensive list of solutions identified by the initial break-out groups, across the areas of focus, are captured below. Of these solutions, each group prioritized the top 1- 2 solutions (captured in bold) which had the greatest amount of discussion around and/or were perceived to make the greatest impact in achieving the shared vision previously articulated.

Recruitment for Future Needs

  • Provide accessible options for healthcare students to learn and train where they live (e.g., rural, remote, and Indigenous communities)
  • Build infrastructure to support healthcare workers’ transition to practice (e.g., greater capacity for clinical placements, accelerate credentialing recognition for IEHWs)
  • Collect pan-Canadian needs-based data (i.e., current and projected health care needs) to inform future recruitment needs (e.g., skills and mix of providers)
  • Provide appropriate incentives to encourage Canadians to pursue jobs in healthcare (e.g., pay equity, student debt forgiveness / guaranteed jobs, Indigenous workforce participation initiatives)
  • Support IEHWs (current & new) journeys with a streamlined and standardized end-to- end approach (e.g., immigration, registration, integration into workforce)
  • Campaign to build positive perceptions about being a healthcare worker for the current workforce and the future generations

Retention of Healthcare Workers

  • Create a health workforce retention strategy (respect; recognize; retain)
  • Improve flexibility in workplace culture and practice environments with consideration for work-life and workload balance (e.g., vacation time, scheduling, work arrangements, and sustainable use of overtime)
  • Create sustainable pathways for bridging between professions with consideration for impact across all health professions (e.g., PSWs training up and taking appropriate education bridging programs to become nurses)
  • Address career progression barriers for equity deserving groups, with an intentional focus on building career laddering opportunities
  • Provide flexibility in training location for on-the-job training, retraining, and cross- training to better serve different sectors / geographies
  • Provide incentives (e.g., improved pensions) to retired healthcare workers to provide mentorship to healthcare workers throughout their careers
  • Ensure title protection for unregulated professions (e.g., PSWs) and providing full-time hours and wages to enhance respect and dignity felt by unregulated professions, and make unregulated professions a profession of choice
  • Ensure similar scheduling options and pay equity across care settings

Workforce Mental Health and Well-Being

  • Increase representation of, and supportive measures for, equity deserving groups (Indigenous, Black, 2SLGBTQ+) in health workforce initiatives
  • Provide mental health supports as part of benefits for workforce and students
  • Invest in resiliency training (e.g., peer networks, training) for leadership and staff
  • Provide education on holistic approaches to well-being for self, peers, and patients
  • Provide support services to help manage working preferences and staffing, especially for underserved communities
  • Conduct research on best practices from other sectors (e.g., Canadian Armed Forces, First Responders) to inform new initiatives to improve workers’ well-being
  • Develop strategies and policies to hold organizations accountable to ensure physically and psychologically safe workplaces

Data to Support Effective Workforce Planning

  • Develop an approach for centralized Pan-Canadian data collection that can integrate existing datasets to inform HHR forecasting and evaluation
  • Proposal to develop a Centre of Excellence for Unregulated Healthcare Providers
  • Require collaborative data sharing between jurisdictions, with clear accountability generated through means such as federal transfer payments
  • Create a pan-Canadian health workforce data strategy to align health system priorities and HHR actions
  • Create minimum data standards to be used across jurisdictions and providers
  • Enhance collection of Indigenous data, with the collection, retention, and control of data kept under the purview of Indigenous people (i.e., through OCAP principles)
  • Develop a focused initiative on enhanced data collection for on IEHWs (e.g., qualifications, education) at point of entry to Canada
  • Create unique national identifiers for registered professionals to ensure accuracy of data collection and analysis

Productivity and Models of Care

  • Enable innovative, team-based models of care to support providers in working to their optimal scope, and better meeting patients’ needs
  • Coordinate a pan-Canadian approach to post-secondary education and programs and leveraging IEHWs
  • Provide funding for providers to train and practice in team-based care models to optimize scopes of practice (including embracing the role of the patient in supporting their own health)
  • Provide universal wages and benefits for every health profession (e.g., living wage, pay equity)
  • Identify key barriers in each jurisdiction that prevent healthcare workers from working to full scope of practice and create solutions to optimize (e.g., harmonize legislation)
  • Enable virtual care models in rural / remote settings to improve service delivery
  • Simplify the licensure process to reduce interprovincial barriers and enable healthcare workers to move where there is demand
  • Work with Indigenous communities to embed culturally safe and appropriate practices in care delivery

The prioritized (bolded) solutions demonstrated alignment within three areas of focus – data, workforce mental health and well-being, and retention – which were then brought forward for further exploration on Day Two of the Symposium.

The seven unique solutions generated are provided below. Note that some solutions were merged, with minor adjustments to the solution titles, where similar solutions were prioritized by different groups.

Prioritized Solutions

  • Create a pan-Canadian health workforce data strategy to align health system priorities and HHR actions
  • Enable innovative, team-based models of care
  • Create positive workplace culture and practice environments
  • Create a health workforce retention strategy
  • Increase representation of equity deserving groups (Indigenous, Black, 2SLGBTQ+) in health workforce initiatives
  • Coordinate a pan-Canadian approach to post-secondary education and programs and leveraging internationally educated healthcare workers (IEHWs)
  • Proposal to develop a Centre of Excellence for Unregulated Healthcare Providers

Priorities

The seven solutions prioritized in Day One were further refined through discussion on Day Two. To prime the discussion on solution refinement, The Honourable Carolyn Bennett, Canada’s Minister of Mental Health and Addictions and Associate Minister of Health, shared opening remarks. Minister Bennett expressed her appreciation for participants’ dedication working collaboratively together to identify solutions for Canada’s HHR crisis. She reinforced that the Symposium is the starting point for further dialogue to materialize “what it will take” to execute on these solutions and begin to act.

The seven prioritized solutions from Day One were refined by all participants in small groups through a World Café exercise – for each solution, participants generated a practical description of each solution, and considered what outcomes each solution would deliver. The outcomes of this exercise are described below.

Create a pan-Canadian health workforce data strategy to align health system priorities and HHR actions

Description: With acknowledgement that the current state of data on Canada’s health workforce is impeding planning efforts, this solution would centralize accountability for the development of a coordinated, pan-Canadian data strategy to enable evidence-based planning moving forwards. This could include:

  • Establishment of governance approach – including accountability in governance, development of the strategy, and creation and upkeep of data (e.g., federal/provincial incentives and consequences).
  • Identification of existing health workforce datasets and data gaps across Canada.
  • Creation of minimum data set requirements to support standardization and usefulness of data collected (e.g., national unique identifiers for health professions, data on actual scope practiced, inclusion of key groups – equity populations, unregulated care providers (UCPs), IEHWs, private sector providers).
  • Creation of a strategy to implement minimum data set requirements, fill gaps, and collect data over time.

Possible Outcomes:

  • Pan-Canadian, evidence-based planning for HHR in Canada.
  • A greater understanding of key attributes of Canada’s health workforce – including supply, recruitment and retention, models of care, demand, and needs.
  • Better reporting and benchmarking at the national and international level.

Enable innovative, team-based models of care

Description: Participants were aligned that a solution to enable collaborative team-based models of care in Canada could support providers in working to their optimal scope, and better meeting patients’ needs. This solution could include:

  • Identification of leading practices from existing, successful team-based models and create the conditions to apply these leading practices to help address Canada’s HHR crisis (e.g., understand the barriers and processes/structures to overcome challenges in implementation).
  • Optimization of healthcare workers’ scope of practice by enhancing training programs with a focus on interprofessional education, and use of technology (e.g., electronic health record, remote technologies to better utilize skillsets, virtual team-based care).
  • Creation of an inclusive health culture through equipping providers with knowledge on traditional healing practices to support their diverse patient populations.
  • Enablement of patient-centered care through partnering with patients to build a strong relationship and understand their expectations for their care delivery.

Possible Outcomes:

  • Improved retention of healthcare workers.
  • A more efficient and effective public health system.
  • Greater alignment of healthcare workers’ day-to-day scope practiced to their optimal scope of practice.
  • Increased accessibility to culturally safe and appropriate care, especially in the rural, remote, and Indigenous communities (through use of innovative care models such as virtual care).
  • Better patient outcomes focused on equitable patient-centered care.

Create positive workplace culture and practice environments

Description: While workers’ mental health was thought to be linked to addressing systemic challenges facing Canada’s health workforce, focused efforts are specifically required to support the development of physically and psychologically safe work environments given the impacts of the pandemic on workers’ well-being. This solution could include:

  • Establish transparency and accountability from health system and organizational leadership to drive workplace culture from the top-down.
  • Implement policies and procedures to enable a safe practice environment, both physically and mentally (e.g., access to safe equipment, anti-harassment policies).
  • Support continuous training and development to allow healthcare workers the opportunity to “train where you live” with mentorship opportunities.
  • Provide comprehensive mental health benefits and support services for healthcare workers.
  • Create a workplace with an emphasis on work-life flexibility that allows healthcare workers to build a career that supports a healthy work-life balance.

Possible Outcomes:

  • Greater job satisfaction leading to better retention and less turnover of the existing health workforce.
  • Equitable, diverse, and inclusive work environment to encourage recruitment.
  • Improved patient outcomes and safety of care due to healthy healthcare providers.

Create a health workforce retention strategy

Description: Given existing rates of burnout and professional departures among the health workforce, a dedicated workforce strategy to demonstrative better responsiveness to workers’ needs was seen as a priority. This solution could include:

  • Creation of a shared vision amongst healthcare workers across Canada to define what a positive workplace experience could look like.
  • Identification and application of existing tools and frameworks to support a physically and psychologically safe workplace (e.g., HESA’s 2019 recommendations against violence, MHCC’s National Standard for Psychological Health and Safety in the Workplace).
  • Implementation of policies and standards to empower and protect healthcare workers (e.g., universal benefits and pay equity; policies to protect against discrimination and harassment; supportive policies for those experiencing mental health issues).
  • Investment in appropriate incentives to support the current health workforce including childcare supports, incentives for full-time work (e.g., pension plans).
  • Enablement of flexible workplace environments where healthcare workers can take entitled vacation, expect guaranteed hours, and provide flexibility in staffing.
  • Investment in peer-to-peer mentorship and career laddering opportunities for equity deserving groups (BIPOC, Indigenous, 2SLGBTQ+).

Possible Outcomes:

  • Greater retention of the health workforce with healthier, more satisfied lives.
  • Upstream benefits on recruitment for professions, where the future workforce can see healthcare professions as a meaningful career path.
  • Reduced instances of harassment and discrimination in the health workforce.
  • Better patient outcomes and care for all Canadians.

Increase representation of equity deserving groups (Indigenous, Black, 2SLGBTQ+) in health workforce initiatives

Description: Participants acknowledged that the path forward for HHR in Canada must include a dedicated commitment to embedding equity deserving groups in planning for Canada’s future health workforce. While this priority will require focused exploration, increasing representation for equity-deserving groups should be embedded in all solutions – and with these solutions led by each equity deserving groups themselves. This solution could include:

  • Review existing documented strategies as a starting point for specific solutions related to HHR (e.g., Truth and Reconciliation Commission’s Calls to Action for Indigenous peoples).
  • Employ upstream recruitment strategies – including awareness/promotion of health workforce professions in secondary school and providing mentorship within equity deserving groups.
  • Provide funding to support efforts within healthcare professions to eradicate systemic barriers to employment, retention, and advancement.
  • Implement processes and policies to support equity in the workplace, including diversity / diversity champion models, and equitable, bias-free hiring processes.
  • Create data collection efforts on equity deserving groups in an ethical manner – with data collected and owned by the equity deserving groups.

Possible Outcomes:

  • A more representative health workforce.
  • Population-specific practices and sustainment initiatives tailored to equity seeking groups.
  • Physically, culturally, and psychologically safe health workforce and workplaces.
  • Achievement of the Quintuple Aims (improving population health, patient experience, health system sustainability, clinician experience, and health equity).

Coordinate a pan-Canadian approach to post-secondary education and programs and leveraging IEHWs

Description: This solution was developed with acknowledgement that a coordinated approach to post-secondary education, with pan-Canadian coordination and planning for the number of seats required across jurisdictions and professions, and agreement on the competencies desired for domestically and internationally trained healthcare workers, could reduce barriers to recruitment and cross-provincial/territorial licensing. This could include:

  • Creating a minimum set of core competencies across provinces and territories that are disseminated through post-secondary programs, with acknowledgement that exceptions may be needed to reflect jurisdictional contexts (e.g., rural/remote).
  • Developing a centralized structure to provide oversight, support data collection, projection, and reporting, and centralize accountability for action against the coordinated approach – with acknowledgement that the federal and provincial/territorial governments would be key players in oversight efforts.
  • Employing focused efforts to build infrastructure for IEHWs – including a review of existing bridging programs to identify leading practices; strengthening immigration and integration pathways; and increased investment in support services (e.g., funding for English/French courses, pre-arrival programs).

Possible Outcomes:

  • Consistency in competencies required for each profession across Canada, reducing complexity for domestic healthcare workers and IEHWs alike
  • A more coordinated approach to planning across jurisdictions and professions
  • A simplified credentialing recognition process for IEHWs

Develop a Centre of Excellence for Unregulated Healthcare Providers

Though important to support unregulated health professions, consensus was not reached on the Centre of Excellence (CoE) as a main solution – and there was alignment among the groups that further work would need to be done to explore the value of a distinct entity or agency to support the advancement of unregulated healthcare workers. The decision was made to not explore this solution through the final phase of Considerations for Pan- Canadian Action.

Proponents of this solution shared that the CoE would serve as a hub to promote and enable excellence in the delivery of care by unregulated health care providers in Canada. This CoE would serve as the central authority supporting information-sharing, research, and advocacy for unregulated health care providers, with an emphasis on LTC and home care workers.

Considerations for Pan-Canadian Action

The culmination of the Symposium was the identification of potential pan-Canadian actions needed to support the transition to the future state vision for HHR in Canada, through the seven identified priorities. While it was reinforced that further discussion would be required to further refine the ideas, proposed actions, and implementation timing, participants developed preliminary considerations for pan-Canadian action over the short- (<12 months), medium- (12-24 months), and long-term (>24 months), as well as identify potential stakeholders that would play a key role, to assess relative urgency for action.

Across the priority solutions, there was general agreement that working towards these solutions would help achieve the Quintuple Aim (improving population health, patient experience, health system sustainability, clinician experience, and health equity) and enable more equitable and coordinated evidence-informed planning to address Canada’s HHR challenges.

Ideas for Action At-a-Glance

Create a pan-Canadian health workforce data strategy to align health system priorities and HHR actions

Short-Term Actions
  • Align on leadership to support the creation of the workforce data strategy: some federal accountability and oversight was viewed as essential.
  • Define the components of the health workforce data strategy – including key outcomes desired, key players, and future-state vision.
  • Build buy-in and accountability with key players for concept (e.g., PTs, municipalities, employers, equity deserving groups).
  • Identify current state of data in alignment with future-state vision – and assess how to reconcile through building on existing capabilities, and creating accountability to incent adherence (e.g., transfer payments).
  • Consult with Indigenous and equity deserving groups, as well as IEHWs, to identify how data should be collected for these priority groups.
Mid-Term Actions
  1. Develop implementation plan of how to action the strategy – a “pilot jurisdiction” to test the proof-of-concept may be required to demonstrate proof of concept, and report-out on early outcomes (i.e., 12 months).
  2. Define a data collection approach to ensure all provinces and territories are collecting and sharing data in a consistent fashion, with consideration for unique jurisdictional contexts (e.g., rural/remote, Indigenous/equity deserving groups).
Long-Term Actions
  1. Create plan to scale out successes / address challenges identified from pilot.
  2. Develop a dashboard view of pan-Canadian health workforce data to continue to monitor change over time.

Potential Stakeholders Identified

  • Federal and provincial / territorial (P/T) governments: collaboration for oversight and accountable for execution
  • IEHW, Indigenous, and equity deserving groups: subject matter expertise
  • Statistics Canada & Canadian Institute for Health Information (CIHI): data subject matter expertise
  • Employers, insurers, and pension plan organizations to supply data

Enable innovative, team-based models of care

Short-Term Actions
  • Conduct leading practices scan to identify innovative models of care – including how these models of care could support Canada’s HHR crisis, and implementation considerations to bring the model to scale.
  • Prioritize model(s) and jurisdiction for pilot implementation – with consideration for local context, barriers, and requirements to scale.
  • Communicate with health system stakeholders (broadly, and within jurisdiction) to facilitate the change and generate buy-in for new model.
Mid-Term Actions
  • Implement new model(s) of care in a community to evaluate success and work with local leadership to document outcomes and lessons learned.
  • Scale out model(s) to other jurisdictions and establish an integrated report-back system to support quality improvement processes.
Long-Term Actions
  • Continue to scale new model(s) of care and monitor outcomes via integrated report-back system to support uptake in other jurisdictions.
  • Develop incentives to facilitate broad adoption of model(s) across Canada.

Potential Stakeholders Identified

  • Federal and P/T governments: provide oversight
  • Unions and professional associations: provide models of care changes
  • Patient safety organizations: and accountability provide patient perspective for

Create positive workplace culture and practice environments

Short-Term Actions
  • Define and assess the current health workforce culture through focused engagement (i.e., surveys, interviews) with frontline healthcare workers.
  • Conduct an environmental scan of leading practices frameworks, policies, and successes that can be built upon.
  • Identify initiatives from leading practices, and gain buy-in for their implementation at the system- and organizational level.
  • Create a national taskforce specifically responsible for workplace culture / safety within organizations to increase accountability.
Mid-Term Actions
  • Establish a standardized reporting mechanism within organizations for healthcare workers to report negative workplace incidents, including defined leadership accountability to respond to these situations.
  • Implement pre-identified leading policies and standards to ensure psychologically safe and inclusive workplaces.
Long-Term Actions
  • Continue to implement priority strategies based on assessment of evolving HHR landscape and workforce needs.
  • Establish a mechanism for re-evaluation of implemented initiatives to enable continuous improvement.

Potential Stakeholders Identified

  • Mental Health Commission of Canada (MHCC): driving strategy development, identifying frameworks
  • Organizational leadership: provide guidance on tailoring strategies to their organization / gathering staff input
  • All organizational staff: contribute to a positive work environment

Create a health workforce retention strategy

Short-Term Actions
  • Identify leading practices related to workforce retention (including EDI policies) and map these to identify scalable successes to address challenges related to workforce retention in Canada (i.e., First Nations Health Authority’s (FNHA) Health & Wellness Planning: A Toolkit for BC First Nations).
  • Develop an investment strategy to be owned by federal / provincial and territorial governments to help scale the leading practices / standards.
  • Create a campaign to generate awareness about the pride of being a healthcare worker and spur the creation of policies to protect against worker harassment.
Mid-Term Actions
  • Secure federal and/or provincial/territorial government funding to implement and scale the leading practices / standards in local communities.
  • Begin to implement and scale the leading practices / standards.
  • Develop an accountability framework to scale the leading practices, complete with metrics and timelines (FNHA resource to be leveraged as starting point).
Long-Term Actions
  • Monitor implementation and ensure operational sustainment of the solutions, gathering feedback from front-line workers to inform go-forward approach.

Potential Stakeholders Identified

  • Federal and P/T governments: funding
  • Provincial / Territorial Committee on solutions / deployment of standards Health Workforce (CHW): develop
  • Indigenous leadership, including FNHA: leading practices inventory provide guidance for use of toolkit and
  • Unions and professional associations: scaling of standards captured within to provide oversight for standard
  • Organization-specific leadership: to help implementation scale leading practices / standards

Increase representation of equity deserving groups in health workforce initiatives

Short-Term Actions
  • Establish an ethical data collection approach for equity deserving groups in Canada to quantify shortages in representation – with all data owned by the equity deserving groups.
  • Consult with equity deserving groups and review literature to better understand barriers to thriving in Canada’s health workforce, and how they can be overcome (with due reference to the Truth and Reconciliation Commission of Canada’s Calls to Action relevant to health and the health workforce).
  • Create upstream, community-based mentorship initiatives within equity deserving groups to promote healthcare as a career of choice.
Mid-Term Actions
  • Based on gathered data, establish benchmarking targets and priority initiatives to increase representation for equity deserving groups.
  • Develop targeted strategies to encourage upward mobility in the profession, demonstrating the potential for these pathways through representative leadership.
  • Develop targeted strategies for mentorship and enhancement of career pathways for visibly gender non-conforming people, and 2SLGBTQ+.
Long-Term Actions
  • Indigenous groups (i.e., IPAC, CINA, NCIME) & equity deserving groups: subject matter expertise and leading the solutions.
  • Organization leadership, unions, and professional association: to promote adoption of strategies

Coordinate a pan-Canadian approach to post-secondary education and programs and leveraging IEHWs

Short-Term Action
  • Conduct an environmental scan to understand post-secondary requirements / offerings for domestic students and IEHWs in each jurisdiction, per profession.
  • Identify opportunities to standardize existing post-secondary requirements and offerings across jurisdictions based on outcomes of environmental scan.
Mid-Term Actions
  1. Identify future-state education requirements and offerings based on current and future need (general vs. specialty) and create capacity plan for post-secondary institutions to provide offerings (e.g., opening seats, adding residency positions).
  2. Leverage innovative approaches (i.e., virtual education) to conduct bridging programs for IEHWs, including the integration of English/French language training.
  3. Establish a pan-Canadian minimum set of standards on educational requirements for IEHW bridging programs.
Long-Action
  • Implement prioritized initiatives in one jurisdiction to demonstrate lessons learned prior to pan-Canadian expansion.

Potential Stakeholders Identified

Short-Term Action
  • Federal and P/T governments: funding and supporting solution development
  • CIHI: conduct environmental scan and identify opportunities to standardize requirements
  • Health Standards Organization (HSO): supply current state data
  • CHW: convene stakeholders for action on this solution
  • Regulators, educators – responsible for implementation
  • UCPs, IEHWs – provide input on bridging programs

Moving Forward & Next Steps

To close out the Symposium, Jo Voisin, Assistant Deputy Minister of the Strategic Policy Branch from Health Canada, thanked participants for their commitment to co- creating a brighter future for HHR in Canada. She acknowledged that the Symposium is only the beginning of the collaboration required in the path forward – and that the solutions generated today can only be achieved through consistent investment and engagement among all stakeholders.

Health Canada will carefully consider the key actions identified through the Symposium. Health Canada is committed to continuing the action-oriented dialogues and considering next steps in executing on the shared vision – together in concert with other levels of government and partners, including regulators, educators, professional bodies and faculties, and health system leaders.

Appendix

Health Canada wishes to thank and acknowledge the many participants who contributed during the Health Human Resources Symposium, including:

  • Adam Mills
  • Adrian MacKenzie
  • Alanna Cates
  • Alix Bacon
  • Andrea Baumann
  • Andrew Wells
  • Anita Paras
  • Anna Ditablan
  • Barbara Lowe
  • Beth Ann Kenny
  • Bianca Carlone
  • Billie-Jean Flynn
  • Brennan Graham
  • Chantal Couris
  • Christine Da Prat
  • Corinne Daly
  • Danielle Soucy
  • Deborah Cohen
  • Denise MacIver
  • Dr. Cynthia Baker
  • Dr. Francine Lemire
  • Dr. Gail Tomblin Murphy
  • Dr. Geneviève Moineau
  • Dr. Harrison Applin
  • Dr. Ivy Oandasan
  • Dr. Katharine Smart
  • Dr. Luigi Lepanto
  • Dr. Nel Wieman
  • Dr. Sarah Silverberg
  • Dr. Susan Moffatt-Bruce
  • Dr. Sylvain Brousseau
  • Emily Watkins
  • Erin Hetherington
  • Eugenia Afolabi
  • Fiqir Worku
  • Fleur-Ange Lefebvre
  • Gabrielle Racine-Lupien
  • Gayle Waxman
  • Glenn Brimacombe
  • Ian DaSilva
  • Ivy Bourgeault
  • Jake Arbuckle
  • Jennifer Berry
  • Jo Voisin
  • Joan Atlin
  • Jocelyn Jalbert
  • Jodi Hall
  • Kelly Grimes
  • Kelly Stang
  • Kelsey Skromeda
  • Erin Connell
  • Kristi Velthuizen
  • Kubra Yilmaz
  • Kwame McKenzie
  • Laura Bulmer
  • Laura DesRoches
  • Leila Gillis
  • Linda Silas
  • Liz Anderson
  • Lori Ellis
  • Lynn McNeely
  • Marilee Nowgesic
  • Mark Goossens
  • Pauline Worsfold
  • Marketa Evans
  • Mary Arsenio
  • Mathieu Sylvestre
  • Melanie Osmack
  • Michael Grant
  • Michael Sangster
  • Michel Rodrigue
  • Michelle Hamilton-Page
  • Michelle Owen
  • Miranda Ferrier
  • Naoko Hawkins
  • Nick Neuheimer
  • Niki Andresen
  • Owen Adams
  • Pam Kent
  • Patrick Cyr
  • Paul Bailey
  • Paula Pincombe
  • Paul-Émile Cloutier
  • Rho Martin
  • Rob Furlong
  • Sam Weiss
  • Samara Lewis
  • Saskia Morin
  • Sean Brygidyr
  • Sharleen Stewart
  • Susan Barrass
  • Susan Weston
  • Tanya Penney
  • Tim Guest
  • Tonia Occhionero

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