Health Human Resources Action Plan - Status Report

Government of Canada
December 2005

In 2004, federal, provincial and territorial governments, in their "Ten-Year Plan to Strengthen Health Care," renewed their commitment under the 2003 Health Accord, and agreed to increase the supply of health professionals in Canada and to make their action plans public. The plans, including targets for the training, recruitment and retention of professionals, are to be released by December 31, 2005.

Regarding this commitment, the Federal Health Care Partnership, which includes Health Canada, Correctional Service Canada, the Department of National Defence, Veterans Affairs Canada, the Royal Canadian Mounted Police and Citizenship and Immigration Canada, will report on the role of the federal government and its collective activities in this area.

Table of Contents

Section I: Introduction

Background

The 2003 First Ministers' Accord on Health Care Renewal sets out an action plan for reform that reflects a renewed commitment by governments to work in partnership to achieve a sustainable health care system that provides timely access to quality health services. First Ministers have committed to accelerate collaborative work on priority issues with respect to patient safety, technology assessment, innovation and research and health human resources.

Canada's ability to provide access to high-quality, safe and effective patient-centred health services is dependent on having the right mix of health care providers with the right skills in the right place at the right time. The appropriate planning and management of health human resources are key to ensuring that Canadians have the health providers they need, both now and in the future.

The primary thrust of a health human resource strategy is to ensure that there is an appropriate supply and distribution of health care workers to meet the identified needs of the population, that patients can receive timely, quality care, and that workplaces remain healthy and safe for our health care providers. A health human resource strategy must work equally across all of these fronts in order to identify the workforce that is required, and to ensure that it is prepared appropriately, supported adequately and used effectively.

In 2004, federal, provincial and territorial governments, in their "Ten-Year Plan to Strengthen Health Care," renewed their commitment under the 2003 Health Accord, and agreed to increase the supply of health professionals in Canada and to make their action plans public. The plans, including targets for the training, recruitment and retention of professionals, are to be released by December 31, 2005.

Purpose

Regarding this commitment, the Federal Health Care Partnership , which includes Health Canada, Correctional Service Canada, the Department of National Defence, Veterans Affairs Canada, the Royal Canadian Mounted Police and Citizenship and Immigration Canada, will report on the role of the federal government and its collective activities in this area.

This report was prepared during a federal election period and represents the first progress report of the federal government regarding its current plans, activities, successes and challenges, in the area of Health Human Resources (HHR).

The Government of Canada is committed to move forward in addressing its HHR issues through its current and future action plans, and the next reports will include more details on future action plans.

Role of Government

The roles and responsibilities for Canada's health care system are shared between the federal and provincial/territorial governments.

Provinces and Territories

The administration and delivery of health care services are the responsibility of each province or territory, guided by the provisions of the Canada Health Act . The provinces and territories fund these services with assistance from the federal government in the form of fiscal transfer payments.

Health care services include insured primary health care services (such as the services of physicians and other health professionals) and care provided in hospitals, which account for the majority of provincial and territorial health expenditures. Provinces and territories also provide some groups with supplementary health benefits not covered by the Act, such as prescription drug coverage.

Federal Government

The federal government provides direct health care services to certain population groups for which it has a mandate (First Nations and Inuit people).

The federal government also provides health services to eligible veterans, refugee protection claimants and inmates of federal penitentiaries. In addition, it has responsibilities for health care for serving members of the Canadian Forces and the Royal Canadian Mounted Police.

The federal government ranks fifth following Ontario, Quebec, British Columbia and Alberta in order of expenditure in the delivery of direct health services to more than one million Canadians.

Federal Healthcare Partnership

Federal Healthcare Partnership (Partnership) is a partnership of federal departments created to identify, promote and implement more efficient and effective health care programs through the collaborative effort of all member departments.

The Partnership has two main goals: to increase the efficiency and effectiveness of all activities related to providing health care services that could otherwise not be achieved through the individual departments acting on their own; and to provide strategic leadership on federal or pan-Canadian issues of common interest. The Partnership has six permanent partner departments, agencies and organizations: Health Canada, Veterans Affairs Canada, the Royal Canadian Mounted Police, Correctional Service Canada, Department of National Defence and Citizenship and Immigration Canada.

As part of its workplan for 2005-2006, the membership of the Partnership, in the interests of enhancing the overall stability of Canada's health workforce, undertook to examine the theme of recruitment and retention of health care workers at the federal level.

Health Human Resource Challenges

Pan-Canadian Context

The challenge for governments at all levels is to provide leadership, direction and support for change within the health sector and to work with partners and stakeholders to ensure that proposed changes are appropriate, fair and sustainable for the longer term.

Over the past several years, shortages of health care providers have emerged both nationally and internationally, resulting in challenges for all levels of governments. More recent commitments under the First Ministers' agreements, including efforts to reduce patient wait times, have had an ongoing impact on the growth in demand for health providers. In addition, while Canada's aging population has also contributed to an overall increase in the demand for services, its aging health care workforce has eroded the capacity of the health system to respond. This has led to a growing competition for health human resources among governments, jurisdictions and sectors.

All of these factors have continued to create challenges within the health system to sustain an adequate supply of health care providers to meet the health needs of the population, now and in the future; and respond adequately to the health reform initiatives over the past years.

Federal Challenges

Issues in the supply and demand of physicians, nurses, pharmacists, physiotherapists and psychologists, cut across all departments of the Partnership. These factors affect recruitment and retention strategies that have been a key focus of federal government health human resource initiatives. The ongoing reorganization and expansion of federal health service delivery will further increase the demand and competition for health care providers and the need to revitalize its current recruitment measures.

A Comprehensive Approach

While financial incentives will remain key, a comprehensive approach to the recruitment and retention of health professionals will need to also emphasize:

  • the identification of population needs through evidence-based planning;
  • the production of appropriately trained health care providers;
  • the development of a workforce that is more representative of the people it serves;
  • the effective deployment and utilization of the skills of health care providers;
  • continuing education and development;
  • improvements in workplace environments; and
  • a long-term health human resources plan that recognizes the roles, responsibilities and relationships of all partners in the pan-Canadian planning process.

Section II: Achievements and Successes

This section explores more recent health human resource achievements and successes by departments of the Partnership in response to some of the challenges that have been identified. The areas explored include health human resource planning, recruitment and retention, and education and training.

Health Canada (First Nations and Inuit Health Branch-FNIHB)

  • Work has begun on the Aboriginal Health Human Resources Initiative (AHHRI), which in 2004 committed $100 million over five years to develop and implement an Aboriginal health human resources strategy that will meet the unique health service needs of Aboriginal people.
  • Issues to help identify First Nations oral health service gaps and strategies are being addressed through the Pan-Canadian Public Health Network (Public Health Human Resources Task Group).
  • A recruitment and retention study of medical officers in Health Canada's regional offices is being completed as well as work on addressing indemnification and liability issues for medical officers.
  • The Nursing Transformation Strategy has aimed funding at retention initiatives such as increased nursing staff numbers and increased management support to field-level nurses to address issues related to nurse retention within First Nations and Inuit communities.
  • A literature review to identify best practices in nurse recruitment initiatives, outreach and marketing was completed in 2004. As a result, the Nurse Recruitment Strategy was revised and a new advertising campaign was introduced.
  • A successful clinical nurse specialist recruitment campaign was also completed in 2005, resulting in 14 specialist nurses hired in First Nations and Inuit communities to address specific health issues.
  • A Nurse Resource Team Strategy was piloted and implemented in four regions to provide relief nursing services in northern communities. A second nurse on standby policy was also implemented in nursing stations where nurses are required to provide around-the-clock care. The policy enhances patient safety and ensures support and backup to nurses who are assigned to after hour, weekend standby and callback duties.
  • Support has been provided for the development of the Canadian Nurses Portal, which will be launched in June 2006. The Portal will assist all nurses to access information and to make better-informed decisions about the care they provide, as well as information to help nurses to manage their careers and connect with colleagues and health care experts. FNIHB provides support and a professional linkage with the Aboriginal Nurses Association to address common issues related to nurse recruitment and retention.
  • Work is under way with the National Aboriginal Achievement Foundation to increase the number of Aboriginal youth entering health careers through increased funding for scholarships and bursaries, and to increase the awareness of health careers among Aboriginal youth through regional career fairs for Aboriginal youth ("Blueprint for the Future"), and an interactive educational module on health careers ("Health Careers in the Classroom").
  • Funding is provided to programs on community health nursing for diploma-prepared nurses to prepare them to deliver culturally appropriate community health programs in First Nations communities.
  • Support is provided to nurses to complete nursing baccalaureate and master's level programs.
  • Primary skills education, directed at nurses employed in northern communities, is being transformed to bring it in-line with training offered in nurse practitioner programs.
  • A Critical Incident Stress Management program provides counselling and peer support to nurses.
  • Clinical Practice Guidelines for Nurses have been reviewed and are currently being updated.

Royal Canadian Mounted Police

  • Currently, the RCMP employs sixteen physicians, ten psychologists, and over twenty nurses to deliver occupational health programs to 19,000 RCMP members through eleven Health Service Units in four regions across Canada.
  • The Absenteeism and Disability Case Management Program aims at early return to health or work of ill or injured employees with temporary or permanent disabilities through promoting best practices. The program is delivered by physicians, nurses and psychologists.

Department of National Defence

  • A study was completed on Canadian Forces health services professionals in order to tailor attraction and retention initiatives to be more effective. A comprehensive demographic survey of physicians was also recently commissioned with the final report expected in March 2006.
  • More flexible terms of service and employment options for medical officers were adopted.
  • A review of incentive pay categories was undertaken.
  • Specialist and general duty medical officer workshops were developed as a means to discuss concerns, access professional education to maintain clinical skills and provide a networking opportunity within the occupations. These venues also increase camaraderie and esprit-de-corps within the occupation, generate Canadian Forces visibility and, in turn, assist with increasing the overall recruitment and retention.
  • Funding is being provided to promote opportunities for staff to attend annual professional heath services association meetings/conferences.
  • Funding is available to assist in providing health service professionals with their geographical preference posting.
  • Experts, recruiters and large-scale exhibits maintained a high profile to attract health personnel at job and career fairs, interdisciplinary conferences, universities and training facilities. Promotional items have been developed to attract potential candidates into the Canadian Forces.
  • The Canadian Forces Recruiting Group has implemented a successful pilot project to assist in the recruitment of medical officers and pharmacists, the two health professions in highest demand.
  • There has been an increase in the number of emergency medicine and psychiatry postgraduate training positions for those interested in working in the Canadian Forces.
  • Annual specialist professional technical workshops have been introduced as a means to discuss concerns, access professional education to maintain clinical skills and provide a networking opportunity within professions.
  • A policy for continuing professional education and funding from a central pool to ensure a consistent approach has been developed.
  • A Military Medical Training Plan and Seat Initiative has been adopted to allow regular and reserve forces to undertake medical school sponsorship within the Canadian Forces. There are twelve reserved seats across Canada for officers wishing to attend medical school.

Correctional Service Canada

  • Reports were produced in 2001 to identify the problems relating to recruitment and retention of nurses and psychologists. A Working Group on Psychology provided an update report in 2005.
  • A campaign to recruit nurses was conducted in 2002.
  • Training was established on infectious diseases control and management, and methadone treatment in 2002 and on a suicide investigation model for psychologists in 2004.
  • Funding was provided for a Chair of Forensic Psychology at the University of Saskatchewan.

Veterans Affairs Canada

  • In 2002, a Resource Allocation Model was developed with a view to facilitating national evidence-based human resources planning. Funding was provided to each Veteran Affairs Canada region to permit staffing up to the model's requirements.
  • In 2005, a resource intensity tool was also developed which uses advanced technology to permit the grouping of clients according to the intensity of resources required for treatment and case management.
  • In 2004, the National Nursing and Medical Officers and Department of Nursing at Hôpital Ste-Anne, undertook a review of health professional resourcing and issues relating to recruitment and retention. The study is currently under revision.
  • All nurses in district and regional offices have identified learning needs that are incorporated into a National Training Plan, which is revised every three years. Continuing education needs for physicians are identified via soliciting input from Departmental physicians.
  • Over the past two years, the Department has implemented, under the Government on Line (GOL) initiative, a Benefits and Health Services On Line (BHSOL) system which enables external (non-Departmental) nurse assessors to receive request for, complete and return nursing assessments to Veterans Affairs Canada using web-enabled technology.
  • In 2005, the Department held a National Medical Officer meeting, which included a focus on professional development.

Section III: Ongoing Plans

This section sets out ongoing plans of federal government departments regarding initiatives directed at strengthening the available supply health human resources.

Health Canada (First Nations and Inuit Health Branch)

  • Work will continue on helping to identify dental service gaps and devise a strategy to address them.
  • A Workload Measurement System project is being developed to assist in planning for the appropriate skill mix of health professionals to deliver nursing services in First Nations communities.
  • Short-and long-term initiatives are under way to assist in forecasting health human resource staffing needs to meet the demands created by the high burden of illness, addiction and mental health issues in First Nations communities. More accurate nursing vacancy reports will inform future recruitment initiatives and health human resource forecasting.
  • The Nursing Minimum Data Set project will provide nurses with a documentation system to enable them to practise more safely. By developing evidence based data elements, supported by consensus through peer review, nurses will document their care in a consistent manner reducing the potential for error through misinterpretation, omission or unclear definitions. It will also serve as the basis for quality improvement activities, integration with provincial health care systems, and support the introduction of an electronic health record.
  • Innovative ways to engage nursing students in clinical practicuums during their educational programs in an effort to increase the likelihood of them seeking employment from FNIHB upon graduation will continue to be developed.
  • The work on health careers under the Aboriginal Health Human Resources Initiative (AHHRI) announced in 2004, will develop strategies to increase the number of First Nations, Inuit and Métis students who are aware of health careers as viable career options, particularly youth, and who succeed in health career studies. The work with the National Aboriginal Achievement Foundation under the pan-Canadian HHRS will continue.
  • Work is under way to link the AHHRI with the federal, provincial and territorial Pan-Canadian Health Human Resources Strategy. The AHHRI aims to lay the foundation for longer-term systemic change in the supply and demand for First Nations, Inuit and Métis health human resources. The two priorities of the AHHRI are to increase the number of health care providers and improve retention of health care workers.
  • The study on the recruitment and retention strategies for community medicine specialists continues. Strategies that are under consideration include education opportunities, improved organizational commitment to public health and compensation options.
  • Generic job descriptions for nurses employed in northern nursing stations are being revised to facilitate the greater use of nurse practitioners and expanded role nurses.

Royal Canadian Mounted Police

  • A proposed re-classification for physicians will involve greater responsibility, accountability, and clinical competency in occupational health medicine. A higher classification of nursing positions will allow nurses to take on more responsibilities and a greater range of delegable acts.
  • Discussions have taken place on the introduction of greater bonuses and allowances that enables the RCMP to be a more competitive organization and to recruit and retain physicians and nurses without compromising overall public service equity.
  • Other types of compensation have been discussed, such as living allowances, employee exchange programs and increases in terminable allowances.
  • Other non-monetary recruitment and retention incentives have been considered such as: more flexible hours, staff involvement in program design, more varied work schedules, greater role clarification, time-off for private practice, ongoing professional development, and enhanced organization support.

Department of National Defence

  • The Canadian Forces Health Services (CFHS) is working on new occupation lifestyle videos to attract potential applicants to the CFHS. Standardized recruitment briefings, information brochures and formalized promotional campaigns are being developed for all health professions.
  • A pathway is being developed to allow medical officers to continue in clinical practice after having attained the rank of Major.
  • The Military Medical Training Plan Seat Initiative secures the number of reserved medical student seats across Canada for serving officers.
  • The Residency Positions for International Medical Graduates (IMGs) initiative is being developed to assist IMGs in obtaining access to medical residency positions in order that they may practise in Canada.
  • Physician specialist fellowships have been put in place through partnerships with academic university fellowship programs.
  • A number of additional programs are being developed in concert with the Director Military Human Resource Requirements, including sponsorship for further postgraduate training in social work and physiotherapy and sponsored training to facilitate staff transfers to new occupations.
  • The Special Officer Training Plan ensures the required training for health services occupations and that it is fully covered and in concert with Canadian Forces requirements.
  • A Special Education Plan provides an avenue for applicants to fulfill all or a greater portion of their initial Regular Force occupation training at civilian post secondary institutions.
  • Medical Officer Training Plan (MOTP ) . A concept of sponsoring medical students during their first year of medical school is being developed. The current structure for sponsoring civilian medical students begins in the second year of medical school and continues until the end of their two years of residency.
  • Information Brochures . Subject Matter Expert Information Sheets, a new Medical Officer Brochure and a Canadian Forces Health Services (CFHS) brochure are being developed to assist in providing information to the civilian community about a career in the CFHS.

Correctional Service Canada

  • There is ongoing work on a human resource business case to expand the number of staff nurse positions as well as the development and revision of generic job descriptions for nurses and psychologists.
  • Regular management-labour relation meetings are being held to discuss issues and solutions with key stakeholder groups.
  • There is ongoing active participation on the Recruitment and Retention Study Group jointly managed by Treasury Board and the Professional Institute of the Public Service of Canada.
  • National training standards are being developed for nurses and for psychologists.

Veterans Affairs Canada

  • There is ongoing re-evaluation and revision of the current Resource Allocation Model, to further examine the impact of the new client base and expanded programs on staff workload, including professional staff.
  • Departmental nurses and physicians are directly involved in the development of national training plans, agendas for regional and national meetings, as well as the identification of resource requirements.
  • There is ongoing collaboration with the Professional Institute of the Public Service of Canada in a union/management consultation reviewing resource issues related to health professional staff.
  • Discussions and planning are under way for immediate recruitment of physicians and nurses to fill positions currently occupied by contracted staff with public service positions.
  • There is continued development of formal recruitment and retention strategies for Departmental physicians and nurses.
  • Ongoing national and regional nursing meetings and individual study opportunities continue to be made available to staff.
  • The Department is continuing national implementation of the Benefits and Health Services On Line system to enable external occupational therapy assessors to receive requests for, complete and return assessments to Veteran Affairs Canada using web-enabled technology.

Section IV: Conclusion

Canada's health care system is experiencing a number of changes in the way health care is delivered to ensure that health services are timely and appropriate and meets the growing demands of Canada's aging population. While an appropriate supply of health human resources to meet these demands remains a challenge, the federal government has made significant strides towards achieving and maintaining an optimal and stable supply of health care providers.

The Partnership has undertaken: i) health human resource planning activities in order to provide the support and direction required, ii) recruitment and retention initiatives to strengthen and stabilize the workforce, and iii) education and training programs to better prepare health professionals for practice. It has broadened and enhanced health care stakeholder partnerships to ensure that proposed changes are appropriate, viable and sustainable for the longer term.

Through the Pan-Canadian Health Human Resources Planning Strategy, Health Canada is working with the provinces, territories and key stakeholders to strengthen the coordinated, collective response to health human resources planning. Three major collaborative efforts under this initiative include strengthening the evidence base for national planning, improving strategies for recruitment and retention and promoting of interprofessional provider education.

The Federal, Provincial and Territorial Advisory Committee on Health Delivery and Human Resources has been a major conduit for the collaborative work that has taken place and provides strategic advice, serving as a key linkage with the Pan-Canadian Health Human Resource Strategy. Health Canada produced this progress report on behalf of the Federal Healthcare Partnership and continues to provide ongoing, primary support and overall coordination of these national health human resources initiatives.

These collective efforts contribute to a strengthening of Canada's healthcare workforce and help to ensure that healthcare service delivery goals are appropriately met, now and in the future.

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