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Health Workforce and the Challenges of Health Care Systems

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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Care Sciences & Services".

Deadline for manuscript submissions: closed (22 March 2023) | Viewed by 23001

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Special Issue Editor

Dr. Alicja Domagała

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Guest Editor

Department of Health Policy and Management, Institute of Public Health, Jagiellonian University Medical College, 31-066 Kraków, Poland
Interests: health care management; human resources management; health care reforms; health workforce; migration of health care professionals; health care systems

Special Issue Information

Dear Colleagues,

The quality and quantity of medical services depend to a large extent on the knowledge, skills, amount, well-being, and geographical distribution of the health workforce. The COVID-19 pandemic has highlighted the weakest link in the operation of the healthcare system: shortages of health workforce.

The most important challenges for the majority of countries today are training a sufficient number of health professionals prepared to address the growing health needs of the population; recruiting, motivating, and retaining health workforce and ensuring satisfactory working conditions. Moreover, health problems resulting from the excessive, long-term mental and physical burden can lead to burnout and, as a result, to people leaving medical professions. This is particularly dramatic in countries where the supply of medical professionals was already low before the pandemic. The intensifying shortages have been driven by numerous factors, of which the most significant are inappropriate management of health workforce, a lack of a rational human resources policy, failure to adjust the structure of employment to the nature and scope of services provided, inappropriate planning in the medical education and in many countries also insufficient financing of the health care system. There is an urgent need to introduce analytical, forecasting, and planning operations related to the education and employment of medical staff.

We believe that this Special Issue dedicated to health workforce will be a valuable voice in the discussion about the current challenges and importance of health workforce and their capacity planning processes in health care systems. By publication in this Special Issue, you can exchange knowledge and experiences with other researchers in the field of human resources for health.

Dr. Alicja Domagała
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

health professionals
medical staff shortages
professional development
medical education
task shifting
burnout
migration of medical staff
health workforce planning
health workforce policies
health care system

Published Papers (10 papers)

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Research

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18 pages, 1649 KiB

Open AccessArticle

Are We Facing a Radical Change in the Migration Behavior of Medical Graduates from Less Developed Countries? Demographic Profile vs. Social Push Factors

by Valentina Vasile, Elena Bunduchi, Daniel Stefan, Calin-Adrian Comes, Razvan Vasile and Anamari-Beatrice Stefan

Int. J. Environ. Res. Public Health 2023, 20(6), 4894; https://doi.org/10.3390/ijerph20064894 - 10 Mar 2023

Cited by 2 | Viewed by 1478

Abstract

The phenomenon of migration among medical personnel from less developed countries is a large one, with negative effects on the origin country, but more worrying is graduates’ propensity to migrate during or immediately after university studies. The analysis of the labor market in the health sector from the last two decades shows us greater attractiveness of employment in (more) economically developed states compared to the demand from the health sector in graduates’ origin countries. This research’s purpose is to identify the determinants of the propensity to study and work abroad of medical students as a defined factor for better employment, and to identify the push factors in the origin country. As a result of the dichotomous nature of the dependent variables, logistic regression was applied. The independent variables (gender, residence, medical specialization, grades and perceived economic status) were used to identify the odds of the intention to migrate for studies. The results highlighted a higher propensity to migrate for studies among medical students, with opportunities offered by universities differing across countries and geographical areas. Moreover, students with a lower level of household income have openness to migrate, the tuition fees being managed through part-time/temporary employment during studies. Full article

(This article belongs to the Special Issue Health Workforce and the Challenges of Health Care Systems)

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13 pages, 748 KiB

Open AccessArticle

Experiences of the COVID-19 Lockdown and Telehealth in Aotearoa New Zealand: Lessons and Insights from Mental Health Clinicians

by Benjamin J. Werkmeister, Anne M. Haase, Theresa Fleming and Tara N. Officer

Int. J. Environ. Res. Public Health 2023, 20(6), 4791; https://doi.org/10.3390/ijerph20064791 - 8 Mar 2023

Cited by 2 | Viewed by 2204

Abstract

Objective: The COVID-19 pandemic rapidly changed health service delivery and daily life. There is limited research exploring health professional experiences with these changes. This research explores mental health clinicians’ experiences over the first COVID-19 lockdown in New Zealand to inform future pandemic responses and improve usual business practices. Method: Thirty-three outpatient mental health clinicians in three Aotearoa New Zealand regions took part in semi-structured interviews. Interviews were analysed thematically applying an interpretive description methodology. Results: Three key themes emerged: (1) life in lockdown, (2) collegial support, and (3) maintaining well-being. Clinicians, fearful of contracting COVID-19, struggled to adapt to working from home while maintaining their well-being, due to a lack of resources, inadequate pandemic planning, and poor communication between management and clinicians. They were uncomfortable bringing clients notionally into their own homes, and found it difficult to separate home and work spheres. Māori clinicians reported feeling displaced from their clients and community. Conclusion: Rapid changes in service delivery negatively impacted clinician well-being. This impact is not lessened by a return to normal work conditions. Additional support is required to improve clinician work conditions and ensure adequate resourcing and supervision to enable clinicians to work effectively within a pandemic context. Full article

(This article belongs to the Special Issue Health Workforce and the Challenges of Health Care Systems)

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18 pages, 700 KiB

Open AccessArticle

The Stakeholders’ Involvement in Healthcare 4.0 Services Provision: The Perspective of Co-Creation

by Norbert Laurisz, Marek Ćwiklicki, Michał Żabiński, Rossella Canestrino and Pierpaolo Magliocca

Int. J. Environ. Res. Public Health 2023, 20(3), 2416; https://doi.org/10.3390/ijerph20032416 - 29 Jan 2023

Cited by 3 | Viewed by 2223

Abstract

Literature research on cocreation in healthcare indicates the theoretical sophistication of research on collaboration between healthcare professionals and patients. Our research continues in the new area of Health 4.0. Cocreation has become an essential concept in the value creation process; by involving consumers in the creation process, better results are achieved regarding product quality and alignment with customer expectations and needs. In addition, consumer involvement in the creation process improves its efficiency. Cocreation allows for more efficient diagnosis and treatment of patients, as well as better and more effective use of the skills and experience of the health workforce. Our main objective is to determine the scope and depth of the cocreation of health services based on modern technological solutions (Health 4.0). We selected four cases involving Health 4.0 solutions, verified the scale and scope of cocreation using them as examples, and used the cocreation matrix. We used literature, case studies, and interviews in our research. Our analysis shows that patients can emerge as cocreators in the value creation process in Health 4.0. This can happen when they are genuinely involved in the process and when they feel responsible for the results. The article contributes to the existing theory of service cocreation by pointing out the limited scope of patient involvement in the service management process. For cocreation in Health 4.0 to increase the effectiveness of medical services, it is necessary to implement the full scope of cocreation and meaningfully empower the patient and medical workers in the creation process. This article verifies the theoretical analysis presented in our team’s previous article. Full article

(This article belongs to the Special Issue Health Workforce and the Challenges of Health Care Systems)

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13 pages, 2514 KiB

Open AccessArticle

Factors Affecting Migration Intentions of Polish Physiotherapists and Students of Physiotherapy—A Cross-Sectional Study

by Daria Kostrzewa, Joanna Bonior, Maciej Polak and Alicja Domagała

Int. J. Environ. Res. Public Health 2022, 19(21), 14556; https://doi.org/10.3390/ijerph192114556 - 6 Nov 2022

Cited by 1 | Viewed by 2261

Abstract

The phenomenon of professional migrations in the healthcare sector may exacerbate the problem of health workforce shortages. The scale of migration of medical personnel in Poland is estimated mainly on the certificates issued by the regional chambers confirming qualifications that grant the legal right to practice in other EU countries. Migrations concern also physiotherapists, who are the third largest group of health professionals. However, the problem of this phenomenon has not been assessed, and there is a lack of research in this area. The aim of the study was to compare the intention of migration among practicing physiotherapists and students in the last two years of master’s studies in physiotherapy, as well as to identify the factors affecting their intentions to migrate. The study covered practicing physiotherapists and students in the last two years of master’s studies in the field of physiotherapy in Poland. A total of 236 respondents took part in the study, including 119 physiotherapists and 117 students of physiotherapy. The tool used for the study was an online questionnaire. The scale of the intention to migrate was estimated at 45.3% among students and 47.1% in the group of practicing physiotherapists. The most frequently indicated destination countries for the migration of physiotherapy students and practicing physiotherapists were Germany, Norway, Switzerland, France and the United Kingdom. In both studied groups, the pull factors with the greatest impact on the intention to migrate were the possibility of obtaining higher earnings and working in better infrastructural conditions. In turn, the most important push factors turned out to be the low prestige of the profession in Poland, limited prospects for professional advancement and the stressful work environment. The respondents most often indicated separation from loved ones and poor command of foreign languages as significant barriers to professional migration. Both students of physiotherapy and practicing physiotherapists show great interest in the intention of professional migration, and the decisive determinant is economic factors. Full article

(This article belongs to the Special Issue Health Workforce and the Challenges of Health Care Systems)

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12 pages, 331 KiB

Open AccessArticle

Professional Obstacles to Anaesthesiology Practice in Punjab, Pakistan: Qualitative Study of Consultant Anaesthesiologists’ Perspectives

by Sumbal Shahbaz, Rubeena Zakar, Florian Fischer and Natasha Howard

Int. J. Environ. Res. Public Health 2022, 19(20), 13427; https://doi.org/10.3390/ijerph192013427 - 18 Oct 2022

Viewed by 1326

Abstract

Limitations in the global anaesthesia workforce contribute to the emigration of skilled anaesthesiologists from lower-income to higher-income countries, jeopardizing workforce balance and patient outcomes in Pakistan. This study aimed to explore the challenges experienced by anaesthesiologists in Punjab, Pakistan’s most populous province, and the potential changes to encourage their retention. We conducted a qualitative study, conducting semi-structured interviews with 25 purposively sampled consultant anaesthesiologists working in Punjab and analysing data thematically. Reported professional challenges and reasons consultant anaesthesiologists chose to work abroad differed between public and private sectors, each sector providing distinct challenges that compromised anaesthesia workforce numbers and quality. Key concerns were security, promotion/incentive structures, and gender inequalities in public hospitals versus inadequate salary and facilities, surgeon dependency, and the lack of out-of-theatre practice in private hospitals that minimized the scope and earnings of anaesthesiologists within Pakistan. Our findings help contextualise Pakistan’s anaesthesia workforce crisis, indicating public-sector improvements could include increasing security in hospital premises, performance-based incentives, and qualification-dependent promotion, while private-sector improvements could include decreasing surgeon dependency, fixing salary percentages by surgical case, and encouraging direct patient-anaesthesiologist relationships. National and subnational interventions to promote anaesthesiology, along with public awareness campaigns, could additionally raise its profile and encourage retention. Full article

(This article belongs to the Special Issue Health Workforce and the Challenges of Health Care Systems)

16 pages, 681 KiB

Open AccessArticle

The Physical and Mental Well-Being of Medical Doctors in the Silesian Voivodeship

by Ewa Niewiadomska, Beata Łabuz-Roszak, Piotr Pawłowski and Agata Wypych-Ślusarska

Int. J. Environ. Res. Public Health 2022, 19(20), 13410; https://doi.org/10.3390/ijerph192013410 - 17 Oct 2022

Cited by 2 | Viewed by 1452

Abstract

Physical and mental well-being are important determinants of medical doctors’ lives, including their professional activity, which has a direct impact on the health and lives of patients. The aim of the study was to assess the health condition of medical doctors from the Silesian Voivodeship. The physical health condition, including the prevalence of chronic diseases, drug therapy, and pro-health activities, was assessed. Data on mental health according to the HADS scale (hospital anxiety and depression scale) referred to the selected socio-economic and professional aspects of life, as well as life and job satisfaction. The doctors most often reported diseases of the circulatory system and diseases of endocrine system, nutritional status and metabolic changes, allergies, and degenerative changes in the musculoskeletal system and connective tissue. Chronic diseases and anxiety or depressive disorders affected doctors aged 50–80 years more frequently, and those doctors undertook preventive pro-health activities more often. The higher risks of anxiety and depression were related to their social and professional roles, lower economic status, overweight or obesity, chronic diseases, pharmacotherapy, diets, and chronic fatigue. On the other hand, frequent physical activity, a longer sleep duration, smaller weekly workload, type of rest, a higher sense of job satisfaction, and a higher level of life satisfaction reduced the risk of disorders. The health condition of medical doctors in the Silesian Voivodeship requires decisive remedial actions in the professional and non-professional spheres. Full article

(This article belongs to the Special Issue Health Workforce and the Challenges of Health Care Systems)

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17 pages, 746 KiB

Open AccessArticle

Reducing Healthcare Employees’ Burnout through Ethical Leadership: The Role of Altruism and Motivation

by Yushan Wu, Qinghua Fu, Sher Akbar, Sarminah Samad, Ubaldo Comite, Mirela Bucurean and Alina Badulescu

Int. J. Environ. Res. Public Health 2022, 19(20), 13102; https://doi.org/10.3390/ijerph192013102 - 12 Oct 2022

Cited by 4 | Viewed by 3000

Abstract

Globally, employee burnout (EBO) is a black swan in healthcare management. Previous organizational management literature shows that EBO was often misunderstood by assuming it as a personal issue. However, the new definition by the World Health Organization (WHO) clearly indicates that EBO is an occupational phenomenon that places responsibility on organizations to manage it. Although recent evidence suggests ethical leadership (ELP) style may be important to mitigate EBO, shockingly, such relationships were not tested in healthcare systems, especially in low- and middle-income countries. Filling this knowledge gap in the existing body of knowledge, this study aimed to investigate the ELP–EBO relationship. To explain the underlying mechanism of how ELP reduces EBO, this study included two psychological factors as a mediator and a moderator: altruism (AL) and intrinsic motivation (IM). The data were obtained from hospital employees via a self-administered questionnaire (n = 289, paper-pencil method). A hypothetical framework was designed and tested for empirical validation through structural equation modeling (SEM). Empirical evidence confirmed that ELP reduces the risk of burnout among hospital employees, and AL mediates this relationship. The results also confirmed the conditional indirect role of IM in the above proposed mediated relationship. This study’s outcomes can help hospital administration deal with EBO’s epidemic in an ELP framework. Other, different implications have also been discussed in detail. Full article

(This article belongs to the Special Issue Health Workforce and the Challenges of Health Care Systems)

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11 pages, 880 KiB

Open AccessArticle

Choices of Specialties and Training Sites among Taiwanese Physicians Graduating from Polish Medical Schools

by Tzu-Ling Weng, Feng-Yuan Chu, Chiao-Lin Li and Tzeng-Ji Chen

Int. J. Environ. Res. Public Health 2022, 19(6), 3727; https://doi.org/10.3390/ijerph19063727 - 21 Mar 2022

Cited by 1 | Viewed by 1823

Abstract

Taiwanese students who graduated from Polish medical schools (P-IMGs) accounted for the second-largest group of international medical graduates in Taiwan. In 2009, domestic medical students in Taiwan staged mass demonstrations against P-IMG’s exemption from the qualifying test before the licensing exam. Although medical circles in Taiwan might still hold prejudices against P-IMGs, little is known about their career development. This study will analyze P-IMGs’ choices of specialties and training sites from 2000 to 2020 using data from the membership section of the Taiwan Medical Journal, the monthly official publication of the Taiwan Medical Association. Of 372 P-IMGs, 34.2% chose internal medicine and 17.1% surgery. Although academic medical centers offered 76% of all available trainee positions in a year, only 49.3% of P-IMGs received training there. By contrast, 20.9% of P-IMGs were trained at nonmetropolitan hospitals that altogether accounted for only 5.8% of trainee positions. In conclusion, P-IMGs had their residency training at less favorable specialties and sites. Their long-term career development deserves further study. Full article

(This article belongs to the Special Issue Health Workforce and the Challenges of Health Care Systems)

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Review

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20 pages, 1760 KiB

Open AccessReview

Methods and Tools Used to Estimate the Shortages of Medical Staff in European Countries—Scoping Review

by Kamila Parzonka, Costase Ndayishimiye and Alicja Domagała

Int. J. Environ. Res. Public Health 2023, 20(4), 2945; https://doi.org/10.3390/ijerph20042945 - 8 Feb 2023

Cited by 7 | Viewed by 2321

Abstract

Healthcare workforce (HWF) shortages are the biggest challenges today in healthcare systems. Therefore, it is crucial to forecast the future needs of HWFs in order to plan accordingly. The purpose of this study was to identify, map, and synthesize the tools, methods, and procedures for measuring medical staff deficits in Europe. We used the Arksey and O’Malley scoping review methodology. Based on predefined criteria, 38 publications that were retrieved from multiple scientific databases, hand-searched on the internet, from relevant organizations, and scanned from references were considered. They were published between 2002 and 2022. There were 25 empirical studies, 6 theoretical papers, 5 reports, 1 literature review, and 1 guidebook. The majority estimated or measured shortages of physicians (14/38) and nurses (7/38) or looked at HWF generally (10/38). Various methods were used, including projections, estimations, predictions, simulation models, and surveys, which used tools such as special computer software or customized indicators, i.e., the Workload Indicators of Staffing Need method. Researchers estimated HWF shortages at both national and regional levels. Such projections and estimations were often based on demand, supply, and/or need. These methods and tools are not always suited to the needs of a country or medical facility, which is why they need to be further developed and tested. Full article

(This article belongs to the Special Issue Health Workforce and the Challenges of Health Care Systems)

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17 pages, 578 KiB

Open AccessReview

Type of Findings Generated by the Occupational Therapy Workforce Research Worldwide: Scoping Review and Content Analysis

by Tiago S. Jesus, Karthik Mani, Claudia von Zweck, Sureshkumar Kamalakannan, Sutanuka Bhattacharjya, Ritchard Ledgerd and on behalf of the World Federation of Occupational Therapists

Int. J. Environ. Res. Public Health 2022, 19(9), 5307; https://doi.org/10.3390/ijerph19095307 - 27 Apr 2022

Cited by 4 | Viewed by 3087

Abstract

Occupational therapists are needed to meet the health and occupational needs of the global population, but we know little about the type of findings generated by occupational therapy workforce research conducted worldwide. We aim to synthesize these findings and their range of content to inform future investigations. A scoping review with content analysis was used. Six scientific databases, websites of official institutions, snowballing, and key informants were used for searches. Two independent reviewers took selection decisions against the eligibility criteria published a priori in the review protocol. Of the 1246 unique references detected, 57 papers were included for the last 25 years. A total of 18 papers addressed issues of attractiveness and retention, often in Australia, and 14 addressed the issues of supply, demand, and distribution, often in the US. Only these two categories generated subtopics. Many workforce issues were rarely addressed as a main topic (e.g., race/ethnic representation). Cross-national, cross-regional, or cross-professional studies generated more actionable findings. Overall, we found few discernable trends, minimal evidence of research programs, and various gaps in content coverage or in the use of contemporary research approaches. There is a need for a coordinated strengthening of the occupational therapy workforce research worldwide. Full article

(This article belongs to the Special Issue Health Workforce and the Challenges of Health Care Systems)

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