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August 07, 2019
Do we really need more doctors?
By: Niamh McKenna

What’s really most important when you’ve got a deep gash in your arm? Having a “Doctor” stitch up your wound, or simply having the best qualified and most experienced person to do it, irrespective of title?

It’s time for the Healthcare industry to have a really honest conversation with itself about the dire need for healthcare skills, and how to find or build them—for the sake of a sustainable system that continues to meet patient needs at an acceptable standard. Health professionals also need to think about what they find stimulating, what is routine and how much of it could be done by others, or even by machines. There is very much a need to get a better understanding of the workforce through data and there is a pending workforce crisis which shows no signs of improving.

I’ve talked to general practitioners who tell me that often what they provide in terms of care really doesn’t require an entire medical degree to handle. Which raises questions like: “Who is the best person to diagnose another case of the common cold, or simply to renew a prescription for contraceptives or chronic asthma medication?” and “Where do we strike the balance between speed/convenience and finding underlying problems masked by seemingly straightforward symptoms?”

The shift is already happening to some degree. If, today, you have a wound that needs stitching in the UK, an Advanced Nurse Practitioner is most likely to do it in a lot of hospitals. Similarly, some traditional nursing tasks have already moved to healthcare assistants (as have tasks in physio- and occupational therapist practices). Physician assistants (normally nurses who do additional training) are covering a lot of what would previously have been junior doctors’ tasks. They also tend to remain on one task rather than rotating, and so end up having deeper specialisation and insight in their area of expertise. In resource-poor settings, surgery is now being done by technicians with supervision from surgeons who manage multiple theatres at any one time. But what if we were to fundamentally let go of the concept of job titles? How could this benefit healthcare professionals and their patients?

Data—creating new professional paradigms

Could we use insight on workforce data to find some new and interesting healthcare profession paradigms? In Accenture’s workforce data study, Decoding Organizational DNA, 91 percent of the 1,400 C-level business leaders we surveyed in 13 major economies recognize that new technologies and sources of workplace data can be used to unlock value that is currently “trapped” in the enterprise. The new paradigms are disruptive, they involve lots of stakeholders and can inspire a lot of caution in healthcare. The reasons are obvious: If you get things wrong, people can die. When you introduce technology in retail or banking, nobody (generally) dies.

Nevertheless, as Ulla Kuukka points out in her blog, workforce data is already telling employees in other industries how vulnerable their job is to automation, using algorithms to identify adjacent skills and employee interests, suggesting roles appropriate employees might aim for with a little development—and then identifying specific training to narrow the skill gap. Our study also documented that 64 percent of those surveyed have concerns regarding the misuse of employee data. Honesty about these fears, transparency about the process and focussed and effective communication are the only ways to address these fears, and also communicate the benefits to both patients and healthcare professionals. There are no short cuts. So again, let’s ask: What if we were to let go of the traditional concept of a “role” or “profession” in healthcare?

What would happen if we simply understood what skills are needed in a particular microcosm of the health ecosystem—like the A&E, for example, and made sure those skills were available as needed? After all, as early as 2016, the World Economic Forum was saying“… data shows that a job title alone doesn’t tell you what is required for that job. That’s because a job title can mean different things in different industries and geographies. Instead, the best way to navigate the rapid change in supply and demand of skills is to describe each job as an agglomeration of skills.” This approach to skills would place individual healthcare professionals somewhere on a continuum of healthcare, rather than labelling them.

Lack of understanding may be stopping us radically changing the workforce model

Health has always been an industry hungry for data—tests and measurements already guide insight. So why is the industry not using the workforce data it has access to? I think part of the reason is the fact that healthcare workers don’t always understand how the benefits could apply to them, and are put off by the disruption that a more cross-organisational structure could pose to their traditionally silo-based environment. The blurring of roles, technology that could make a lot of training pointless—these are potentially scary ideas. To make things worse, healthcare workers are not typically inclined to change. A 2018 study titled “Resistance of health personnel to changes in healthcare” notes: “The implementation of changes in medical facilities (changes in the healthcare system) is not an easy issue. Usually, only a small number of medical workers are inclined to changes, i.e., they are willing to participate in changes, or their personality tends to accept changes.”

The change in paradigm based on workforce data will be enormous. Job profiles need to get more flexible using data support, and data could help you do your job better, make your job more interesting, share tasks in a more interesting way—not only interacting with machines, but with other humans, while you might be given new, more advanced tasks.

The bottom line is, we have to use workforce data to help us rethink the workforce model. We can’t just focus on reskilling—it simply won’t make up for the chronic shortage of healthcare professionals. Acknowledging that healthcare is lagging other industries while also acknowledging genuine concerns about the challenges of this new world, definitely requires a grown up conversation. Being open and transparent is a good way to start—to allay people’s fears in a complex ecosystem with a diverse stakeholder group.

In the meantime, I think we’re kidding ourselves. While we avoid the conversation, change is happening regardless. We should be getting on the front foot, understanding how workforce data can impact people’s jobs, improve the provision of healthcare and health outcomes. Or, we could continue to avoid the conversation and have the revolution happen without an honest conversation.

I’m sure you might have some opinions on this, so please get in touch if you do. I’m more than happy to chat about these scenarios and their implications.

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