A path to improved health workforce planning, policy & management in Canada: The critical coordinating and convening roles for the federal government to play in addressing 8% of its GDP

The goals of a health workforce system are to develop, deploy and sustain an integrated and collaborative network of health workers that is equipped with the necessary skills, supports, incentives, and resources to provide quality care that meets all population health needs in an acceptable, equitable and cost-effective manner. This requires robust data and evidence. A key problem in Canada is that it lags behind comparable OECD countries in terms of health workforce data and digital analytics. As a result, health workforce planning here is ad hoc, sporadic, and siloed by profession or jurisdiction, generating significant costs and inefficiencies for all involved. Health workers in Canada account for more than 10% of all employed Canadians and over 2/3 of all health care spending which amounted to $175 billion in 2019, or nearly 8% of Canada’s total GDP.[i]Recognizing these facts, supporting strategic health workforce planning, policy and management ought to be key priorities for federal and provincial/territorial governments and other health care organizations. Across all the different stakeholders that make up the complex adaptive health workforce system in Canada, we lack a centralized and coordinated health workforce data, analytics, and strategic planning infrastructure, a neglect that has been readily acknowledged for over a decade. The significant gaps in our knowledge about the health workforce have been exposed during the COVID-19 pandemic causing critical risks for planners to manage during a health crisis. The time is ripe for the federal government to take on a coordinating leadership role to enhance the data infrastructure that provinces, territories, regions, and training programs need to better plan for and support the health workforce. Efforts should centre on three key elements that will improve data infrastructure, bolster knowledge creation, and inform decision-making activities: A new data standard and enhanced health workforce data collection across all stakeholders More timely, accessible, interactive, and fit-for-purpose decision support tools Capacity building in health workforce data analytics, digital tool design, policy analysis and management science. This vision requires an enhanced federal government role to contribute resources to coordinate the collection of accurate, standardized, and more complete health workforce data to support analysis across occupations, sectors, and jurisdictions, with links to relevant patient information, healthcare utilization and outcome data, for more strategic fit-for-purpose planning at the provincial, territorial, regional, and training program levels. In this paper, a proposed vision for enhanced federal support to data-driven and evidence informed health workforce planning, policy and management is presented. First, two data infrastructure and capacity building recommendations include: the federal government should create through a specially earmarked contribution agreement with the Canadian Institute for Health Information a Canadian Health Workforce Initiative dedicated to the necessary enhancement of standardized health workforce data purpose built for strategic planning purposes and associated decision-making tools for targeted planning. In addition to the need to build better data, digital tools, and decision-support infrastructure, there is a parallel need to build the human resources capacity for health workforce analytics. Through a special CIHR-administered fund to build health workforce research capacity, this could include a Strategic Training Investment in Health Workforce Research and a complementary Signature initiative to fund integrated research projects that cut across the existing Scientific Institutes. Building on these two necessary but insufficient building blocks, three options for a coordinating pan Canadian health workforce organization could include one of the following: The federal government could create a dedicated Health Workforce Agency of Canada with an explicit mandate to enhance existing health workforce data infrastructure and decision-support tools for strategic planning, policy, and management across Canada. The federal government could support through a contribution agreement the creation of an arm’s length, not-for-profit organization, Canadian Partnership for Health Workforce, as a steward of a renewed health workforce strategy and to provide health labour market information, training, and management of human resources in the health sector, including support for recruitment and retention. The federal government could support the creation of a more robust, transparent, and accessible secretariate for a Council on Health Workforce, Canada to improve data and decision-making infrastructures, bolster knowledge creation through dedicated funding and policy to inform decision-making and collaborate on topics of mutual interest. Because of the importance of the health workforce to Canada’s economy and pandemic recovery, a sizeable and sustained investment over the course of at least 10 years is needed to build the necessary infrastructure for better decision-making. In addition to building a more robust health system for Canada’s post pandemic recovery, these actions would align with the World Health Organization’s Global Strategy on Human Resources for Health (2016) which encourages all countries (including Canada) by 2030 to have institutional mechanisms in place to effectively steer and coordinate an inter-sectoral health workforce agenda and established mechanisms for HRH data sharing through national health workforce accounts. [i] In 2019, healthcare constituted 11.5% of GDP. Although the data are not readily available for the full costs of the health workforce, it is generally accepted that approximately 70% of health care costs are the costs of labour; 70% of 11.5 is 8.05.

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