Informing policy to support regional health human workforce planning for integrated care models: Results from a qualitative study

Background: In the province of Ontario, Canada, Ontario Health Teams were introduced in 2019 to support the needs of their local populations by bringing health care providers and sectors together to deliver seamless care. Ontario Health Teams are a model of integrated care and an example of large-scale health reform focusing on local populations and regional health workforce.  However, there is currently sparse evidence and policies to support local health workforce planning.  While several approaches have been proposed, many are siloed, focusing on one profession, sector or population.  In addition, a substantial amount of the research has focused on the perspectives of the larger scale health system or a specific discipline.  The objective of this study was to understand regional health workforce planning from the perspectives of systems leaders, providers and community members.

Approach: A qualitative descriptive approach was used to focus on understanding current regional approaches to health workforce planning as well as contextual factors that influence this planning. This qualitative component was part of a larger mixed methods case study design that was conducted collaboratively with one Ontario Health Team with the overall goal of informing policy to support regional health workforce planning.  Key informant interviews were conducted with regional decision makers, systems leaders, providers and community members.  In partnership with the Ontario Health Team, we identified and recruited participants to reflect  the diverse perspectives across the multiple sectors and roles including primary care, hospitals, community partners and caregivers. Interviews were transcribed verbatim and analyzed using reflexive thematic analysis. Three members of the team conducted the analysis, developing a code book with regular meetings to encourage reflexivity about data analysis coding procedures.

Results: Fourteen individuals were interviewed. Four themes were generated from the data: i) Getting By... which reflected the current reactive approach to planning, issues of supply and demand resulting in competition, lack of collaborative planning and insufficient resources including data, time, staff, tools, governance and funding, ii) Driving Forces which focused on external priorities and pressures that influence workforce planning, iii) (In)Capacity for Change,  focusing  on structural challenges including funding models, unions, and a focus on organizational needs vs the overall population needs , [AO2] and iv) Innovative Solutions such as 1) standardized, granular and current data on relevant populations, services and workforce both present and future 2) regionalized planning, sharing of resources and a regionalized workforce 3) appropriate resources such as funding, dedicated tables and staff with sufficient time and skills 4) evaluating needs and models of practice and 5) inclusion of, and resources for, patients, informal caregivers and volunteers.

Implications: The results highlight inequity across the sectors to support health workforce planning including the availability and use of data, resources, expertise, time, and models.   Integrated models of care can serve as a leveler to conduct this work in a manner that is equitable across the health care system, promoting partnerships, strong leadership, governance and accountability.  One key issues is the need for collaborative and pro-active approaches across disciplines, sectors and organizations.