By Ivy Lynn Bourgeault
It is no longer hyperbole to say that we are witnessing our health system moving slowly but surely to a point from which it will be very difficult to return.
Despite the weighty First Ministers meeting with the Prime Minister on healthcare last week, complete with a lot of promises, health workers continue retreating from the system, as they have for the last year, in a sort of slow-motion form of resistance.
Health workers are reducing their hours from increasingly toxic work environments, moving to more attractive positions in the private sector or leaving their professions entirely.
The work of health care has always been challenging but work environments at present can only be described as toxic because of shortages of workers, because of the endemic and rising levels of violence and because they can’t do the job they love, taking care of those who need it under such circumstances.
The work of health care lacks support for our health workers.
Canada’s health workers are sounding the alarm and we must heed their wake-up call. The meeting should have been about our opportunity to reform the health system to better support health workers, better care for our population and ultimately create a more sustainable system that will be there when we need it regardless of our age.
Governments need to act swiftly and boldly. The days of incremental change have passed.
The recent First Ministers meeting announcements addressing needed supports for health workers are a step in the right direction. But is it enough?
Across each of the identified areas of shared priority — primary care, service backlogs, mental health and substance use, health system modernization — a strong health workforce will be required to deliver on these initiatives.
Thankfully, solutions to support health workers are at hand.
Report after report has called for action to address the immediate issue of retention– to stop the bleeding of health workers from our public health systems. Provincial/territorial governments – with support from the federal government — should spread and scale evidence-informed retention initiatives with targeted investments in partnership with employers and health authorities.
Employers should be supported by all levels of government to act decisively to foster safe, healthy and supportive work environments.
We also need to foster the return of health workers who have retreated from the public healthcare system. Provincial and territorial governments should fund flexible return-to-practice programs. Employers should provide mentorship and other supports bridging workers’ return to work.
Other workers we need to return to work in our health systems are those in Canada with international training.
The federal government should enhance supports for bridge training and mentoring programs. Provincial/territorial governments should support these health workers while training and continue to encourage regulators to streamline the licensure recognition process. Employers should implement paid mentorship and support from experienced practitioners to ease integration pathways.
Strategic and supported recruitment pathways are also needed.
Here, the federal government should target tuition support for work of a broad range of health workers in underserved sectors and communities. In partnership with provincial and territorial governments, it should also support faculty recruitment to enable increased capacity in the training system.
Employers should support the training capacity of clinical faculty through funded secondments in partnership with universities and colleges. Provincial/territorial governments should also scale programs that support transitions from training to employment.
The spread of these and other promising retain-return-recruitment initiatives from other jurisdictions requires dedicated leadership, infrastructure and funding.
Once these measures are implemented on multiple fronts, we need to look at upstream strategies to help prevent future crises. Here the meeting announcement to create a Centre of Excellence on health workforce data is crucial.
Enhanced health workforce data accessible through interactive platforms will enable various decision-makers to embed health workforce planning into their ongoing decision-making processes. This is the role that such a Centre should support. This should include digitally enabled tools for employers and regional authorities to integrate into their ongoing planning.
Provincial/territorial governments would be better supported to initiate or reinstate integrated health workforce planning in collaboration with educators, regulators, employers and unions/professional associations. And employers would be better able to utilize human resource information systems to embed ongoing planning for safe staffing.
Leaving these chronic health workforce issues unaddressed has critical impacts beyond the workforce itself. Patient safety, quality care and health system sustainability are also at risk. There are also implications for the economy, as we’ve all witnessed.
Let’s listen to and support health workers.
It is imperative that all levels of government act now.
Dr. Ivy Lynn Bourgeault is a Professor and Research Chair at the University of Ottawa and the Lead of the Canadian Health Workforce Network.
