By Dr. Kevin Smith
Some of the greatest unsung heroes of this pandemic – and our healthcare system more broadly – are the personal support workers (PSWs) who often care for our most vulnerable citizens. As we consider what lies ahead for health professions, and those who support them, it is incumbent upon us to create an attractive future and career progression for our PSW colleagues.
Sadly, we often hear from PSWs a profound feeling of under-appreciation and a plan to leave the profession, in large part due to a shortage of full-time positions, poor compensation arrangements, a lack of benefits including a predictable retirement income, and a general perception that their unique skills and abilities aren’t valued. Yet it is these very individuals who we have seen, over and over again during COVID, keeping our long-term care system afloat, permitting home-care services to continue to function (thereby seeing hospitals able to discharge), and perhaps most importantly, supporting a high quality of life for those homebound residents during our last 24 months. Daily we see the need for a massive expansion of those who are called to this important work yet we also see and hear that this career path is deeply flawed and frustrating.
In many parts of the world, we are seeing extenders of regulated health providers as an important part of an evolving system. Has the time come for Canada to also embrace the model? This may be in large part due to an inadequate pipeline of regulated providers but also due to the importance of increasingly allowing regulated health providers to work their full scope of practice.
If this is a direction to which Canada aspires, then the opportunity to create specialized care roles, building upon the training and lived experience of PSWs, would allow us both from an employment and immigration perspective to attract those who might play a meaningful role in addressing the intractable problems of healthcare. These include the growing demand of geriatric patients who desire to stay at home, the post-acute care models that are de-institutionalized, the effort to create a rich and meaningful palliative care experience, and the pressure to meet the needs of complex paediatric patients and their families, to name but a few.
At University Health Network we have been fortunate to enjoy the expertise of the Michener Institute of Education at UHN. Indeed, we are the only academic hospital in Canada that is fortunate enough to have a health professional training school within it. As such, we see the opportunity to help address the massive human-resource shortfall of regulated providers through the creation of evidence-informed, pedagogically outstanding programming.
Such programs would ensure the very best education and training while seeing regulated providers truly work to their full scope of practice. In doing so we can and must value and respect the unique skill and ability of regulated health professions while also recognizing the important role that highly trained “extenders” can offer. This is hardly a new or bold idea internationally. This has been broadly adopted in other environments though not always based on rigorous educational programming and principles of adult education. This is an opportunity for Canadian higher education to not only impact our own healthcare system but offer a model for others to emulate and evolve.
As we combine the very best of the current professions with emerging technologies such as big data and artificial intelligence, we have the makings of a career path for those who start out as personal support workers who are willing to gain the knowledge and experience to bridge the shortcomings of our existing system. In talking to patients and families, we know that it is in the moments of transition between primary care and acute care, acute care and rehabilitation, rehabilitation and palliative care, or long-term care, where we most disappoint patients and families. Might this approach be part of the solution to our communications abyss, both between and among providers and most importantly with patients and families?
Like any skilled group of professionals, there must emerge a career path and a reward system that is attractive and desirable. We must create a meaningful plan to see the very best of our caregivers progress both in skill and reward. If the COVID pandemic has proved anything it is that it is incumbent upon all of us – governments, policymakers, healthcare organizations, and care delivery providers – to think differently about how we can coordinate care across the continuum in the future and reflect on the quality of work-life of the multidisciplinary team undertaking increasingly complex models of care.
Creating attractive career opportunities and progression for PSWs and ensuring an adequate supply of providers is not only our responsibility, it is our calling.
Dr. Kevin Smith is the President and CEO of University Health Network.
