Healthcare Horizons - A Workforce Perspective

Last year Anna van Poucke brought together a number of experts from the global KPMG Healthcare practice to think about what healthcare in 2030 might be like and the actions we should take today to ensure services are patient centric, responsive and sustainable. The outcome of this work #HealthcareHorizons was published last month and describes three potential futures. Below I look specifically at some of the important the workforce considerations necessary to ensure systems thrive in the future and the actions they must take today Professor Mark Britnell Anna van Poucke Evan Rawstron Beccy Fenton Gordon Burrill Lydia Lee Jason Parker Matt Roberts Dean Royles James Devine FCIPD Deanna Heroux HPMA Healthcare People Management Association Navina Evans Emma MacLellan-Smith Em Wilkinson-Brice Thomas Simons Roujin Ghamsari (FCIPD) Janet Wilkinson Jayne Adamson FCIPD Professor Stephen Eames CBE Rob Webster Samantha Allen Samantha Jones OBE Julian Hartley Wayne Yeung

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Retention and Attraction

Love, support and invest in the workforce of today and your workforce of the future

The extant workforce shortage, staff burnout and the expansion of universal healthcare?will intensify the competition for staff.?In other words, it’s an employees' market.?This competition and the rapidly changing composition of the workforce presents both?opportunities and challenges. Over the next seven years?baby boomers and early?generation X will?retire and?be replaced?by a workforce from generation Y and Z, with?very different needs and expectations of the workplace. Employers must be alive to this and do everything they can to attract and retain staff by offering competitive remuneration?and an employee value proposition which appeals to generations X, Y and Z.?Easy access to physical and psychological support,?better options for flexible and part-time work, support with childcare, substantially more investment in learning and development and greater staff?empowerment are all essential.?For example, nurse and midwife departure rates in the NHS acute sector vary significantly by age and gender. For women, the highest probability of leaving is between 30-34 years of age, while for men the probability of leaving remains consistently low from ages 18-49. This difference is primarily driven by people having children and the fact that women are often the primary carer.[1]

Addressing?student and early career attrition in the west is also a priority but frequently overlooked. Reducing this attrition by 30% from 2025 would increase the available workforce in developed countries by over a million by 2030 and materially improve access to care. In the United Kingdom for example almost 30% of undergraduate nurses do not complete their?course of study and a further 20% leave the health service within two-years of qualifying.?The story is similar in Australia where 17% of students drop out prior to graduation and in Canada, 37-57% of new graduate nurses leave within two years of entering the profession[2][3]. Using data to identify those at greatest risk, providing intensive support and strengthening the financial incentives for senior staff, colleges, universities and employers is important.?In the future we will see the personal remuneration of senior?clinicians and board members linked to the experience and retention of trainees and early career staff.

Generation Z

There is no shortage of young people who want to be doctors; most developed countries have at least five candidates with the relevant qualifications for each place at medical school.?However,?there is much more governments and employers must do to inform and educate young people about other careers?in healthcare and to make them attractive.?Given?the strong social conscience of generation Z this should be pushing at an open door. In the National Health Service (NHS) in England for example, there are over 250 unique job roles, most of which the average teenager will have no awareness of.?Governments, health systems and individual employers who proactively engage young people to raise their awareness of potential careers and invest in the expansion of training places will be the best placed to meet future needs. At the same time, it is important to inform those responsible for funding education that an expansion in places is an investment rather than a cost.?For example, recent research by the NHS Confederation in England showed a four times ROI associated with the expansion of healthcare roles.

A workforce to support digital transformation

To achieve the vision described in Healthcare Horizons 2030 providers will have to significantly expand the workforce in digital, data and cyber.?Some specific examples of this include

Increases in the number of cyber security specialists.?Healthcare is already a target for cyber criminals with 92% of providers subjected to an attack in the last year.?Personal health?data is usually highly confidential and extremely valuable and as a result will make the sector even more attractive to criminals and rouge states.?Competition for talent in this area will be intense, with healthcare organisations, competing with other sectors such as financial services. At a practical level this means health systems and providers need to think about how they differentiate their employee value proposition and reward structure.?At the time of writing most healthcare organisations source and employ their?staff from the area they service.?Looking forward they need to consider alternative onshore, near shore and offshore options.

The ability to draw actionable insights from the sea of genomic, wearable and other data which will exist about each patient or citizen in 2030 will be critical to achieving the vision described.?To do this there will need to be a rapid expansion in the number of data scientists and data analysts and significant investment in training and development.?Local health and care systems should be starting to work much more closely with colleges and universities now to create a pipeline of data scientists for the future, review the employee value proposition and challenge themselves regarding their delivery model including their appetite to use off-shore resources.?At KPMG for example up to 60% of the hours spent on engineering, data analytics, technology implementations etc... come from near shore and offshore employees.?Most healthcare organisations have been slow to consider or adopt a similar model despite the obvious benefits.

Key Takeaway

A multifaceted approach will be required to alleviate the demands of the healthcare system, especially for highly desirable skillsets like registered healthcare professionals and digital and data. Governments, educators, and employers will need to consider increasing the number of graduates, retaining them in the workplace and attracting talent from other countries.

At?KPMG Healthcare we have teams of experts?to help providers:

???????Develop their employee value proposition and understand and address the causes of burnout?

???????Develop their broader workforce strategy

???????Understand?their future workforce requirements and plan for these

???????Develop their workforce strategy for digital and data based on their broader strategy and the trends described in Healthcare Horizons

Micro-credentialing

Necessity is the mother of invention

Governments across the world are slowly waking up to the enormity of the global workforce crisis, highlighted by the World Health Organisation?(WHO) in 2019 and exacerbated by Covid-19.?However, few countries have committed to the expansion of trainee numbers required to address the shortfall and?even those who have will experience a?shortage in 2030 due to the time it takes to?train new doctors (15 years), nurses (3-5 years) and other healthcare professionals. As a consequence, global competition for registered healthcare professionals in 2030 will be intense and most providers and systems will have a capacity shortfall.

One notable opportunity providers’ have to address this medium-term capacity and skills shortage is by training and accrediting people to perform tasks previously performed by someone else.?The global rollout of the Covid-19 vaccines at the beginning of 2021 is a good example of where this was done through necessity.?In most western countries thousands of people were trained and accredited to administer the vaccine under strict protocol to expedite the rollout.?Had this approach not been adopted and countries relied upon the staff traditionally employed to administer vaccines?it would have taken doctors, nurses and healthcare professionals away from other duties and many of us would still be waiting for our first dose.?This approach is axiomatic when one considers that registered healthcare staff spend 80% of their time performing activities, they are under-qualified for; this time is latent capacity.?

To achieve this requires providers to engage with their regulators to agree the specific activities which can be performed in this way and the training, supervisory and regulatory systems to do so.?They must then work with universities and colleges to develop relevant training (like consumer grade learning) and assessment.?In 2030, this will be the norm, with providers, regulators and education providers working together to train and accredit staff to perform additional tasks.?To achieve this, it requires clinical leadership to challenge convention and work closely with regulators and training institutions.?Although there will inevitably be some opposition to this approach, there is huge scope to increase our capacity to care.?At KPMG Healthcare we have teams of experts in healthcare regulation to help providers on this journey.

The other short-medium term opportunity to?increase the capacity to care is to scale new roles, especially where these don't take as long to train as more traditional roles.?Physicians Assistants, Anaesthetic Assistants, Nursing Associates/Practical Nurses, Healthcare Aides, and Personal Support Workers are all registered roles which have been successfully introduced in small numbers by some providers. However, in most countries the number of these practitioners can still be counted in the tens and hundreds not in their thousands.??

Key Takeaway

Micro credentialing of clinical duties to a non-clinical workforce will be pivotal to ensuring that the existing specialized workforce like physicians and nurses can continue to operate at the top of their scope instead of performing under-qualified duties. Policymakers will also have to work closely with care providers to create regulations and standards that will ensure that these new subsets of workers are held to the same account as their licensed clinical colleagues.

At?KPMG Healthcare we have teams of practitioners?to help providers:

???????Assist organizations with strategic workforce planning to predict the future of where skills will be most needed

???????Support the development of a long-term people strategy to help attract and retain top talent

???????Develop organizational learning strategy to enable the workforce to continually upskill through micro-credentialing

???????Support the development of healthcare regulations with policymakers to enable a micro-credentialed workforce

The Future of Middle and Back Office in Healthcare

Effective middle and back-office functions are essential to the success of any high-performing provider or healthcare system; however, they are also a cost?for both payors and providers.?In 2030, both payors and providers will benefit from much smaller middle and back-office functions as a result of their investment in technology.?For example: The NHS in England spends ￡1bn a year on Human Resources (0.7% of its total budget).?Recent studies have shown that 90% of the work performed by this function is administrative?in nature, recruitment is a good example of this. Similarly, in the US, more than 30% of hospital and healthcare costs are due to administrative tasks, further highlighting the need to digitally enable processes to alleviate the financial pressures within healthcare systems and realize further value for patients by bringing down the cost of care.[4] Compared to other sectors of the economy, the NHS and other public care systems have been slow to appreciate the financial and operational benefits?that solutions like ServiceNow, Workday, Oracle?and SAP can realize.?In 2030 these solutions will be universal as healthcare providers/employers across the world recognise the huge competitive advantage they offer.??

Globally, health and care systems spend over $20bn a year?coding clinical activities into billing systems.?In Beveridge (tax funded) systems this is typically 1-2% of health spending and as high as 5% in the US where there are public and private payers[5]. Coding of clinical activities are crucial both to provide population level information?on the incidence of disease and treatment and for the purpose of billing.?With the advent of machine learning much of this activity will be performed using AI technology in the future as opposed to people, releasing human capital and cost. These savings could be significant given that the Americans spend the highest per capita on health administration. The Journal of American Medical Association found that it took 13 minutes and $20 to process the billing for an average primary care visit and up to 100 minutes and over $210 per inpatient surgical procedure.[6] While in single payer systems the effort expended for billing is significantly less, opportunities to streamline middle and back-office processes are paramount to alleviating workforce and financial constraint pressures.

Key Takeaway

Those in a position of leadership should be actively planning their adoption of digital solutions in the middle and back-office to reduce their costs, drive competitive advantage and improve the patient and employee experience.?The financial and economic?case for the adoption of such solutions is highly compelling and will drive the transformation of these services. Leaders also need to think about the readiness of their workforce to adopt such technologies as benefit realization of digital transformations will be hindered otherwise.

At?KPMG Healthcare we have teams of experts?to help providers:

???????Enable a people, process, and technology approach for digital transformation by leveraging our target operating models to help organizations free their people of onerous administrative tasks

???????Support organizational wide digital transformation by leveraging our ready-to-use Connected Enterprise and Powered for Healthcare methodology to help accelerate adoption of cloud technology in Finance, HR and Supply Chain functions

[1] Factors associated with staff retention in the NHS acute sector. Elaine Kelly et al. Aug. 2022.

[2] Stemming the tide of nursing attrition: developing resilience via peer mentorship program. Lisa Sanzone et. Al. Oct. 2021

[3] Health at a Glance. OECD. Nov. 2021

[4] Administrative expenses in the US Health care system – Why is high? Michael Chernew and Harrison Mintz. JAMA. Oct. 2021

[5] Administrative expenses in the US Health care system – Why is high? Michael Chernew and Harrison Mintz. JAMA. Oct. 2021

[6] Administrative expenses in the US Health care system – Why is high? Michael Chernew and Harrison Mintz. JAMA. Oct. 2021