Visions of a fluid healthcare workforce - Part 2

I recently posted on applying critical thinking skills to the celebration and criticism of Florence Nightingale, and how paradoxes require complex systems thinking (I call it, mapping the elephant) by nextgen nurses, healthcare professionals and decision makers at all levels (this post received 10K impressions, 100s of likes and fantastic comments).

I now try to recreate a similar critical thinking exercise using the paradoxes among healthcare workforce and their professional scope and boundaries. In this article I present,

1. Turf wars in healthcare according to GPT
2. An article describing professional boundaries as helpful (2022)
3. An article describing professional boundaries as barriers (2005)
4. A team who built and delivered a transdisciplinary training (x4 or more) during a pandemic and currently building a global curriculum for the rest of us - the best part, it is demonstrating a culture of inclusivity, diversity and equitable access to when upskilling or cross training (the impossible has been done, and repeated)

Part 1: A recap from GPT defining 'turf wars' among healthcare staff:

• "Turf wars in healthcare refer to conflicts or tensions that arise between healthcare providers over their roles, responsibilities, and authority in patient care. These conflicts can arise between different types of healthcare professionals, such as doctors, nurses, and pharmacists, or between providers from different organizations, such as hospitals and clinics."
• "Turf wars can negatively affect patient care, as they can lead to fragmented care, duplication of services, and confusion among patients and their families. In addition, they can create a stressful work environment for healthcare providers, leading to burnout and job dissatisfaction."

Part 2: An article describing professional boundaries as helpful (2022)

Farchi and team (2022) write about "The conspicuous presence of boundaries allows professionals to anticipate other team members’ expertise and roles, as well as different aspects of team tasks. We theorize our findings by showing how professional boundaries can be positively interlaced with interprofessional collaboration by making visible and grounding naturalized systems of classification."

While, they demonstrate theoretical perspectives and draw conclusions from their study looking at both softened boundaries in one group and broken-down boundaries in another, I have a hard time with this.

We know that teams and culture takes time to form.

When anthropologists study cultures they are attentive to links and flows between macro- and microenvironments, and pay close attention to the distribution (and maldistribution) of resources, in short. If I am to refer to the image above, who deals with the black hole in the middle of the healthcare professional circle?

As someone who has worked in the Southern hemisphere and the Arctic regions in Canada, a warm body, deals with the space left in-between (the black hole). The lack of staffing and expertise, leaves community health workers and lesser trained folks in nursing care, to deliver the point-of-care service required in that context. Regardless of training and competencies. The work needs to get done. (I will write on this more in a future article)

This is why, a fluid workforce in healthcare is the answer to the existing workforce complexities. Allowing individuals to upskill, cross-train and reskill based on the context and environment they find themselves. (Imagine that there are skills based co-ordinators in place to help with these kinds of training needs) Task oriented work, which is common among nurses scope, could be re-adapted for the current system's need. The pandemic demonstrated that this can be done, and it has been done (using low-cost technologies), further describe below, in part 4.

Part 3: An article describing professional boundaries as barriers (2005)

Pippa Hall (2005) describes very eloquently the reasons and compexities as to why professional boundaries are hindering, in her paper:

"Each health care profession has a different culture which includes values, beliefs, attitudes, customs and behaviours. Professional cultures evolved as the different professions developed, reflecting historic factors, as well as social class and gender issues. Educational experiences and the socialization process that occur during the training of each health professional reinforce the common values, problem-solving approaches and language/jargon of each profession. Increasing specialization has lead to even further immersion of the learners into the knowledge and culture of their own professional group. These professional cultures contribute to the challenges of effective interprofessional teamwork. Insight into the educational, systemic and personal factors which contribute to the culture of the professions can help guide the development of innovative educational methodologies to improve interprofessional collaborative practice."

On culture and drivers of the 'Great Resignation' cannot be avoided either,?

• “A toxic corporate culture is by far the strongest predictor of industry-adjusted attrition and is 10 times more important than compensation in predicting turnover.” - Sull, Sull and Zweig, 2021?

The WHO sounds the alarm bells for the healthcare workforce crisis regardless of country's GDP and economic status. The chronic under-investments can no longer be ignored, so debates on scope and professional boundaries needs to take a complex systems approach for any solution to appear, and such solutions be successful in a digital age.

The Sustaining Nursing in Canada report (2022) describes 3 top strategies:

1. Retain and support
2. Return and integrate
3. Recruit and mentor

While all 3 are important at the same time, which group would hold the greatest levels of corporate memory (the gold we need)? Where do you find workforce capacity at its best to lead, mentor the novice and deliver care today?

As mentioned previously, culture remains the largest predictor of attrition in the workplace. If decision makers do not actively find innovative ways to return skilled workers, will 1 and 3 even show up?

I have yet to hear anyone talk about job-sharing.

I have worked in a job-share position and it is fantastic. Happy to explain to those interested.

But let's get to the true leaders who have demonstrated that transdisciplinary, evidence-based, innovative training can happen, which further demonstrates that a fluid workforce is possible in public health training and beyond.

Part 4: WHO infodemic management and using simex to train new competencies in public health (2020-2023 and beyond...)

The WHO infodemic management team delivered their first SimEx training on Nov 2020 called 1st WHO infodemic management training and since then delivered subsequent trainings followed by

1. Online certification - WHO Infodemic Management 101
2. Competency framework
3. Research agenda
4. Currently, building a global curriculum for beyond the pandemic

However, I would like to focus on the fact that using low-cost technologies such as whatsapp groups, zoom calls, and shared documents, they were able to train over 1400+ folks, across 140+ countries, 16+ time zones, and deliver 'best-evidence-at-the-time' (avoiding the 17 years common for new evidence to enter into helathcare practice).

This is incredible effort, and the impossible has been accomplished.

Building the plane while flying, really.

This is the best example for using the latest technologies to support motivated individuals to stretch their competencies further.

Imagine if this kinds of activities existed across healthcare specialties. This is why I believe a fluid workforce in healthcare is not only possible, but it has been demonstrated. This example focuses on infodemics, but it is possible for all areas in healthcare, and beyond.

I wrote about this in a previous article here and image on nurse licensing here.

The problems are complex, so I don't mean to suggest that online training and building a community of practitioners could be the answer. But getting everyone access to the most recent evidence IN PRACTIC should be the focus for all administrations and decision makers.

In order to keep this article short and briefly touch on the opportunities for building a modernized training program during emergency response and beyond, I will leave it here.

But I do hope those who have the power to channel funding towards hiring staffing and offering trainings will take a look at their elephant size legacy process and find tiny steps to usher in adaptation and offer easy ways to upskill, reskill and cross train those folks with 5+ years of practice experience, and do NOT watch them leave the system.

Adaptabelfolks.com is here to help support your adaptation transformation as your trusted partner in crime : )

Cheers

Renata