Background
Case presentation
Regional health workforce monitoring in Rhineland-Palatinate, Germany
The regulatory and occupational contexts
The conceptual dimension: methods, tools and actors
Dimensions of monitoring | Governance tools |
---|---|
Information: data collection and quality improvement | • Efficient/‘intelligent’ data collection through the matching of primary data collection and secondary sources, representative statistics and qualitative explorative expert knowledge, and time series • Expert review and multiple stakeholder perspectives to improve quality of data • Expansion and adaption of data source and categories • Standardization of workforce categories |
Communication: stakeholder involvement and networking | • Joint assessment of data and knowledge • Shared decision-making based on transparent criteria • Collaboration and coordination between stakeholders, sectors and professional groups • Pioneering cross-border collaboration and coordination • Developing governance structures bottom-up to reduce institutional gaps and transaction costs |
Decision: policy-making and implementation | • Building structure and formalizing bottom-up decision-making and stakeholder involvement through establishment of a board of (a broad range of) stakeholders • Developing participatory governance • Establishing cross-border stakeholder groups and decision-making bodies • Connecting health and education systems to improve policy implementation • Developing thematic working groups to facilitate implementation • Defining success criteria and target setting • Evaluating policies to promote transparency |
The empirical contribution: selected illustrative results of an integrated monitoring
Category | Registered nursesa | Assistant nursesb | Developments in relation to qualification mix |
---|---|---|---|
Workforce trends (1999–2011) | 22.5% increase | 7.5% increase | % increase in RNs is 3× higher than in ANs |
Qualification mix trend 1999–2011 | 7.9 RNs:1 AN (in 1999) | Relevant increase in qualification overtime | |
9.0. RNs:1 AN (in 2011) | |||
Qualification mix per sector, 2011 | The share of RNs per AN is nearly five times higher in the hospital sector than in LTC | ||
Hospital | 22.4 RNs:1 AN | ||
LTC | 4.9 RNs:1 AN | ||
Nursing staff per sectorc | Hospital sector is better resourced in numbers and qualifications | ||
Hospital (54%) | 95.7% | 4.3% | |
LTC (46%) | 83.2% | 16.8% | |
Mobility (% of total) | Mobility is overall low; outflow of RNs 6.5× higher than inflow, outflow–inflow of ANs is more balanced | ||
Outflowd:Inflowe | 1.3%:0.2% | 0.7%:0.6% |
Category | Total nurse workforce, head counts | RN workforce | AN workforce | Qualification mix |
---|---|---|---|---|
Practising nursing staff | 39 390 | 35 453 | 3 937 | 9.0:1 |
Hospital (54%) | 21 449 | 20 532 | 917 | |
LTC (46%) | 17 941 | 14 921 | 3 020 | |
New supplya | 3 278 | 2 659 | 619 | 4.3:1 |
New supply in % of practising nursing staff | 8.3% | 7.5% | 15.7% | Relatively higher increase in ANs |
Demand total and per sectorb | 6 182 | 4 925 | 1 257 | 3.9:1 |
Hospital | 1 498 | 1 462 | 36 | |
LTC | 4 684 | 3 463 | 1 221 | |
Demand in % of practising nursing staff, total and sector | 15.7% | 13.8% | 31.9% | Relatively higher demand for ANs and LTC |
Hospital | 6.9% | 7.1% | 3.9% | |
LTC | 26.1% | 23.2 | 40.4% | |
Shortage in % of practising staff total and per qualification | −2 904 | −2 266 | −638 | Relatively higher shortage of ANs |
7.4% | 6.6% | 16.2% |
The governance dimension: facilitating policy and implementation
Dimensions of monitoring | Actors and processes |
---|---|
Policy actors | • Representatives from educational institutions/schools • Professional associations • Unemployment insurance • Sickness funds • Old age care insurance • Federal Government/ministries • Researchers |
Policy processes | • Building networks and channels to improve coordination • Connecting government, stakeholder board and research to enable shared decision-making • Reducing interest-driven strategies of professional groups through developing shared goals and identities to improve integrated policy-making • Providing research-based data to improve evidence-based decision-making |
Policy implementation and evaluation | • Connecting top-town (government) regulatory power and bottom-up stakeholder agency • Using stakeholder participation to strengthen accountability and support of provider organizations and institutions • Establishing evaluation of targets and policies |
Learning system/governance improvements | • Revising targets and policy according to evaluation data • Establishing transsectoral and trans-border governance • Including new stakeholders where relevant |