Recommendations were formulated in order to support reviewing and developing HWF planning systems. Some recommendations focus on revising and improving HWF planning processes, some on HWF planning – quantitative and qualitative – data development and at the end on HWF planning evaluation. Recommendations – and supporting practical tools belonging to the recommendations – are adaptable to different country situations so they can support MS in customising and tailoring the further HWF planning development processes. Recommendations are developed both for national-level stakeholders and EU-level professional organisations. All recommendations must comply with the necessary data security and privacy regulations.

Recommendations on HWF planning processes
R1 Since some countries identified the lack of a systematic approach and unstructured line of steps in HWF planning, a feasible and achievable HWF planning process should rely on minimal common guiding steps.
R2 Considering the path towards systematic and strategic HWF planning, a measurement instrument could be supportive for listing the objective criteria of systematic HWF planning. An evaluation list providing a set of elements for systematic and comprehensive HWF planning could facilitate self-evaluation and additionally reveal areas for improvement and/or expansion.
R3 In light of the fact that several countries face problems with respect to setting up national-level collaboration (e.g. coordination and communication management as a typical bottleneck, information and data flow failures, roles and responsibilities are often unclear), special attention should be paid to information flow and communication management. Quick tools, instruments should be designed and developed to help realising national-level collaboration and tackle emerging difficulties.
R4 Invest in HWF planning resources (human, financial, infrastructural, technical, skills-related) and revise them annually/biannually at the national/Member State level. Such investment and the efficient use of resources, together with the continuous evaluation of the use of resources, could result in cost-effective operations in the long run.
R5 Setting up a designated responsible entity, a HWF Planning Committee/authority at the national/Member State level for operational HWF planning would be beneficial in strengthening national-level collaborations. Stronger leadership, with clear decision-making levels and roles, could help eliminate fragmented efforts and thus provide more coherent actions. Optimising the involvement of a broad range of actors/stakeholders would lead to achievable and better defined roles/functions/skills/tasks.

 

  • The composition of a national HWF Planning Committee/body/team/group would require capacity building and multidisciplinary expertise in, e.g. health management, health policy, health financing, statistics, epidemiology, sociology, data analyses, communication, HR information system managers, technical officer/computer operator, administrative support, etc.

  • Ensuring expertise by involving stakeholder representatives of central governmental bodies, ministries, regulatory bodies, authorisation offices, professional representative bodies/organisations, chambers, statistical offices, regional/local representatives, universities and research institutes, health insurance funds/insurance companies, civil society-NGOs, patient organisations, multilateral agencies/network representatives, etc.
R5a EU-level professional organisations can contribute to the development of MS-level HWF planning systems by having continuous interactive consultations with their national-level member organisations. Strengthening the role of EU-level professional organisations might add diverse perspectives or ensure more reliable and valid data. Therefore, these Recommendations focus on Strengthening the role of EU-level Professional Organisations in overcoming difficulties in national HWF planning and forecasting.
 
Following the handbook produced by WP5, stakeholder involvement is to be considered a good practice for accurate planning and political consensus. Among the stakeholders, the professional organisations play a special rol as the main representatives of the health workforce themselves. Within the focus of this report, they may in particular contribute to closing the identified gaps by being:

  1. “Supportive” – Supporting awareness-raising at the EU level and contributing to the policy process that determines HWF planning in strategic discussions with a proactive attitude.
  2. “Active” – Taking an active part in policy and strategy discussions sharing knowledge in HWF planning consultations at the EU level.
  3. “Consultative” – Being consulted and participating in the data validation process with national-level member organisations.
  4. “Mutual” – Sharing HWF data at the national and international level, which complies with necessary data security and privacy regulations.
  5. “Informed” – Discussing HWF planning data and information with national member organisations and encouraging members by fostering exchanges in this two-way process.
  6. “Cooperative” – Facilitating and contributing towards bringing together actors in consensus building to target specific country problems at the EU level.
  7. “Communicative” – Disseminating information at the EU level: Gathering and communicating needs and incentives for data-sharing among member organisations and communicating technical and operational competence for managing information (HR, technology).
  8. “Coordinative” – Assessing the capacity to act as a focal point to coordinate input and feedback at the EU level.
    Recommendations on HWF planning data
    R6 Based on the findings, many countries lack specific data for HWF planning, therefore countries should improve and focus on the aspects of data collection, sharing, and management.
    R7 Since data is doubtlessly a crucial element in HWF planning, efforts on increasing data quality should be ensured by

    • strengthening registry data (providing anonymisation and data protection for individuals),
    • setting up sufficient data collections and cleansing (regular updates),
    • making use of existing accurate data,
    • conducting additional surveys,
    • performing validity and reliability checks through triangulation (duplications in data collections should be eliminated),
    • increasing transparency (clear information flow and communication management),
    • increasing the interest and motivation of data collections to modify their sets of data required for HWF planning,
    • building up a one and only unified data source linking-supported data warehouse.

     

    Health policy interventions should use appropriate evidence with considerations for methodological limitations. The danger of bias should be considered in order to prevent inappropriate health policy actions occurring from:

    • misinterpretation of data (e.g. frequent change in data sources, “break in the series”),
    • misuse of data,
    • using data collected for different purposes, without taking this into account,
    • no updates of old data that then cannot be used for monitoring trends, and
    • lack of real-time databases (which enables data analysis directly from the real-time databases).
    R8 Since trends significantly matter in HWF planning, estimates based on quantitative and qualitative data in the continuous situation analysis/trend analysis and environment scan should be utilised. Quantitative databases should require annual updates in order to understand the latest trends and changes in the HWF. Survey-based quantitative estimates would be preferred in case of the lack of comprehensive data on important issues. Qualitative methods and data could complete the understanding and interpretation of the current HWF situation via triangulation.
    R9 Big data and e-health solutions should be incorporated to enable more efficient HWF planning data gathering and data linking, and the utilisation of interoperable and comparable datasets should be fostered. Building a wider network of information and providing increased connectivity could strengthen the focus on HWF planning data. Big data and e-health solutions, as innovative technologies and new possibilities can optimise healthcare service delivery through strengthened data linking and exchange of information, therefore organisation and planning the HWF can be managed in a new strategic level. These initiatives must comply with the necessary data security and privacy regulations.
    R10 Based on the findings, the required data for HWF planning is sometimes incomplete or unavailable. Setting goals is an important aspect for establishing and maintaining HWF planning. Setting up a three-level continuum of objectives in HWF planning – organising objectives from the most basic ones (first level) to the more complex ones (third level) – is recommended depending on the maturity level of planning system.
    R10a The first-level objective of HWF planning is the inventory of stock and the related objective is the replacement of the current domestic HWF.
    R10b The second-level objective of HWF planning is the identification of imbalances between the existing stock of health professionals (current imbalance), the projection of stock (future imbalance) and the consumption forecast (current and future demand and whether it is resulting in imbalances) in the future.
    R10c The third-level objective of HWF planning includes the complete variation of the stock as measured and converted into potential service through the application of real FTE, taking into account the gender and the mobility of the HWF.
    R11 In light of the expansion of the utilisation of qualitative methodology, qualitative data collections should be incorporated to enable deeper analysis and understanding of quantitative data in HWF planning. Qualitative methods and data could complete the overview, understanding and interpretation of the current HWF situation.

     

    Incorporating qualitative approaches could be beneficial, as they:

    1. contribute to continuous situation analysis of the main trends,
    2. contribute to deeper analysis and understanding, while focussing on issues needing in-depth analysis,
    3. contribute to select methods by rationales (see D061-D062),
    4. contribute to the triangulation of HWF results channelled into health policy implications (content/thematic analysis of policy documents), and
    5. contribute to evidence-based HWF planning.
    Recommendation on HWF planning evaluation
    R12 The assessment of HWF planning is rather challenging in several countries. Regular evaluation, revision and fine-tuning – in addition to established mechanisms – are needed in order to further update, modify and develop HWF planning. The “Toolkit on HWF planning” and the use of the tools and recommendations themselves are relevant for this evaluation purpose.