Health Care Skills Gap: We Need Workforce Flexibility

The health care skills gap is widening, but facilitating a more flexible workforce could help. This Health Professions Network blog takes a deep look at workforce flexibility in health care.

Health Care Skills Gap Widening in the "Age of Accelerations"

In his book, "Thank You for Being Late: An Optimist's Guide to Thriving in the Age of Accelerations," New York Times columnist Thomas L. Friedman predicts a future of accelerating change, where individuals in the workforce will need to continuously change and adapt via "dynamic stability"—just to keep a job.

"Average is officially over," writes Friedman. "When I graduated from college, I got to find a job; my girls have to invent theirs. I attended college to learn skills for life, and lifelong learning for me afterward was a hobby. My girls went to college to learn the skills that could garner them their first job, and lifelong learning for them is a necessity for every job thereafter."

Friedman's work describes a mounting trend toward the "gig economy," globalization, and the more distasteful facets of workforce "flexibility" being a new economic norm. Personally, I find Friedman's outlook throughout the book to be a pessimistic extrapolation taken to a logical extreme—the book being labeled "An Optimist's Guide" is a red herring—but his outlook, here, is certainly based in current truths about the skills gap.

In 2014, a Gallup poll found that only one-third of business leaders agreed with the statement, "Higher education institutions in this country are graduating students with the skills and competences that my business needs." The US Department of Labor has long been focused on addressing skills gaps across industries, pursuing apprenticeship expansion in both Obama and Trump administrations, and the development of competency models to facilitate better preparation of the workforce.

In 2015, the Health Professions Network undertook an update to the DoL fundamental competency pyramid for clinical health professions, and our white paper examined how competencies could help address the health care skills gap.

And true to Friedman's theme—many expect the skills gap to continue to grow in this "age of accelerations." A recent white paper from the centrist, democratic Progressive Policy Institute, argues that the skills gap is "growing with each passing month," while 7 million U.S. jobs remain unfilled.

"Employers know that America has a significant skills gap," writes author Ryan Craig. "America’s economy has digitized over the past decade and our legacy infrastructure – postsecondary education institutions and workforce development boards – have not come close to keeping up."

Skills Gap Shown in Shortages of Health Professionals

In health care, too, the data show shortages in skilled professionals. "There are 1.7 openings for every qualified worker in high-skill health care jobs like nurse practitioners, physician's assistants, physical therapists, and occupational therapists," writes Craig. "The job site alone lists nearly a million open positions with salaries at or above $75,000."

In fact, this skills gap may be an even larger issue in health care than in other sectors. The Indeed Hiring Lab produced research in March which detailed a "consistently larger skills gap" in health care, as measured by a consistently above-average "mismatch" between job seekers and availabilities.

Health Care Skills Gap Larger than Economy Overall

Perhaps it goes without saying, but the skills gap in health care has life-and-death implications on the quality of care—and its cost. A survey from August of last year showed 78 percent of health care finance leaders expecting hospital labor costs to grow as the industry faced worsening shortages of health care professionals—as early as 2019.

"Increasingly, health workforce shortages are corresponding with growing demands on the health care system and continuing growth in health-care expenditure," writes Susan Nancarrow of Southern Cross University in BioMed Central's Human Resources for Health. "Staff shortages not only limit health care accessibility but are a key factor in health-care quality and safety."

Is the Health Care Skills Gap the New Normal?

The extrapolating opinion of Friedman's "Thank You For Being Late" assumes the skills gap is the new normal—that skills required in the workforce will continue to grow at an accelerating rate, and closing the skills gap will be a constant uphill battle for individuals in the workforce. Pessimistic, right?

Certainly, we're experiencing widespread restructuring where new roles and skill sets are quickly being defined, and legacy systems are struggling to keep up with the rapid change—for now. Cost pressures, business model innovations and a host of global societal and economic factors may continue our state of flux in the short term, but not indefinitely.

Plus, there's plenty we can do to improve how we prepare individuals for work which may or may not yet be defined—like the use of standardized foundational competencies, for example—and promote flexibility and opportunity for the workforce as a whole. We can close the health care skills gap!

workforce flexibility in health care

What We Mean By Workforce Flexibility in Health Care

So, what can we do? Tackling the health care skills gap means promoting workforce flexibility—making up-skilling or lateral career movements easier to attain, or allowing individuals to practice at the top of their scope of training and education, for example.

Interest in workforce flexibility is growing for stakeholders in the health care workforce pipeline—employers, educators and professionals, for example. More parties are seeking to address the health care skills gap by breaking down barriers that reduce the ability of the workforce to respond to employer and community needs.

But before we can discuss how best to facilitate greater workforce flexibility in health care, first we need to clearly define what that means—especially as the idea carries some negative connotations.

"'Flexibility' has sometimes been interpreted as a management attempt to get more for less, by exploiting the good will of health professionals and getting the workforce to carry the burden of system inadequacies and resource gaps," writes Professor James Buchan of Queen Margaret University on BioMed Central's Human Resources for Health blog network.

In fact, this was exactly my issue with Friedman's thesis—he extrapolated his predictive world view from an exploitative trend toward "flexibility," where individuals are required to carry the burden of system inadequacies. But that doesn't have to be how we think about workforce flexibility.

"Flexibility can have a more positive connotation," writes Buchan. "Flexibility should be about identifying the best balance of health service improvements and workforce requirements, and not ignoring one or other. The aim should be to implement [human resources] policies which give 'win-win' flexibility."

From a professional perspective, we can be quick to dismiss principles of workforce flexibility as threatening to established professions. Nancarrow, referenced previously, identified "Six principles to enhance health workforce flexibility" in her paper, largely aimed at breaking down "professional monopolies" to that end:

Nancarrow's Six Principles to Enhance Health Workforce Flexibility

  1. Measure health system performance from the perspective of the patient.
  2. Minimize training times.
  3. Regulate tasks (competencies), not professions.
  4. Match rewards and indemnity to the levels of skill and risk required to perform a particular task, not professional title.
  5. Ensure that practitioners have all the skills they need to perform the tasks required to work in the environment in which they work.
  6. Enable practitioners to work to their full scope of practice; delegate tasks where required.

Rather than reacting defensively, I think it's important to recognize that organizing professions around competencies does not necessarily reduce the importance of those skill sets or the organizations which offer specialized education for those competencies. Indeed, professions could also play a crucial role in principle five, ensuring practitioners have the skills they need to perform the tasks in their environment.

Greater workforce flexibility along these parameters should, ultimately, be a boon to non-physician health professions. I think all professionals would support greater flexibility in pay and career structures which reward skills, contributions and continued learning.

The current evidence suggests that increased workforce flexibility is a robust (read: inevitable) trend. "In an increasingly de-regulated, competitive, consumer-led marketplace, the health workforce of the future is likely to look very different to the workforce of today," writes Nancarrow.

Professions should plan ahead and consider what their role will be in a more flexible workforce.

Next Blog: A Deeper Look at Stackable Credentials in Health Care

Of course, there are many practical barriers to workforce flexibility in health care which will need to be overcome. In our next blog, we'll explore these barriers and methods of facilitating greater flexibility by taking a deeper look at stackable credentials.

Join us in Albuquerque for More on Workforce Flexibility

It's no coincidence that flexibility in the health care workforce is the guiding theme of our upcoming Fall 2019 conference in Albuquerque, New Mexico, October 2-4. Our sessions and discussions will all focus on this mounting trend: what's happening to promote workforce flexibility, what the future will look like, and what roles non-physician professions might play.

This conference will organize a unique program of expert sessions all about how employers, stakeholders and new technologies are promoting the flexible movement of talent laterally and vertically throughout health care to fulfill staffing and community needs—initiatives like multi-skilling, micro-credentialing, and much more. We’ll also take a deeper look at what role professions, professional associations, educators and credentialing bodies might play in preparing and supporting professionals when flexible staffing is a greater priority of the health care industry.

Join us in Albuquerque to join the discussion and learn from other leading professions, educators and credentialing bodies making a difference in the future of health care.

HPN Fall 2019 Conference: Flexibility in the Health Workforce

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