Annex B. Anticipating skill needs in the health workforce: Interview guide

Introduction

The COVID-19 pandemic has revealed a lack of preparedness in health workforces in all countries. Two years into the pandemic, health workforces are struggling with high rates of burnout, reflecting both manpower shortages (quantity) and skills shortages (quality). Even prior to the pandemic, health workforces in many OECD countries were under strain, with shortages reported both in terms of numbers of professionals and in terms of the skills needed to deliver quality healthcare. Population ageing in OECD countries will continue to increase the demand for healthcare-related services, putting additional pressure on health workforces.

Skills mismatches and shortages have adverse consequences in all sectors, but are particularly disastrous in the health workforce. Negative consequences can include loss of life and poor patient care, in addition to the negative economic consequences usually associated with skills mismatches and shortages in other sectors of the economy.

Improving the match between the supply and demand for skills in the health workforce can limit these negative effects. Effective assessments of skills shortages and mismatches, as well as the anticipation of future skills needs, can be important tools in this respect.

Therefore, the OECD, in collaboration with the International Labour Organization (ILO), is working to identify effective strategies among countries for assessing and anticipating the skill needs of the health workforce, and to understand how this qualitative and quantitative information is used to build more resilient health workforces. The interviews aim to gather information on:

• the types of skills assessment and anticipation exercises that the respondent’s country implements to identify current and future skill needs in the health workforce;

• how this information is used to influence labour market, education and training and/or migration policy;

• the involvement of key stakeholders, including ministries of labour, education and health, local and regional authorities, employers and trade unions;

• any good practices and/or barriers which are encountered in developing such assessments or using them in policy development.

Scope

Please focus on skill assessment and anticipation exercise(s) that are carried out for the health workforce in the respondent’s country.

Definitions of key terms used throughout the interview

A number of technical terms are used throughout the interview guideline. To minimise confusion, the following definitions are provided. When in doubt, please do not hesitate to contact a member of the OECD team.

Health workforce: This includes all people engaged in actions whose primary intent is to enhance health, or who help operate health care facilities. That means that the health workforce includes clinical staff (e.g. physicians, nurses, pharmacists, dentists) irrespective of the sector in which they work, as well as non-health care professionals working in the health sector, i.e. those who do not deliver health services directly but are essential to the performance of health systems (e.g. managers, ambulance drivers, or teachers of health education).

Skills will be interpreted broadly and can refer either to particular qualifications (e.g. technical/vocational, university), field of study (e.g. medicine, psychiatry, or nursing), or specific skills (e.g. numeracy, literacy, problem-solving, soft skills, or skills to work with new types of medical equipment).

Skill shortages arise when employers are unable to recruit staff with the required skills in the accessible labour market and at the going rate of pay and working conditions due to a lack of an adequately qualified workforce. They can be defined in terms of unfilled and/or hard-to-fill vacancies.

Skill mismatch either refers to the inadequacy of a worker’s skills relative to the requirements of the job he/she is currently in (under-skilling, skill deficit or gap), or to the opposite phenomenon whereby a worker’s skills exceed those required by the job (skills under-utilisation or over-skilling).

Matching can be seen as the deliberate attempt to bring the supply of, and demand for, skills better in line with each other to reduce skill shortages or skill mismatch.

Skill needs assessments evaluate the current supply and demand for skills, with a particular focus on mismatches or shortages.

Skills anticipation attempts to evaluate future skills needs as part of a strategy to improve matching.

Skill needs forecasts are qualitative or quantitative studies that use available information or gather specific information to anticipate future skills needs, mismatches or shortages. In some cases this may be part of a broader skill foresight exercise.

Skill foresight exercises. There is no single agreed definition of what constitutes a foresight exercise but for the purposes of this questionnaire it is taken to mean an exercise that is based on consultation, collaboration and networking across a range of stakeholders and experts that uses a variety of techniques (forecasts, scenarios, Delphi, expert panels, etc.) to reach a shared vision about the future and the strategic choices and decisions that are involved. Skill foresight exercises often involve reaching a shared cross-disciplinary view of future changes in the world of work and the implications for skill needs and skill development policies.

Resilience is here defined as the ability to adapt to unforeseen circumstances that may change the required quantity or quality (i.e. type of skills) of the health workforce.

Interview questions

Introduction

• The OECD, in collaboration with the International Labour Organization (ILO), is working to identify effective strategies among countries for assessing current and future skill needs of the health workforce, and to understand how this qualitative and quantitative information is used to build more resilient health workforces.

• Note that when we talk about “skills”, this should be interpreted broadly and can refer either to particular occupations (e.g. nurses, surgeons, dentists, psychiatrists), qualifications (e.g. technical/vocational, university), or specific skills (e.g. numeracy, literacy, problem-solving, soft skills, skills to work with new types of medical equipment).

• That means that, when we talk about “assessing skill needs”, this could include evaluations of how many workers are needed, as well as what type of qualifications or skills these workers need to have.

• During this conversation with you today, we aim to gather information on how your organisation identifies current and future skill needs in the health workforce; and/or how this information is used to influence labour market, health, migration or education policy; and any good practice and/or barriers which are encountered in developing or using such assessments.

Can you please briefly introduce yourself, and explain your role in developing or using skills assessment and anticipation exercises for the health workforce in your country?

Please complete the following three sections for each assessment you are involved in developing.

Skill assessment and anticipation exercises

Name of the assessment	[Project name, etc., if any]
Is this assessment carried out on a regular basis?	☐ Yes ☐ No [If yes, please indicate here the frequency]
When was the [last] assessment undertaken?	[Start/end date]
Is the assessment publicly available?	☐ Yes ☐ No [If yes, please add here a link or attach the document to your reply] [If no, would you make the assessment available to the ILO/OECD?]
Bodies responsible for the assessment	How was the assessment conducted? ☐ In-house work ☐ Commissioned work Name of the body that conducted the assessment: [Please indicate ministry/ies, research institute, etc.] If commissioned work, name of the body that commissioned the assessment: [Please indicate ministry, etc.]

How was the assessment undertaken? Multiple responses are possible.

☐ Expert hearings, stakeholder consultations, foresight methods, Delphi methods [Who are generally the participants/respondents?]

☐ Collecting data, statistics

☐ Quantitative forecasts

☐ Direct assessments of skills (e.g. tests directed at health professionals)

☐ Conducting and analysing surveys (hospitals, health professionals, patients) [Who are generally the participants/respondents?]

☐ Other [Please specify]

Does the assessment focus on healthcare professionals (e.g. physicians, nurses, pharmacists, dentists), or on all workers in the health workforce including workers in non-health care occupations such as managers, ambulance drivers or cleaning staff in hospitals?

Does the assessment focus on “skills” per se (e.g. numeracy, literacy, problem-solving, etc)? ☐ Yes ☐ No

[If no, which proxies of skills does the assessment focus on?]

☐ Occupation (e.g. nurses, surgeons, dentists, psychiatrists)

☐ Qualification level (e.g. lower/upper secondary, undergraduate, masters)

☐ Area of specialisation (e.g. general medicine, cardiology, psychiatry, dentistry)

☐ Other [Please specify]

IF the assessment does not focus on “skills” per se (i.e. defines skills as occupations, qualification levels or area of specialisation):

 What is the main reason for not focusing on skills? Are there any barriers to doing so?

Does the assessment try to describe current skill needs or anticipate future skill needs, or both?

☐ Current skill needs ☐ Future skill needs ☐ both

[IF future, what is the time horizon over which the assessment of future skill needs are made?]

Who funds the development of the assessment?

Approximately how much funding do you/those who are responsible for the assessment receive per year?

Approximately how many people work on this assessment in terms of FTE?

Which sources of information (if any) does this assessment rely upon as inputs, besides any that come from your own data collection?

 Who/which organisation typically provides this additional information?

At what level is the assessment carried out for the health sector?

☐ National

☐ Regional

☐ Sub-regional

☐ Sub-sectoral [Please specify, e.g. for a particular occupation within the health sector or for a particular hospital or medical institution]

How (if at all) do you validate your results?

If EXPERTS / FOCUS GROUPS:

 Who typically takes part in this validation exercise?

 Are there any mechanisms/procedures in place to achieve consensus between these actors regarding the final output, i.e. to determine which skills are needed in the health workforce? Please provide examples.

What do you consider the minimum requirements to be able to perform the assessment(s) we just discussed?

Are there any plans to build new skills needs assessments, forecasting or foresight exercises or to significantly change or discontinue existing ones?

If YES:

 Could you please provide a brief description of the changes planned?

 What is the rationale behind the changes?

Resilience

There is always a certain level of uncertainty around the assessment of future skill needs. For instance, it would probably have been very hard to predict the vast amount of healthcare workers that are needed right now during the COVID-19 pandemic.

How (if at all) does this assessment deal directly with the issue of uncertainty in its design?

Using skills intelligence for policymaking related to the health sector

The following questions aim to unveil how the skills assessment and anticipation exercises for the health workforce are being used for policymaking.

Is your organisation involved in translating the results of (your own) skills assessment and anticipation exercises into policy?

If needed, please put us in contact with someone who would be better placed to answer questions about how the skills intelligence is used in policy making.

How are the findings of this assessment being used for policymaking?

Which (if any) stakeholders use the final output of the assessment?

At which level do they use the output? National / regional / sub-regional / sub-sectoral ?

What (If any) are the mechanisms/systems in place to enable collaboration across these different stakeholders?

What (if any) are the mechanisms/procedures in place to reach consensus about what the policy response should be? Please provide examples.

How (if at all) is the information on uncertainty used to develop policy responses?

Lessons learnt

One of the aims of this project is to provide a toolkit for countries that want to (re-)design skills assessment and anticipation exercises for the healthcare sector, so that they know what they could do and how. With your experience in conducting these exercises, you may have some tips and tricks regarding what works more or less well in certain situations.

Positive experiences

What do you consider to be the strengths of this particular assessment?

With respect to collaboration/coordination between actors, what (if anything) has worked well?

With respect to use of the assessment for policy making, what (if anything) has worked well to translate the information collected from skill assessment and anticipation exercises into policy and practice?

Negative experiences and obstacles

What do you consider to be weaknesses of this particular assessment? How might those weaknesses be addressed?

What would be a country/region/institution that you consider to be a best practice when it comes to health workforce planning, and why?

What obstacles, if any, lie in the way of (further) developing skills assessment and anticipation activities in your country?

What are the main challenges in enabling coordination/collaboration between stakeholders? Please provide examples.

What, in your view, are the main barriers (e.g. methodological, dissemination-related, those relating to developing a policy response,) to translating the information collected from skill assessment and anticipation exercises into policy and practice?

Closing

Are there other organisations in your country that assess current or future skill needs for the health workforce?

If YES:

 To which extent do you reach the same conclusions regarding current or future skill needs in the health workforce?

 Could you put us in contact with someone in that organisation, so that we can interview them about their exercise too?

Do you have any remaining questions or remarks?

Thank the respondent. Ask if we can contact them in case we have follow-up questions, or to review (parts of) the draft report.