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With an estimated shortfall of 10 million workers in the sector by 2030, the health and care economy is under severe stress. What multi stakeholder policies and strategies can help recruit, retain and rethink healthcare jobs?
This is the full audio from a session at the World Economic Forum’s Growth Summit 2023, Future of Work - Health and Care.
Ricardo Baptista Leite
Member of Parliament, Portuguese National Parliament (Assembleia da República)
Chief Executive Officer, International Council of Nurses (ICN)
International Correspondent, Globo TV
Professor of Medicine; Medical Director, Office of Equity, Inclusion and Diversity, Mayo Clinic
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Bianca Rothier, International Correspondent, Globo TV: Good morning. Good afternoon. Good evening. I'm saying that because I'd like to welcome not only our participants in this room in the World Economic Forum headquarters in Switzerland, but also our online audience, as this session Future of Work - Health and Care is broadcast live. So this is one way to open an all-night online event, with good morning, good afternoon, good evening I learned from Dr. Tedros Adhanom, the director general of the World Health Organization, in his press conference that I had to cover during the pandemic.
By the way, my name is Bianca Rothier, I am the international correspondent based in Geneva for Globo, the largest TV network in Brazil. And it's impossible to talk about our subject today without remembering the pandemic, this COVID health crisis. We all know, at least we have an idea, about how hard it was for the healthcare workers to deal with this crisis: fatigue, stress, burnout, lack of protective equipment and risk of infection, death. But the situation was already very complicated even before that and the pandemic just highlighted the challenges.
We are talking about a sector undervalued and underfunded. In high-income countries, workers are quitting because of different reasons, including low pay out as we see, for example, here in Switzerland, workers from low- and middle-income countries migrate searching for better conditions. And at the end there is a dangerous global shortage of workers.
To better understand the challenges and think about the possible solutions we have here, Ricardo Baptista Leite, medical doctor and member of the Portuguese Parliament where he sits on the Health Committee. Thanks. Howard Catton, Chief Executive Officer of the International Council of Nurses and Anjali Bhagra, Professor of Medicine, Medical Director at Mayo Clinic Office of Equity, Inclusion and Diversity.
So my first question is for the three of you. As per the World Health Organization, there will be an estimated shortfall of 10 million healthcare workers worldwide by 2030. How to attract and retain the workforce? I would like if you could give a first perspective, each one of you. You can start, Ricardo.
We need to address this challenge by listening to the health care workers. We can't we can't continue doing what we've done until now, which is a top down approach from governments telling health care workers what they're going to provide.
Ricardo Baptista Leite, Member of Parliament, Portuguese National Parliament (Assembleia da República): Well, thank you. And I'd like to greet my colleagues here on the panel also and everyone watching us here and at home. The truth is, we do have those estimates, but in reality we do not know exactly how many healthcare workers we will be needing because there are so many and diverse challenges that we will be embracing, but also opportunities such as digitisation. And I'll get to that more ahead.
Today, due to the standardisation of universal practices when it comes to health practice, education, we're seeing even in low- and middle-income countries, high-quality healthcare professionals being trained. While this is leading to a situation due to the lack of health care professionals across the world that richer countries are attracting many of those health care workers to their own countries. So we're seeing a transition from the public sector, many to the private sector, because the public sector is unable to pay what people are expecting. And many of those in the private sector and public sector are leaving the country. So going from domestic to international careers because they have better opportunities elsewhere. So in reality-
Bianca Rothier: I see a lot of Portuguese here in Switzerland.
Ricardo Baptista Leite: Sadly, from my country, we export more nurses than we train in our own countries. I can tell you between 2015 and 2022, we had 13,000 nurses that were trained and got into our nursing association and 15,000 actually left the country. So it's actually a negative. We have a deficit. And that's Portugal, which is in the European Union. If you go to other low- and middle-income countries, you can see the tremendous impact and the risks in terms of the gap, and that can be created and enlarged.
We also have an issue where we don't have much data when it comes to the specialisation of the healthcare workforce. So we talk about doctors, nurses, pharmacists, but in detail we're missing a lot of the data.
But most importantly, you mentioned the pandemic, which is of course impossible to ignore. The expectations of healthcare workers have changed dramatically. The idea of a balanced personal life is top of the list for many healthcare workers after the pandemic. And we see that in many countries where health care workers were treated as heroes, you know, we're barely through the pandemic and people have already forgotten the role that healthcare workers played in the front and the of this battle against COVID-19. And that leads to a sense of sometimes of despair, of lack of acknowledgment.
And so I would say that we need to address this challenge by listening to the healthcare workers. We can't we can't continue doing what we've done until now, which is a top down approach from governments telling healthcare workers what they're going to provide. We need to listen to healthcare workers. What do healthcare workers expect to work within the organisation? Is it a balanced personal life? Opportunities in terms of research and lifelong learning and so forth? And digitisation is also an opportunity. Just to leave this comment: not to make health care less humane, but exactly the opposite. So that nurses, doctors, pharmacies and other health care workers have more time to be with the patient, to have more connection with the patient from a human perspective. And we can leave those repetitive basic tasks to machines. So in a way, we need to task shift to machines and make sure that humans are left with more time to take care of other humans.
Bianca Rothier: I hope we have more time to go into detail on this topic. Howard, your view? And you are representing millions of nurses so.
It's quite simple: We are not investing enough in educating enough nurses.
Howard Catton, Chief Executive Officer, International Council of Nurses (ICN): Well, firstly, to say as as a nurse, to be part of an economic and growth summit, I'm very pleased that our voice is here and is being heard. The 10 million figure — I think it's worse. Before the pandemic. We know that we had a shortage of 6 million nurses worldwide. It was work that we did with the World Health Organization. We have an aging nursing workforce that's about another 4 million nurses. And the impacts of the pandemic, the huge toll, the physical and the mental health toll as well, this COVID effect, we think could add another 2 to 3 million nurses. We're seeing the evidence already of people leaving and quitting early. So just from a nursing perspective, I'm looking at a number that's bigger than 10 million.
Bianca Rothier: 12 million?
Howard Catton: 12, 13 million. And our latest evidence suggests that there isn't any signs yet of that decreasing. So what needs to be done? And in one way it's quite simple: We are not investing enough in educating enough nurses.
This dynamic of international recruitment of countries who are short because they haven't educated enough nurses, they're looking to the quick fix solution — go to other countries and they are often six or seven high-income countries going to countries that can least afford to lose their nurses.
We need to educate more nurses, but we need decent work. Throughout the pandemic, health workers as heroes who step forward, who put their lives on the line. But millions who had to wait for PPE, who had to wait for a vaccine, who had to face abuse and aggression in the workplace as well. Decent work is something we need to do.
And then leadership. Whilst it's great to have nursing and health professionals' voices as part of this discussion, many organizations, you know, they don't have chief nurses bringing that advice and that expertise. We think a lot of, you know, nurses as doers, as deliverers of health care, yes, they're great at that. But with nurses or health professionals, because they know delivery they know where the problems are, they know where care isn't patient-centred, where it's not safe. They've got ideas about how we can improve and join up care as well. And I think seeing more nursing voices in leadership positions, government policy and in health institutions as well, really important.
And the final point on this as well. I'd say from all the work that we've done, it's there is a single magic bullet for this. It's not just about educating more, it's not just investing in leadership. It's not just about better retention policies, about doing all of those things. And when you do all of those things, as well as strengthening and improving nursing and health outcomes, I'm in the majority in my profession because I'm one of only 10%. 90% of the nursing profession are women. We can actually go a long way to address longstanding gender inequalities as well by investing in the nursing workforce.
Bianca Rothier: I'm sure Angela knows very well this subject, please. Your view?
We've got to infuse the healthcare culture with joy, with focus on humanity. And for that, we need leadership. We need commitment.
Anjali Bhagra, Professor of Medicine; Medical Director, Office of Equity, Inclusion and Diversity, Mayo Clinic: Yes. Well, first of all, thanks to my co-panelists. I'm just going to build a little bit on what both of you have already shared before. The fact is we are in a state of deficit and we had this prior to the pandemic. And now we've pulled back the sheets and it's magnified. And we also know that we cannot recruit from a deficit for an ever-increasing demand within healthcare. So fundamentally, I'm just going to break it down for the future workforce the two big areas where I feel the emphasis is whether it's physicians, nurses, allied health administrators. We've got to create a better work experience.
And the second big pocket I see is value proposition, because I know and let's talk about the second bucket first since we are on the topic of equity, wellbeing, resilient systems. You know, I think it's time that we prioritise the human nature of our culture. We've got to infuse the healthcare culture with joy, with focus on humanity. And for that, we need leadership. We need commitment.
At Mayo, for example, you know, we have a big group. We work on our culture proactively, not just reactively. We want to be ready. So we have a future-back approach of how do we want our culture to evolve? Because we know at any given day we can have strategy, but culture will eat strategy any day if we are not careful about how as leaders, as health care providers, as other industries collaborating with health care providers, we are building the narrative for the value proposition.
We know that this is the field where we have the immense potential to impact communities across the globe, health of communities across the globe. And I think fundamentally that's powerful. Having that capability of making a big difference with the lens of equity, well-being, joy, resilience, healthcare systems is powerful.
The second thing, which I said was work experience. Now we know that the workforce of 2030 is going to look very different. We heard this morning 23% of the jobs are going to go away due to digitisation. So we cannot recruit a future workforce that is not upskilled. I think fundamentally, healthcare has relied heavily in the past on a physical pipeline model for healthcare delivery. And at Mayo, we are pushing that to a platform model where, there's seamless integration of physical digital health care provision. And what do we need to do for that? We need to get the workforce ready. We need to get them skilled.
I think for the incoming students and learners, there's a lot of potential where we skill them in a way that they feel confident and competent with these changing landscapes. But for the workforce that's currently in the industry for 20 years, they are beginning to ask: Am I still relevant? Do I still contribute? So there's a lot of burnout setting in from that proportion of the workforce. And I think we need to do a better job. A better job than what we are currently doing to upskill them. And certainly, you know, it's been highlighted — training, governance, regulation, incentives for integrating our enhanced AI capabilities and training programmes will be the way we are going to build the workforce that is more resilient, that is more ready, and we can do it collectively with a future-back approach.
Bianca Rothier: Let's try maybe to learn a bit from Portugal. Ricardo, how did Portugal deal with the pandemic and how is the situation now? What can we take from Portugal?
Ricardo Baptista Leite: From a healthcare worker's perspective, we suffered the same phenomena as we saw in many countries of the world, where initially there was a huge recruitment of everyone available. You know, the hero speech was put out there. There were promises that healthcare workers would have a transformative career after the pandemic was over. But that led to disappointment, to be honest, because after, you know, a couple of years, they went through the hardship of those health care workers in the frontline. I went back as a volunteer to the medical team, to my medical hospital in my town, and I was working with my colleagues and I saw how they were desperate, honestly, and particularly in the most difficult moments of the pandemic. And so I think we need to be very conscious of the way we manage expectations when it comes to the health workforce. And the numbers that we just heard here are going to be close to impossible to reach if we do not change the way we work.
I think we need to do many things at the same time, to be honest. One is, of course, more training. We need more healthcare workers, that's a given, which means more investment no doubt if we want to reach our goals. However, we need to also change our health systems which are [inaudible] systems towards being focussed on creating value for health, which means focusing on health outcomes.
If we do not lower the demand for our health systems, we can continue pumping in billions of dollars. Our health systems will not be able to respond. We need to lower the demand. The only way that we can have enough resources to treat those that need to be treated is to make sure that those diseases that are preventable are prevented. Those diseases that are curable are cured. That way we will have enough health workforce and resources to treat those that actually do inevitably get sick no matter what we do.
And we also need to, as I was saying, to focus on digitisation, which played a very important role in Portugal, facilitating, for example, as the first line of response, mainly our hotline, our national health service hotline, which is run by nurses, played a very important triage role, making sure that people would not go to hospitals without needing so. Even some attempts in terms of using artificial intelligence-driven tools to do that triage were also tested.
That shows that there's a tremendous way forward. But we need to do it in a way that is responsible, that has a notion that there are tremendous biases behind historical gender and other biases when we apply artificial intelligence. That's why in my new role here in Geneva, as of the end of this month, as the new CEO of the International Digital Health and Artificial Intelligence Collaborative, I-DAIR, we will be focusing precisely on responsible AI in the sense that applied to health care, in the sense that these technologies need to be developed in a way that in a way protects citizens from these biases and provides the best health outcomes for the citizen, but for society at large. By doing so, as I said at the beginning, we will be freeing time for compassionate care, for the human connection. And there's an amazing book called Compassionomics, that actually measures the outcomes related to compassion. Patients that are treated in a compassionate way actually get better health outcomes. And so incorporating that within a digital ecosystem, but also a larger health ecosystem or wellbeing ecosystem, delivers better results and that then leads to less need for human talent that can be released in a way for those that will need them.
Bianca Rothier: Okay. Good point. Howard, yesterday, nurses went on strike, I think, in around half of England's hospitals, right? So, even a country that is very, extremely, proud of its public health system, the NHS, is suffering. How to address this dissatisfaction not only of nurses but also of doctors, especially young doctors?
It seems there is an overwhelming economic case, as well as a patient safety, as well as a quality case, for investing in nursing and the healthcare workforce.
Howard Catton: Go to the root causes. Is this what we've seen in the UK? We've seen it around the world, an increase in strikes and disputes by nurses and healthcare workers.
The history of this firstly, is that nurses, health workers around the world feel as though they had been undervalued for years. Their pay, their conditions, below often the average for their economy. Working in very stretched healthcare systems without the equipment, without the staff to do the job. And that's taken a huge strain on people. And you imagine going to work every day where you feel professionally compromised. You're not able to give the care to the quality of safety that you have been educated to, which you know is part of your professional responsibility. You step up for the pandemic. You are told that you are heroes, that you are the most valuable asset that the country has. You put your own life on the line, often without the support and protection, that they should have expected. And then afterwards, when it comes down to a pay well, all of a sudden: "No, no, no, no. We can't afford. We've got a cost of living crisis. You'll drive inflation." All of these factors have come together to say this, this, this anger. But also and this is really, I think, important that at the centre of improving the pay and the conditions for nurses around the world, they are making this absolutely a case about patient safety when we do not have enough people educated professionally, we know that the risks to patients of greater harm increases. We know around the world that the number of healthcare workers in different countries and different regions is related to mortality. You can see this across all regions as well. So this is a patient safety case.
But still, we seem to have this hit this brick wall that when it comes to talking about investment in our healthcare systems, we struggle to make the investment in healthcare workforce. We talk about capacity strengthening. We talk about resilience. We talk about increasing coverage and access to health care. How are you going to do all of that? You can only do all of that through healthcare workers. Investment in nursing and healthcare workers is not a cost, it's investment. We need to think about it as a smart human capital investment.
I look at these strikes and I see the nurses who where they have gone on strike, a backlog of waiting times, people not being able to access healthcare. I see healthcare systems having to spend millions to bring in agency workers, nurses from overseas, to fill gaps as well. I see absentee levels that run into millions and sometimes billions. We know that trillions the pandemic has cost the world. I'm a simple nurse and I'm I'm here in the hallowed environments of the World Economic Forum. But to me and to nurses it seems there is an overwhelming economic case as well as a patient safety, as well as a quality case for investing in nursing and the healthcare workforce. And we have to change that mindset. And if we don't, what will the consequence of that be? If there aren't nurses and health care workers, either we see people who suffer terribly in isolation on their own or frankly, all of us as friends, as family, as mothers, brothers, husbands, wives — we will have to pick up that care burden.
Bianca Rothier: It's a dangerous crisis, definitely. And Anjali, in your estimation that equitable workforce is critical for long-term resilience, right? How to ensure this diversity, this inclusion in the system?
Anjali Bhagra: Yeah, well, thank you, Bianca. I'm going to build on what you know, what Howard sort of sowed the seeds for. Fundamentally, equity, inclusion and diversity is an investment. It is not a cost, it is an investment. And we are morally responsible for this. For this to be successful, I think two fundamental approaches are: it needs to be authentic, not tokenism. And we need to hold ourselves accountable.
And two broad categories where I feel we can gain a lot of traction first is commitment from the top leadership. I think that's very essential for these initiatives to have the appropriate visibility, have the appropriate resourcing, have the appropriate strategic alignment with the rest of the strategy of the organization, because this is not of a satellite of a planet sitting somewhere where stuff is happening. So fundamentally, having that leadership commitment from the top to the bottom and all the way around, I think is absolutely necessary for these initiatives to be meaningful and to drive the impact that we want them to.
Second thing with leadership commitment is accountability, because empty commitments don't lead to impact or don't lead to change. And one way at Mayo Clinic, for example, we do this is back in the pandemic, when I think it became abundantly clear that we cannot rely on interative small programmes. We need a transformational shift in how we look at equity, inclusion and diversity in health care. And so we made a commitment from a board of a hundred million dollars towards racism and really fostering anti-racism. And we have accountability metrics at all leadership levels across our structures to do this. Second, I would say in addition to leadership, is strategy and organizational structure, where DEI is not the, you know, the right thing to do for the organization. It's absolutely the only thing to do for the organization. In other words, it is really knit into the fabric of the organization, and it's not a separate business unit.
So just to give you an example of how that would happen in health care. So for example, we have three shields at Mayo Clinic. One is the clinical practice shield facing patients, the other is research where we focus on research, transformation and development and finally education. So an example of how this is knit into the patient-facing side is our digital and virtual platforms, where we will get into the patients homes no matter where they are. So through our enhanced digital capabilities, we are able to reach patients. So we are increasing access to care and equity to care. On the research side and collaboration again with our other business units such as the Centre for Digital Health as well as Mayo Clinic platform, and thanks to improved data capabilities as well as a decentralised clinical trials design, we are able to impact outcomes of diverse groups of patients whom we were not able to reach earlier.
And finally, in education and training, there is a lot of partnership in this work. So we work with higher education, with community organizations in building pathway and pipeline programmes. So we get that diverse workforce that looks like the patients that we care for. And you know, this is the beginning. We've got to then nurture this workforce, this diverse workforce, that we get in. So a lot of policy, structural change, supporting our workforce. Howard already mentioned that one example is through ERGs (Employee Resources Groups). At Mayo Clinic, we have greater than 35 Employee Resource Groups, with over 10,000 members enrolled in these resource groups. So empowering the workforce through one lens of equity as well as empowering our patients through a lens of equity. That's what it takes.
Bianca Rothier: I think we have time to open the floor to one quick question. Who wants to take advantage of this opportunity and ask?
Audience member: You've talked a lot about the challenges facing the healthcare workforce, but I haven't heard much on behavioural health and the real emotional pressures that the health care workforce is facing. In the US, upwards of 400 clinicians die by suicide every year. I'd love your thoughts on strategies that we should be thinking more about to address the mental health crisis facing the healthcare workforce.
Bianca Rothier: We have one minute for this.
Howard Catton: We've just reported Recover to Rebuild, on the latest evidence, the impact on nursing we call the mental health impacts mass traumatisation. But it was a really, really big message that came out from nurses who said we have had enough of being told to be more resilient ourselves. It is our health systems that lack resilience, the lack of staff, the lack of equipment, all of those things as well. That's where the resilience needs to be.
So I think there's there's an important part of making sure that we don't look as though we're blaming individuals when our systems. But in terms of individuals, I think there's a whole important piece around the culture. You know, sometimes the competitive nature of health organizations, the heroic nature, that if you speak out because you're not coping or if you see a problem within the healthcare system, it can look as though you're being disloyal to the organization that you work for as well. And the modelling of that behaviour for senior leaders to talk about their mental health, their ups and downs, and not to penalise people who do that, but to support and encourage that sort of culture I think would go an awful long way to to help with those issues.
Anjali Bhagra: And if I may quickly add, David, I think that's the biggest question right now. And to paraphrase Howard, what you just said, I think we've got to break this stigma, but we also got to create more resources. Right now, we are very under-resourced, specifically in the United States and across the globe, arguably. And so creating in time, you know, point of care resources for our providers so they aren't waiting weeks and months before they get access. Again, this is another ripe area for virtual tools for really looking at those integrated models.
Bianca Rothier: Final words.
Ricardo Baptista Leite: Building on what everyone is saying, really, the few countries and health systems that actually have been collecting data have been focusing on patient-reported outcomes and so forth. You know, the CROMS, we need, H-CROMS, you know, the healthcare workforce outcome measurements, and doing that in a systematic way so that we know in real time what is the sentiment of healthcare workers so that we can act and actually using tools as artificial intelligence to even predict potential sources of tension and of breakdown, so we can act preventively so that we're not just reacting to these mental health challenges that health systems are now facing and that have come to light with the pandemic, although they were always there but not given enough attention. And so hopefully something good can come out of the pandemic, which is that finally we are discussing this important topic. So I think it was a very important question. Thank you.
Bianca Rothier: Yeah. Unfortunately, we arrived at the end of the session. Future of Work - Health and Care with relevant remarks and takeaways. The scenario is challenging, but there are ways to address these issues thanks to participants in the room, our specialists. Thank you very much.
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