Guidance Document for the Development of Data Sets to Support. Health Human Resources Management in Canada

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1 Guidance Document for the Development of Data Sets to Support Health Human Resources Management in Canada February 2005

2 All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying and recording, or by any information storage and retrieval system now known or to be invented, without the prior permission in writing from the owner of the copyright, except by a reviewer who wishes to quote brief passages in connection with a review written for inclusion in a magazine, newspaper or broadcast. Requests for permission should be addressed to: Canadian Institute for Health Information 377 Dalhousie Street Suite 200 Ottawa, Ontario K1N 9N8 Telephone: (613) Fax: (613) ISBN X (PDF) 2005 Canadian Institute for Health Information Cette publication est disponible en français sous le titre : Guide d'élaboration de fichiers de données pour appuyer la gestion des ressources humaines de la santé au Canada ISBN (PDF)

3 Guidance Document for the Development of Data Sets to Support Health Human Resources Management in Canada February 2005 Gail Tomblin Murphy, PhD Linda O Brien-Pallas, PhD

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5 Support Health Human Resources Management in Canada Table of Contents Acknowledgements... i Introduction... 1 Project Parameters... 3 Scope of Project... 3 Purpose of Report... 4 Framework for Analysis... 5 The Approach... 7 Phase 1 What Currently Exists?... 7 Phase 2 Focused Workshops With Key Stakeholders... 9 Phase 3 Broad Consultation... 9 Information Needed to The Priority Information Needs Table 1.0 Priority Information Needs, Indicators and the Data Elements Required to Support Compilation of Health Human Resources Information in Canada Conclusion Appendix A Scope of the Project... A 1 Appendix B Acknowledgements... B 1 Appendix C National Minimum Data Set Questionnaire... C 1 References Bibliography

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7 Acknowledgements The Canadian Institute for Health Information (CIHI) and its Health Human Resources team are delighted to collaborate with Dr. Gail Tomblin Murphy and Dr. Linda O Brien- Pallas in the presentation of the Guidance Document for the Development of Data Sets to, February CIHI is very grateful to Dr. Gail Tomblin Murphy and Dr. Linda O Brien-Pallas for authoring this report. Brent Barber and Rummy Dhoot, consultants with the Health Human Resources area at CIHI, also made a significant contribution to the writing and content of this document. Dr. Tomblin Murphy is an associate professor at the School of Nursing, Faculty of Health Professions and Department of Community Health and Epidemiology, Faculty of Medicine, Dalhousie University and a co-investigator at the Nursing and Health Services Research Unit at the University of Toronto. The Canadian Health Services Research Foundation (CHSRF)/Canadian Institutes of Health Research (CIHR) recently appointed her to the position of Science Lead in Health Human Resources. Dr. O Brien-Pallas is the Canadian Health Services Research Foundation (CHSRF)/Canadian Institutes of Health Research (CIHR) National Chair of the Nursing Human Resources, and a professor of Nursing at the University of Toronto. CIHI would like to acknowledge the financial contribution of the Health Care Strategies, Policy Contribution Program, Health Canada. The views expressed herein do not necessarily represent the official policies of Health Canada. CIHI also wishes to acknowledge and thank the policy-makers, researchers, health personnel group representatives and others who generously contributed their time and input into the workshops and consultation process that shaped much of the content of this document. All contributors who provided consent for inclusion in the acknowledgements are identified in Appendix B. CIHI was fortunate to have the enthusiastic participation of so many interested stakeholders from across the country, and we believe this report contributes significantly to standards development for the collection of HHR data in Canada. Francine Anne Roy Manager, Health Human Resources Canadian Institute for Health Information Brent Barber Consultant, Health Human Resources Canadian Institute for Health Information Rummy Dhoot Consultant, Health Human Resources Canadian Institute for Health Information CIHI February 2005 i

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9 Introduction Health human resources (HHR) is recognized to be of fundamental importance in Canada. HHR management is an important and enduring issue for policy-makers, health care administrators, professional associations, unions and health services and policy researchers. In the past few years, understanding the human resources (the people) who work in the health system, and the care that they are involved in with Canadians, has become one of the top priorities at the national, provincial/territorial and sub-provincial/territorial levels. The provision of quality health care services is dependent on the availability of trained HHR professionals. Currently in Canada, there are over 800,000 individuals working in the health care sector. 1 The health care system costs Canada $130.3 billion dollars, or $4,078 per person (2004 figures). 2 By far the largest component of health care costs is labour, and while the specific statistics vary by jurisdiction and/or by year, HHR expenditures are never below 60 percent and may sometimes be as high as 80 percent of total operating costs. 3 Many of the issues identified as fundamental to the successful evolution of the Canadian health care system (for example, wait times and patient safety) are complex and require, among other things, an adequate health personnel workforce. 4 This priority status assigned to HHR has resulted in HHR being the subject of national, provincial/territorial and subprovincial/territorial reports, health commissions and reviews and considerable media attention. Nationally, there have been two major reviews of the health care system: the HHR Information Systems: Management, Planning and Research What Is the Focus? To understand HHR in Canada, it is necessary to develop information systems. For the purposes of this document, information systems can be thought of as a set of information resources organized for the collection, processing, maintenance, transmission and dissemination of information. The Census conducted by Statistics Canada every five years and the Registered Nurses Database (RNDB) maintained yearly by CIHI are examples of national information systems that collect data on health human resources in Canada. The foundation of any information system is data standards. The focus of the data standards development activity in this document is targeted at building a foundation on which to begin to address the information-based functions of HHR management. For the purposes of this document, the term health human resources management (HHR management) is defined by the information-based functions of monitoring and evaluation, planning and research. 3 Why a National Approach to HHR Data Standards? HHR personnel pharmacists, medical radiation technologists, physicians, nurses, etc. are highly skilled, mobile resources in demand inside and outside of Canada. Mobility between provinces, territories and countries is a reality increasingly reinforced by legislative changes inside and outside of Canada. 5 In addition, the education/training of health personnel crosses provincial/territorial and national boundaries. Canadian health personnel can be viewed as a national resource; for this reason, data collection activities need to be grounded in national data standards. Standards are required to avoid costly duplication of effort and to guide new data development away from the disciplinespecific silos that currently exist. (A silo, in the context of data and information, is a place where there is little or no opportunity for integration with other related data sources.) National data are needed to facilitate cross-jurisdictional comparability and a vision of an integrated health information system for Canada. Senate s Standing Committee on Social Affairs, Science and Technology 6 and the Royal Commission, headed by Mr. Roy Romanow. 7 Several provincial/territorial governments have also conducted reviews of their health care system CIHI February

10 A consistent theme within all of the national and provincial/territorial reports is recommended action aimed specifically at developing information standards and systems to support long-term HHR management. Data for HHR Management In the Canadian context, information systems to provide data necessary to address the information needs of HHR management come from two potential sources: survey sources and administrative sources. Survey sources collect data via ongoing or one-time survey instruments. Many entities survey health care providers for commercial and/or non-commercial purposes. Administrative sources collect data as a function of some administrative processes collecting membership fees, communicating with members and issuing licences to qualified registrants, for example. To plan for HHR in a meaningful way, we require data of good quality that is comparable and comprehensive enough to address the priority information needs and that is available to policy-makers and researchers in a timely fashion. In the face of growing expectations, technological innovations in health care and an aging population with varying needs that differ from those of previous generations, decisionmakers are increasingly challenged to improve efficiency in the use of health care resources. This challenge consists of changing the level and mix of HHR delivering the services, while at the same time ensuring that there is an adequate supply of human resources to meet the needs of the population. Efforts to improve current and future policy would be better informed by high-quality, comprehensive and timely information on HHR at the national level. There are clear information gaps in the decision-making process. All stakeholders in the health system require enhanced information about health personnel to improve both short-term and long-term planning. To address some of these data gaps, CIHI undertook an initiative that consisted of a consultation process designed to identify and validate HHR priority information needs and related indicators, as well as to identify data elements that should be collected in a standardized fashion across Canada. Simple data on credit card transactions yield to those with access far more comprehensive and timely information than is available for the so-called health services system on which we citizens of Canada spend over $70 billion each year. 14 Can you imagine the state of employment policy if, instead of the monthly labour force survey, we had only two-year-old data on unemployment? Why should health human resources planning depend on stale-dated data? 15 The identification of data elements was needed to support the compilation of national measures and indicators associated with the supply, distribution, practice/ employment characteristics, education/training and migration patterns of health personnel in Canada. This is a starting point a preliminary, but important, effort that will require review and refinement over time. The ultimate objective remains the creation of a guidance/reference tool for the development and enhancement of information systems, for use by anyone interested in HHR management. 2 CIHI February 2005

11 Project Parameters Scope of Project CIHI initiated a process leading to the development of a guidance document to support information system development and enhancement related to health human resources (HHR) in Canada. The results of this process are presented in the present document. It is important to note that the project does not address all of the information needs required to analyze demand factors, utilization, or needsbased planning, nor does it include comprehensive profession-specific data. In addition, the results are of such a high level that they are not intended to address information needs of specific subsets of regulated health This initiative focused on: Identifying data elements required to compile indicators that are necessary to address priority information needs (associated with HHR management); Supply-side data... recognizing that continuing to understand the demand/need based component of HHR is essential for future planning; and Regulated health professions... however, standards should be relevant to unregulated health professions as well. For more information on the approach taken and the rationale for the project parameters, please see Appendix A. personnel. For example, the indicators and data elements presented in Table 1.0 are far too general to address all Aboriginal or public health related HHR planning requirements. However, Table 1.0 could serve as a starting point for groups interested in further consultation to develop appropriate HHR data indicators and data elements. Currently in Canada, no single information system (for example, a database or survey) or data source (for example, provincial/territorial licensing authorities or public employers) can provide all of the data necessary to address the full range of priority information needs identified in this report. Public sector employers may capture very comprehensive data on the range of personnel in the public sector, but very limited information on health professions whose activity is focused in the private sector. Provincial/territorial licensing organizations typically capture data on all personnel able to practise within a given jurisdiction; however, the range of data collected is often limited to what is required for registration (for example, name, address, credentials). Continued progress towards integration of standards in data collection among national and provincial/territorial stakeholders is necessary: this will ensure that information system development currently underway can create and benefit from opportunities in the future (for example, electronic health record related developments). It is recognized that information from a variety of sources is required for meaningful HHR management. The range of data elements identified in Table 1.0 are conceived to be basic enough to provide a reasonable expectation of successful reporting at a national level, while still being comprehensive and flexible enough to address priority information needs at the provincial/territorial and sub-provincial/ territorial levels. At a future stage of national information system development, additional data elements may be identified for some health professional groups. Furthermore, additional data elements may be required to address more detailed information needs at the jurisdictional or profession-specific level. CIHI February

12 Purpose of Report This guidance document is intended to serve as a tool for individuals and organizations across Canada as they begin to develop or enhance information systems to support HHR management. This effort represents a starting point a preliminary effort that will require review and refinement over time. The indicators and the associated data elements presented are not intended to be a onesize-fits-all prescriptive expression of national standards. While some working definitions and examples are inserted for specific data elements and indicators in an attempt to provide a baseline understanding of the intended meaning, the challenging work of developing precise data element definitions as part of a data dictionary, as well as identifying the appropriate range of permissible values associated with each data element, are beyond the scope of the current project. Data specification development activities are essential to the development of information systems, and require close consultation with key stakeholders. 4 CIHI February 2005

13 Framework for Analysis The issues in health human resources (HHR) management are complex. Teams at the national, provincial/territorial and sub provincial/territorial levels are working to understand the relationships of inputs, outputs and interactions that define HHR in Canada. Figure 1 shows a conceptual framework useful for examining the complexity of the HHR environment (developed by O Brien-Pallas, Tomblin Murphy, Birch and Baumann in 2001). The framework highlights the need to consider the dynamic interplay among factors that have frequently in the past been considered in isolation from one another. The framework provides researchers and planners with a guide to decision-making that takes account of current circumstances (such as supply of workers) as well as factors that need to be accounted for in making predictions about future requirements (such as fiscal resources, changes in worker education and training). In addition, the framework includes external factors that have not always been part of the planning process (for example, social, political, geographic, economic and technological). The framework recognizes that HHR needs to consider many factors, such as the health needs of the population. Health needs, demand for health care services and utilization of health care services are important factors to consider. Although understanding differences in the utilization of and expected demand for health care services is important, the focus of this project is on the supply side of HHR management. The supply side of HHR is composed of the existing supply (people already working in health) and the potential supply inputs (people who are in health education/training programs, or health personnel migrating from other locations). Some components of the supply side (that is, the supply and production of health personnel), and the associated data supply chains (the people, infrastructure and mechanisms that collect the data) are relatively well defined. Not surprisingly, most information system development activities in Canada and around the world focus on the supply side. The factors that are important to the information-based functions of HHR management that relate to the supply of HHR include, but are not limited to: 16 The number and characteristics of applicants to, and graduates of, HHR-related education programs, by geographical location and nature of practice area; The number and characteristics of HHR personnel who are available, and those who are practising; The number and characteristics of health personnel who are immigrating from other countries or who are emigrating from Canada; The number and characteristics of health personnel who are leaving the profession due to retirement, death or other factors; The employment practices of health personnel; and The productivity levels of health personnel. CIHI February

14 Although beyond the scope of this project, it is important to note that there are additional factors that are important to understanding the HHR environment. These factors include, but are not limited to: The health and demographics of the population, which may influence the need for health services; The extent to which the population uses health services, by geographic location and nature of service; The volume, cost and nature of health services delivered, by geographic location; External factors (political, social, economic, etc.) that may influence the use of health services; and Client, health personnel and system outcomes by geographic location. Factors and Shocks to the System Political Social Health Outcomes Geographical Population Health Needs Supply Economic Production (education and training) PLANNING and FORECASTING Financial Resources Management, Organization, and Delivery of Services across Health Continuum Resource Deployment and Utilization System Outcomes Provider Outcomes Efficient Mix of Resources (Human and Non-Human) Technological Figure 1. Health Human Resources Conceptual Framework, by O Brien-Pallas, Tomblin Murphy, Birch and Baumann (2001) 6 CIHI February 2005

15 The Approach CIHI used a consultative approach to developing this guidance document. The process included three key steps: review of literature and relevant reports; facilitation of workshops with leaders in health human resources (HHR) research, policy and planning and representatives of health personnel and employers; and broad consultation with stakeholders on the scope of information needs and the range of indicators required. To assist with the process, CIHI also commissioned external experts in the field of HHR management. It is important to reiterate that this initiative is a starting point a preliminary effort that will require review and refinement over time. Phase 1 What Currently Exists? A review of international, national and jurisdictional empirical and grey literature was undertaken. The review included published scientific and professional publications and unpublished reports from various organizations and governments. A full list of the references is available in the References and Bibliography sections of this document. The findings from the review clearly and consistently reinforce that effective HHR management requires accurate and accessible data that can fill existing knowledge gaps about the state of the workforce and that can enable efforts to forecast future HHR requirements. 17, 18 In recent years, various levels or governments have made significant resource commitments to HHR issues. For example, in the 2003 federal budget, million dollars was allocated to enhance national HHR management with a focus on strengthening the evidence base for national planning, promotion of interdisciplinary provider education and enhancement of recruitment and retention, indicating strong federal commitment to HHR. At the national level, attempts to examine the health workforce in Canada from a variety of perspectives (including profession, sector and disease) have also been undertaken. Deficiencies in the data collection infrastructure and the absence of timely access to quality data for a range of health personnel have been evidenced in environmental scans completed by health personnel groups and associations (for example, occupational therapy, physiotherapy, pharmacy and others) The recently released Canadian Home Care Human Resources Sector Study: Synthesis Report (2003), also highlighted the lack of consistent, accurate data to inform human resource planning and decision-making and stressed that data collected for the home care sector be integrated with broader HHR data collection processes. 24 In addition, the Canadian Strategy for Cancer Control (CSCC) also stressed the need for coordinated development of human resources information systems that would permit the collection, analysis and dissemination of reliable information and data to inform policy-makers and funding authorities (2002). 25 CIHI February

16 Across Canada, numerous reports and data development projects have also reinforced the importance of HHR management. Here are just a few examples: In Atlantic Canada, the four jurisdictions are presently carrying out a study to forecast the Atlantic region s future supply of and demand for major health personnel occupations and to assess the implications of future fluctuations in supply and demand on education and training programs. 26 In Alberta, HHR database development 27 and a comprehensive health workforce plan 27, 28 have been identified as health system management priorities. For several years in Ontario, the Halton-Peel District Health Council has produced a range of analytical reports that investigate human resources within its own district. 29 On the international stage, a comparative review of planning human resources in health care in Australia, France, Germany, Sweden and the United States 30 concluded that all countries ignore relationships between professions, and that planning is inadequate. Although future demand for physicians is often considered, most planning is carried out in silos using supply-based information systems with major gaps. The report reinforced the need to carry out integrated planning across health personnel groups with an emphasis on the impact of geography and skill mix. Although some countries, such as Australia, 31 are identifying the necessary data elements for a national minimum data set, there remains a lack of easily accessed clinical, administrative and provider databases or survey tools to provide the necessary range of inputs (for example, population needs, health system and caregiver outcomes, as well as management information systems that reflect utilization and costs) necessary for HHR planning and modelling activities The World Health Organization and reports from the U.S., 41 the United Kingdom 42, 43 and Australia 31 identify the need to collect certain data elements to support HHR management. In addition, the emphasis to date has largely been on the collection of supply-based variables; this is also the case with the Canadian reports. The review consistently identified that HHR management in most countries and jurisdictions is limited by the availability of high-quality data data that are comparable across jurisdictions as well as being comprehensive (in terms of addressing the information needs across the desired range of health personnel groups). It is evident from the review that there is a need to address these data deficiencies and to collect and maintain data on a broader range of health personnel groups. Overall, the review indicated that considerable and valuable contributions to HHR information in Canada have been made, and continue to be made, at the provincial/ territorial 44 51, and national levels. 1, 16, 52, However, at the national level, no singular effort has been made to identify the priority information needs, indicators and data elements necessary to support HHR management across the range of regulated health personnel groups. In order to address this gap, a national consultation process was conducted in order to validate the proposed priority information needs, related indicators and data elements, some of which were identified during the review of literature. 8 CIHI February 2005

17 Phase 2 Focused Workshops With Key Stakeholders The focused workshop phase consisted of CIHI conducting two meetings with key stakeholders. The aim of the workshops was to validate the priority information needs, HHR indicators and key data elements required for effective HHR management. The first workshop was held March 8, 2004, and involved representatives from various provincial/territorial ministries of health. The second workshop was held March 26, 2004, and involved Canadian experts and researchers in HHR and representatives from selected health personnel and employer organizations. The findings from the focused consultation were incorporated into the working document and the final guidance document. Phase 3 Broad Consultation The final phase involved broad consultation with key stakeholders. Consultation was a critical component that provided CIHI with feedback and that ensured that the right information needs and priority areas were identified. As part of the consultation process, The Development of a National Minimum Data Set for Health Human Resources in Canada: Beginning the Dialogue Working Document, August 2004 (the predecessor working document to the current report) was made available on the CIHI Web site ( to all interested individuals and organizations. It was accompanied by a questionnaire (see Appendix C). More than a hundred individuals/organizations provided input and comments throughout the summer of 2004, reflecting many diverse perspectives on information needs and indicators. Feedback was incorporated into the present document. All contributors who provided consent for inclusion in the acknowledgements are identified in Appendix B. CIHI February

18 Information Needed to Support Health Human Resources Management in Canada This section outlines a summary of the proposed information needs, which were developed and validated through the three phases of the project. As indicated previously, the management of health human resources (HHR) can generally be thought of in terms of the performance of the following information-based functions: monitoring, evaluation, planning and research. 3 In identifying priority information needs in this report, consideration has been given to addressing all of these functions. Systematic monitoring and evaluation of the characteristics and trends in the health workforce are rudimentary, but essential, to providing both an understanding of successful strategies and an opportunity to anticipate emerging issues. Planning activities involve examining current and future resources and deployment patterns in order to ensure that health services are effectively met. Research activities increase knowledge about the health workforce and advance the science of HHR management within increasingly complex health systems. All of the activities in HHR management (monitoring, evaluation, planning and research) presume the existence of information systems that can provide high-quality data data that are timely, accurate, comparable, accessible and relevant. Data standards, grounded in identified information needs, are a fundamental underpinning of any useful HHR information system. The Priority Information Needs Priority Information Needs for Supply-Based HHR Management in Canada The priority information areas identified for HHR management are the following: Demographics Education/training Geographical distribution Migration Non migration-related attrition Employment/practice characteristics Productivity Focused workshops (Phase 2) with key stakeholders provided a substantive foundation from which the authors of this report identified the priority information needs, indicators and requisite data elements necessary to compile the measures and indicators for effective HHR management. It should be noted that the contributions of participants at the two facilitated workshops were remarkably consistent in validating the supply-based priority information needs required for cross-jurisdictional HHR management in Canada. Further refinements were made by drawing on common themes identified in the feedback submitted during the broad (Phase 3) consultation. Through this work, the following seven priority information needs have been identified: 1. Demographics the number and demographic characteristics of health personnel who are registered or licensed or who otherwise are part of the available health workforce. Demographic characteristics of health personnel provide important information. For example, they permit an examination of how age and sex can influence workforce participation. 10 CIHI February 2005

19 2. Education/training the number and characteristics of applicants to, and graduates of, health education/training programs that may potentially enter the workforce. The education/training system in Canada is the primary source of new HHR workers in Canada. Understanding the path taken by individuals as they enter this system on their way to the health workforce is important to HHR management. The foundation of the health personnel education/training system is the institutions and faculty that are employed by these institutions. It is necessary to know certain things about this crucial component in the production of future health personnel: the number of institutions, the characteristics of each institution, the programs within each institution and the faculty employed within institutions. 3. Geographical distribution the number and characteristics of health personnel employed by geographical distribution. Geography is important in a country the size of Canada, and understanding the distribution of health personnel (for example, in terms of rural or urban choice of practice/employment setting) and how this distribution relates to geography is important to workforce planning and policy development. 4. Migration the number and characteristics of health personnel who immigrate from other countries, those who emigrate from Canada to other countries and those who migrate between geographical locations within Canada (for example, between provinces and/or territories). Health personnel are highly skilled and mobile, and understanding migration patterns is the first step in influencing the push/pull factors that contribute to migration. While international migration is often the focus of media attention, the relative importance of migration within Canada is not clearly understood yet it is potentially important to HHR management activities. 5. Non migration-related attrition (losses due to retirement, change of profession, etc.) the number and characteristics of health personnel leaving the health workforce through various sources of attrition, other than inter provincial/territorial or international migration. Health personnel may leave their chosen profession for a variety of reasons (such as retirement or changing profession), and understanding the pattern of this attrition is important to HHR management. 6. Employment/practice characteristics the number and nature of health personnel engaged in employed activity. Understanding the nature of labour force participation of health personnel (for example, whether personnel are working full-time or part-time) can help inform policy decisions from the national/provincial/territorial level (for example, more educational seats to produce more health personnel could be funded) to the site of employment (for example, more full-time positions could be made available). CIHI February

20 7. Productivity the output of any health human resource (for example, client/patients seen by a health personnel) per unit of input (for example, earned compensation). Productivity indicators provide an understanding of the efficiency of health personnel in their delivery of health services. Measurement of productivity also permits deployment of the supply of health personnel that will meet identified service requirements, while still respecting accepted levels of personnel work intensity. The following table is a template for the future development and/or enhancement of HHR information systems. It reflects the feedback received during the consensus process which identified the priority information needs, the related indicators for national-level reporting and the associated data elements required to compile the indicators. It is a useful reference for individuals and organizations to support information system development and enhancement. Please note: For the purposes of this document, indicators are defined as single summary measures, often expressed in quantitative terms, such as rates, ratios, or percentages. Indicators frequently include or imply a numerator and denominator. For example, the number of pharmacists (numerator) per 10,000 population (denominator). As a result of this focus on indicators, readers will notice that many basic reporting measures utilized for HHR management (for example the number of employed health personnel by province/territory or the number of health personnel by level of education) are not presented in detail within the table. Instead, these basic measures are captured broadly within the priority information needs, and specifically within the list of associated data elements. 12 CIHI February 2005

21 Table 1.0 Priority Information Needs, Indicators and the Data Elements Required to Support Compilation of Health Human Resources Information in Canada Information Needs Priority National Indicators Data Elements 1. Demographics of Health Personnel The number and demographic characteristics of health personnel who are registered or licensed, or who are otherwise part of the available health workforce. Number of health personnel by personnel type per 10,000 population.* Distribution of health personnel by personnel type and sex (percentage of health personnel that are male or female). Distribution of health personnel by personnel type and by five-year age groups. Health care personnel National unique identifier or jurisdictional unique identifier Personnel type Sex Year of birth * Requires population data at the desired level of analysis (for example, sub-provincial/territorial, provincial/territorial, national). While generating personnel per 10,000 population ratios for all provinces and territories provides a basis for comparative reporting at the provincial level, when making decisions about the most appropriate population denominator, the following must be considered: the numerical size of the underlying population within a given geographic location (for example, personnel per 10,000 population will not account for varying health personnel resources in northern, rural and remote communities and often magnifies differences for the northern territories); the numerical size of a given health personnel group (for example, developing rates per 10,000 population for numerically smaller professions may be inappropriate); selecting a more relevant population denominator than simply the general population (for example, for midwives, a useful population denominator may be the population of women of childbearing years); and opportunities to use standardized rates in which personnel and population counts are adjusted based on the age and/or sex. Note: An attempt was made to avoid repeating elements that are primarily associated with other proposed information needs. CIHI February

22 Information Needs Priority National Indicators Data Elements 2. Education/Training The number and characteristics of applicants to, and graduates of, health education/training programs that may potentially enter the workforce. In addition: the number of institutions, the characteristics of each institution, the programs within each institution and the faculty employed within institutions. Ratio of qualified applicants to entrants within a given year. Ratio of entrants to graduates within a given year. Ratio of new graduates to number of health personnel in the current workforce. Percentage of all new graduates who enter the workforce within one year of graduation. Percentage of all new graduates who continue with further education (i.e. after entry/initial practice education) within one year of graduation from health personnel related education programs, by education/program type and credential sought. Average time to complete program. Distribution of health personnel by place of education/trainingrelated clinical placement and province/territory or country of education/training-related clinical placement. Distribution of health personnel, by personnel type and highest level of health personnel specific education. Distribution of health personnel by province/territory or country of graduation. Health personnel: Personnel entry to and exit from education/training (prior to entering the workforce) National student/trainee unique identifier Year of birth Sex Postal code of residence at application to program Province/territory or country of residence at application to program Highest level of education at application to program Postsecondary institution unique identifier Education/training program type Expected date of completion Date of entry (month, year) Date of graduation (month, year) Credential conferred upon graduation Reason for failure to complete Place of education/trainingrelated clinical placement (e.g. hospital, community, private) Province/territory or country of education/training-related clinical placement Personnel entry to and exit from education/training (after entry to the workforce) Entry/initial practice education personnel-type specific Highest level of education personnel-type specific Postsecondary institution unique identifier Certified area of specialized training personnel-type specific 14 CIHI February 2005

23 Information Needs Priority National Indicators Data Elements Source of certification Province/territory of initial personnel-type specific registration in Canada Year of initial personnel-type specific registration in Canada Other education/training non health personnel specific Institution: Health personnel education/ training institution Postsecondary institution unique identifier Education/training program type Postal code of education/ training program site Level of credential offered Available seats Applicants Entrants Graduates Distribution of faculty instructors by five-year age group. Faculty: Personnel education/training faculty National postsecondary institution faculty personnel unique identifier Year of birth Sex Postsecondary institution unique identifier Education/training program type Highest educational designation Faculty primary area of concentration Note: An attempt was made to avoid repeating elements that are primarily associated with other proposed information needs. CIHI February

24 Information Needs Priority National Indicators Data Elements 3. Geographic Distribution The number and characteristics of health personnel by geographical distribution. Personnel-to-population ratio: number of health personnel per 10,000 population* (by province/territory and sub provincial/territorial area). Number of health personnel employed in urban areas, per 10,000 population.* Number of health personnel employed in rural areas, per 10,000 population.* Health personnel: National unique identifier or jurisdictional unique identifier Personnel type Current province/territory or country of residence Primary employment province/territory or country Primary employment postal code Secondary employment province/territory or country Secondary employment postal code Current province/territory of registration * Requires population data at the desired level of analysis (for example, sub provincial/territorial, provincial/territorial, national). While generating personnel per 10,000 population ratios for all provinces and territories provides a basis for comparative reporting at the provincial level, when making decisions about the most appropriate population denominator, the following must be considered: the numerical size of the underlying population within a given geographic location (for example, personnel per 10,000 population will not account for varying health personnel resources in northern, rural and remote communities and often magnifies differences for the northern territories); the numerical size of a given health personnel group (for example, developing rates per 10,000 population for numerically smaller professions may be inappropriate); selecting a more relevant population denominator than simply the general population (for example, for midwives, a useful population denominator may be the population of women of childbearing years); and opportunities to use standardized rates in which personnel and population counts are adjusted based on the age and/or sex. Note: Obtaining the six-digit postal code was identified as a priority in order to examine geographic distribution at all of the desired units of analysis (i.e. national, provincial/territorial and sub provincial/territorial area). There is currently no singular gold standard for the geographical concepts of urban and rural. The collection of full postal codes permits multiple definitions for geographical constructs not easily defined or in a state of development and provides maximum flexibility in responding to information needs, as health care boundaries (e.g. health regions) continually change. An attempt was made to avoid repeating elements that are primarily associated with other proposed information needs. In the absence of national unique identifiers, elements associated with geography and migrations are closely connected, necessitating inclusion under both areas. 16 CIHI February 2005

25 Information Needs Priority National Indicators Data Elements 4. Migration The number and characteristics of health personnel who immigrate from other countries and those who emigrate from Canada to other countries, as well as those who migrate between geographical locations within Canada (for example, between provinces and territories). Percentage of health personnel workforce who move between provinces/territories in Canada annually. Percentage of the health personnel workforce who join the Canadian workforce annually as a result of immigration. Percentage of health care workforce who leave the workforce annually as a result of emigration from Canada. Annual net interprovincial migration rate, by personnel type and province/territory. Annual net international migration rate, by personnel type and province/territory. Health care personnel: National unique identifier or jurisdictional unique identifier Personnel type Previous province/territory or country of residence Previous province/territory or country of employment Previous postal code of employment Current province/territory or country of residence Primary employment province/territory or country Primary employment postal code Secondary employment province/territory or country Secondary employment postal code Province/territory of initial registration in Canada Current province/territory of registration Previous registered activity status Current registered activity status Note: Monitoring migration patterns (all sources) is hampered and made much more complex due to the absence of a national unique personnel identifier. An attempt was made to avoid repeating elements that are primarily associated with other proposed information needs. In the absence of national unique identifiers, elements associated with geography and migrations are closely connected, necessitating inclusion under both areas. CIHI February

26 Information Needs Priority National Indicators Data Elements 5. Non Migration- Related Attrition The number and characteristics of health personnel leaving the health workforce for various reasons other than migration (retirement, change of profession, etc.). Percentage of losses to the health personnel workforce due to non migration-related attrition (by geographical location and personnel type). Percentage of losses to the health personnel workforce due to specific reasons for non migration-related attrition. Average duration of departure (for select types of attrition, such as parental leave or education). Annual net attrition rate (non migration-related, by personnel type, type of attrition, and province/territory). Health care personnel: National unique identifier or jurisdictional unique identifier Personnel type Current registered activity status Previous registered activity status Previous employment duration (in months) Previous employment reason for leaving Note: The reason for non migrationrelated attrition could be further developed to include more specific categories for measurement (retirement, parental leave, continuing education, etc.), depending on which areas warrant individual attention. An attempt was made to avoid repeating elements that are primarily associated with other proposed information needs. 18 CIHI February 2005

27 Information Needs Priority National Indicators Data Elements 6. Employment/Practice Characteristics The number of and nature of health personnel engaged in employed activity. Percentage of the registered/licensed workforce currently employed in their specific profession (by profession, by sector, by age, by gender). Percentage of the registered/licensed workforce not currently employed in their specific profession (by profession, by sector, by age, by gender). Ratio of health personnel working full-time to health personnel working part-time. Proportion of employed health personnel by: Place of work (for example, hospital or community) Area of responsibility (for example, direct care or administration) Position (for example, manager, direct care personnel or researcher) Percentage of health personnel with multiple employers. Percentage of health personnel with certified specialized training. Health personnel National unique identifier or jurisdictional unique identifier Personnel type Certified area of specialized training personnel-type specific Source of certification Current registration status Current province/territory of registration Previous registered activity status Current registered activity status Other provinces/territories or countries of registration Primary employment employment/practice status Primary employment preferred employment/practice status Primary employment place of work Primary employment area of responsibility Primary employment position Primary employment duration of service Secondary employment same elements as for primary employment All employment more than two distinct employers? Note: An attempt was made to avoid repeating elements that are primarily associated with other proposed information needs. CIHI February

28 Information Needs Priority National Indicators Data Elements 7. Productivity The output of any health human resource (for example, clients/patients seen by health personnel) per unit of input (for example, earned compensation). The proportion of health personnel working beyond some measure of maximum capacity.* Worked hours/activity statistics.* Earned compensation/activity statistics.* National unique identifier or jurisdictional unique identifier Personnel type Output elements Activity statistics (patient days, visits, exams, procedures, attendance days, workload units, etc.) Input elements Earned compensation Worked hours Comment: Productivity indicators are complex to measure. During the consultation, it was recognized that this subject area requires future research. The indicators identified provide a useful starting point. *Note: The concepts of maximum capacity and/or activity statistics are not consistently defined for all types of health care providers. For example, research in these areas has been more prevalent for physicians and nurses. Therefore, it must be recognized that this may be an area that requires further customization based on the type of health care professional. Please note: The data elements required for productivity indicators are dependent on the type of productivity measure of interest. 20 CIHI February 2005

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