Background Paper on Occupational Therapy Human Resource Data: Sources, Utilization, and Interpretative Capacity

Transcription

1 Background Paper on Occupational Therapy Human Resource Data: Sources, Utilization, and Interpretative Capacity Prepared for the Canadian Association of Occupational Therapists By D. Parker-Taillon and Associates Page 1

2 TABLE OF CONTENTS 1. EXECUTIVE SUMMARY INTRODUCTION Background Purpose of Background Paper: Approach Taken: REVIEW OF THE LITERATURE ON HEALTH HUMAN RESOURCE DATA COLLECTION Human Resources Planning Models: Summary and Analysis Information Needs for Human Resource Planning HHRP Data Requirements Methods of Collecting Data Using the Data for Human Resource Planning INVENTORY OF OCCUPATIONAL THERAPY HUMAN RESOURCE DATA Data Sources Internal to the Profession Occupational Therapy Regulators Occupational Therapy Professional Organizations Occupational Therapy Academic Programs Education Programs for Support Personnel in Occupational Therapy Data Sources External to the Profession Canadian Institute for Health Information (CIHI) Human Resources Development Canada (HRDC) Statistics Canada Citizenship and Immigration Comparability of data / interpretative capacity across jurisdiction GAP ANALYSIS RECOMMENDATIONS/SUMMARY APPENDIX. 17 REFERENCES Page 2

3 1. EXECUTIVE SUMMARY This paper was undertaken to provide an overview of the sources of workforce data in occupational therapy, its utilization and the interpretative capacity across jurisdictions, as well as recommendations for the future. It is anticipated that the background paper will serve as a starting point for future work in this area. The overall approach used was a gap analysis which involved an inventory of occupational therapy human resource data, a review of health human resource planning literature, a gap analysis, and development of the background paper and recommendations. The inventory indicates that there are significant gaps and limitations in the existing data that prevent the development of a reliable and comprehensive national and provincial profile of Canadian occupational therapists. The paper highlights a number of issues related to human resources management and planning in occupational therapy. Recommendations arising from this discussion are identified in four key areas: leadership and partnerships; information needs; data requirements; and next steps for effective human resource management and planning in occupational therapy. It is essential that effective health human resource planning in occupational therapy be undertaken within an interdisciplinary, integrated framework of health workforce planning. 2. INTRODUCTION 2.1 Background The Canadian Association of Occupational Therapists (CAOT) recently published a paper describing the education, supply and distribution of occupational therapists in Canada. 1 The paper identified several important trends in terms of occupational therapy human resources including: There are wide discrepancies in the distribution of occupational therapists in Canada; The widespread reports of shortages across Canada are supported by statistics that indicate that despite significant increases in the supply of occupational therapists in the past decade, large increases in the supply of occupational therapists are still required to meet the needs of the population; The practice pattern of occupational therapists has shifted in the past decade with the majority of occupational therapists now working in community, school, work or home-based practice; University occupational therapy programs have increased enrollments over the past decade to meet service demands for occupational therapy; and The entry to practice level of education of occupational therapists is increasing. Collectively these trends signal the importance of the profession strategically looking at human resource planning in order to ensure that there is a sustainable and responsive occupational therapy work force for the future. 2.2 Purpose of Background Paper: In preparation for the development of a labour force planning and monitoring system, CAOT received funding from Health Canada to develop a background paper that will provide an overview of the sources of workforce data for the profession, its utilization and the interpretative capacity across jurisdictions, as well as recommendations for the future. It was anticipated that the background paper would serve as a starting point for future work in this area. Specifically the background paper: Reports on the data sources available that are relevant to occupational therapy including: o Location of the data Page 3

4 o Components of the data o Comparability and harmonization of the data o Future use of the data; Provides an analysis of the various mechanisms used to collect data such as registration forms used by regulatory associations; Identifies the methods of storing and retrieving data; Discusses the interpretive capacity of the data across jurisdictions; Provides recommendations: o For further harmonization of data; o On information needs for supply and demand projections; o For further consultation with stakeholder groups; o Areas requiring further work concerning occupational therapy data. 2.3 Approach Taken: The Background Paper was developed by an external consultant (D. Parker-Taillon and Associates) under the management and guidance of the Director of Standards and Professional Affairs at CAOT (CAOT primary contact). The overall approach used was a gap analysis which involved the following steps: Step 1: Inventory of Occupational Therapy Human Resource Data The present status of occupational therapy human resource data was collected using two methods, an survey for organizations internal to the occupational therapy profession, and key informant interviews for organizations external to the occupational therapy profession. Each of these methods is described below. Survey: A survey of occupational therapy regulatory bodies, provincial professional organizations, CAOT, university education programs, and education programs for support personnel in occupational therapy was developed and conducted to obtain information on current human resource data collection (location of data, method of data collection and storing, components of data (i.e. specific data collected), comparability of data, present and future use of the data) and any recent human resources studies that have been done. The survey was conducted using and each survey was tailored to the type of organization (i.e. regulatory body, provincial association, CAOT, university program, support worker program). The survey tool was piloted with one key contact for each of the target groups listed above prior to being circulated. Reminders using and telephone messages were sent to non-responders to maximize the response rate. A sample copy of the surveys is included in Appendix I. Results of the survey are provided in section 4.1 of this paper. Key Informant Interviews: Key informant interviews were conducted with organizations external to the occupational therapy profession that are involved in collecting human resource information about occupational therapists. The purpose of these interviews was to identify for each organization: how, why and what information is collected; where and how the data is stored; who has access and how the data is used; comparability of the data (between jurisdictions, and with other professions); opportunities for partnerships with CAOT; and any recent human resources studies that have been done. Key informants were selected in conjunction with the CAOT primary contact and included representatives of: The Canadian Institute for Health Information, Health Canada and Human Resources Development Canada. The information on external organizations gained from the interviews was supplemented by reviewing documents and information on websites, many of which were provided by the key informants. Results of the information obtained on data collected by organizations external to the occupational therapy profession are provided in section 4.2 of this paper. Page 4

5 Step 2: Review of the Literature and Relevant Reports An extensive review of the literature related to best practices in human resource data collection was carried out (see Bibliography, Appendix V). Search strategies included: On-line searching of the databases Medline/Pubmed and CINAHL; Reviewing articles/books already in possession for additional references; Obtaining references recommended by key informants. Step 3: Gap Analysis The gap between the current status and desired state was analyzed by the consulting team. Step 4: Develop Recommendations for Future Action Based on the gap analysis, recommendations for future action were developed by the consulting team in conjunction with the CAOT primary contact. In addition, an Occupational Therapy Regulator was interviewed to provide input into the recommendations. Step 5: Develop Discussion Paper The Discussion Paper was developed which describes the purpose, methodology, key findings and recommendations for further action. The draft was circulated to the CAOT key contact for feedback and revised as necessary prior to being submitted. 3. REVIEW OF THE LITERATURE ON HEALTH HUMAN RESOURCE DATA COLLECTION 3.1 Human Resources Planning Models: Summary and Analysis A review of the literature related to health human resources planning (HHRP) reveals the overarching objective of having the right number of workers, with the right skill mix, organized in such a way as to meet the needs of the population they serve. 2,3 Very little human resource planning has been done for the allied health professions and occupational therapy in particular. 4 In health care, this is a daunting task, since health care provision is diverse, complex, and very labour intensive, with human resources representing over 70% of expenditures. 5 The science underpinning HHRP is young and in the development stages and to date has mainly been based on supply focused modeling. 6, 7 Although many models exist, the literature reveals three approaches to HHRP that are most frequently described. These include: the utilization-based approach, the needs-based approach, and the effective-demands-based approach, each of which will now be briefly reviewed. 8, 9 The utilization-based model, frequently used in the past to predict physician and nursing resources, assumes that the current level, mix, and distribution of services are appropriate and that these variables should remain constant. 1 0 This paradigm revolves around the question, how many health providers are needed to serve the future population in the way that is currently done? It uses a population-based utilization rate (usually per 10,000 population) as a baseline. This approach assumes that current delivery models actually meet the current population health care requirements. 7 Risks involved with this forecasting model include the assumption that present distribution rates are appropriate and effective and thus there is the potential for errors, which may have consequences in the future. The second model, the needs-based approach assumes that all health needs can and should be met, and that cost-effective methods to HHRP can be implemented. It assumes that the only reason for not meeting population health needs is because of inadequate human resources supply. 10 This model focuses around how many health providers are needed to meet the present and future needs of the population. In this case, population-based rates of health care providers are used as baselines. The model does not assume that the current use of services is optimal, nor does it omit resources for services that are ineffective and add those that serve unmet needs. This approach to HHRP requires Page 5

6 substantive data, and even if these were available or could be developed, health service delivery mechanisms would need to be in place to ensure that the health human resources are used in the way they were planned 7. The third approach frequently described in the literature is effective demands-based modeling which takes into account the resources available to fund health human resources, knowing that there are other resource and societal trade-offs in setting priorities. 9 It focuses on how many health providers are needed to support society s commitment to health care. It takes into account the economic resources that society is willing to allocate to health and health care, in consideration with other policies and programs. There isn t necessarily one model that is best; the conceptual model used will depend on the type of questions asked and the type and quality of data that are available. 1 1 North America has seen many cycles of under and over supply of healthcare workers (mostly physicians and nurses), and this is related to inadequate forecasting methods and a lack of appropriate databases. 5 Pong also points out that even if more accurate projections for health human resources could be made, the implementation of effective strategies is often difficult for the responsibility for health workforce planning and development are widely dispersed ministries of health, ministries of education, universities, colleges, professional associations, regulatory bodies, accreditation agencies, health care facilities, consumers, labour unions etc.. Effective HHRP requires constant adjustments according to the level and distribution of health needs between planning periods. Another factor that plays a large role in human resources management is the output or productivity of health providers. The intensity and complexity of cases vary in different services and environments and all these factors have an impact on productivity. This is especially relevant to professional groups like occupational therapists who work in a wide variety of settings (inpatients, outpatients, community centres etc.) and provide a range of different service types (acute care, long term care, chronic care). Better methods for quantifying workload and productivity for different clientele work settings and roles must therefore be developed. Much of HHRP has been carried out on a disciplinary/professional basis, not taking into account that productivity, changes in one professional sector, and the evolution of new workers on the scene has an impact on services provided by other professionals. Recognizing these factors, the CAOT has been one of several groups that have long recognized the importance of integrated HHRP. 1 2 Pong predicts that three major changes will occur in health human resources practices in the future. These include: an increase in collaborative practice, personnel substitution (such as the use of support personnel in occupational therapy), and multiskilling of individual health providers. It is therefore essential that data related to HHRP in occupational therapy also include information on occupational therapist assistants Information Needs for Human Resource Planning Management of health human resources of a profession in an integrated fashion involves intensive planning, monitoring the present and changing workforce, evaluating its effectiveness in meeting real and perceived needs, and carrying out policy research in the field. 3 The information requirements for effective HHRP are therefore substantial and complex. The absence of reliable data is one of the major obstacles in effective HHRP. 1 3 Forecasting models are only as good as the data they are based on. The following section summarizes data requirements and methods of collecting data for HHRP HHRP Data Requirements The data required for HHRP can be broken down into two categories: supply information and utilization/demand data. These two types of data will now be described. Supply information is information that describes the number and distribution of occupational therapists and may be obtained through a variety of sources. For those health providers employed in direct clinical care, information can be obtained from provincial regulatory bodies. It is Page 6

7 much more difficult however to account for those who are trained as occupational therapists but do not require mandatory regulation (e.g. those working in government) or those who are not employed. Some of this information may be found through employment insurance commissions, membership in voluntary professional associations or through census data. 3 However, there may be considerable overlap between these groups and it is difficult to obtain accurate numbers regarding the supply and geographic distribution of occupational therapists. Other sources of data to obtain supply information include federal taxation information, immigration records and surveys. Comprehensive supply information includes demographics (including age and sex), education, registration, and employment information. One of the major shortcomings of the current supply information is with respect to support personnel in occupational therapy. For example, it is known how many students graduate each year (although this is not centrally collected), but it is not known how many work in occupational therapy upon completion of their education. Utilization/ demand data is information that describes the current levels of available occupational therapy services and considers population needs. In terms of availability of this information in relation to occupational therapists, very little is known about the utilization of occupational therapy services. Many hospital-based workload data either lack specificity regarding the occupational therapy profession or information is absent. Consistent basic reporting could facilitate the determination of caseload guidelines and guide information gathering regarding quality of care. Even less is known about the utilization of occupational therapy services in the community-based or private sector. Population health needs with respect to occupational therapy services is currently limited. This has created a major knowledge gap with regards to occupational therapy services and/or human resource requirements Methods of Collecting Data Data used for human resources planning come from a variety of sources such as professional and regulatory organizations and are therefore sometimes referred to as secondary data. 3 There are a number of considerations when collecting the data including: o Permission to use personal data for purposes other than the specific purpose for which it is originally submitted must be obtained from respondents. Systematic methods for obtaining this permission may need to be implemented. Privacy laws prevent the sharing of information where the findings can be attributed to individuals. In most cases aggregate data can be used for HHRP; o Data must be valid and reliable and the rigour with which the primary data are collected affects the overall quality of the data; o It is important to determine a standard set of data elements that the profession must collect specifically for human resource planning. o Data definitions must be the same when comparing aggregate data; o Individual providers should have a unique identifier to prevent double counting and track mobility; and o Timing of data collection should be synchronized. 3.3 Using the Data for Human Resource Planning In order to acquire the data for HHRP across Canada, national standards for data categories and collection must be developed and adopted. HHRP and management is a complex process that takes place at several levels (local, provincial and federal) and involves a large number of stakeholders (from professional associations to unions and educational institutions). 1 4 Since the planning and delivery of health services takes place at a provincial level, provinces and regions must agree to these standards and must develop methods and infrastructures to ensure accurate and valid data are collected. Strategic and integrated health human resource planning requires that planning be done in collaboration with other professions and that new planning methodologies be tied to service delivery and be based on population health needs. 4. INVENTORY OF OCCUPATIONAL THERAPY HUMAN RESOURCE DATA As noted in the previous section, HHRP is a highly complex process; its effectiveness and success is largely dependent on the quality and quantity of data gathered on the workforce. Pertinent HHRP data currently collected for the occupational therapy profession in Canada can be Page 7

8 found with organizations internal to the profession as well as those external to the discipline. This section outlines what pertinent occupational therapy HHR data is currently collected, how it is collected and stored, as well as its interpretative capacity across jurisdictions. 4.1 Data Sources Internal to the Profession Those organizations internal to the profession were surveyed in this project and include occupational therapy regulators, provincial professional associations, CAOT, occupational therapy academic programs and educational programs for support personnel in occupational therapy. Table 1 shows that the response rate for this survey is high for all groups. Table 1. Survey Response Rate Type of Organization Number Sent Responses Received Occupational Therapy Regulators 10* 10* (100%) Occupational Therapy Professional Organizations 8* 7* (88 %)) Occupational Therapy Academic (university) (92%) Programs Education Programs for Support Personnel in 11 8 (73%) Occupational Therapy *NB: The provincial regulatory associations in four jurisdictions (Alberta, Saskatchewan, Quebec, New Brunswick) also carry out the function of a provincial professional association. The survey asked respondents to report on the type of data collected, the frequency of data collection, and how and in what format information is shared with other organizations Occupational Therapy Regulators Information collected by all regulatory bodies includes data such as contact information, employment, registration status, and number and education information (the year and place of graduation). Information regarding the type of practice and clinical specialty areas are collected as well. However, definitions for the number of practice hours or type of work settings or areas of practice are not standardized and vary across the country. A summary of data collected by occupational therapy regulatory bodies in Canada (summarized from the 2002 registration/renewal forms) can be found in Appendix II. Copies of renewal/registration forms are included in Appendix III. The data collected are self-reported. Four provinces carry out random audit checks and Quebec carries out pre-programmed quality checks. Other regulatory organizations did not report regular data quality checks. Renewal dates vary in the different provinces and range from February 28 to July 1. Most of the regulatory data is stored using Microsoft compatible software such as Access, Excel or Word (n=10). Other software programs used to store data include Filemaker Pro (1) and Reflections (1). Most of these software programs are able to share data in Microsoft Access, Excel or Word format, indicating that sharing in a common format should be easy to achieve. Three of the regulatory bodies (Alberta, Ontario and Quebec) reported using the information to analyze the geographical distribution of occupational therapists per employment category. Some used the collected information to identify potential risk factors related to competence and practice activities, level of education or employment status (full-time vs. part-time). The regulatory bodies reported very little data sharing. The data are shared with the Canadian Institute for Health Information (CIHI) who uses the information in their reports on health providers (see section 4.2.1). Some report sharing with their provincial ministries of health (Nova Scotia and Saskatchewan). However, there is Page 8

9 no national framework for data sharing and data collection is also not collated on a national level. Much of the data is shared on an ad-hoc basis upon request. Some of the regulatory bodies carry out some limited HHR analysis, but this is not done on a widespread basis Occupational Therapy Professional Organizations There is a national professional organization in Canada, CAOT, and ten provincial organizations. As noted above, six of these organizations also function as regulatory bodies in their province. Membership with CAOT is voluntary. Approximately 84% of registered occupational therapists are members of CAOT (1999/2000), making this national association a rich source of data 1. Data collected by CAOT are summarised in Appendix II. Most of the data collected by the professional organizations are stored in Microsoft Access or Excel and one province reports the use of IMIS software that has capabilities of exporting to Microsoft database software. Most of the data collected are used internally to review membership information, to network, to perform continuing information analysis and for volunteer recruitment. CAOT and Ontario use the data to identify trends, analyse compensation offered, determine recruitment opportunities and sources for therapist funding (private vs public). Overall very little analysis is carried out by the provincial professional organizations, and very little data are shared. The data collected by CAOT are not received through the provincial organizations, but rather from the individual members directly. This indicates that for some provinces, CAOT has more data elements for occupational therapists than the respective provincial regulatory body Occupational Therapy Academic Programs One type of supply information that is available from Occupational Therapy Academic Programs is the number of graduates per year. In addition, they collect some information on successful and unsuccessful applicants. For successful applicants, information on academic performance, language test results, personal reference letters and CV s are kept on file. Some program directors reported that privacy protection laws prevent the universities from collecting and retaining personal information regarding applicants. Very little data are kept related to unsuccessful applicants (six reported keeping academic results). Most responding programs (7) reported not knowing how the data are stored or shared, since this is done centrally within the university. This would indicate that these programs do not have access to the data at the present time. Six of the responding programs reported not collecting any information or performing any analysis of students leaving the program. Three programs recorded the reasons for leaving the program and one reported recording the name of the program the student transferred to. After graduation, four programs reported collecting information regarding satisfaction with the program and two collect employment information, mostly upon graduation or 6 months after graduation. The Quebec university programs were the only ones that reported information sharing with their provincial government (the Quebec government monitors the number of seats in the program). It is unclear what role the other governments play in other provinces. In general very little is known about what type of individual applies to an occupational therapy program, why they leave the program or where they chose to work upon graduation. This makes it difficult to understand the recruitment and retention factors in occupational therapy Education Programs for Support Personnel in Occupational Therapy Only four respondents reported collecting any applicant information. Those that do, collect information on age, previous education, and former employment experience. In general information on applicants is scarce. Many programs are not aware how applicant information is obtained or shared, since this occurs centrally within colleges as with universities. All of the colleges collect information from their graduates upon completion of the program and report this on their websites. Information collected includes: information on employment (8); satisfaction with the training program (3); the population(s) served (1); further education (3); and workplace demands (1). Two programs reported on collecting information of those not completing the program. Most of the programs share this information with the program advisory committee and their provincial government of education. Page 9

10 4.2 Data Sources External to the Profession Canadian Institute for Health Information (CIHI) The Canadian Institute for Health Information ( ) is a national independent, not-for-profit organization whose mandate is to develop and maintain an integrated approach to health information in the country. In terms of data related to occupational therapy supply they collect primarily head count information from: the regulatory bodies where they exist; the provincial associations where there is no regulatory body; and CAOT. They publish this information every two years in a report on Canada s Health Care Providers 15. In terms of ensuring data quality they cross check the data received from the provincial and national organizations. One of the challenges they identified was the lack of a common set of data elements within and between professions that would improve the comparability of the data collected. On the demand side, gaps currently exist in the information available on the scope of rehabilitation services in Canada and on patient outcomes. As a result, CIHI recently implemented a new national information system for adult rehabilitation inpatient services Human Resources Development Canada (HRDC) Human Resources Development Canada ( ) is the federal department whose mission is to enable Canadians to participate fully in the workplace and the community. In terms of occupational therapy human resource data there are two initiatives of interest, Job Futures and the Canadian Home Care Human Resources Study. Each of these will be briefly described. Job Futures ( ) provides a national overview of the labour market and general economic trends. It provides detailed information on 226 occupational groups, including occupational therapists. The information is designed for career/education professionals, teachers, parents, workers, unemployed persons, and individuals re-entering the job market. Each occupational profile is updated annually and includes information on job duties and responsibilities; the level and type of education training and experience required for work in the occupational group; key labour market characteristics of the group such as recent employment trends, distribution of workers by age, and percentage of full-time, part-time and self employed and male/female workers; rate of earnings; relative unemployment rates; current prospects of finding work; and prospects of finding work over five years. The information is based on information obtained from a variety of sources including the Labour Force Survey, the Census, reports from regions, the National Graduate Survey and professional organizations like CAOT. As discussed elsewhere in this paper, since there are limitations in terms of the quality and quantity of data available on occupational therapists, inferences based on these data may be limited. An example of the data recently collected on occupational therapists from the Job Futures Website is included in Appendix IV. The Canadian Home Care Human Resources Study ( ) is a study that seeks to analyze the short and long-term human resource issues and challenges facing the home-care sector. It will service as the basis for coordinated action by the sector by providing muchneeded insight into the kinds of actions needed to improve the availability of high quality home care for all Canadians. One of the specific objectives includes providing labour market information to address short- and long-term requirements for formal caregivers (paid regulated and paid unregulated occupations). Occupational therapists were one of the paid regulated groups included in the study. The study involved three phases including Phase 1: Understanding the Factors Affecting the Home Care Resources Study Phase 2: Understanding the Human Resource Challenges Phase 3 Analysis and Recommendations Page 10

11 The report on Phase 1 is available on the website and contains limited information on Occupational Therapists. The final report is not yet available but one of the reported limitations is that the information on occupational therapists in home care has been grouped with information on physiotherapists and social workers Statistics Canada Under the Statistics Act, Statistics Canada is required to collect, compile, analyze, abstract and publish statistical information relating to the commercial, industrial, financial, social, economic and general activities and conditions of the people of Canada. ( ). In terms of occupational therapy human resource data. Statistics Canada has two surveys of interest, the Census Survey and the Labour Force Survey. Each of these will be briefly described. By law, Statistics Canada must take a census every five years and every household in Canada must fill in a census form. The last census was taken on May Four out of five households receive the short form, while the remaining one receives a long-form questionnaire. The shortform includes seven questions: name, sex, age, marital and common-law status, family and householder relationships and mother tongue. The long-form includes the seven questions, plus an additional fifty-two questions. The census provides point-in-time estimates on the supply of occupational therapists by occupational class, based on the Standard Occupational Classification. The data collected by the census has limitations 1 6 that include: Since it is conducted every five years, analysis is limited to highlighting the changes in the data between census years, it cannot look at average annual rates of change or attrition rates; Limited sample size (1 in 5 self-reported); and Occupational class codes and group of codes need review. The Labour Force Survey ( ) is a monthly survey involving about 50,000 Canadian households. The goal of the survey is to provide a detailed, current picture of the labour market across the country. The survey provides monthly estimates of total employment (including self-employment) and unemployment. The survey also provides employment estimates by industry, occupation, hours worked and more. For employees, wage, union status, job permanency and workplace size are also produced. While the survey provides detailed information, there are limitations as the number of occupational therapists represented is only a small proportion of the total supply. In addition, the survey excludes Nunavit, the Northwest Territories and the Yukon and the occupational class codes and grouping of codes need review Citizenship and Immigration The Citizenship and Immigration Department ( ) was established to link immigration services with citizenship registration, to promote the unique ideals all Canadians share and to help build a stronger Canada. This department collects information provided by the provinces including the annual number of landed immigrants by immigrant class, and the intended field of health occupations. 4.3 Comparability of data / interpretative capacity across jurisdiction At the present time, the information collected by the different stakeholders is not centrally collected. Little sharing takes place between the stakeholders even within the same province or with stakeholders external to the profession (including governments, regional health authorities or employers). Although some data is common to several organizations (e.g. provincial regulatory bodies), data element definitions are not standardized, which limits their interpretative capacity across regions and jurisdictions. Thorough data quality verification methods are not universally in place, which poses some questions as to the reliability of the data. The absence of unique identifiers for individual occupational Page 11

12 therapists makes it impossible to track occupational therapist mobility across the country and over time. Different timeframes for the collection of the data poses an additional challenge. 5. GAP ANALYSIS According to the literature reviewed, an effective approach to HHRP involves a comprehensive strategy encompassing elements of supply of health care providers, present and future projections of utilization rate, and the economic impact of health workers costs with respect to other societal priorities. Effective planning for HHRP in occupational therapy requires an integrated approach, which using the aforementioned models, also considers occupational therapists within the context of other health care providers and acknowledges their productivity within a variety of service delivery and environmental contexts. As indicated in the previous discussion, the critical factor for effective HHRP is the availability of comprehensive, valid and reliable data, which is collected on an on-going basis at regular consistent intervals. This study has uncovered a number of gaps between best practice models of HHRP and what is presently occurring in occupational therapy in Canada. It has also highlighted the gaps and limitations in the data that are presently available. With relation to the supply side of HHRP in occupational therapy, at this point in time the existing database is diffuse and inconsistent. Data related to the supply of occupational therapists are collected at both national and provincial levels by voluntary and regulatory professional agencies. There is no consistency in the data categories collected or timeframe for collection, there are no linkages to create a comprehensive and reliable national/provincial profile, and as most of these data are self-reported there are few mechanisms in place to validate the authenticity of the information. As a result there are significant gaps in the existing database that prevents the development of a reliable and comprehensive national and provincial profile of Canadian occupational therapists. Academic/educational institutions also maintain their own data set, however again there is inconsistency in the data elements and no agreed-upon methods and timeframe for the information gathering. Similar to the database of practicing occupational therapists, this information is for the most part guarded and maintained within the home institution/agency and not shared among and between other constituencies. There is an acknowledged commitment on the part of CAOT of the value of integrated human resources planning with other health providers, and initial steps have been taken towards this goal. Occupational therapy HHRP must be considered within the context of the broader picture of health service delivery professionals and support personnel, as multiskilling and collaborative practice are trends of future health service delivery. On the utilization/ demand side of HHRP, as indicated previously, the data are even more limited and fractured. While some fragments of information are available related to utilization rates in public sector facilities, again the data are not consistent nor are the data elements synchronized among and between sectors. The status of available information related to private sector practice is even more restrained as diverse funding sources hinder the identification and thus access to therapists working in this sector. In addition, to date data gathering processes have not acknowledged or made any attempt to account for the productivity of practitioners in various sectors, an element that is also critical to the understanding of human resources utilization. The existing utilization data does not provide a comprehensive national and provincial profile of the availability of occupational therapy services across the country highlighting regional and provincial variations, nor does it take into account populations needs for occupational therapy services. The data that does exist seems to be collected at infrequent, asynchronous intervals. Efforts should be made to track and trend occupational therapy utilization patterns over regular time intervals which will provide important evidence upon which to base future HHRP. Finally, there are minimal available data related to the funding priorities and social costs of providing occupational therapy services. These data are even more illusive and difficult to capture than those mentioned above. Using a comprehensive database of supply and utilization data as outlined will provide a sound foundation for policy analysis and trending, as well as identification of environmental/economic/ social/demographic elements which influence policy related to occupational therapy HHRP. Regular surveys and/or focus groups of the Page 12

13 recipients of occupational therapy services will also provide increased evidence upon which to base future planning. Finally centralization of an identified agency with protected funding and the specified mandate to provide leadership and coordination of HHRP issues will be a critical factor to successful HHRP in occupational therapy. It is interesting to note that the present status of supply and utilization/demand data in occupational therapy continues to demonstrate the same fragmented characteristics documented in 1998 by the Woodhead Lyons Report. 1 7 Very little progress has been made to improve consistency and comprehensiveness over the intervening five-year period. 6. RECOMMENDATIONS/SUMMARY This inquiry has highlighted a number of issues related to human resources management and planning in occupational therapy. Recommendations arising from this discussion are related to four key areas: leadership and partnerships, information needs, data requirements, and next steps. Within each of these four key areas, specific recommendation are described and each is classified as either short-term (up to two years [S]), or long-term (over two five years [L]). 1. Leadership and Partnerships 1.1 Establishment of a Centralized Agency There is the need for one centralized Agency (Working Group, see also 4.2) to take the leadership around issues related to HHRP in occupational therapy, including data collection, storage, retrieval, and policy related to HHRP (S & L). Funding should be sought on a sustained basis to support the activities of this Agency (see also 4.4) (S & L). 1.2 The Development of Linkages and Partnerships The Agency should work closely with provincial regulators to establish effective linkages to support human resources data gathering on a thorough, consistent, and reliable basis (S). Closer ties need to be forged with academic programs providing the professional education of occupational therapists, to promote consistent and comprehensive data which is gathered on regular intervals, identifies characteristics of individuals who choose occupational therapy, follows their progression through the academic program, and tracks their initial employment characteristics, identifying essential issues related to recruitment and retention in the early stages of their careers (S). On-going linkages should be established with colleges offering education programs for support personnel in occupational therapy to track the practice patterns of these graduates and to identify the impact of these workers on occupational therapy service delivery (S). The Agency should collaborate with other health provider groups to become familiar with on-going strategies in other professions and to support concrete initiatives of integrated health human resources planning (L). Partnerships should be developed with other data holders such as CIHI, HRDC, and Statistics Canada to facilitate standardization of data collection and storage and to share information as appropriate for effective occupational therapy and integrated HHRP (L). On-going linkages should be established with human resource researchers to define and promote best practices related to occupational therapy and integrated HHRP (L). Page 13

14 2. Information Needs for HHRP 2.1 Consistent Guidelines/Policies There is a need to develop guidelines/policies related to the establishment of an occupational therapists database (S). Efforts must be made to improve the validity and reliability of data in order to provide a basis for understanding the utilization of occupational therapy services in both the public and private sector; productivity of practitioners within different health contexts and sectors must be considered (L) Environmental Scanning There is a need for on-going environmental scanning to identify and track trends and issues that may have a future impact on the delivery of occupational therapy services (S & L). The voices of a broad representation of recipients of occupational therapy services need to be heard in order to identify strengths of the profession, opportunities, attitudes, and impressions that may impact on the profession in the future (L) Information Privacy Further information should be obtained to identify the policies around privacy of information to determine what aggregate data can be used for HHRP purposes, and to identify the elements or processes to obtaining respondents consent for use of personal information (S). Data elements/strategies should be developed around privacy policies to facilitate maximum use of available information for HHRP (L). 3. Data Requirements for Comparability and Harmonization 3.1 Data Elements/Collection Schedule There should be consensus on the data elements (and their definitions) to be collected by each partner agency. A national consensus meeting involving all key partners is suggested to facilitate this process. This process should consider other work related to common data elements (S). Ideally the data should be collected at synchronized, regular intervals across the country; there should be participation of all appropriate agencies to ensure that all jurisdictions across Canada are covered (L). 3.2 Unique Identifier Upon entry into the profession, occupational therapists should be provided with a unique identifier, coordinated at the national level, to permit the reliable tracking of a individual s career path in occupational therapy and across geographical jurisdictions Efforts should also be made to provide the existing occupational therapy workforce with unique identifiers (S & L). 3.3 Data Verification There should be built-in audit/verification systems to ensure the authenticity of the data (L). Page 14

15 3.4. Technology and Software Guidelines There should be detailed and defined guidelines specifying the technology and software used for human resources databases to ensure optimal potential for sharing and transfer of information (L). 4. Next Steps for HHRP in Occupational Therapy 4.1. Dissemination and Feedback on the Findings of this Report This report should be disseminated amongst internal stakeholders (CAOT, regulators, provincial professional organizations, academics, and education programs for support personnel in occupational therapy) to solicit feedback (within a restricted timeframe), facilitate buy-in, and create momentum concerning the issues related to occupational therapy HHRP (S). The findings should also be distributed to the general membership of CAOT to heighten general awareness and facilitate future participation in occupational therapy HHRP (S). The report should be distributed to external stakeholders to promote awareness and solicit feedback on the issues identified related to HHRP in occupational therapy (S) Development of a Working Group on Occupational Therapy HHRP CAOT should take the lead role in the development of a Working Group (centralized agency 6.1.1) of internal stakeholders, consisting of representatives of CAOT, regulators, provincial professional organizations, academic programs, and education programs for support personnel, to meet at regular intervals to discuss issues and strategies related to HHRP (S & L). The roles of each of the five partners (CAOT, regulators, provincial professional organizations, academic programs, and education programs for support personnel) in occupational therapy HHRP must be defined and established (S). A study should be undertaken to determine the infrastructure required for effective occupational therapy HHRP (S). A comprehensive plan should be developed that outlines the steps, schedule, participants, funding, and anticipated outcomes for future HHRP (S & L) Liaison with Health Canada CAOT should take the leadership in meeting with Health Canada to discuss the ramifications of this report and future directions (S). Health Canada should be approached to sponsor an interdisciplinary conference to share information gained from this and other interdisciplinary HR projects to explore and develop future strategies for integrated HHRP (S). Discussions with Health Canada should include the exploration of funding for specific identified projects to move occupational therapy HHRP forward and to sustain the activities required for effective HHRP (S & L) Funding As indicated above, funding should be solicited from external sources (including Health Canada) to sponsor conferences, initiatives, and projects related to occupational therapy and integrated HHRP (S & L). Funding must be obtained on an indefinite basis to support the human resources and infrastructure required for sustained HHRP activities (L). Page 15

16 4.5. Build Internal Capacity Required for Effective HHRP in Occupational Therapy. Individuals with expertise in occupational therapy HHRP and policy analysis should be identified/developed to champion, guide, analyze, and evaluate activities and initiatives of occupational therapy HHRP (S & L). Summary This report has identified a number of recommendations related to leadership and partnerships, information needs, data requirements, and the next steps for effective human resource management and planning in occupational therapy. The implementation of a successful human resources plan requires a series of carefully orchestrated steps, each of which must be in place before embarking upon the next phase. Effective occupational therapy HHRP requires first of all the development of a centralized agency of essential partners to provide internal leadership and strategic direction. Once this is in place, there must be agreement and buy-in among internal stakeholders related to roles, priorities, plans, and timelines for HHRP initiatives. Funding must then be obtained from external sources to develop and sustain the outlined HHRP activities. Each of these three elements is critical and must be in place to move forward. Finally, the practicality and feasibility of moving ahead in occupational therapy HHRP is very dependent on the interdisciplinary HR direction taken on a national basis. It is essential that effective HHRP in occupational therapy be undertaken within an integrated framework of health workforce planning. Page 16

17 Issues APPENDIX I Data collected by Occupational Therapy Regulatory Bodies in Canada and CAOT Data collected by the occupational therapy regulatory bodies where they exist, associations where they do not, and CAOT (summarized from 2002 registration /renewal forms) Earnings Employment status Internet use and access Information regarding liabilityinsurance Number of languages spoken Number of Years worked in OT / Province Registration in other provinces or other professions Population Size and Urban / Remote Acuity of Clients Age group of clients Areas of Practice 4 Role in Employment Setting 3 Type of Work Setting 2 Practice Hours 1 Payment Source Education Information Employment Status (FT/PT/Casual) Employer Contact Information Date of Birth Contact Information Province BC AB SK _ MB ON QC _ NB NS PEI _ NF _ NWT/N _ YK _ CAOT 1 The number of practice hours in the defined differently by the regulatory bodies that collect this information. 2 The number of types of work settings varies widely across the country. 3 The types of roles in the different employment settings are not standardized across regulatory bodies. 4 The definitions for areas of practice are not standardized and the number of choices varies Page 17

18 References 1 Canadian Association of Occupational Therapists. The Education, Supply and Distribution of Occupational Therapists in Canada. CAOT Publications ACE, Birch S. Designer's Corner - Health Human Resource Planning for the New Millennium: Inputs in the Production of Health, Illness, and Recovery in Populations. Canadian Journal of Nursing Research 2002; 33(4): Kazanjian A., Hebert, M., Wood L., Rahim-Jamal S. Regional Health Human Resources Planning & Management: Policies, Issues and Information Requirements. Health Human Resources Unit, Centre for Health Services and Policy Research, UBC. Bc. January HHRU 99:1 4 Mable AL, Marriott J. Steady State: Finding a Sustainable Balance Point - International Review of Health Workforce Planning Health Human Resources Strategies Division; Health Canada. 5 Pong R. Towards Developing a Flexible Health Workforce: A Conference Background Paper. Canadian Journal of Medical Radiation Technology 1997; 28(1): O'Brien-Pallas L, Birch S, Baumann A, Tomblin Murphy G. Integrating Workforce Planning, Human Resources, and Service Planning Geneva, World Health Organization. 7 Markham B, Birch S. Back to the Future: A Framework for Estimating Health-Care Human Resource Requirements. Canadian Journal of Nursing Administration 1997; O'Brien-Pallas L, Baumann A, Donner G, Tomblin Murphy G, Lochhaas-Gerlach J, Luba M. Forecasting Models for Human Resources in Health Care. Journal of Advanced Nursing 2000; 33(1): Lomas J., Stoddart, GL, Barer, ML. Supply projections as planning: A critical review of forecasting net physician requirements in Canada. Social Science and Medicine 1985, 20, Tomblin Murphy G. Methodological Issues in Health Human Resource Planning: Cataloguing Assumptions and Controlling for Variables in Needs-Based Modeling. Canadian Journal of Nursing Research 2002; 33(4): JN Lavis, S. Birch. Applying alternative approaches to estimating nurse requirements. The answer is Now what was the question? Canadian Journal of Nursing Administration, 1997,10(1) Canadian Association of Occupational Therapists, Canadian Dietetic Association, Canadian Nurses Association, Canadian Physiotherapy Association. Integrated health Human Resources Development: Pragmatism or Pie in the Sky. August L. O Brien-Pallas, S. Birch, A. Baumann and G. Tomblin Murphy. Integrating Workforce Planning, Human Resources and Service Planning. Workshop on Global Health Workforce Strategy. Geneva, World Health Organization, Fooks, C. Duvalko, K, Baranek, P, Lamothe L, Rondeau, K. Health Human Resource Planning in Canada: Physician and Nursing Workforce Issues. A Research report for the commision of Health Care in Canada. Canadian Policy Research Networks Inc., Canadian Institute for Health Information. Canada s Health Care Providers. Ottawa, 2001 Page 18

19 1 6 Canadian Institute for Health Information. Future Development of Information to Support the Management of Nursing Resources: Recommendations. Ottawa, Woodhead Lyons Consulting. Data Collection on Health Human Resources. Report Prepared for Knowledge Development and Analysis Section, Health System s Division, Strategies and Systems for Health Directorate, Health Promotion and Programs Branch, Health Canada. Edmonton, Page 19