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Premiers health report a good start but important opportunities missed

The health care report released last week following the Premiers meeting in Halifax, which focused on moving from innovation to broader health system action, represents a critical step in a more collaborative and engaged approach. The recommendations contained in the report From Innovation to Action, regarding the three inter-related areas of health human resource management initiatives, team-based models of care and clinical practice guidelines, also highlighted how we must take better advantage of our knowledge infrastructure to better address these key issues. The recommendations also called for a platform for ensuring the ongoing identification and dissemination of information on innovative models in order to help promote the adoption of leading practices. The report highlighted a series of innovations or promising practices which should be scaled up to improve the efficiency of health care in Canada. But how and why were these innovations chosen? It seems ironic that, in recommending more evidence-informed policy and practice, a more systematic, evidence-based approach was not undertaken in the choice of innovations. One of the promising practices that could have been highlighted, around the need for shared workforce planning models, would be the work undertaken by the pan Canadian HHR (Health Human Resources) Planning Toolkit which helps planners select models that match their particular needs and resources. Some of the innovations highlighted are not particularly new. Take the promotion of lean management for example. During the last round of health care cuts in the mid 1990s, this approach was employed as a means to cut costs. We need to heed lessons learned from that era: bottom up approaches identified by front line workers tended to be more successful than those imposed from the top down. Just as important as which innovations are chosen is how these innovations are to be scaled up to broader health system action. What prerequisite contextual features need to be in place in order to, again, achieve the desired results? The situation for innovators can often be quite different from that for adopters. This kind of information is critical to the development of deployment strategies for specific innovations, particularly in the case of the health workforce because of the complex manner in which health professional practice and workplace environments are regulated. In the case of team-based care, for example, we know that there are still some significant barriers at the practice level, as well as in terms of funding and the regulation of health professionals, that prevents them from working together collaboratively and to their full scope. A better understanding of the advantageous and not so advantageous features of the context of health professional practice is a particularly promising area in which to develop a concentrated applied health research strategy. But it is an area in which we need more dedicated resources from our research infrastructure. A key facilitator of many of the recommendations in the Premiers report would be a coordinated pan-Canadian health

workforce observatory. Many countries have established over the last 10 years such an organization that: a) shares evidence, datasets and analysis, b) seeks and share innovation in a systematic manner, c) respects and work within a context of interdependence, d) provides evidence to make informed decisions, and e) integrates planning at a variety of levels and through various stakeholder organizations. We have created a prototype of what such an observatory could entail with the pan Canadian Health Human Resources Network. We have already begun working to build capacity in health human resource research and link researchers to a range of knowledge users and policy decision makers to address the issues addressed by the Premiers Health Innovation Working Groups, among others. There is also a need to situate the health workforce challenges we face within a broader international context. This includes how the changes to Canadian immigration policy will impact on the role that internationally- educated health professionals will play in our health system, as well as how health reform in the U.S. will impact our own health human resource planning. Having a pan Canadian health workforce observatory linked to other similar entities in other countries would better enable such a linked in approach. The Premiers report does represent a step forward on the way to improving health care in Canada, but it falls short of getting us more clearly on the right path. Ivy Lynn Bourgeault is the CIHR/Health Canada Research Chair in Health Human Resource Policy at the University of Ottawa and the lead of the pan Canadian Health Human Resources Network.