The WHO defines HRH (Human resource for health) planning as "the process of estimating the number of persons & the kinds of knowledge, skills, & attitudes they need to achieve predetermined health targets & ultimately health status objectives".
HR planning is a dynamic process, involves 3 stages; stocktaking, forecasting, & designing temporary workforce. In the first stage of stocktaking, recruitment & selection of key types of employees align with strategic business plan to achieve specific targets. The second stage of forecasting is subdivided into two phases, forecasting future people needs (demand forecasting) & forecasting availability of people (supply forecasting). The third & final phase involves flexible strategy to recruit temporary employees as per need assessment & cost-effective benefits.
1. Stock-taking: – The principle is to identify how many people are needed at every level of the organization to achieve business objectives- in line with overall strategic plans – & what kind of knowledge, skills, abilities & other characteristics these people need .
The optimal staffing of modern health services requires many different types of staff. These include; –
1. Clinical workers – doctors & nurses.
2. Technical staff for diagnostic services, such as laboratory & radiology, pharmacy staff.
3. Environment health workers, such as health inspectors.
4. Preventive & promotive staff, such as community health workers, administrative staff, etc.
In a healthcare organization, traditional quantitative approach are used to make enumerative judgments based on subjective managers prediction to allocate certain budgets for employee's payroll expenditure & need assessment of key employee potentiating responsive to organizational system & design. Resource allocations are best executed with the help of activity based cost management, that controls cost & labor required for specific job / event & reduce wastage.
For example: Comparative rates of healthcare activity: –
Inpatient care bed days per capita
Acute care bed days per capita
Acute care staff ratio – staff per bed
Acute care nurses ratio – staff per bed
Inpatient admissions per 1000 population
Acute care admissions per 1000 population
Doctors consultation's per capita.
The types of health staff in a particular country are dictated by the kinds of health services provided & level of technology available.
For example: –
Nature of health organization: primary, secondary, & tertiary.
Types of sector: public, private, non-profit funded organization.
Infrastructure: size of the hospital (200 beds, 400 beds, 1000 beds).
General (multispecialty) or specific care providers (cardiovascular, cancer).
2. Forecasting: –
Demand forecasting: – Planning for the medical workforce is complex & determined by relatively mechanistic estimates of demand for medical care. Dr. Thomas L. Hall (1991) proposed 5 generic methods for estimating demand for health care, such as
1. Personnel to population ratio method: – This method calculates ratio of number of health
Personnel as compared with the population count. However, with inappropriate data available, it has serious limitations, such as it is only applicable with acceptable health conditions, a stable health sector, & a limited capacity for planning.
2. The health-needs method: -This method requires & translates expert opinion about people's health needs to staff requirements. Health needs are derived from the determination of disease specific mortality & morbidity rates. The staff requirements are evaluated from the norms for the number, kind, frequency, & quality of services, & staffing standards that convert the services into time requirements by a certain category of health workers to perform the services. This method initiates the need for sophisticated data system & survey capabilities, & a high level of planning expertise which are not readily available.
3. The service -demands method: -This method accounts the numbers & kinds of health services people will use at an anticipated cost of obtaining them, rather than their professionally determined need for such services. This specifically provides data about economical regression pertaining to utilization of private healthcare sector as compared to government funded health sector.
4. The managed healthcare system's method: – The managed health care system's entails a known client population who would have reasonably good access to health amenities. But flexible socio-political trends & economical recession influence healthcare reform policies.
Supply forecasting: –
Forecasting HR supply involves using information from the internal & external labor market. The calculation of staff turnover & workforce stability indices measures internal supply for HR Planning. External labor market gives detailed spectrum on tightness of supply, demographic factors, & social / geographic aspects.
Internal supply: – The evaluation of the gross number of people needed for a specific job & arrange for other provisions of HR processes, such as training & developmental programs, transfer & promotion policies, retirement, career planning, & others have crucial importance in maintaining constant supply of HR in an organization.
1. Stock & flow model: – This model follow the employee's path through the organization over time, & attempt to predict how many employees are needed & in which part of the organization.
a) Wastage analysis; – This analysis refers to the rate at which people leave the organization, or represents the turnover index.
The number of people leaving in a specific period
Wastage analysis = x 100
The average number employed in the same period
b) Stability analysis (Bowey, 1974): – This method is useful in analyzing the extent of wastage in terms of length of service.
Total length of service of manpower employed at the time of analysis
Stability analysis = x 100
Total possible length of service had there been no manpower wastage
2. Replacement Charts: – Replacement chart is a list of employee's for promotion, selected upon the opinions & recommendations of higher ranking people (Mello, 2005). Some replacement charts are more systematic showing skills, abilities, competences, & experience levels of an employee.
3. Succession Planning: – An aging workforce & an emerging "Baby boom" retirement waves are driving the need for new management process known as succession planning that involves analyzing & forecasting the talent potentials to execute business strategy.
Will Powley, senior consulting manager for GE Healthcare's performance solutions group says, that the first step in effective succession planning is a quarterly talent review that begins with an examination of the hospital or health system's organizational chart.
In a 2008 White Paper on succession planning, GE Healthcare identified a few best practices for healthcare for succession planning:
1. Identify & develop talent at all levels
2. Assess top performer's talent rigorously & repeatedly
3. Link talent management closely with external recruiting
4. Keep senior management actively involved
5. Emphasize on-the-job leadership & customized employee development
6. Create systematic talent reviews & follow-up plans
7. Maintain dialogue with potential future leaders.
External supply: – HR managers use outside information, such as statistics concerning the labor market from the organization & external labor market, in other words external & internal statistics.
External statistics: – Graduate profile
Graduate profile: – There is substantial public sector regulation of all health care markets, & entry to labor market is highly constrained by licensing & professional regulations.
Unemployment rates: – There is lack of economic principles, the role of incentives is largely ignored & supply elasticity in the labor market is mostly unknown & poorly researched.
Skill levels: – Higher education (specialization & super-specialization) are proportionally restricted to limited seats of admission governed by medical regulatory bodies.
Age profile: – The organizational charts of recruitment gives details of rates of recruitment, retention, return & early retirement of employee's, which helps to enumerate future vacancy rates, shortages, & need for replacement.
Internal statistics: – Demographic profile
Demographic profile: – Demographic changes (eg the number of young people entering the labor force) affect the external supply of labor. Age composition of workforce will force to review recruitment policies. The trend of increasing proportion of women in employment has lead to progressive development of both organization & country.
Geographic distribution: – The attraction of workforce to urban areas are influence by following reasons; employment opportunity, access to facilities – transportation & technology, & others.
3. Temporary workforce planning: –
Herer & Harel (1998) classifies temporary workers as: temporary employee's, contract employees, consultants, leased employees, & outsourcing.
High social costs has initiated work sharing strategy which are flexible & provides more benefits, such as
1. Part- time temporary workers numbers & hours can be adapted easily with low maintenance cost to meet organizational needs,
2. Employees possessing appropriate / specialized skills benefits functional areas within & outside the organization.
3. No responsibility for exclusive benefit enrollments, such as job security, pension plan, insurance coverage, etc.
In today's work environment, outsourcing can be added as a temporary worker planning technique. Outsourcing requirement is assessed & evaluated on cost & benefit decision. Ambulatory services, pathological or diagnostic testing services, laundry, catering, billing, medical transcription, & others are most commonly outsourcing services promoted in healthcare organization.