Evidence submitted by Pascal Zurn (WP
86)
Pascal Zurn is a health economist with a master's
degree in health economics from the University of York and a PhD
in economics from the University of Lausanne. He joined the World
Health Organization in August 2001. His area of work covers analysis
regarding the issues of imbalance and migration of health workforce,
as well as data collection and monitoring activities. From August
2005 to July 2007, he will be on a secondment at the OECD in Paris,
where his work will focus on health workforce migration in OECD
countries. His evidence is submitted on an individual basis.
Ageing population, technological change and ageing
health workforce
1. It can be anticipated that shortages
of health professionals in OECD countries will grow in the next
20 years, unless countermeasures are taken, because population
ageing and changing technologies are likely to contribute to an
increase in the demand for health workers, while workforce ageing
will decrease the supply as the "baby-boom" generation
of workers reaches retirement age. Unless domestic training programmes,
or other domestic policy changes, take the strain, there is likely
to be an even greater "pull" on health workers from
developing countries into OECD countries and between some OECD
countries with both gains and losses for receiving and sending
countries.
2. In many countries, a trend towards earlier
retirement dovetails with a rise in the average age of health
workers, and these dual shifts could lead to mass exits from the
health workforce. Middle-aged nurses, who are part of the "baby
boom" generation born after the Second World War, dominate
the workforce in many countries and will reach retirement age
within the next 10 to 15 years (From the World Health Report (2006),
page 110).
To what extent can and should the demand be met,
for both clinical and managerial staff, by:
— Changing the role and improving the
skills of existing staff.
— The recruitment of new staff in England.
— International recruitment.
3. Addressing the demand for both clinical
and managerial is a challenging task. It appears that a mix of
policies is likely to produce better result than by just focusing
on one. However, the issue of better retention is a central one.
Indeed, in addition to the potential loss of group efficiency
and organizational performance due to high turnover rates, evidence
suggests that the costs associated with high turnover, recruitment
and retentions problems are substantial.
4. The literature shows that the costs associated
with recruitment and retention problems can be substantial. In
the USA, the National Association for Health Care Recruitment
estimated direct costs of recruiting and hiring a nurse at US
$2,396. In the UK, administrative costs associated with the recruitment
of a nurse were estimated to be between £401 and £637
(Gray et al 1996). An early study estimated the initial productivity
losses occurring as recruits learn on the job at between £1,422
and £6,166 per staff nurse (Buchan et al 1991). In an attempt
to account for those indirect costs, Johnston evaluated total
turnover costs at around US $25,000 per nurse (Johnston 1991).
In terms of policy option, policies developed by so called "magnet
hospital" seem to offer examples of policies improving nursing
recruitment and retention in hospital. The main characteristics
of such hospitals are:
— high-quality nursing leadership;
— flat organisational structure;
— supportive, individual personnel
policies and processes;
— professional models of care;
— high level of autonomy of nurses;
— quality assurance initiatives;
— consultation and other resources
available;
— positive relationships between community
and hospital;
— support role of nurse as teacher;
— positive image of nursing;
— positive nurse-physician relationship;
— professional career development.
(This paragraph is derived from Zurn P, Dolea
C, Stilwell B. Nurse retention and recruitment: developing a motivatedworkforce.
Geneva, International Council of Nurses, 2005 (Issue Paper 4;
http://www.icn.ch/global/Issue4Retention.pdf, accessed 2 February
2006).
5. The issue of migration has raised a lot
of concern recently. In comparison with other countries, England
is among the countries with one the most important share of foreign
trained workers.
| Doctors trained abroad
| Nurses trained abroad
|
OECD country |
Number
| Percentage
of total |
Number
| Percentage
of total |
Australia | 11,122
| 21 | NA | NA
|
| Canada | 13,620 | 23
| 19,061 | 6 |
| Finland | 1,003 | 9
| 140 | 0 |
| France | 11,269 | 6
| NA | NA |
| Germany | 17,318 | 6
| 26,284 | 3 |
| Ireland | NA | NA
| 8,758 | 14 |
| New Zealand | 2,832 | 34
| 10,616 | 21 |
| Portugal | 1,258 | 4
| NA | NA |
| United Kingdom | 69,813 |
33 | 65,000 | 10
|
| United States | 213,331 |
27 | 99,456 | 5
|
| |
| | |
NA, not applicable.
Source: World Health Report, 2006.
6. In this context, one of the key challenge for England
would be to manage migration in order to contribute to generate
benefits for both England and the sending countries. In this context,
ethical guidelines for recruitment, memorandum of understanding
between England and other countries, such as the one with South
Africa, twinning health institutions between receiving and sending
countries, developing knowledge transfer through health worker
immigrants are all example of policies aiming at a better management
of migration.
Pascal Zurn
31 May 2006
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