steven lewis access consulting ltd., saskatoon & centre for health & policy studies...

Steven Lewis

Access Consulting Ltd., Saskatoon &

Centre for Health & Policy Studies

University of Calgary

CAAHP Conference

Ottawa, April 4, 2003

A Public Policy Perspective onEducational Credentials for

Health Professions

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Steven Lewis CAAHP Forum April 4, 2003

The Current Health Care Scene

Higher degree of specialization Greater technical sophistication Sicker institutional populations Rapid change HHR shortages Increased urbanization

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HHR Problems

Mismatch of need and supply Aging workforce Maldistribution of personnel Inefficient division of labour Slow development of team concept Long production cycles for personnel

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Some Major Questions

Job-readiness: what does it mean and who is responsible?

Which educational programs can be most responsive to changing workplace needs?

Educating for a short half-life of knowledge Credentials: whom do they serve and should

educational programs pile them on?

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Educational Issues

Costs (to system, to students) Shelf life—how long does initial education last in a

rapidly changing practice and scientific milieu? Structure

Relative importance of theory and practice Traditional vs. co-op programs Continuous vs. modular programs

Impact on career development

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The Knowledge Paradox

Health care more knowledge-intensive than ever, promoting specialization

The greater the requirement for knowledge, the less time available for problem-solving and creativity

The knowledge base changes constantly Dilemma:

How much is enough for new graduates? How should problem-solving be taught?

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Educating People to Embrace Change

Most people hate change Educational institutions really hate change and

their structures are admirably designed to thwart it You cannot manage successfully in health care

unless you can manage change Neither change nor change management are

integral aspects of health science education

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What Do Students Want?

Jobs that use their skills Portable and respected credentials Opportunities to continue education Opportunities for career advancement Lowest possible direct costs Shortest time possible

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What Does Government Want?

High quality, low cost programs Short production cycles Ability to adjust intake and output rapidly Graduates qualified to do the job Programs adaptable to needs of workplace

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What Do Professions Want?

Well-defined and exclusive scope of practice Status and respect Good pay Access to senior administrative positions National and international standards Self-regulation and self-definition

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What Do Educators Want?

High quality, sustainable programs Good students Respect from their peers Opportunities to do research (some) Prospects for career advancement Security and stability

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What Do Employers Want?

Job-ready graduates Organizational competence Good match of education with requirements of the

job Large pool of qualified applicants to fill positions Portable national credentials and standards

The Interests At Play

Low Cost

Ease of Entry

Short Duration

Higher pay and prestige

High Mobility

Prospective Students

Support Support Support Support Support

CurrentStudents

Support Mixed Support Support Support

Current Workforce

Mixed Mixed Mixed Support Mixed

Colleges Mixed Mixed Support Support Support

Universities Oppose Mixed Oppose Support Support

Employers Support Support Support Oppose Mixed

Governments Support Support Support Oppose Mixed

Public Support Support Support Oppose Mixed

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What Drives “Credential Creep”?

Almost invariably generated by the occupational groups themselves

Governments’ initial reactions almost invariably negative

Employers often not consulted and when they are, often skeptical of the change

Research-based evidence rarely available or influential in the decisions

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Problems Enhanced Credentials Ostensibly Solve (if they exist)

Inadequate job skills—unprepared graduates Development of new kinds of skills—better match

with needs of contemporary practice Need to attract “better” students Failure to be taken seriously as integral parat of

health care team Need to educate students in a different

environment alongside their future colleagues

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Possible Justifications for Raising Credentials

Desire of current members of the profession Interests and desires of educational programs Views and interests of employers Views and interests of governments Empirical evidence that status quo is

unsatisfactory Empirical evidence that enhanced credentials will

solve the problems identified

Impact of Increasing Credentials

Costs to government Up

Costs to students Up

Potential no. of students who might pursue the program

Down

Goodnes of fit with actual employment needs

Down unless job changes with credential

Short-run capacity to produce graduates

Down

Salaries of practitioners Neutral to Up

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What Does “Job-Ready” Mean?

Health system jobs are not static Knowledge base changes very rapidly Success depends on:

Adaptability Judgment in face of uncertainty Ability to find, synthesize and apply new

knowledge Ability to communicate

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Are Higher Credentials Justifiable?

Evidentiary basis for changing credentials is weak or non-existent

No evidence produced to suggest that diploma nurses were or are unable to do the job

May be indirect rationale, e.g., as ticket to higher management positions

Natural tendency for occupational groups to want to upgrade their status

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Changing Programs or Changing Venues—or Both

All professions becoming more knowledge-intensive

Information management is supplanting technical-physical skills

All educational programs must be in the business of information management and analysis

When do needs warrant conversion to a university-based program?

Who should decide, and on what basis?

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The “Critical Thinking” Rationale

Some argue university-based programs add value in form of critical thinking and judgment

Assumes that formal education rather than job experience and apprenticeship creates these qualities

Assumes that college-based programs do not or cannot develop these capacities

Quality control in universities is arguably uneven at the undergraduate level

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The Dangers of Misalignment

Contentment arises partly from good match of education and job requirements

Higher credentials may create unrealistic expectations in workforce

Career advancement may require a different knowledge base, not simply an expanded one

Important to track the impact of new standards on job satisfaction

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Credentials as Pathway to Career Advancement

Contemporary world is inordinately focused on formal educational credentials

Upward career path does require different skill set (human and financial management, judgement, big-picture and synthetic view of organization)

Changing from diploma to degree unlikely to be the best route to acquiring these capacities

Timing is an issue—often better to return to school when needs and ambitions clarify

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Initial Credentials and Lifelong Learning

A great deal of health care knowledge is obsolete in 5 or 10 years

Science and technology advance rapidly Suggests that techniques of learning, not just a

body of knowledge, are the real mandates of health science education programs

These trajectories will blur the distinction between colleges and universities

Requires new understanding of time horizons

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Assessing Credential Needs: A Public Interest Checklist

Do requirements match needs of workplace? Do requirements create unnecessary barriers to

entry? Is there evidence that current programs do not

produce suitable graduates? Do educational shortcomings require normal and

continuous adaptation or wholesale redesign?

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Public Interest Checklist (continued)

How much would raising the requirements cost, and who would bear the cost?

Who is making the case for raising credentials, and on what evidence or argument?

What process led to the conclusion that credentials should be raised—was it inclusive and transparent?

Will raising credentials actually solve the problems identified?

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Conclusion

A public interest and public policy perspective places credentialism in wider context

Reconciling public and particular interests not always possible

Crucial to ensure solutions fit problems If key constituencies are ignored, the result is likely

to be sub-optimal Important to learn from experiences to date

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Contact Information

Steven Lewis

Access Consulting Ltd.

211-4th Avenue South

Saskatoon SK S7K 1N1

Tel. 306-343-1007

Fax. 306-343-1071

E-mail: [email protected]

steven lewis access consulting ltd., saskatoon & centre for health & policy studies...

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