Making the right decisions in a complex world

WHO seminar, Geneva12th December, 2014

Dr. Graham WillisHead of Research and Development, CfWI

Matt EdwardsHead of Horizon scanning and International, CfWI

Many years ago…

How many trained hospital doctors will we have by 2040?

Cost

How many do we need?

Do we trust this?

Trai

ne

d h

osp

ital

do

cto

rs

(th

ou

san

ds)

60

50

40

30

Year2014 2040

Supply

Demand

?

Policy

What if the future is not what we expect?

Failure

Megatrends

ProblemSystem

Events

Consider many futures…

Expected future

Use plausible, challenging and consistent futures to test policies

Principles

Systemic

Future-oriented

Flexible

Transparent

Inclusive

Comprehensive

Understandable

Robust workforce planning

Understand the system

Explore the future

Simulate the possibilities

Make robust decisions

Focal question

Transparent and participatory

Horizon scanning

Context

Issues

Factors

Events

Ideas bank System mapping

Scenario generationStakeholder workshops

Influencing factors

Keyfactors

Consistency check

Narrative scenarios

Quantified scenarios

Scenario generation workshopKey factors

Low

Imp

act

Hig

h

Low Uncertainty High

Predetermined Key factors

Secondary

Scenario generation workshop

Population GDP growth Energy usageCarbon

emissions

High

LowCA

B

Consistency analysis

Scenario generation workshop

Vary across different futures

Formal elicitation protocol

Monte Carlo simulation

Pro

bab

ility

Value

Quantify critical parameters

Modeling and simulation

Demand side

OutputsSupply

side

Po

licy

ou

tco

me

s

Policy analysis

Policy options: A

B

C

D

Pharmacy exampleScenarios

Scenario 1Narrower

Scenario 2Internet-driven

Scenario 3Broader

Pharmacists role

Enabling technology

Projection 1

Projection 2 Scenario 4e-Pharmacy

Nu

mb

er

of

ph

arm

acis

ts (

full

-tim

e e

qu

ival

en

t)

20

12

20

14

20

16

20

18

20

20

20

22

20

24

20

26

20

28

20

30

20

32

20

34

20

36

20

38

20

40

100,000

80,000

60,000

40,000

20,000

0

20

12

20

14

20

16

20

18

20

20

20

22

20

24

20

26

20

28

20

30

20

32

20

34

20

36

20

38

20

40

100,000

80,000

60,000

40,000

20,000

0

20

12

20

14

20

16

20

18

20

20

20

22

20

24

20

26

20

28

20

30

20

32

20

34

20

36

20

38

20

40

100,000

80,000

60,000

40,000

20,000

0

20

12

20

14

20

16

20

18

20

20

20

22

20

24

20

26

20

28

20

30

20

32

20

34

20

36

20

38

20

40

100,000

80,000

60,000

40,000

20,000

0

Year

Scenario 1

Scenario 3

Scenario 2

Scenario 4

Pharmacy exampleHow uncertain is the future?

Pharmacy examplePolicy options

20%

35%

50%

5%10%

15%

A B C D E F

3%

One-off supply reduction Phased supply reduction

5 Years 10 Years

Po

licy

ou

tco

me

s

Pharmacy example

2

31

4

Policy options: A

B

C

D

E

F

Policy analysis

What about the rest of the system?

Health

Public health

Social care

2%

98%Workforces not yet

modelled

Workforces modelled to date

What about the rest of the system?

Health

Public health

Social care

10% Other health and support

21% Paid adult care and support

24%

Volunteer adult care and support

43%

Unpaid adult care and support

2% Workforces modelled to date

Not just workforce numbersWhat skills and competences are needed?

Competences

Skills

FacilitationLeadershipWellbeing

Knowledge Personal

Types of skill

Level of skillLow to High

Quantitative skills

Qualitative skills

Not just the skillsWhat drives the demand?

Demand for skills

Long-termconditions

Infectiousdiseases

Births

One-offevents

Not just the skillsWhat drives the supply?

Supply of skills

Up or downskilling

Education &training

Workforcesupply

Capacityto learn

Po

pu

lati

on

Learning disabilities

Oral health

Singular demand for service

Maternal and perinatal

Infectious disease

Mental long-term conditions

Physical long-term conditions

Skill level: 1 2 3 4 5

We need a new framework

Prevent

Enable

Assess

Plan

Treat

Rehabilitate

Relieve

Link

Unpaid adult social care workforce

Nurses

Dentists

Medical generalists

Medical specialists

Volunteer care and support workforce

Other workforce groups

Horizon 2035 workforce groups

Increasing concentration and experience

A new challenge: Horizon 2035

What skills and competences do we have?

What might we need in future?

Future demand for skillsSk

ill h

ou

rs/Y

ear

(B

illio

ns)

2012 2016 2020 2024 2028 2032 2036

Time (Year)

Probability: 80% 100%Central estimate:

5 Skill levels

4

3

2

1

Super-specialist

Specialist

Generalist

Increasing length of training

Skill dimensions

Visualising the system

Learning disabilities

Oral health

Singular demand for service

Maternal and perinatal

Infectious disease

Mental long-term conditions

Physical long-term conditions

Demand sourcesMedical Specialist

Visualising the system

Learning disabilities

Oral health

Singular demand for service

Maternal and perinatal

Infectious disease

Mental long-term conditions

Physical long-term conditions

Demand sources

Super-specialist

Specialist

Generalist

Up-skilling targets

Midwife

Super-specialist

Specialist

Generalist

Up-skilling targets

Visualising the system

Learning disabilities

Oral health

Singular demand for service

Maternal and perinatal

Infectious disease

Mental long-term conditions

Physical long-term conditions

Demand sourcesPaid care and support

Stress testing

European perspective

EU Joint Action

Work packages Objectives

Increased knowledge

Improved tools

Higher effectiveness

Horizon scanning and qualitative

Quantitative

Data, migrationand mobility

Coordination

Dissemination

Evaluation

Sustainability

69 partners

Funded by the Health Programme of the European Union

Work package 6 – Horizon scanning

Horizon scanning and qualitative

Qualitativemethods

Pilotstudy

Future skills

User guidelines – qualitative methods

Published 27 November 2014www.euhwforce.eu www.horizonscanning.org

Examples of methods in use across EU e.g. scenarios, surveys, Delphi

Helps deal with inherent complexity and uncertainty of workforce planning

Descriptions of health workforce planning and forecasting approaches for Belgium, Finland, Germany, Hungary, Netherlands, Spain and the United Kingdom

Qualitative methods

1

2

3

User guidelines – qualitative methods

Published 27 November 2014www.euhwforce.eu www.horizonscanning.org

Use alongside quantitative methods to achieve integrated approaches across Europe

Recommends taking into account the different useful approaches for different contexts

Methods can be used to systematically investigate different workforce futures and deal with uncertainty

4

5

6

Qualitative methods

Future drivers and skills across Europe?

Provide an estimation of the future needs of skills and competencies needed in the health workforce and their distribution.

Drivers and trends

Report on Future Skills and Competencies

Future drivers and skills across Europe?

54Horizon scanning

interviews

264Drivers collected

and grouped

Megatrends under investigation

Wellbeing skills

Visual key

Van der Heijden (2005) Scenarios – the art of conversation

Different environments of influence

7 indicative causal loop diagrams

These guide the identification of megatrends.

FocalSkills and

competence of the health workforce

in 2035.

1. Connecting and enabling technologyEnable. Effective engagement with engaged ‘consumers’. Patient engagement/partnership/ empowerment. Interpretation of data/statistics. Interpersonal and communication skills.

Availability of health

information

System performance

data

Patient empowerment

Policy and regulation

Professional interpretation

Remote consultations

Connectivity between

patients and professionals

Health and care data

Remote monitoring

ICT

Population health literacy

‘Big Data’

+

+

+

+

+

+

+ +

+

+

+

+

+

+

Working

Transactional

Contextual

Focal

2. Demographic demandRelieve. Enable. Link. Chronic disease management/supported self-management. Coordination/linking skills. Multidisciplinary coordination and team working allied with generalist skills. Long-term care skills. Challenge to single disease framework. Communication skills.

Working

Transactional

Contextual

Focal

Multi-morbidity

Chronicconditions

EU fertility rate

Healthy cohort of older

people

Prevention

EU life expectancy

+

=+

+‘Age’ of the population

+

=

+

-

Economic and social inequality

+

2. Demographic demand

Working

Transactional

Contextual

Focal

Multi-morbidity

Chronicconditions

EU fertility rate

Healthy cohort of older

people

Prevention

EU life expectancy

+

+ =

+‘Age’ of the population

+

=

+

-

Economic and social inequality

+

Attach indicators which describe the current state or trend

2. Demographic demand

Working

Transactional

Contextual

Focal

Multi-morbidity

Chronicconditions

EU fertility rate

Healthy cohort of older

people

Prevention

EU life expectancy

+‘Age’ of the population

+

+

Economic and social inequality

+

< 5

10 - 14

20 - 24

30 - 34

40 - 44

50 - 54

60 - 64

70 - 74

80 - 84

2035

2010

Source: Eurostat

Source: Barnett et al, 2012

3. MobilityEducation, registration, licensing and regulation of skills. Workforce planning skills. Health system and workforce system incentives.

Working

Transactional

Contextual

Focal

Mobile health professionals

National skillsdistribution

European skills distribution

Healthoutcomes

National skillsrequirements

Mobile patient

‘consumers’+

+ +

European health market

for skills

+

Freedom of movement

+

4. ProductivityEnable. Self-care and self-management. Task allocation. Leadership skills. Productive teams.

Working

Transactional

Contextual

Focal

Location of care

GDP allocated to ‘healthcare’

Skill mix

Resistanceto change

Complexcomorbidities

Public health expenditure

Health systemefficiency

Patient/public expectations

Gross DomesticProduct

Access to care

Quality of care

+

--

5. PersonalisationAssess. Enable. Treat. Communication of risk. Shared decision making. Translation of research developments. Task allocation.

Working

Transactional

Contextual

Focal

Workforceproductivity

Behaviouralsciences

Population health literacy

Personalised care

Innovation genomics, Pharmaco-

genetics

Diagnostics Decision aids

Industrialinnovation

Riskstratification

+

+

Therapeutics+

+

+

+

+

+

+

+

Data collected by individuals

+

6. Future patientsAssess. Enable. Prevent. Communication skills. Coaching skills. Broader skill base and competence of healthcare in the population. Mobility. Role changes or partnerships. Defensive medicine.

Working

Transactional

Contextual

Focal

Proportionof types of

care

Ageingpopulations

Complexdemand

Diversepopulations

Proportion of generalists to specialists

Climate change

+

+

+

Diseaseprofiles

+

+

Patientempowerment

Informedpatients

+

+

7. SupplyLink. Cooperation. Task allocation. Supply of skills and competences. Workforce planning skills. Leadership skills. Multidisciplinary teams/integration. Workforce flexibility. Skill mix. Task shifting.

Working

Transactional

Contextual

Focal

Mobile healthprofessionals

Workforce roles

Healthworkforceheadcount

Attractiveness of career

Labour forceWork-lifebalance

expectations

Age of the population

- -

Induced demand

-Workforceinteraction

Quality of care

7. Supply

Working

Transactional

Contextual

Focal

Mobile healthprofessionals

Workforce roles

Healthworkforceheadcount

Attractiveness of career

Labour forceWork-lifebalance

expectations

Age of the population

- -

Induced demand

-Workforceinteraction

Quality of care

Demand is increasing and accelerating

(World Bank)

Global population

Global and national imbalances of workforces

6.9Bn

9.5Bn

2010 2050

World population by 2100

UN Population Division (UNPD) projects an 80 percent probability that the world’s population will be between 9.6 and 12.3 billion by 2100.

www.sciencemag.org/content/ 346/6206/234.abstract

http://www.newsecuritybeat.org/2014/10/refines-population-projections-80-percent-probability-10-12-billion-people-2100/

Wo

rld

po

pu

lati

on

(B

illio

ns)

2010 2020 2030 2040 2050 2060 2070 2080 2090 2100

13

12

11

10

9

8

7

6

UNPD and IIASA Projections, 2010-2100

IIASA SSP2 medium variant

UN medium variant

UN 80% upper probability

UN 80% lower probability

Key shifts and possible solutions?

Integrated care

24/7 and tech enabled working

24/7

Care model shifts

Secondary Care

Patient and service user empowerment / self-

management

New workforce roles and prototyping

Prototyping and discovering

New roles and skills

Key points

What if the future is not what we expect?

Consider many futures Transparent and participatory approach

Scaling skills analysis to new levels?

Country Continent Global

Acknowledgements

Thanks to Jim Campbell, the WHO and GHWA for the invitation and hosting of this session.

Dr Delanyo Dovlo for chairing.

Also to acknowledge the continued support from the EU Commission, EU Joint Action, the Department of Health, UK and our national and international partners and advisors for participating in our research.

Contact details

Dr Graham WillisHead of Research and DevelopmentCfWI, England

@

+44(0)7812 340 405

graham.willis@cfwi.org.uk

www.cfwi.org.uk | www.horizonscanning.org.uk

Matt EdwardsHead of Horizon Scanning & InternationalCfWI, England

+44(0)7834 800 393

matt.edwards@cfwi.org.uk

Questions welcomed…