A Path to Improved Health Workforce Planning, Policy & Management in Canada: The Critical Coordinating and Convening Roles for the Federal Government to Play in Addressing Eight Per Cent of its GDP

Health workers are the foundation of health systems. The alignment of health workforce structures and processes to achieve the quadruple aim outcomes is central to any learning health system. This requires robust data and evidence. A key problem is that Canada lags behind comparable OECD countries in terms of health workforce data and digital analytics. As a result, health workforce planning and decision-making tend to be ad hoc, sporadic and siloed by profession or jurisdiction, generating significant costs, inefficiencies and risks for all involved.2 Health workers in Canada account for more than 10 per cent of all employed Canadians and over two-thirds of all health-care spending, which amounted to $175 billion in 2019, or nearly eight per cent of Canada’s total GDP.3 Recognizing these facts and supporting strategic health workforce planning, policy and management ought to be key priorities for federal and provincial/ territorial governments and other health-care organizations. Across all the different stakeholders that make up the complex, adaptive health workforce system in Canada, we lack a centralized and co-ordinated data, analytics and strategic planning infrastructure, a neglect that has been readily acknowledged for over a decade. COVID-19 has exposed the significant gaps in our knowledge about the health workforce, causing critical risks for planners to manage during a health crisis. The time is ripe for the federal government to take on a co-ordinating leadership role to enhance the data infrastructure that provinces, territories, regions and training programs need to better plan for and support the health workforce. Efforts should centre on three key elements that will improve data infrastructure, bolster knowledge creation and inform decision-making activities: • A minimum data standard and enhanced health workforce data collection across all stakeholders; • More timely, accessible, interactive and fit-for-purpose decision-support tools; • Capacity building in health workforce data analytics, digital tool design, policy analysis and management science. This vision requires an enhanced federal government role to contribute resources to co-ordinate the collection of accurate, standardized and more complete data to support analysis across occupations, sectors and jurisdictions, with links to relevant patient information, health-care usage and outcome data, for more strategic fit-for- purpose planning at all levels. This paper presents a vision for enhanced federal support of data-driven and evidence-informed health workforce planning, policy and management. First, two data infrastructure and capacity-building recommendations include: 1. The federal government should create an initiative dedicated to enhancing standardized health workforce data, purpose-built for strategic planning and associated decision-making tools for targeted planning, through a specially earmarked contribution agreement with the Canadian Institute for Health Information (CIHI). 2. In addition to the need to build better data, digital tools and decision-support infrastructure, there is a parallel need to build the human resources capacity for health workforce analytics. Through a special Canadian Institutes of Health Research-administered fund, this could include a strategic training investment in health workforce research and a complementary signature initiative to fund integrated research projects that cut across the existing scientific institutes. Building on these two necessary but insufficient building blocks, a co-ordinating national health workforce organization could include one of the following three options: 1. The federal government could create a dedicated agency with a mandate to enhance existing data infrastructure and decision-support tools for strategic planning, policy and management across Canada. 2. Through a contribution agreement, the federal government could support the creation of an arm’s-length, not-for-profit organization — a partnership for health workforce — as a steward of a renewed strategy and to provide health labour market information, training and management of human resources in the health sector, including support for recruitment and retention. 3. The federal government could support the creation of a robust, transparent and accessible secretariat for a council on health workforce to improve data and decision-making infrastructures, and to bolster knowledge creation through dedicated funding to inform policy and decision-making and collaborate on topics of mutual interest across stakeholders. In addition to building a more robust health system for Canada’s post-pandemic recovery, these actions would align with the World Health Organization’s Global Strategy on Human Resources for Health (2016) which encourages all countries to have institutional mechanisms in place by 2030 to effectively steer and co-ordinate an inter- sectoral health workforce agenda and established mechanisms for health workforce data sharing through national health workforce accounts. Because of the importance of the health workforce to Canada’s economy and pandemic recovery, building the necessary infrastructure requires a sizable and sustained investment over the course of at least 10 years.