“The greatest danger for most of us is not that our aim is too high and we miss it, but that it is too low and we reach it.” Michelangelo Mark Britnell Global Chairman & Senior Partner Healthcare, Government & Infrastructure KPMG International @markbritnell
10 years, 77 countries, 330+ occasions … Global Health Council 2014 - 2018
“In search of the perfect health system” Sold in 109 countries Translated into Mandarin, Korean and Portuguese
The global healthcare workforce crisis We face a future of too much work with too few workers 18 million 20% The global shortfall of health Of the total capacity to care workers by 2030 UK USA India China Japan 9.2% 1m+ Tripled nurses from nurses and 120,000 550,000 1.7m to Needs Needs 3.9m but still in 13 years of all NHS doctors 180,000 posts vacant by 2030 250,000 need by 2025 more doctors and nurses Obstetricians by 2022
Cognitive dissonance Politicians and healthcare employers exhibit cognitive dissonance: 1 Healthcare staff lauded but persistently underappreciated 2 Celebrate extra jobs but fail to plan to fill them 3 Proclaim technology but don’t 4 No one country gets it completely right prepare for digital disruption
Ten changes to tackle the global health workforce crisis 1 6 Productivity. Professionals. Health is wealth Top of their game 2 7 With 10 large-scale changes Entrepreneurial New cadre of we can increase the capacity government care workers to care by roughly 3 8 20% New models Digital meeting the anticipated shortfall in health staff of care dividend 4 9 Patients as Agile learning partners organisations 5 10 Communities Managed and as carers motivated workforce
Productivity 1 Health is wealth Health investments generate up to nine x Pathways to economic growth times their costs in terms of economic growth “ 9 Productivity isn’t everything , but in the long run it is almost everything . It is the ultimate engine for economic $9trillion 10.4% Productivity growth vs 2% across all industries dollar industry of GDP in healthcare has growth. averaged 0.9% ” Paul Krugman
Entrepreneurial government 2 From under to oversupply Stimulate demand Australia: and supply Following the Bradley Review of 2008, restrictive Plan for entry policies into nursing productivity were abandoned. The number of students admitted to nursing schools more than doubled Proportionate between 2001 and 2013, regulation UK: from 8,000 to 19,000 . Physiotherapy opened up leading to jump in Progressive applications of 15% Immigration between 2016 and 2017 .
New models of care 3 Driving productivity gains of 16% to 20% 5 Switch from face to face to virtual consultations Driving Scale up primary care to become the undisputed leader forces Integrated and accountable care Clinical improvement science and standardisation Blockchain, robotics, machine learning and AI
Patients as partners 4 Renewable energy People powered health could save the NHS £4.4. billion Over 65% of consultations take place in the cloud Relatives care for patients post-operatively
Communities as carers 5 Germany Alaska Brazil Offers cash payments Community power ‘The program, which to the person needing and cultural respect costs $50 per person per care - more popular has enabled Nuka to year, has lessened the and significantly secure a 50% reduction pressure on more expensive cheaper than care homes. in emergency room and care providers and led to Range from £283 a urgent care visits, along significant improvements month to £1,784 a month. with good results for in clinical outcomes illness prevention, nationally— reducing screening and a cultural hospitalizations and respect rating of 99.2%. mortality and improving equity and access’. (Commonwealth Fund)
Professionals 6 Top of their game Expand Employ scope of new cadre of practice care workers to support professionals Adopt Redesign supporting pathways technology of care Burnout and stress 76% 79% “Top of your game” not of doctors of nurses “top of your capacity all the time” Perform tasks for which they are overqualified
New cadre of care workers 7 Spanning health and social care and supported by cognitive augmentation Midwives in Nairobi have been trained to use Point of Care Ultrasound and internet teleradiology to provide antenatal care in rural Kenya
Digital dividend 8 Rise of the humans 36% of healthcare work could be automated Source: McKinsey
Agile learning organisations 9 A more flexible and responsive workforce Moving from traditional “ ” predict and provide workforce planning to More than “ ” agile workforce shaping 50% of the UKs healthcare workforce will still be working in the health service in 2032
Loving your staff 10 Bring joy to work 5 drivers of doctors’ Top and nurses’ dissatisfaction 1 Less than 30% of staff have meaningful appraisals 2 Work/life balance and no time to engage with patients are main staff complaints 3 Pay needs to be competitive 4 Retention is key 5 Leadership , culture and agility is crucial Source: Deloitte
Traditional models of care lead to low productivity Strong history of FFS Canada reimbursement Geographical 20% of disparity population Still at the lives rurally but only crossroads 10% of doctors do Commonwealth Health system rankings for access, ranked 9 th out 11 outcomes and equity commonwealth 1 in 6 Canadians countries Shortage lack access to a of family primary care doctor doctors GP’s
Canada Telemedicine Innovation in Medical Education Expensive medical evacuations reduced by 60% after introduction of virtual consultations in a rural 92% of medical students come from Northern Triple C competency-based curriculum aligns innuit setting using connected Ontario and over 70% stay after graduation skills of graduates with local population needs 53% to 13% equipment such as stethescopes and ultrasound Progressive policy in Ontario Innovating for the Expanded Scope of Practice Integration: Ontario healthcare FFS reimbursement: from future for nurse practitioners in primary care reforms will see the formation of 2002 to 2015, FFS payments leading to better primary healthcare multi-disciplinary healthcare to primary care physicians access teams reduced from 94% to 25%
UPDATES NOT RECEIVED Why some rabbits outrun foxes 1 6 There is no linear management solution. It is a We are hurtling towards a global workforce wicked problem requiring complex adaptive crisis in healthcare thinking 2 7 The solution is within our grasp. We can “Work as imagined vs. work as done” create an extra 20% capacity to care Wicked problems are not solved through 3 8 We need to entirely reframe the workforce healthcare hierarchies. Agile networks are debate to one of productivity, health and wealth needed Apperception is the ability to use our collective 4 9 There is an emerging global consistency on experience to frame or re-frame situations to new models of care find new solutions It took Michaelangelo four years to paint 5 10 10 solutions leverage all assets and need to be the Sistine Chapel. We have a bit longer. managed through new partnerships Let’s get going.
UPDATES NOT RECEIVED “ “I first worked with Mark twenty-four years ago. He has worked across the world since. This book confronts the truism that there is no healthcare without a workforce.” Professor Dame Sally Davies, Chief Medical Officer for the UK Government “ “Mark shows us that, in health, every country has something to teach and every country has something to learn.” Dr Yasuhiro Suzuki, Chief Medical and Global Health Officer and Vice-Minister for Health, Japan “ “Humans need to master the technological and digital potential offered through the Fourth Industrial Revolution. This book makes a compelling case for doing so.” Ms Sangita Reddy, Managing Director of Apollo Hospitals in India “ “This is a terrific book. It reminds us that demography is not our destiny and offers far reaching solutions to seemingly intractable health system problems.” Professor David Bloom, Harvard T.H. Chan School of Public Health, USA “ “Britnell calls for politicians and professionals, patients and the public, to act now to avoid a global workforce crisis.” Professor Detlev Ganten, President World Health Summit, Germany “ “This book is a call to action. Mark reminds us that people are the biggest challenge – and best solution – to the problems in healthcare.” Dr Francisco Balestrin, President International Hospital Federation, Brazil “ “Students and scholars alike will find this book illuminating. It has global reach and is infused with practical examples of what works.” Professor Ling Li, Peking University, People’s Republic of China
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