Healthcare staffing shortages and how to manage them

Healthcare is a high-risk, high-stakes sector. While staff shortages have negative consequences for all types of businesses, they are unlikely to carry the same threat to livelihood and wellbeing as they do for hospitals and health services.

Ensuring that healthcare facilities are appropriately staffed is critical to providing both a safe work environment for healthcare professionals and safe, effective patient care. While always a key concern for clinic managers and health leaders, the Covid-19 pandemic has thrown a spotlight on the colossal impact and sheer scale of consequences that staffing shortages mean for critical care settings worldwide.

This has only been exacerbated by international healthcare worker mobility. The International Council of Nurses reports that countries such as the United States of America, Canada and the United Kingdom are increasingly recruiting from countries who can least afford to lose their nurses – including from across the Caribbean.

What are the causes and consequences of low staffing levels?

The universal shortage of healthcare professionals poses an existential threat to public health systems. The World Health Organization (WHO) estimates a projected shortfall of 18 million health workers by 2030, primarily affecting low-income and lower-middle-income countries.

Many services are already facing an uncertain future due to fundamental imbalances between the supply and demand of frontline healthcare workers. It’s a deep-rooted, structural issue: poor long-term workforce planning, budget constraints, difficulties with staff retention, an ageing labour force and the international mobility of healthcare staff all play a role. Experts pinpoint widespread issues, including:

• Low job satisfaction
• Recruitment and retention
• Training and education
• Workforce deployment, performance and absenteeism

As a result of the above – and the subsequent impact on staff numbers – two of the most-glaring challenges are the impact shortages have on patient outcomes and patient care, and issues of mental health, burnout and attrition among healthcare services and hospital staff. Conversely, when a health unit has enough staff to run at its optimal quality, there are major – life-changing – benefits:

• Improved patient outcomes
• Reduced mortality rates
• Increased productivity

Clearly, it’s not something that can be ignored: patient lives and healthcare workers’ livelihoods are at risk.

Measures and interventions for staffing shortages

What lessons have been learned from previous shortages, and what measures are known to be the most practical? How can healthcare providers ensure that the balance of patient safety with staff numbers and wellbeing is addressed? How can long-term measures be implemented to protect against future shortages?

Senior management and other decision-makers must anticipate, and account for, low staffing levels. They must develop contingency plans and processes to mitigate potential shortages to maintain quality of care and address workforce wellbeing.

Suggested initial measures include:

• Identifying the extent of the issue. Services should seek to understand normal staffing needs and identify the minimum number of staff required to maintain a safe work environment and deliver safe patient care, under normal circumstances. While systemic shortages affect all disciplines and healthcare sectors, are there areas where greater numbers are required? Can any patterns be identified – for example, clinic to clinic – which suggest times when shortages would be more detrimental? Gathering this evidence and data can then inform any decision-making regarding workforce strategy and deployment.
• Addressing the problem of staff retention. One of the most efficient ways to source information concerning staff retention is to speak with the people who are most qualified to answer: workers themselves. From doctors and ward managers through to nursing staff and support staff, staff can offer valuable insights into the negative realities of healthcare employment that are driving them to quit in such large numbers. The Royal College of Nursing polled 30,000 professionals about experiences of their previous shift; their accounts highlighted insufficient staff numbers, compromised care, chronic unpaid overtime, poor work-life balance, insufficient working conditions, impact to mental health and burnout, and feeling ignored and side-lined by senior colleagues. Exit interviews and anonymous questionnaires are effective ways to garner feedback from a variety of respondents.
• Creating a more sustainable workforce in the long-term. Qualified staff, with the competencies to carry out their duties to the highest standards, protect not just the public but the profession. While recruiting more staff nurses, GPs and other health professionals is key, it’s also critical to ensure that job descriptions and advertised vacancies match the type of care required. For example, simply increasing the number of healthcare support workers – but not at the correct skill, knowledge or ability-level – is actively detrimental to care, and can have potentially life-threatening consequences. Can any funding or bursaries be made available to support training and the costs of studying? In this way, investment can be matched to the service areas and professions with the greatest need.
• Developing and implementing contingency capacity strategies. Shortages are often anticipated, particularly in the current climate. Health systems and health facilities employers – in collaboration with human resources, occupational health services and other stakeholders – should plan and prepare to mitigate and minimise this issue. For example, and depending on the circumstances: hiring additional healthcare professionals; adjusting staff rotas and schedules, and rotating healthcare workers to positions that support patient care activities.
• Seeking change in law and governance. Assurances regarding safe, effective staffing levels should be enshrined in law – both at the local and national levels. While meaningful change must go beyond legislation alone, it would help to provide a framework of accountability, clarity and responsibility surrounding staffing policy, strategy and planning.
• Redressing the balance of international mobility. The WHO’s Global Code of Practice on the International Recruitment of Health Personnel recognises the right of individuals to migrate, but calls for wealthy nations to recruit through bilateral agreements and involve the health ministry of the country of origin. Destination countries should provide support for healthcare initiatives in the origin country, implement skills exchanges and much more.

Develop the skills to transform healthcare sector operations

The University of the Commonwealth Caribbean’s online MBA Healthcare Management programme is a flexible course designed for those pursuing careers in senior healthcare leadership.

It combines business and leadership expertise with specialist modules in healthcare management, preparing you for the challenging and fast-paced nature of these environments. You’ll gain core insights into the overall workings of organisations, as well as expertise across healthcare innovation, quality management, healthcare delivery, and more.