In November 2017 we published our report Time to care: Securing a future for the hospital workforce in Europe. The research for the report examined how hospitals in 14 countries across Europe are responding to the challenge of clinical workforce shortages in the face of growing demands from people with more complex health care needs. It identified universal concern about workforce shortages and the lack of time for hands-on care. Last week, Deloitte Ireland published it's Time to care report supplement, based on its analysis of our research evidence on the Irish healthcare system, particularly the findings from the Irish cohort of our crowdsourced survey.

A spotlight on Ireland

Ireland is facing most of the workforce challenges featured in the European report including increasing demand for hospital care and difficulties in attracting and retaining the requisite clinical workforce in a tight labour market. This has been compounded by difficult economic conditions over the past decade with pay freezes and hiring embargos within the public system. While these constraining factors are no longer in place, the HSE is still feeling the impact of these policies on staff satisfaction, morale, attraction and retention.

Facts and figures about the Irish Health care system

Ireland has a population of 4.7 million, with a comprehensive, publically-funded national health care service. The Health Service Executive (HSE) is the largest employer in the country, employing over 105,000 people, approximately 45,000 of whom are doctors and nurses. In 2016 there were:

  • 1,692,009 inpatient and day case discharges, up 2.5 per cent from 20151
  • 1,296,571 emergency department attendances, up 5.1 per cent from 20152
  • 10,592 acute beds, an increase of 1.1 per cent from 2015 but a decrease of 12.6 per cent since 20073
  • an average length of stay of 5.4 days, a decrease of 0.7 per cent since 2015 and 9.2 per cent since 20074
  • 7,999 physicians employed in hospitals, an increase of 5 per cent since 20155
  • 23,994 nurses (and midwives) employed in hospitals, an increase of 1 per cent since 2015.6

The views of the Irish hospital workforce

The Irish cut of the Time to care report focuses on the crowdsourced survey data captured from hospital respondents in Ireland (82 hospital workers, 28 doctors and 54 nurses). Thirty three of the respondents were female (40 per cent) and 49 were male (60 per cent)). A majority (91 per cent) work in the public/non-profit hospital sector.

We acknowledge that this is a relatively small sample and isn't representative of the wider hospital workforce, but believe that the responses provide food for thought and should stimulate debate on how Ireland might prepare its hospital workforce for the future. More specifically, it focuses on the questions regarding workforce satisfaction workload, wellbeing and adoption of technology, as being key contributors to overall health system performance – particularly when it comes to ensuring that the right staff-mix is attracted and retained in a tight labour market. Its main finding are:

  • Employee Satisfaction: 62 per cent of doctors and nurses surveyed expressed satisfaction with their job (43 per cent of doctors compared with 72 per cent of nurses). This overall finding is in line with results from the 2016 HSE staff survey. Interestingly, doctors in Ireland express the lowest levels of satisfaction when compared with their European counterparts. Having a sense of accomplishment in their role, and a positive work environment were identified as the top two factors contributing to this sense of satisfaction.
  • Workload: on the impact of workload, 56 per cent of Irish respondents say they find it difficult to manage their workload. When split by profession, doctors found their workload more difficult to manage than nurses (61 per cent and 54 per cent respectively).
  • Wellbeing: 44 per cent of respondents say that their work has negatively affected their physical health in the past year, and almost half (49 per cent) say that work has negatively affected their mental health. Doctors are also more likely to say that both their physical and mental health has been negatively impacted by their work (Figure 1). These findings echo the HSE's most recent staff survey which highlighted the mental-health impact of work on respondents, with 62 per cent stating that they believe they suffer work-related stress.

Figure 1: Perceptions of doctors and nurses in Ireland regarding the effect of work on their physical and mental wellbeing

Source: Deloitte research and analysis

  • Digitisation and the adoption of technology: Across the European countries sampled in the report, interviewees indicated an increasing engagement with digital strategies. However, the implementation of technology has progressed most in back-office and administrative functions, with much lower use by frontline staff in their daily work.  Irish employees reported the lowest use of technology amongst the countries studied, and is particularly behind when it comes to the use of electronic prescribing (2 per cent) and remote consultations (8.5 per cent). Moreover, both nurses and doctors in Ireland are amongst those least satisfied with the training and support received from their organisation to integrate new technologies into their daily work.

Connecting the dots

Irish respondents suggested that increasing staff levels and efficiencies would be key factors for their employers to act on to increase their overall work satisfaction levels and that these factors can influence areas such as patient outcomes, and the adoption and implementation for digital technologies:

  • there is increasing evidence of the link between healthcare professional satisfaction, clinician wellbeing and patient outcomes7  -recognising that if those providing care are not cared for themselves, then the health system cannot function at optimum levels
  • the implementation of digital health technologies influences staff morale and visa-versa- many digital health innovations are by their nature disruptive to how care is currently delivered. Even where new technologies provide efficiencies and improvements in care quality, if it requires fundamental changes to the roles of healthcare professionals and patients it can be challenging to implement. New ways of working take time and effort to bed-down, and if healthcare organisations are to adopt new ways of working organisations they need to be 'innovation-ready'.8 This requires a culture that cultivates tolerance, fosters open discussion, and allows employees time to think holistically and systemically.9

Providing time to care is an investment in the future of the workforce

Though many countries across Europe differ in how they fund, prioritise and manage their health care service, one thing remains constant – health care is first and foremost a people business. The quality of care is dependent on having the right professionals with the right skills in the right place at the right time. Having a happy, motivated and flexible workforce, with time to provide care, is crucial if we are to alleviate the current and future issues facing our health care workforce and systems. While this study on Ireland is developed from a relatively small sample, the responses from these health care professionals provide food for thought and can stimulate debate on how we can prepare our hospital workforce in Ireland for future challenges.

Footnotes

1 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2885721/
2 Ibid
3 Ibid
4 Ibid
5 Http://Stats.Oecd.Org/Index.Aspx?Datasetcode=HEALTH_STAT#
6 Ibid
7 Https://Hbr.Org/2016/01/Manage-Your-Emotional-Culture
8 Http:// Jdc.Jefferson.Edu/Cgi/Viewcontent.Cgi?Article=1738&Context=Hpn
9 Https://Www.Ncbi.Nlm.Nih.Gov/Pmc/Articles/PMC2885721/

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