For decades now, much of the health policy being debated across the world has focused on laudable but technocratic changes aimed at influencing the way in which healthcare is delivered.

As a result, reform has tended to concentrate on payment systems, governance practice, organizational structures, regulation, better purchasing and the welcome explosion of clinical information to patients and citizens alike. But anyone who has ever managed a healthcare provider will tell you that the most important and sustainable differences to the quality and cost of patient care actually result from the design of the clinical care process, the degree of innovation in the business model, and the motivation of staff.

Key points:

Demography is not destiny

All evidence points to the fact that, in the coming years, the combination of demographic changes and increased healthcare usage per capita will continue to increase demand for healthcare services. At the same time, the supply of healthcare professionals is facing a sharp decline and there will be growing international competition for the best talent. The combined effect of demographic change, increasing demand and changing working habits will be a shortage of healthcare professionals of between 22 and 29 percent in OECD countries. The situation in other parts of the world is even more stark.

Analysis of potential range of options

Having analysed the potential range of options available to policy makers, it seems clear that the number of healthcare professionals can be increased, thereby allowing most (but not all) countries and specialties to avoid the predicted shortfall. By leveraging measures such as raising the retirement age, stimulating people to work more hours per year, increasing the participation of women in the sector and raising the total share of people working in healthcare, governments can effectively bridge the looming workforce gap, but will need to spend to do so. But this is simply not a feasible option. With workforce costs constituting the single largest cost in healthcare expenditure, the funding of an additional 10 to 20 percent increase in workforce is virtually impossible, particularly in the current economical climate.

The reality is that, rather than hiring more people, we must find approaches that utilise the current workforce in a smarter and more efficient way. In our study we show that there are providers that successfully manage the workforce challenge.

The five successful habits for improving workforce motivation and productivity

These providers share five distinguishing habits that help them make a difference. First, they have incorporated a strategic focus on value for patients into the DNA of their organizations. This means ensuring that this concept is built into recruitment, staff objectives, appraisal and reward systems and these are directly aligned to the organization's goals. From the Board to front line managers, actions are governed by this focus on value.

At the same time, they empower professionals by giving them the freedom to take responsibility for creating value. Team work, appropriate autonomy and control over work processes and high quality front line leaders with the skills to support and coach their teams provide an important part of a strategy to drive productivity.

In particular it supports the deployment of a third key component, the use oftask and process redesign to transform care processes to ensure that everyone in the care pathway (including the patient) is adding value to the patient's journey and that problems with their flow through the system can be identified, dealt with and the process improved as a result. Redesign is well understood in non-clinical areas but its application to clinical processes and pathways still has much further to go. In the best organizations this includes processes that anticipate problems rather than simply respond to them and goes beyond the boundaries of the institution by, for example, ensuring that patients can be discharged as quickly and safely as possible.

A key strategy which supports these approaches is that the best organizations actively manage staff performance using outcome measures which also promotes safe culture and continuous improvement. Many of the successful organizations discussed in this report have embedded their strategic focus on value for patients into the development of concrete and clear management information. And so rather than measuring input parameters or publishing process indicators, these organizations tend to hold their staff to account for the value actually created, such as optimal outcomes at reasonable costs and margins.

Finally, there is more to do in many organizations to ensure high quality staff management practices, as all of the innovative practices can be undermined by a failure to address this. Recruitment, induction, training, reward strategy, appraisal, feedback and the active management of poor performance are often surprisingly poorly managed in healthcare.

Taken together, these five characteristics can enable providers to outperform their peers in terms of quality of care delivered, attractiveness of work and productivity of professionals. There is a strong ethical and business imperative to do this. All these measures need to be executed together, rigorously and continuously. If done well they have the potential to buy healthcare organizations enough time and staff support for much more fundamental changes to their business models of which the changes, redesign initiatives and innovations we feature here are just the beginning.

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