Gail Murphy - Academia.edu (original) (raw)

Papers by Gail Murphy

BMC Health Services Research

Background Strengthening leadership and management is important for building an effective and eff... more Background Strengthening leadership and management is important for building an effective and efficient health system. This paper presents the findings from a L&M capacity building initiative which was implemented as part of a larger study aimed at improving maternal and newborn outcomes within primary health facilities in the Morogoro, Tanzania. Methods The initiative, involving 30 stakeholders from 20 primary health facilities, 4 council health management teams and the regional health management team in the Morogoro region, provided leadership and managerial training through two 5-day in-person workshops, onsite mentoring, and e-learning modules. The initiative was evaluated using a pre-post design. Quantitative instruments included the ‘Big Results Now’ star-rating assessments and a team-developed survey for health providers/managers. The ‘Big Results Now’ star-rating assessments, conducted in 2018 (19 facilities) and 2021 (20 facilities), measured overall facility leadership and...

World Health & Population, 2017

Healthcare Policy | Politiques de Santé, 2017

Healthcare systems must be responsive to the healthcare needs of the populations they serve. Howe... more Healthcare systems must be responsive to the healthcare needs of the populations they serve. However, typically neither health services nor health workforce planning account for populations' needs for care, resulting in substantial and unnecessary unmet needs. These are further exacerbated during unexpected surges in need, such as pandemics or natural disasters. To illustrate the potential of improved methods to help planning for these types of events, we applied an integrated, needs-based approach to health service and workforce planning in the context of a potential influenza pandemic at the provincial level in Canada. This application provides evidence on the province' s capacity to respond to surges in need for healthcare and identifies specific services which may be in short supply in such scenarios. This type of approach can be implemented by planners to address a variety of health issues in different contexts. Résumé Les systèmes de santé doivent se montrer réactifs aux besoins de santé des populations qu'ils desservent. Cependant, habituellement ni les services de santé ni la planification de la maind' oeuvre en santé tiennent compte des besoins des populations en termes de soins, ce qui donne lieu à d'importants besoins inutilement non comblés. La situation s' exacerbe davantage quand il y a une intensification imprévue en matière de soins, tels que les pandémies ou les désastres naturels. Afin d'illustrer le potentiel des méthodes améliorées pour faire face à ce type de situation, nous avons appliqué une démarche intégrée axée sur les soins aux services de santé et à la planification de la main-d' oeuvre en santé dans le contexte d' une éventuelle pandémie d'influenza au niveau provincial, au Canada. Cette application permet de dégager des données sur la capacité de la province à réagir à l'intensification des besoins en santé et permet de repérer les services précis qui pourraient présenter une carence dans ce type de scénario. Ce genre de démarche peut être utilisé par les planificateurs pour traiter une variété d' enjeux de santé dans divers contextes.

Human resources for health, Mar 31, 2017

Dramatic increases in the migration of human resources for health (HRH) from developing countries... more Dramatic increases in the migration of human resources for health (HRH) from developing countries like the Philippines can have consequences on the sustainability of health systems. In this paper, we trace the outflows of HRH from the Philippines, map out its key causes and consequences, and identify relevant policy responses. This mixed method study employed a decentered, comparative approach that involved three phases: (a) a scoping review on health workers' migration of relevant policy documents and academic literature on health workers' migration from the Philippines; and primary data collection with (b) 37 key stakeholders and (c) household surveys with seven doctors, 329 nurses, 66 midwives, and 18 physical therapists. Filipino health worker migration is best understood within the context of macro-, meso-, and micro-level factors that are situated within the political, economic, and historical/colonial legacy of the country. Underfunding of the health system and un- or...

Introduction: The majority of African countries lack sufficient human resources for health (HRH) ... more Introduction: The majority of African countries lack sufficient human resources for health (HRH) to deliver basic maternal, newborn, child health (MNCH) care, particularly in rural areas. To inform planning for the scarce HRH available, specifically as it pertains to the Millennium Development Goals and the post-2015 agenda, a rapid systematic review of evidence on training and deployment policies for doctors, nurses and midwives for MNCH in rural Africa was undertaken. Methods: Documents for synthesis and analysis were obtained through a scoping review of 14 peer-reviewed electronic databases and systematic searches of international organization and government websites. In-depth policy analyses were then conducted for sub-set of 8 countries: Ethiopia, Ghana, Mali, Mozambique, Niger, Tanzania, Uganda and Zambia. Results: A paucity of evidence on such policies exists. Beyond policy names and contextual information, little material on actual policy development, implementation, or impact was available. However, multiple cross-cutting political and socio-economic issues affecting the policy process were identified. Conclusion: This lack of evidence hinders objective assessment of policies and the development and management of health care systems, which require clear linkages between evidence, policy, and service provision. Further research into the identified contextual factors and issues of planning-implementation gaps, transparency, limited evidence, research bias, and resource management, among others, is critical to strengthening Africa’s rural health systems through the increased presence of adequately trained HRH for MNCH.

The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2010

HealthcarePapers, 2013

In order to respond effectively to the health needs of Canadians, healthcare planners must direct... more In order to respond effectively to the health needs of Canadians, healthcare planners must directly consider these needs when planning and delivering services. However, Canada's various healthcare systems have traditionally been organized based on historical levels of service provision as opposed to population health needs. A number of innovations in care delivery redesign in Canada have already been developed as part of efforts to foster a more effective and sustainable healthcare system. This paper presents two of these as case studies illustrating some of the main challenges in trying to identify and address healthcare needs, as well as some potential solutions to those challenges.

Human resources for health, 2014

Planning for human resources for health (HRH) is central to health systems strengthening around t... more Planning for human resources for health (HRH) is central to health systems strengthening around the world, including in the Caribbean and Jamaica. In an effort to align Jamaica's health workforce with the changing health needs of its people, a partnership was established between Jamaican and Canadian partners. The purpose of the work described in this paper is to describe the development and application of a needs-based HRH simulation model for pharmacists in Jamaica's largest health region. Guided by a Steering Committee of Jamaican stakeholders, a simulation modelling approach originally developed in Canada was adapted for the Jamaican context. The purpose of this approach is to promote understanding of how various factors affect the supply of and/or requirements for HRH in different scenarios, and to identify policy levers for influencing each of these under different future scenarios. This is done by integrating knowledge of different components of the health care system...

Journal of health services research & policy, Jan 11, 2014

The financial sustainability of publicly funded health care systems is a challenge to policymaker... more The financial sustainability of publicly funded health care systems is a challenge to policymakers in many countries as health care absorbs an ever increasing share of both national wealth and government spending. New technology, aging populations and increasing public expectations of the health care system are often cited as reasons why health care systems need ever increasing funding as well as reasons why universal and comprehensive public systems are unsustainable. However, increases in health care spending are not usually linked to corresponding increases in need for care within populations. Attempts to promote financial sustainability of systems such as limiting the range of services is covered or the groups of population covered may compromise their political sustainability as some groups are left to seek private cover for some or all services. In this paper, an alternative view of financial sustainability is presented which identifies the failure of planning and management o...

Healthcare Quarterly, 2003

Background: Many health human resource planners have warned that Canada, like much of the industr... more Background: Many health human resource planners have warned that Canada, like much of the industrialized world, is facing a nursing shortage. In Canada, nearly one-third of registered nurses (RNs) in the workforce are aged 50 years or older, and will soon reach the typical retirement age of 65 years. Research also indicates that an increasing proportion of RNs are retiring early, many by age 56. This paper examines the impact of RN retirement and death on the future RN supply. Design: A cohort projection model was developed to estimate the number of RN losses due to retirement or death using data from the RNs Database (RNDB) at the Canadian Institute for Health Information and vital statistics data from Statistics Canada for the period 1997-2001. Population: RNs who were employed in nursing in Canada in 2001 in the first six months of annual registration. Methods: The numbers of RNs that would be lost to retirement or death are estimated under three different sets of circumstances: (1) all RNs working to a maximum age of 65 (i.e., retirement at age 65 as a best case scenario); (2) all RNs working to a maximum age of 55 (i.e., retirement at age 55 as a worst case scenario); (3) RN losses when observed retirement rates are reduced, assuming a maximum work age of 65. Separate estimates are made for six regions of Canada (Atlantic, Quebec, Ontario, Manitoba/Saskatchewan, Alberta and British Columbia), for all of Canada (including territories) and for four employment sectors (hospital, long-term care, community, and other employment). A method for examining the distribution of the proportionate losses among regions or employment sectors was also devised (i.e., the index ratio). Results: If all 2001 RNs were to continue working to age 65, Canada is projected to lose 29,746 RNs aged 50 or older to retirement or death by 2006, representing 13% of the RN workforce in 2001. Quebec has the highest proportionate loss, 16% of its 2001 workforce. If all RNs were to retire at age 55, Canada is expected to lose 64,248 RNs or 28% of the 2001 RN workforce by 2006. If retention strategies could be implemented to mitigate the current observed rates of retirement, the estimated loss of RNs retiring prematurely could be reduced by 53%. This analysis suggests that effective retention incentives would most benefit Quebec, potentially retaining 66% of possible losses to retirement by 2006. Interpretation: The results of this analysis highlight the importance of identifying effective retention strategies as a tool for health human resource planners. Implementation of retention strategies targeted to senior nurses is critical to sustaining the experienced RN workforce and to the efficient use of health human resources. BACKGROUND Many human resource planners have warned that Canada, like much of the industrialized world, is facing a nursing shortage (Buchan 1999; Buerhaus 1998; Duffield and O'Brien-Pallas 2002; O'Brien-Pallas and Baumann 1999). Concerns for a global shortage of registered nurses (RNs) are aggravated by the increasing size and proportion of elderly populations, healthcare system restructuring, changing work environments and competition from other career opportunities for potential nursing school applicants. Although the number of RNs employed in nursing in Canada has generally increased over time

Human Resources for Health, 2014

Background: In response to Zambia's critical human resources for health challenges, a number of s... more Background: In response to Zambia's critical human resources for health challenges, a number of strategies have been implemented to recruit and retain health workers in rural and remote areas. Prior to this study, the effectiveness of these strategies had not been investigated. The purpose of this study was to determine the impacts of the various health worker retention strategies on health workers in two rural districts of Zambia. Methods: Using a modified outcome mapping approach, cross-sectional qualitative and quantitative data were collected from health workers and other stakeholders through focus group discussions and individual interview questionnaires and were supplemented by administrative data. Key themes emerging from qualitative data were identified from transcripts using thematic analysis. Quantitative data were analyzed descriptively as well as by regression modelling. In the latter, the degree to which variation in health workers' self-reported job satisfaction, likelihood of leaving, and frequency of considering leaving, were modelled as functions of participation in each of several retention strategies while controlling for age, gender, profession, and district. Results: Nineteen health worker recruitment and retention strategies were identified and 45 health care workers interviewed in the two districts; participation in each strategy varied from 0% to 80% of study participants. Although a salary top-up for health workers in rural areas was identified as the most effective incentive, almost none of the recruitment and retention strategies were significant predictors of health workers' job satisfaction, likelihood of leaving, or frequency of considering leaving, which were in large part explained by individual characteristics such as age, gender, and profession. These quantitative findings were consistent with the qualitative data, which indicated that existing strategies fail to address major problems identified by health workers in these districts, such as poor living and working conditions. Conclusions: Although somewhat limited by a small sample size and the cross-sectional nature of the primary data available, the results nonetheless show that the many health worker recruitment and retention strategies implemented in rural Zambia appear to have little or no impact on keeping health workers in rural areas, and highlight key issues for future recruitment and retention efforts.

BMC Health Services Research, 2014

Background: Human resources for health (HRH) planning in Zambia, as in other countries, is often ... more Background: Human resources for health (HRH) planning in Zambia, as in other countries, is often done by comparing current HRH numbers with established posts, without considering whether population health needs are being met. Service-based HRH planning compares the number and type of services required by populations, given their needs, with the capacity of existing HRH to perform those services. The objective of the study was to demonstrate the effectiveness of service-based HRH planning through its adaptation in two rural Zambian districts, Gwembe and Chibombo. Methods: The health conditions causing the greatest mortality and morbidity in each district were identified using administrative data and consultations with community health committees and health workers. The number and type of health care services required to address these conditions were estimated based on their population sizes, incidence and prevalence of each condition, and desired levels of service. The capacity of each district's health workers to provide these services was estimated using a survey of health workers (n=44) that assessed the availability of their specific competencies. Results: The primary health conditions identified in the two districts were HIV/AIDS in Gwembe and malaria in Chibombo. Although the competencies of the existing health workforces in these two mostly aligned with these conditions, some substantial gaps were found between the services the workforce can provide and the services their populations need. The largest gaps identified in both districts were: performing laboratory testing and interpreting results, performing diagnostic imaging and interpreting results, taking and interpreting a patient's medical history, performing a physical examination, identifying and diagnosing the illness in question, and assessing eligibility for antiretroviral treatment. Conclusions: Although active, productive, and competent, health workers in these districts are too few to meet the leading health care needs of their populations. Given the specific competencies most lacking, on-site training of existing health workers to develop these competencies may be the best approach to addressing the identified gaps. Continued use of the service-based approach in Zambia will enhance the country's ability to align the training, management, and deployment of its health workforce to meet the needs of its people.

Nursing Leadership, 2012

The evaluation of the Research to Action project was conducted using an Outcome Mapping (OM) meth... more The evaluation of the Research to Action project was conducted using an Outcome Mapping (OM) methodology (Earl et al. 2001) with a mixed-methods, repeat survey (before/after) study design. This design uses concurrent measurement of process and outcome indicators at baseline and follow-up. 22 Research to Action: An Evaluation The RTA project proved effective at improving work environments and thereby promoting the retention and recruitment of nurses. Nurses involved in the RTA initiatives had a higher perception of leadership and support in their units, improved job satisfaction, increased empowerment and occupational commitment, and a greater intention to stay on the job. The pilot projects were most successful when there were clearly stated objectives, buy-in from nurses, support from the steering committee and management, and adequate communication among stakeholders. Committed coordination and leadership, both locally and nationally, were central to success. Considerable evidence has documented the challenges facing Canada's nursing human resources and their workplaces, such as high levels of turnover, excessive use of overtime and persistent shortages. There is a growing imperative to translate this research into action, and much of the available evidence presents viable policy alternatives for consideration. For example, a recent national synthesis report (Maddalena and Crupi 2008) recommended that, in consultation with stakeholders, processes should be put in place to share knowledge and best practices in nursing management, practice, staffing models and innovations in workplace health and well-being. Nurses across the country report a desire to be more involved in decisions affecting them and their patients (Wortsman and Janowitz 2006). A recent study on the shortage of registered nurses in Canada (Tomblin Murphy et al. 2009) highlighted the need for collaboration among governments, employers, unions and other stakeholders to improve working conditions for nurses. Another report notes the potential benefits of reduced turnover among nurses, the cost of which has been identified as a major burden on the Canadian healthcare system (O'Brien-Pallas et al. 2010). One of the goals of the pan-Canadian framework for health human resources (HHR) planning adopted by the Federal/Provincial/ Territorial Advisory Committee on Health Delivery and Human Resources is to enhance all jurisdictions' capacity to build and maintain a sustainable workforce in healthy, safe work environments (ACHDHR 2005).

Journal of the American Medical Directors Association, 2013

Objectives: To test a service-based health human resources (HHR) planning approach for older adul... more Objectives: To test a service-based health human resources (HHR) planning approach for older adults in the context of home and long term care (LTC); to create a practical template/tools for use in various jurisdictions and/or health care settings. Design: The most serious health needs of seniors in 2 Canadian jurisdictions were identified and linked to the specific services and associated competencies required of health care providers (HCPs) to address those needs. The amounts of each service required were quantified and compared against the capacity of HCPs to perform the services, measured using a self-assessment survey, by using a previously developed analytical framework. Setting: Home and LTC sectors in Nova Scotia and Nunavut, Canada. Participants: Regulated and nonregulated HCPs were invited to complete either an online or paper-based competency self-assessment survey. Results: Survey response rates in Nova Scotia and Nunavut were 11% (160 responses) and 20% (22 responses), respectively. Comparisons of the estimated number of seniors likely to need each service with the number who can be served by the workforces in each jurisdiction indicated that the workforces in both jurisdictions are sufficiently numerous, active, productive, and competent to provide most of the services likely to be required. However, significant gaps were identified in pharmacy services, ongoing client assessment, client/ family education and involvement, and client/family functional and social supports. Conclusion: Service-based HHR planning is feasible for identifying gaps in services required by older adults, and can guide policy makers in planning hiring/recruitment, professional development, and provider education curricula. Implementation will require commitment of policy makers and other stakeholders, as well as ongoing evaluation of its effectiveness. More broadly, the ongoing effectiveness of the approach will depend on workforce planning being conducted in an iterative way, driven by regular reevaluation of population health needs and HHR effectiveness.

Journal of Public Health Management and Practice, 2009

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Journal of Health Services Research & Policy, 2003

Objectives: To introduce health care production functions into human resources planning and to ap... more Objectives: To introduce health care production functions into human resources planning and to apply the approach to analysing the need for registered nurses in Ontario during a period of major reduction in inpatient capacity. Methods: Measurement of changes in services delivered by acute care hospitals in Ontario between 1994/95 and 1998/99, and comparison with changes in the mix of human resources, non-human resources and patient needs. Results: Inpatient episodes per nurse fell by almost 2%. At the same time the number of beds was cut by over 20%. As a result, the number of patients per bed increased by 12%. Allowing for severity, there was a 20% reduction in beds per episode and a 3.7% reduction in nurses per episode. Conclusions: The demands on nurses in acute care hospitals have increased as an increasing number of severity-adjusted episodes are served using fewer beds by a reduced number of nurses. Human resources planning traditionally only considers the effects of demograph...

Health Policy and Planning, 2012

A competency-based approach to health human resources (HHR) planning is one that explicitly consi... more A competency-based approach to health human resources (HHR) planning is one that explicitly considers the spectrum of knowledge, skills and judgement (competencies) required for the health workforce based on the health needs of the relevant population in some specific circumstances. Such an approach is of particular benefit to planners challenged to make optimal use of limited HHR as it allows them to move beyond simply estimating numbers of certain professionals required and plan instead according to the unique mix of competencies available from the existing health workforce. This kind of flexibility is particularly valuable in contexts where healthcare providers are in short supply generally (e.g. in many developing countries) or temporarily due to a surge in need (e.g. a pandemic or other disease outbreak). A pilot application of this approach using the context of an influenza pandemic in one health district of Nova Scotia, Canada, is described, and key competency gaps identified. The approach is also being applied using other conditions in other Canadian jurisdictions and in Zambia. Keywords Health workforce planning, healthcare competencies, needs-based planning, competency-based planning, pandemic influenza KEY MESSAGES When planning for health workforces in the context of short-or long-term shortages, consideration of the specific competencies required of the health workforce can help to ensure efficient use of scarce health human resources. An analytical framework for competency-based planning has been developed to allow health workforce planning based on the competencies required to deliver the specific services planned to address key population health conditions. Competency-based planning can be used to guide pre-and post-licensure training, recruitment and management of healthcare providers. The framework has been pilot tested in the context of an influenza pandemic in one District Health Authority in

Canadian Public Policy, 2007

Traditional approaches to health human resources planning emphasize the effects of demographic ch... more Traditional approaches to health human resources planning emphasize the effects of demographic change on the needs for health human resources. Planning requirements are largely based on the size and demographic mix of the population applied to simple population-provider or population-utilization ratios. We develop an extended analytical framework based on the production of health-care services and the multiple determinants of health human resource requirements. The requirements for human resources are shown to depend on four separate elements: demography, epidemiology, standards of care, and provider productivity. The application of the framework is illustrated using hypothetical scenarios for the population of the combined provinces of Atlantic Canada.

Human resources for health, Jan 16, 2014

Most African countries are facing a human resources for health (HRH) crisis, lacking the required... more Most African countries are facing a human resources for health (HRH) crisis, lacking the required workforce to deliver basic health care, including care for mothers and children. This is especially acute in rural areas and has limited countries' abilities to meet maternal, newborn, and child health (MNCH) targets outlined by Millennium Development Goals 4 and 5. To address the HRH challenges, evidence-based deployment and training policies are required. However, the resources available to country-level policy makers to create such policies are limited. To inform future HRH planning, a scoping review was conducted to identify the type, extent, and quality of evidence that exists on HRH policies for rural MNCH in Africa. Fourteen electronic health and health education databases were searched for peer-reviewed papers specific to training and deployment policies for doctors, nurses, and midwives for rural MNCH in African countries with English, Portuguese, or French as official lang...

BMC Health Services Research, 2014

BMC Health Services Research

World Health & Population, 2017

Healthcare Policy | Politiques de Santé, 2017

Human resources for health, Mar 31, 2017

The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmières, 2010

HealthcarePapers, 2013

Human resources for health, 2014

Journal of health services research & policy, Jan 11, 2014

Healthcare Quarterly, 2003

Human Resources for Health, 2014

BMC Health Services Research, 2014

Nursing Leadership, 2012

Journal of the American Medical Directors Association, 2013

Journal of Public Health Management and Practice, 2009

Journal of Health Services Research & Policy, 2003

Health Policy and Planning, 2012

Canadian Public Policy, 2007

Human resources for health, Jan 16, 2014

BMC Health Services Research, 2014