The Hidden Health Care Workforce: A Report of the California 21st Century Workforce Project Susan Chapman MPH, RN UCSF Center for the Health Professions October 1999

California 21st Century Workforce Project An 18-month initiative, funded by the California HealthCare Foundation to assess the allied and auxiliary health care workforce within the changing health care environment. Profile of allied and auxiliary workforce –Demographics –Qualitative findings, skills and competencies –Conclusions/Recommendations UCSF Center for the Health Professions, 1999

Who are Allied Health Care Workers? professions in 4 areas: Therapeutic Informational Diagnostic Environmental Examples: –Physical Therapists, PT Assistants and Aides –Medical Technologists and Laboratory Assistants –Diagnostic Imaging Personnel –Medical Office Managers –Medical Records Technicians –Medical Assistants –Home Health Aides –Dieticians UCSF Center for the Health Professions, 1999

Who are Auxiliary Health Care Workers? Less well defined than allied health Associated with or provide the delivery of health care Generally do not have a formal degree or certification from a formal educational program May receive OJT training from care delivery site Examples: Unlicensed assistive personnel and food service, laundry and janitorial staff UCSF Center for the Health Professions, 1999

Data sources include the California Employment Development Department, the Current Population Survey and the Bureau of Labor Statistics and the Office of Statewide Health Planning and Development. UCSF Center for the Health Professions, 1999

Demographics of Allied and Auxiliary Health Care Workers 36% employed in hospitals Predominantly female Not representative of population’s racial/ethnic composition Variation in wages with control of wages seen in recent years Almost 17% represented by unions UCSF Center for the Health Professions, 1999

Project Methods Review literature Collect secondary demographic data –Employment Development Department –Bureau of Labor Statistics –California Office of Statewide Health Planning and Development –1990 Census Data Gather primary qualitative data –Administer surveys and interviews –Conduct focus groups of allied and auxiliary workers in the San Francisco Bay Area patient care non-patient care UCSF Center for the Health Professions, 1999

Sources of Qualitative Data Surveys & Interviews: –hospitals –skilled nursing facilities –home health agencies –clinical laboratories Other Activities: –focus groups and interviews with out patient clinics –focus groups with representative allied and auxiliary health care workers –health care leaders interviews UCSF Center for the Health Professions, 1999

Racial/Ethnic Composition of Personnel Employed n California Nursing Facilities, 1996 Note: Nursing Facilities defined as SIC 805. Source: 1996 Employer Information Report EEO-1. Joint Reporting Committee. Equal Employment Opportunity Commission and the Office of Federal Contract Compliance Programs (Labor).

Racial/Ethnic Composition of Personnel Employed in California Hospitals, 1996 Note: Hospitals defined as SIC 806. Source: 1996 Employer Information Report EEO-1. Joint Reporting Committee. Equal Employment Opportunity Commission and the Office of Federal Contract Compliance Programs (Labor).

Wage Trends UCSF Center for the Health Professions, 1999 Source: Unpublished tabulation from the Current Population Survey, Bureau of Labor Statistics. CPI, national city average used to adjust for inflation. Analysis by the Center for the Health Professions.

Percent Change in Median Weekly Earnings (Unadjusted), 1989 to 1996 (Percent change in Consumer Price Index between 1989 and 1996 = 26.5%) Source: Current Population Survey, Bureau of Labor Statistics. National samples for 1989 and Analysis by the Center for the Health Professions. *Note: Includes occupational classification codes : respiratory (098), occupational (099), physical (103), and speech (104) therapists; and therapists nec (105). **Note: Includes occupational classification codes: clinical laboratory (203), dental hygienists (204), Health record (205), radiologic (206), and Health n.e.c. (208) technologists and technicians

New Skills & Competencies Required for Allied Health Care Workers Communication and interpersonal skills Ability to work in team Management/supervisory skills Foundation in sciences & critical thinking Willingness to be flexible and continue learning Computer proficiency Ability to access, organize, analyze and format data Understanding of larger health care system Work ethic UCSF Center for the Health Professions, 1999

Key Themes and Findings 1. New Divisions of Labor –transfer of work to less costly providers –creation of a flexible, multiskilled workforce –efficacy has not been established 2. Lower Pay, Increased Responsibility –limiting wages and benefits for cost reduction –allied health workers wages are flat or decreased –competition for entry level workers UCSF Center for the Health Professions, 1999

Key Themes and Findings 3. The Struggle to Attract and Retain a Quality Workforce –current and future labor shortages –critical skills are lacking –decrease in support for clinical training sites 4. Human Resources Need to Tie to Quality Strategy –need to compete on the basis of quality –few link human resource initiative to strategy UCSF Center for the Health Professions, 1999

Key Themes and Findings 5. Regulatory Inconsistency –regulations may be overlapping –standards disconnected from current care delivery 6. Gap Between Education and Industry Needs –skill deficits increasing: technical, communication, leadership –students feel less than fully prepared for work –slow responses to changes in care delivery UCSF Center for the Health Professions, 1999

Key Themes and Findings 7. Changes in Work and Career Advancement –overall change in the nature of “work” –need for flexible, multi-skilled workforce –individual is responsible to update skills or retool –compensation and promotion based on performance UCSF Center for the Health Professions, 1999

Recommendations Partnerships among and between Care Delivery Educational Institutions (Postsecondary & K-12) Organized labor Corporate sector To address Skill sets Reinventing work Career enhancement UCSF Center for the Health Professions, 1999

For more information, please contact: UCSF Center for the Health Professions 3333 California Street, Suite 410 San Francisco, CA / UCSF Center for the Health Professions, 1999