Beyond demographic change in human resources planning: an extended framework and application to nursing.
OBJECTIVE
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 demographic change on the need for and supply of health care. Failure to recognize the variable and endogenous nature of other health care inputs leads to false impressions about the adequacy of existing supplies of human resources. Consideration of human resources in the context of the production function for health services provides a meaningful way of improving the effectiveness and efficiency of human resources planning.
Centre for Health Economics and Policy Analysis, McMaster University, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada.
Stephen
S
Birch
Linda
L
O'Brien-Pallas
Chris
C
Alksnis
Gail
G
Tomblin Murphy
Donna
D
Thomson
D003710:Demography; D017598:Efficiency, Organizational; D017050:Episode of Care; D006301:Health Services Needs and Demand / Q000639:trends*; D006280:Health Workforce; D006742:Hospital Bed Capacity; D006752:Hospital Planning; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D020380:Needs Assessment; D009741:Nursing Staff, Hospital / Q000600:supply & distribution*; D009864:Ontario / Q000453:epidemiology; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data; D010343:Patient Admission / Q000706:statistics & numerical data / Q000639:trends; D012040:Regional Health Planning; D012720:Severity of Illness Index