Health workforce needs and health policy responses to COVID-19: a European comparative assessment

Abstract Background The COVID-19 pandemic revealed the importance of the health workforce for health system resilience. This study aims to explore whether and how healthcare system in Europe have responded to new emergent needs and transformed their health workforce policies. Methods A qualitative comparative approach is applied, based on multi-level governance theory and a rapid assessment of three areas of health workforce policy: mental health, gender equality, and public health competencies. We consider two years of the pandemic with a focus on recent waves, October 2021-January 2022. Denmark, Germany, Portugal, Romania and Switzerland are selected for comparison, representing different health systems, health workforce conditions and COVID-19 indicators in the European Union and European Economic Area. Results Across countries the pandemic has highlighted mental health needs, persisting gender inequalities and demand for public health competencies. Our comparison reveals similar weaknesses and governance gaps. (1) Mental health needs of healthcare workers are increasingly recognised (more strongly in Denmark and less in Romania with the other countries clustering in-between); however, health workers’ perceptions are not used as guidance and effective programmes are lacking. (2) The situation is worst in relation to gender equality goals that are largely ignored in pandemic policy and recovery plans. (3) Public health competences are more advanced and integrated in the NHS systems in Denmark and Portugal, but no country has taken action to innovate health workforce education and strengthen public health. Conclusions The comparative assessment highlights that health systems failed to adequately respond to health workforce needs and the COVID-19 challenges. Action has to be taken to implement participatory governance and step up efforts towards more responsive and resilient health workforce policy.


Background:
This study considers some of the effective governance tools that have been utilised to mobilise, redeploy and repurpose the health workforce during the COVID-19 pandemic to create surge capacity, protect workforce health and wellbeing and ensure effective implementation of vaccination programmes. Methods: Data were systematically extracted from the Observatory/ WHO Europe/European Commission Health System and Response Monitor, covering the period from March 2020 to May 2021 with a focus on four dimensions of health workforce governance: national/regional government policies; legislation; regulation; the role and remit of employers and management.

Results:
A wide-range of governance actions across all levels were required to ensure the health workforce could provide effective pandemic responses. Creating surge capacity, for example, often required adoption of emergency legislation to facilitate exceptional hiring procedures and the changing of (re-)registration requirements, as well as additional training and development of new competencies among other actions. Putting in place physical and mental health support meanwhile required defining infection control policies, monitoring PPE supply and distribution, ensuring access to free mental health support, and implementation of breaks. Some countries also allowed ''new'' types of workers to vaccinate; online or in person training; adjustments to payment mechanisms; and creating new supervision requirements.

Conclusions:
Pandemic responses have broken up sclerotic governance structures which have hampered past health workforce development and reform, new training programmes have been rapidly developed, leadership roles have been delegated to a wider-range of health professionals than before and monitoring systems that provide more rapid data on staffing levels have been put into place. Learning from and evaluating these changes will be important to help inform future pandemic responses.
Abstract citation ID: ckac129.042 Health workforce needs and health policy responses to COVID-19: a European comparative assessment

Background:
The COVID-19 pandemic revealed the importance of the health workforce for health system resilience. This study aims to explore whether and how healthcare system in Europe have responded to new emergent needs and transformed their health workforce policies.

Methods:
A qualitative comparative approach is applied, based on multilevel governance theory and a rapid assessment of three areas of health workforce policy: mental health, gender equality, and public health competencies. We consider two years of the pandemic with a focus on recent waves, October 2021-January 2022. Denmark, Germany, Portugal, Romania and Switzerland are selected for comparison, representing different health systems, health workforce conditions and COVID-19 indicators in the European Union and European Economic Area. Results: Across countries the pandemic has highlighted mental health needs, persisting gender inequalities and demand for public health competencies. Our comparison reveals similar weaknesses and governance gaps. (1) Mental health needs of healthcare workers are increasingly recognised (more strongly in Denmark and less in Romania with the other countries clustering in-between); however, health workers' perceptions are not used as guidance and effective programmes are lacking.
(2) The situation is worst in relation to gender equality goals that are largely ignored in pandemic policy and recovery plans. (3) Public health competences are more advanced and integrated in the NHS systems in Denmark and Portugal, but no country has taken action to innovate health workforce education and strengthen public health.

Conclusions:
The comparative assessment highlights that health systems failed to adequately respond to health workforce needs and the COVID-19 challenges. Action has to be taken to implement participatory governance and step up efforts towards more responsive and resilient health workforce policy.

Background:
General practices are experiencing increasing pressures due to rising demand, declining staff numbers, and knock-on impacts on patient care. The COVID-19 pandemic has added further challenges and reinforced the importance of teamwork and organisational settings. We undertook a mixed-method systematic review to explore which interventions can improve teamwork within primary care and improve inter-sector partnerships with other health and social care services.

Methods:
Five major bibliographic databases were systematically searched for relevant studies from inception to February 2022. We included controlled intervention study designs and linked qualitative studies. For amenable data, meta-analysis is being undertaken using random effects models taking into account the between study heterogeneity (quantified using the I2 statistic) and potential publication bias (funnel plots and Egger's test). The qualitative studies are analysed using thematic analyses.

Results:
The original search yield of 3012 studies, of which 14 studies with 1,534 participants were include in our analyses. Most of the evaluated interventions focused on improving nontechnical skills and provided evidence of improvements in the quality of teamwork in primary care. Meta-analysis and narrative synthesis is undertaken to examine the impact of the teamwork interventions on staff outcomes (team attitudes, knowledge, and functioning; wellbeing), and patient outcomes (e.g. quality of patient care, patient satisfaction/experience).

Conclusions:
The findings provide information of immediate importance for the mental health and wellbeing and teamwork support of professionals entering primary care and for the organisation of primary care services.

Background:
This study was part of a 5-year, HRB-funded research project about hospital doctor retention and emigration.

Methods:
In 2021, we conducted a Mobile Instant Messaging Ethnography (MIME) with 28 hospital doctors in Ireland. This involved interviewing doctors via Zoom and engaging them in a 12-week work-related conversation via WhatsApp.

Results:
Our findings illustrate that the pandemic intensified already difficult working conditions. Respondents described working in an under-staffed and under-resourced system, in which they were unable to protect their own wellbeing or achieve a worklife balance. Morale was low and few had hope of health system improvement.

Conclusions:
The findings reveal a workforce under strain and raise concerns about health worker wellbeing and health worker attrition, post-pandemic. However, they also highlight the importance (and value) of listening to the voices of frontline health workers and using their insights to inform and enhance retention policies.

Background:
Within the SARS-CoV-2 screening campaign offered through RT-PCR test by Sapienza University of Rome, we conducted a case-control study to identify the risk factors for the acquisition of SARS-CoV-2 infection among university students.

Methods:
Positive students identified through the SARS-CoV-2 screening campaign (September 2021 -February 2022) were enrolled as cases and matched to two randomly selected students who tested negative on the same day. The interview questionnaire consisted of 39 questions investigating exposure to modifiable and nonmodifiable risk factors for SARS-CoV-2 in the two weeks before testing. A multivariable conditional logistic regression model was constructed to identify predictors of SARS-CoV-2 infection. Adjusted odds ratio (aOR) and 95% CI were calculated. Results: Out of 8.730 tests for SARS-CoV-2, 173 students tested positive (2.0%), of which 122 were included in the case-control study (response rate: 70.5%). Most students were female (73.2%), with a mean age of 23.3 years (SD AE 3.6), vaccinated for SARS-CoV-2 (97.8%) and enrolled in non-health faculty (56.8%). At the multivariable analysis, significant positive associations were found with having had contact with a person who tested positive for SARS-CoV-2 (aOR: 3.04, 95% CI: 1.59-5.82) or having been to a disco/nightclub (aOR: 5.37, 95% CI: 2.00-14.38). Instead, being vaccinated against SARS-CoV-2 (aOR: 0.13, 95% CI: 0.01-0.93), having a valid EU COVID