Moreover, without a national, integrated approach to workforce planning, one that includes and obligates the critical stakeholders to the goals of an evidence-based and effectively deployed health care workforce, forecasting efforts will produce estimates that cannot guide future workforce planning. In the absence of interdisciplinary collaboration, health care education and the supply forecasts it feeds will proceed as a decentralized, professionally governed activity that produces estimates of health care workforce requirements that meet individual professional goals that may not serve the nation’s need for an effectively prepared and deployed workforce.

Further challenging these efforts will be incorporating the effects of fully integrated health information support, which available evidence suggests will significantly influence the skill mix needed to deliver health care services. HIT will be a key factor affecting the practice of nursing and medicine over the next generation, and its impact on nursing practice and workforce requirements is still very poorly understood. In the future, a more complex calculus will be needed to assess the overall change in efficiency or cost versus benefit of HIT systems. It will be necessary to provide controlled evidence showing the impact of an entire well calibrated HIT supported system within an ACO or other integrated delivery systems. Rather than a single end point (like RN time spent charting) a full market basket of patient outcomes will need to be included as the end point in this equation. And this assessment would also need to account for the fact that the ACO will likely be able to adjust the skill mix of its HIT-supported workforce in order to deliver the same or higher level of care quality more efficiently. For example, this could be accomplished by substituting a higher percentage of lower salaried professionals who can extend their scope of practice with guidance from computerized clinical support systems.


Recommendations

Recommendation 1: The U.S. Department of Health and Human Services should spearhead an interagency innovations research collaborative with responsibility to test new models for organizing health care services and determine the workforce features critical to achieving desired cost and quality outcomes.

For too long health services research and health workforce studies have not been effectively integrated. Studies testing various models for redesigning health care service delivery have focused primarily on the outcomes achieved by delivery system innovations in contrast to usual care but have not included an explicit assessment of the relative contributions of different configurations and skill sets of health care clinicians to the outcomes achieved. Health care workforce research has largely adopted a human capital approach—i.e., stud-



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