Health Human Resources Productivity: What it is, how it’s measured, why (how you measure) it matters, and who’s thinking about it

by Robert Evans, David Schneider, Moris Barer | Feb 01, 2010
Full Report (PDF, 401 KB)
Appendices (PDF, 672 KB)

Executive Summary

The healthcare sector makes up roughly one-tenth of the economic activity of modern economies, and labour inputs make up a large share of its costs, relative to other industries. As a result, the measurement, tracking and improvement of labour productivity in this industry, referred to here as health human resources productivity (HHRP), should be of significant policy concern.
In principle, HHRP should be defined in terms of the relationship between health outcomes achieved (health status protection or improvement for individuals or populations) and health human resource inputs (time, effort, skills and knowledge) required. However, the vast majority of HHRP literature defines HHRP as the ratio of procedural and service outputs over inputs measured in terms of numbers of personnel, or time.
The objectives of this scoping exercise were to prepare a “state of the science” report that includes:

  • an overview of existing definitions and concepts of HHRP from healthcare and from pertinent non-healthcare domains;
  • a summary of the important contributions on this topic in the scientific and grey literature, with an indication of the relative strength of the evidence;
  • an overview of the leading researchers/centres with expertise on HHR productivity in Canada and elsewhere and current initiatives in policy and research (where available); and
  • gaps and priorities for further research (syntheses and development of new knowledge) identified within the literature regarding practical concepts and definitions of HHR productivity for the current Canadian HHR planning and evaluation context.

Key Messages

  • In principle, health human resources productivity (HHRP) should be defined in terms of the relationship between health outcomes achieved (health status protection or improvement for individuals or populations) and the health human resource inputs (time, effort, skills and knowledge) required.
  • The vast majority of current HHRP literature does not consider health outcomes, often using inappropriate and misleading measures of output. For example, more MRIs or more radiologists may contribute to increased procedural output but do not necessarily result in better health outcomes or improved productivity.
  • Opportunities for increasing HHRP may be realized:

    • by examining unexplained variations in clinical practice evident in current comparative studies; and
    • through new ways of deploying health human resources that take advantage of full scopes of practice and roles, particularly within collaborative practice models.
  • Many examples of HHRP-related successful innovation may not make their way into published literature because “getting published” is not a priority of those involved with HHRP-related innovation at the “coalface.”
  • Key points from this scoping review included:
    • Virtually all health services research is related in some way to HHR productivity, and yet few studies are explicit about their relevance to productivity. It would not be productive, or even feasible, to conduct a single summative synthesis of the literature in this area. Future research questions, primary and secondary, about HHR productivity need to be specific and sharply focused.
    • Most, if not all, HHRP literature focuses on inputs and outputs measured in terms of activities or processes rather than health benefits. The exception may be in the clinical variations literature, where there has been a clear focus on outcomes but little or no reflection on the implications for HHR productivity.
  • Past research provides few clues as to when and why decision makers make improving HHR productivity (measured “properly”) a priority. The impediments to productivity improvement include perverse incentives and misaligned objectives (e.g. other agendas take precedence). As a result, despite the fact that there are points of light scattered throughout the system, a large implementation gap persists between potential and actual improvements.
  • Recommendations for further work in this area:
    • The identification and dissemination of success stories – where particular HHRP enhancements or interventions have led to improved health outcomes with similar or reduced inputs, or stable health outcomes with reduced inputs. The aim would be to find common success factors underlying such productivity gains.
    • HHRP prospective primary research; for example, evaluations of organizational, funding or programmatic changes or pilot initiatives that focus on the relationship between inputs and health outcomes/benefits.