Spotlight Interview
With Dr. Linda Aiken Conducted November 2006
Dr. Linda Aiken is a Professor of Sociology and Director of the Center for Health Outcomes and Policy Research at the University of Pennsylvania in the US. She is an international authority in nursing health workforce and outcomes research.
	ICHRN: Based on your experience, what is the present state of health human resources in health care facilities around the world?
Dr. Aiken: There is a global shortage of doctors, nurses, and other healthcare providers and inequitable distribution of human resources in health between and within countries. Inadequate healthcare workforce infrastructure undermines the delivery of medical interventions that prevent, treat, and cure disease thus resulting in altered life chances, disability, preventable death, and threats to global health
	ICHRN: What do you think is the main contributing factor to the conditions currently seen in the health sector of both industrialised and developing countries?
Dr. Aiken: Barriers to accessing qualified health care providers because of workforce shortages, insufficient budgeted positions for healthcare providers, and financial barriers to health services.
	ICHRN: What has been your professional activity in the area of health human resources?
Dr. Aiken: I conduct national and international research on the impact of health workforce factors on patient outcomes. Much of my primary research has involved understanding how nurses affect patient outcomes. I direct the International Hospital Outcomes Study which examines the effects of variation in nurse staffing, nurses' education, and the nurse work environment on patient outcomes and nurse retention in a range of developed and developing countries. I co-chair the U.S. national Council on Physician and Nurse Supply which seeks policy solutions to shortages of health professionals in the U.S. and elsewhere in the world. I study international nurse migration. I serve as an expert advisor to the World Alliance for Patient Safety on the link between workforce adequacy and patient safety.
	ICHRN: From your experience in the industrialised and developing world, what do you regard as the main HR challenges?
Dr. Aiken: Policy failures in industrialized countries are, in large part, to blame for global shortages of health professionals. Policy makers continue to be ignorant of the lasting impact of national healthcare cost containment policies on nurse shortages. In industrialized countries, healthcare cost containment focuses on reducing inpatient hospital days. However, rather than decreasing the need for nurses as has been the assumption of policy makers and managers, there is consistently an increased demand for nurses in hospitals because of increased intensity of services and a more complex patient case-mix. Additionally, industrialized countries have not been producing enough nurses to meet demand because of poor health workforce policy planning rather than a shortage of labor. The combination of soaring demand in industrialized countries for nurses exacerbated by cost containment policies and insufficient investment in education of nurses and doctors has created large shortages and increased pressure to recruit from developing countries without accompanying investment of foreign aid in workforce development in source countries. Making a bad situation worse, international development policies supported by industrialized countries have required developing countries to reduce their domestic expenditures on health thus reducing the number of jobs for nurses and physicians who then migrate in search of employment. The only practical solution to the global shortage of health professionals is for industrialized countries to become more self-reliant on their domestic healthcare workforces and to establish human resources in health a priority investment for international aid.
	ICHRN: You have been instrumental in leading and supporting nurse staffing and outcomes research in a range of countries. What are the main policy messages that have emerged from this work? Are there common messages?
Dr. Aiken: We have collaborated in studies of the effects of nurse staffing and nurse practice environments in 10 countries: US, Canada, UK, Germany, New Zealand, Switzerland, Belgium, Japan, Russia, and Armenia with additional studies ongoing or planned in Australia, Thailand, and South Korea. Within each country we have documented significant levels of nurse burnout and job dissatisfaction, and nurse reports of uneven quality of care. Variation in nurse staffing levels and quality of the nurse practice environment is associated with patient and nurse outcomes in every country we have studied. More favorable professional nurse staffing and skill mix is associated with better patient outcomes such as lower risk-adjusted mortality, lower failure-to-rescue patients with complications, and higher patient satisfaction. Additionally nurse job dissatisfaction, burnout, and intent to leave present job are all significantly lower in institutions with more adequate nurse staffing ratios and better nurse work environments. We conclude that the relationships between nursing and patient outcomes are similar within countries regardless of country-specific characteristics of health care. Thus, innovations that are successful in improving nurse retention and quality of nursing care in any country are likely to be effective in all countries with modest adaptation to local circumstances. Magnet Recognition is a concept that seems to have universal adaptability.
	ICHRN: You are committed to influencing policy with your research findings. What are the most effective ways of doing this?
Dr. Aiken: Framing nursing research findings in a broader context of the problems that the larger healthcare community is considering is a very effective way to influence policy. Currently, with the increased global interest on patient safety, I believe that nurses could be more influential if they framed their practice, education, and research agendas in patient safety terms. The World Alliance for Patient Safety has a very informative website at www.who.int/patientsafety that can facilitate efforts to frame nurse research in safety terms. Publishing nursing research in high prestige, interdisciplinary scientific journals is very helpful in getting research findings to policy makers. Additionally considerable efforts have to be invested in dissemination of nursing research findings in the public media. Policy makers take note of healthcare issues covered in the popular press.
	ICHRN: How do you see the future planning and management of health human resources?
Dr. Aiken: There is a long history of inadequate planning and management of health human resources. The topic is not high among the priorities of healthcare leaders in public and private sector roles. Unless nurses and physicians, the two primary advocates for healthcare workforce, invest more of their own organizational resources in creating coalitions of interests within health care and in the larger business community to pressure governments to establish and fund workforce planning and management capacity, I suspect that the status quo will endure. In order to create powerful coalitions to motivate renewed interest in workforce policy-making, stakeholders need to be informed about how their own particular interests will be adversely affected by large shortages of nurses, doctors, and other healthcare providers. Nurses and physicians will have to take the lead in amassing convincing arguments for the business case in favor of an adequate workforce.