#careforce

CareForce is a roving outreach platform dedicated to advocating for domestic worker’s rights. Artist Marisa Jahn uses the co-opted visual language from comic books to frame care givers as self-empowered super heroes actively working to realize change and  is currently touring the country in an outfitted 1967 Mercury Colon Park station wagon, engaging directly with domestic care providers and consumers. Through interactive performances, workshops, and educational materials, CareForce creates opportunities for mobilization in support of legislative reform and labor justice.

Nominated for the 3rd wave by Jenny Polak

HWDC Standards

by Justin Crow

Last week in this space we demonstrated the versatility of the HWDC data system and its CareForce Indicators. As we noted this level of versatility is unique to Virginia. But it was not always so.

In 2007 then-Governor (now Senator) Tim Kaine's administration published its Roadmap for Virginia's Health, the results of the multi-year effort of the Governor's Health Reform Commission. The Commission worked extensively on workforce issues (including the recommendation to establish the HWDC), but it had trouble identifying comparable data sources. The following three charts are from the executive summary of the Roadmap:

Each of these data sources are very good on their own, but for examining the health care workforce as a whole they have some limitations. Note, for instance, the basic unit of measure from each chart. The first chart, for direct care workers, measures the number of jobs. It does not account for difference in part or full-time work, or for unemployed workers. It also does not include the many independent practitioners that characterize the health workforce. As self-employed individuals, they are not included in this data on payroll jobs. The next chart examines Full-Time Equivalency units, or FTEs. In this case, FTEs are calculated as 1 FTE for a full-time work or 0.5 for part-time work. Finally, the data for physicians counts "active physicians", defined as those who work 20 or more hours per week.

A worker who worked 19 hours a week would be counted as "one job", "0.5 FTEs" or not at all, depending on profession. Although each data source is fine on its own, it is easy to see how these differences make it impossible to evaluate the health workforce as a whole. So early on, the HWDC made a strategic decision to standardize how it surveyed health professionals.

While this sounds like a simple concept it is rarely executed so broadly. The HWDC inherited several existing surveys at its founding, and they were better characterized by their incongruity than anything else. The following is a sample of the many ways you could ask about something as simple as amount of time worked. Most of these examples are pulled from the surveys HWDC inherited:

Additionally, each profession has evolved differently. They have different concepts of how, for instance, similar specialties are defined. Many professions have unique educational and internship requirements. They may work in different areas of the health industry, such as hospitals, small offices or home health. It is simply difficult to capture the richness of work and work habits of professions as diverse as Certified Nursing Assistants and Physicians, Respiratory Therapists and Psychologists, in a standard survey.

The HWDC handles this by allowing some flexibility in the questions asked and in the response sets for questions shared by all professions. Rather than forcing all survey responses to be identical, we use back end coding to standardize our results. For instance, practitioners may select from a wide range of establishment types, but our back end coding matches all of them to the North American Industrial Classification System code.

So you saw how workforce data was presented without the HWDC in the above three charts. If you follow this blog, you've seen how that same information is presented using HWDC's CareForce Indicators. But it is worth showing again. The chart below (from last week's blog) includes the same information as in the three charts above. And then some. But it can all be included in one chart, allowing us to easily examine the health workforce as a whole.

Virginia's CareForce Indicators

by Justin Crow

Last week we discussed the beginning of the Healthcare Workforce Data Center's data structure: focusing on our core mission to collect research quality health professions supply data. This week we discuss the end product of our system: Virginia's CareForce Indicators. This should provide a nice frame for next week's post, an overview of our back end processing system. Early next year we will begin reporting out data from our 2014 survey season. This post contains some images from our data tools, available by clicking the links at the top left of this page.

Virginia's CareForce Indicators

The mainstay of HWDC’s data products are our CareForce Indicators. These indicators provide a robust look at the health workforce in key concept areas. The best way to understand the CareForce Indicators is too see them, so I’ve copied one of our “At a Glance” graphics from one of our many profession reports, this one for Dental Hygienist in 2014. Click the image to view or reports on even more professions. Or,you can see all of our 2013 CareForce Indicators for all professions in our CareForce Snapshot.

These are just a few of our indicators, but you can see how just these few provide a robust look at the Dental Hygienist workforce in Virginia. We do this for 26 (and counting) health professions in Virginia, every time they renew their license. Since all of our measures are the same, all of our indicators are the same, and we can easily make comparisons, see trends, or combine our datasets to get a broad look at the health workforce. At this time, no other state in the nation can do this at this level of detail. Just Virginia. Which, if you ask me, is pretty cool.

Bridging the Data Divide

So what can you do with the HWDC CareForce Indicators? Quite a bit. One of our latest tools, created just prior to the start of the 2014 school year, is our "Student Choice" toolset. A screenshot of just one of our tools appears below:

This chart compares median income to median debt levels for health professions. Circles are colored by degree level and sized by projected job openings using Bureau of Labor Statistics projections. Although not pictured, students can limit their view to professions by desired income and years of post-secondary education. This tool demonstrates two of the best things about HWDC's CareForce Indicators: they are easily compared across professions and can be linked to other data sources, in this case national data from the US Bureau of Labor Statistics.

Other charts cover work hours, job satisfaction, employment stability, and other factors we thought are important in choosing a career. All of that is just one example of how our CareForce Indicators bridge the data divide between the health professions, and between external data sources.

Drilling Down

In addition to making bridges across professions and data sources, we can also drill down into the data using our CareForce Indicators. Want to know about the health workforce in your COVF region? In rural areas? In hospitals? We can do that? Want to compare job turnover and satisfaction rates among professions at nursing homes and hospitals in Virginia’s Metropolitan Statistical Areas? We can do that too. If you have a question about a specific facet of the health workforce in Virginia, chances are we can do that too. One of our interactive online tools looks specifically at the health workforce by AHEC region.

Pretty, eh? It is informative too. There is a lot of information on this page, but I want to bring your attention to the bubble charts on the right hand side. The bubbles are sized by the size of the workforce for each profession, and colored by median age on the top and percent female on the bottom. Stakeholders can quickly see which professions may soon face a rash of retirements in their region, and which regions may benefit by efforts to recruit more women physicians and dentists (or more male nurses!). This is just one example for a single year.

Data that Informs

These examples show how HWDC data can help stakeholders, from policy-makers to business leaders to health students, improve decision-making and effectiveness. But this is just the tip of the iceberg. We designed the HWDC data system to be the link between health services research and health economics, and it is compatible with a wide variety of federal and state data sources, including the US Cenus Bureau, the North American Industrial Classification System and the O*NET Standard Occupational Classification. The map below from our Medicaid Workforce Map Packet links HWDC data with Federal uninsurance and income data in the Virginia Atlas of Community Health.

This map combines HWDC data from three professions (physicians, nurse practitioners and physician assistants), looking specifically at those with primary care specialties who also accept Medicaid. It provides a robust look at the entire primary care workforce and its ability to meet demand from a potential Medicaid Expansion in Virginia’s local health districts. Although it looks simple, it uses all three of HWDC's CareForce Indicators' capabilities: comparable indicators, bridging the data divide, and drilling down.