Mark Britnell, PhD, KPMG Global Chair of Healthcare: Ten Strategic Initiatives to Address the Global Health Workforce Crisis

The China Hospital Development Conference, hosted by DXY, also welcomed this grand industry event on May 24–25 this year. As a critical asset for hospital development, talent can be regarded as a strategic resource, while brand serves as an intangible asset driving hospital growth; both have consistently drawn close attention from healthcare professionals.

The “China Hospital Development Conference,” themed around hospital branding and talent development, naturally attracted significant attention from numerous industry professionals. At the recently concluded conference, nearly a thousand experts, scholars, and hospital administrators engaged in vigorous discussions and an exchange of ideas on two perennially relevant topics: talent and branding.

The conference attracted healthcare institutions, investment firms, and scholars from both China and the West, all of whom shared their perspectives on the global shortage of healthcare workers. The crisis of healthcare personnel shortages emerged as the issue that resonated most deeply with the many administrators in attendance.

As is well known, 2030 is a critical year and the deadline for numerous global policy agendas, particularly in the healthcare industry. Taking China as an example, the Outline of the “Healthy China 2030” Plan was released three years ago, which sets a target of having five general practitioners per 10,000 people by 2030. However, according to the latest Statistical Bulletin on the Development of Health and Hygiene Causes in China, there were only 2.22 general practitioners per 10,000 people in 2018.

This is merely the tip of the iceberg. In fact, the shortage of medical and health workforce is a critical issue facing countries worldwide, not only in China and not limited to general practitioners.

At the 2019 China Hospital Development Conference, DXY invited Dr. Mark Britnell, Global Head of Healthcare at KPMG, to share his insights on this issue.

Dr. Mark is a globally renowned expert in the field of healthcare. He has held multiple leadership positions within the UK’s healthcare system and possesses forward-looking and constructive insights into health and wellness in both developed and developing countries from a global perspective. In 2015, Dr. Mark Britnell published his book *In Search of the Perfect Health System* 《寻找完美医疗体系》, which garnered significant attention worldwide. In 2019, Dr. Mark Britnell’s second book, *Human: Solving the Global Workforce Crisis in Healthcare* 《解围之“人”，全球卫生人力资源危机》 (provisional title), was officially published. The Chinese edition of this book was translated under the joint organization of DXY and KPMG China and is scheduled for official release at the end of 2019.

In the interview, Dr. Mark Britnell primarily elaborated on the viewpoints presented in his second book, stating, “Recently, Indian Prime Minister Modi proposed providing free healthcare in India; however, in reality, India would need an additional 1.5 million doctors and 2.4 million nurses to reach the global average number of doctors and nurses per 1,000 people.”

The United States is the world’s largest economy, with annual healthcare spending accounting for 18% of its GDP. Nevertheless, this has not altered the fact that the U.S. will face a shortage of 120,000 physicians and 1 million nurses by 2030.

In the view of Dr. Mark Britnell, the shortage of healthcare workers is a global issue. “It is projected that by 2030, the global shortfall in health workforce will reach 18 million, accounting for 20% of the total global demand for health personnel.”

This phenomenon is also present in China. Taking obstetricians as an example, China still faced a shortfall of 180,000 obstetricians by 2022. Dr. Mark Britnell stated, “Over the past two years, I have visited hospitals in various regions and found that the distribution of healthcare human resources in China is highly uneven. Developed provinces and popular specialties suffer from talent surplus, while hospitals in less developed areas struggle with severe staffing shortages and lack of interest.”

Previously, Ma Xiaowei, Director of the National Health Commission, stated to the media that there are some imbalances and inadequacies in the construction of China's physician workforce, which urgently need to be strengthened and improved. For example, there is an insufficient total number of physicians and an uneven distribution. "China's physicians are overly concentrated in large tertiary hospitals in major cities, while the number of physicians in urban and rural grassroots areas, especially in rural and remote mountainous regions, is very limited. In 2018, China had 2.59 physicians per 1,000 population (compared to over 4 in developed countries such as Germany and Austria). Among these, the number of physicians per 1,000 population in rural areas was 1.8, only 45% of that in urban areas. There are relatively few physicians in specialties such as rehabilitation, pediatrics, emergency medicine, and psychiatry, indicating weaknesses in certain disciplines. The number of public health physicians is insufficient and has been decreasing year by year; the talent pool is relatively weak and does not align with the policy priority of prevention."

Dr. Mark Britnell stated, “China, with a population of 1.4 billion, has achieved a remarkable milestone by reaching 97% health insurance coverage.” However, as China gradually relaxes its two-child policy, the already insufficient resources of obstetricians have become even scarcer. Furthermore, the public’s trust is concentrated solely in large hospitals, hindering the development of primary healthcare and reducing equity and accessibility. “Gray income” continues to be a pervasive issue, while physicians face low incomes, high work pressure, and frequent threats of doctor-patient violence.

These pressing issues are all laid before policymakers.

Raising questions must be followed by solving them; fortunately, solutions to the aforementioned issues exist.

Dr. Mark Britnell believes that there are ten transformative changes that can be adopted to address the global healthcare workforce crisis, namely:

1) Reframe healthcare issues as productivity challenges, where investment in healthcare can yield a ninefold return, stimulating economic growth and national wealth accumulation;

2) Encourage the government to adopt a more entrepreneurial approach, reasonably relax entry standards, and increase the supply of healthcare personnel;

3) Encourage new nursing models and mobilize resources from all sectors;

4) Empower patients to enhance their health management capabilities;

5) Develop community-based service delivery models;

6) Encourage professional health personnel to perform at their optimal level;

7) Cultivate a new generation of healthcare professionals capable of seamlessly bridging the fields of medical health and social care, delivering services across community, hospital, and home settings.

8) Explore the potential applications of artificial intelligence, cognitive assistance, robotics, and blockchain in the healthcare sector to enhance productivity;

9) Health systems and healthcare institutions need to become more flexible and committed to learning;

10) The entire industry needs to place greater emphasis on healthcare professionals, provide reasonable incentives, and enhance their work motivation. With the support of these ten transformative measures, we can improve medical service capacity by approximately 20%, thereby offsetting the anticipated shortage of healthcare personnel.

Take, for example, the encouragement of governments to adopt a more entrepreneurial approach and appropriately relax entry standards. The UK government lifted relevant restrictions on admissions to physiotherapy programs, resulting in a 15% increase in applications for the profession between 2016 and 2017.

From the perspective of encouraging healthcare professionals to perform at their optimal level, data indicate that 76% of physicians and 79% of nurses are engaged in tasks that are overly basic relative to their professional expertise.

To this end, “medical assistants” and “nursing assistants” should be hired as appropriate to free healthcare professionals from tedious routine tasks, redesign clinical pathways to improve efficiency, and adopt computer-aided diagnostic technologies to reduce workload.

Last but not least, Dr. Mark Britnell pointed out that “we need to care for healthcare workers.” In his view, there are five main reasons for job dissatisfaction among doctors and nurses: 1) excessive ineffective and meaningless evaluations; 2) lack of work-life balance, with insufficient time to communicate with patients; 3) uncompetitive compensation; 4) high staff turnover rates; and 5) neglect of leadership development, hospital culture building, and organizational flexibility.

Dr. Mark Britnell stated, “China should provide greater care and support to physicians, as they are arguably the most valuable resource in hospitals. Currently, doctor-patient relations in China are highly strained, necessitating further improvements.”

“Over the past decade, I have worked around the world and reached a regrettable conclusion: no country—whether rich or poor—has been able to effectively manage its health workforce and address its health workforce needs.”

We hope that, through the collective efforts of all parties, the shortage of healthcare personnel will be alleviated in the next decade.