Steven Lewis Access Consulting Ltd., Saskatoon & Centre for Health & Policy Studies University of Calgary CAAHP Conference Ottawa, April 4, 2003 A Public Policy Perspective on Educational Credentials for Health Professions
Dec 13, 2015
Steven Lewis
Access Consulting Ltd., Saskatoon &
Centre for Health & Policy Studies
University of Calgary
CAAHP Conference
Ottawa, April 4, 2003
A Public Policy Perspective onEducational Credentials for
Health Professions
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Steven Lewis CAAHP Forum April 4, 2003
The Current Health Care Scene
Higher degree of specialization Greater technical sophistication Sicker institutional populations Rapid change HHR shortages Increased urbanization
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Steven Lewis CAAHP Forum April 4, 2003
HHR Problems
Mismatch of need and supply Aging workforce Maldistribution of personnel Inefficient division of labour Slow development of team concept Long production cycles for personnel
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Steven Lewis CAAHP Forum April 4, 2003
Some Major Questions
Job-readiness: what does it mean and who is responsible?
Which educational programs can be most responsive to changing workplace needs?
Educating for a short half-life of knowledge Credentials: whom do they serve and should
educational programs pile them on?
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Steven Lewis CAAHP Forum April 4, 2003
Educational Issues
Costs (to system, to students) Shelf life—how long does initial education last in a
rapidly changing practice and scientific milieu? Structure
Relative importance of theory and practice Traditional vs. co-op programs Continuous vs. modular programs
Impact on career development
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Steven Lewis CAAHP Forum April 4, 2003
The Knowledge Paradox
Health care more knowledge-intensive than ever, promoting specialization
The greater the requirement for knowledge, the less time available for problem-solving and creativity
The knowledge base changes constantly Dilemma:
How much is enough for new graduates? How should problem-solving be taught?
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Steven Lewis CAAHP Forum April 4, 2003
Educating People to Embrace Change
Most people hate change Educational institutions really hate change and
their structures are admirably designed to thwart it You cannot manage successfully in health care
unless you can manage change Neither change nor change management are
integral aspects of health science education
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Steven Lewis CAAHP Forum April 4, 2003
What Do Students Want?
Jobs that use their skills Portable and respected credentials Opportunities to continue education Opportunities for career advancement Lowest possible direct costs Shortest time possible
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Steven Lewis CAAHP Forum April 4, 2003
What Does Government Want?
High quality, low cost programs Short production cycles Ability to adjust intake and output rapidly Graduates qualified to do the job Programs adaptable to needs of workplace
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Steven Lewis CAAHP Forum April 4, 2003
What Do Professions Want?
Well-defined and exclusive scope of practice Status and respect Good pay Access to senior administrative positions National and international standards Self-regulation and self-definition
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Steven Lewis CAAHP Forum April 4, 2003
What Do Educators Want?
High quality, sustainable programs Good students Respect from their peers Opportunities to do research (some) Prospects for career advancement Security and stability
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Steven Lewis CAAHP Forum April 4, 2003
What Do Employers Want?
Job-ready graduates Organizational competence Good match of education with requirements of the
job Large pool of qualified applicants to fill positions Portable national credentials and standards
The Interests At Play
Low Cost
Ease of Entry
Short Duration
Higher pay and prestige
High Mobility
Prospective Students
Support Support Support Support Support
CurrentStudents
Support Mixed Support Support Support
Current Workforce
Mixed Mixed Mixed Support Mixed
Colleges Mixed Mixed Support Support Support
Universities Oppose Mixed Oppose Support Support
Employers Support Support Support Oppose Mixed
Governments Support Support Support Oppose Mixed
Public Support Support Support Oppose Mixed
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Steven Lewis CAAHP Forum April 4, 2003
What Drives “Credential Creep”?
Almost invariably generated by the occupational groups themselves
Governments’ initial reactions almost invariably negative
Employers often not consulted and when they are, often skeptical of the change
Research-based evidence rarely available or influential in the decisions
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Steven Lewis CAAHP Forum April 4, 2003
Problems Enhanced Credentials Ostensibly Solve (if they exist)
Inadequate job skills—unprepared graduates Development of new kinds of skills—better match
with needs of contemporary practice Need to attract “better” students Failure to be taken seriously as integral parat of
health care team Need to educate students in a different
environment alongside their future colleagues
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Steven Lewis CAAHP Forum April 4, 2003
Possible Justifications for Raising Credentials
Desire of current members of the profession Interests and desires of educational programs Views and interests of employers Views and interests of governments Empirical evidence that status quo is
unsatisfactory Empirical evidence that enhanced credentials will
solve the problems identified
Impact of Increasing Credentials
Costs to government Up
Costs to students Up
Potential no. of students who might pursue the program
Down
Goodnes of fit with actual employment needs
Down unless job changes with credential
Short-run capacity to produce graduates
Down
Salaries of practitioners Neutral to Up
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Steven Lewis CAAHP Forum April 4, 2003
What Does “Job-Ready” Mean?
Health system jobs are not static Knowledge base changes very rapidly Success depends on:
Adaptability Judgment in face of uncertainty Ability to find, synthesize and apply new
knowledge Ability to communicate
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Steven Lewis CAAHP Forum April 4, 2003
Are Higher Credentials Justifiable?
Evidentiary basis for changing credentials is weak or non-existent
No evidence produced to suggest that diploma nurses were or are unable to do the job
May be indirect rationale, e.g., as ticket to higher management positions
Natural tendency for occupational groups to want to upgrade their status
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Steven Lewis CAAHP Forum April 4, 2003
Changing Programs or Changing Venues—or Both
All professions becoming more knowledge-intensive
Information management is supplanting technical-physical skills
All educational programs must be in the business of information management and analysis
When do needs warrant conversion to a university-based program?
Who should decide, and on what basis?
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Steven Lewis CAAHP Forum April 4, 2003
The “Critical Thinking” Rationale
Some argue university-based programs add value in form of critical thinking and judgment
Assumes that formal education rather than job experience and apprenticeship creates these qualities
Assumes that college-based programs do not or cannot develop these capacities
Quality control in universities is arguably uneven at the undergraduate level
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Steven Lewis CAAHP Forum April 4, 2003
The Dangers of Misalignment
Contentment arises partly from good match of education and job requirements
Higher credentials may create unrealistic expectations in workforce
Career advancement may require a different knowledge base, not simply an expanded one
Important to track the impact of new standards on job satisfaction
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Steven Lewis CAAHP Forum April 4, 2003
Credentials as Pathway to Career Advancement
Contemporary world is inordinately focused on formal educational credentials
Upward career path does require different skill set (human and financial management, judgement, big-picture and synthetic view of organization)
Changing from diploma to degree unlikely to be the best route to acquiring these capacities
Timing is an issue—often better to return to school when needs and ambitions clarify
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Steven Lewis CAAHP Forum April 4, 2003
Initial Credentials and Lifelong Learning
A great deal of health care knowledge is obsolete in 5 or 10 years
Science and technology advance rapidly Suggests that techniques of learning, not just a
body of knowledge, are the real mandates of health science education programs
These trajectories will blur the distinction between colleges and universities
Requires new understanding of time horizons
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Steven Lewis CAAHP Forum April 4, 2003
Assessing Credential Needs: A Public Interest Checklist
Do requirements match needs of workplace? Do requirements create unnecessary barriers to
entry? Is there evidence that current programs do not
produce suitable graduates? Do educational shortcomings require normal and
continuous adaptation or wholesale redesign?
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Steven Lewis CAAHP Forum April 4, 2003
Public Interest Checklist (continued)
How much would raising the requirements cost, and who would bear the cost?
Who is making the case for raising credentials, and on what evidence or argument?
What process led to the conclusion that credentials should be raised—was it inclusive and transparent?
Will raising credentials actually solve the problems identified?
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Steven Lewis CAAHP Forum April 4, 2003
Conclusion
A public interest and public policy perspective places credentialism in wider context
Reconciling public and particular interests not always possible
Crucial to ensure solutions fit problems If key constituencies are ignored, the result is likely
to be sub-optimal Important to learn from experiences to date
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Steven Lewis CAAHP Forum April 4, 2003
Contact Information
Steven Lewis
Access Consulting Ltd.
211-4th Avenue South
Saskatoon SK S7K 1N1
Tel. 306-343-1007
Fax. 306-343-1071
E-mail: [email protected]