Q&A with Ed Salsberg, NCHWA Director

By Laura Trude, HWIC Information Specialist

The Affordable Care Act established the National Center for Health Workforce Analysis (National Center) to collect and analyze health workforce data and related issues, create a uniform health professions data set, evaluate relevant programs, and maintain a database of Title VII grants along with longitudinal performance data. Ed Salsberg, formerly the director of the Center for Workforce Studies at the Association of American Medical Colleges, was chosen as director for the new National Center for Health Workforce Analysis. He discusses his vision for the National Center, how it plans to coordinate work with similar organizations, what the National Center is currently working on, and his visions for the Center’s future work.

What is your vision for the National Center for Health Workforce Analysis?

The National Center is intended to be the focal point for health workforce data and information, a place where people can go to find the most up-to-date information and data on supply and demand and distribution. In doing this, we’ll work closely with other federal agencies, health profession associations, and other organizations to gather and analyze the available data. The key goal is to be a trusted source of data and information on the health workforce.

How do you envision the National Center working with other related initiatives such as the National Health Care Workforce Commission (National Commission) and the State and Regional Centers for Health Workforce Analysis?

The National Commission is clearly an important part of the health workforce information and data infrastructure for the nation. They are specifically charged in the Affordable Care Act with producing regular reports that are designed to help inform the nation. We expect to work closely with them. Since HRSA has ongoing responsibility around data collection and analysis, we think that the Center’s focus will be on data collection and analysis and that we would work with the Commission to provide them with the data they need. I view this very much as a partnership between the Commission and the Center.

The states play a particularly critical role. The health reform legislation authorized a series of grants for states to do health workforce planning and development. HRSA awarded twenty-five planning grants and one implementation grant in September 2010 to states. The concept here is that states are really in the best position to understand their local needs and develop local solutions. Our role at the national level is to provide data and information that informs states, local communities and education and training organizations who have to make decisions about specific programs.

We’ll look at the general supply and demand trends in the nation, but it’s really up to the states to decide what to do with that data. For example, we may look at nursing and assess the overall trends in supply, demand and use as well as the educational pipeline of nurses, but it’s going to be up to each state to decide what it means for their state. If they need more nurses, for example, they will have to determine the best strategy for their state to increase their supply.

The National Center will work to provide information and data to the states. I see us producing state health workforce profiles that will allow a state to see their data in comparison with other states. Often a state will know something about their own supply of health professionals, but it’s very hard for them to know how that compares to other states of similar size or in the same region. At the national level, we can provide them with data, information and tools that will help them do quality state-level health workforce planning.

The regional workforce centers also have a significant role to play. There are some centers that were funded in previous years that have an infrastructure around workforce data analysis and planning studies. There may also be other state and regional centers that will develop over time with newer programs or projects that will build capacity. When we think about the general idea of state and regional centers, I want to be clear: we are not just talking about the ones that were previously funded. The statute broadly defines entities eligible for funding as state and regional centers, so this really is an opportunity for other states and research units to develop their capacity.

We hope to have sufficient funds to contract with other organizations to help us with data collection and analysis. One of our priorities is to encourage different health occupations and professions across the nation to use the minimum data set guidelines when they collect workforce-related data. There is going to be a need for guidance and support for states and others on how to collect and analyze the data in a standard manner.

Is this the uniform health professions data reporting system you are referring to?

Yes, we are designing a uniform minimum data set. We have a contract to help develop this. We’ve brought in a number of researchers and experts to help advise us about the most important data to collect and how to gather it most effectively. The goal is to encourage data collection that facilitates analysis and comparison over time and across states, jurisdictions, and professions. We want to make sure everyone is asking the basic questions in the same manner so the data can be compared across professions and areas. Some of that is pretty straightforward, like asking a health professional how many hours per week they work.

What about the states who don’t already have a mechanism in place to collect data? Will there be funding for them?

At this point, we don’t have new funding for states to improve their data collection but it is really in their interest to improve the quantity and quality of data they collect. There are some good models out there of states and associations that have developed data reporting or collection systems. It’s very important within the profession or the state to have quality data to guide their own decision making. The cost of improving health workforce data collection when linked to licensure re-registration is quite small especially when compared to the potential benefits. We want to develop a national database, but the minimum data set is not just about building a national data set, it is to help states and professions do a better job in their own data collection in order to understand their workforce needs.

Would the state profiles draw off the data the states would be collecting or would that be from additional research conducted by the National Center?

What we have in mind is for the National Center to produce some of these state health workforce profiles with national data sets that would, wherever possible, inform states. So if the report were about the supply of nurses, it would provide the nursing per-capita supply ratio and maybe the nursing educational capacity across states. It would use national data sources in order to inform the individual states.

The first step we have undertaken is to look at all the potential data sources that are presently available. Granted, many of them use different definitions or jurisdictions which make it difficult to compare, but at least it provides some data. For example, the Bureau of Labor Statistics has a lot of information about employment and jobs and job growth. That’s very different from educational or practice data which may be at the individual level. Someone can work two jobs or work part-time, so a job or vacancy is not the same as an individual, which makes comparison difficult. But we can certainly present the information on jobs as well as on individuals.

Where is the National Center at on developing performance measures for workforce programs?

That work is underway. We had a lot of internal activity to try and identify the right metrics and measures to assess performance. We are developing and will shortly be implementing strategies to evaluate the outcomes of the health workforce-related programs. We consider this a top priority for the Bureau of Health Professions.

We greatly appreciate the support for our Title VII and Title VIII programs and we recognize how critical it is to make sure we have systems in place to evaluate the performance of these programs.

Is there anything else the National Center is currently working on that you would like to highlight?

We recognize that the data collection and analysis are only the first two pieces. The third piece is the dissemination of the information. We are looking at the issues and options related to getting information out. Obviously, this is an issue near and dear to the heart of the Health Workforce Information Center. If we’ve got the data, how do we reach the people who need the data? How do we put the data in a format that’s understandable and very usable to states, universities, colleges, individuals? If we’re going to project supply and demand and gaps, how do we make sure that information reaches people who can make decisions to address those gaps? We are looking at the alternatives for packaging, presenting, and disseminating that data.

One other issue worth mentioning is the area of primary care. The National Center is concerned about the whole range of workforce issues – supply and demand and shortages from entry-level direct care workers to the most advanced higher education professions. But we have particular concerns about primary care, recognizing that improving the design of the delivery system and increasing efficiency and effectiveness requires an adequate supply and distribution of primary care practitioners. Primary care is an area of particular emphasis within the Bureau of Health Professions and the Health Resources and Services Administration. We’re assessing what data we have, what we know about the supply and distribution, what the projections are, and using that to help guide planning and policies here.

Contact information:
Edward Salsberg
Director, National Center for Health Workforce Analysis
Bureau of Health Professions; Health Resources and Services Administration
esalsberg@hrsa.gov

Please note that the views expressed in this article are the opinions of the interviewee and do not reflect the official policies, positions, or opinions of the Health Workforce Information Center or its funder.