Affordable Care Act Will Spur California Health Care Workforce to Develop New Leadership, Flexibility and People Skills

As health care shifts away from a fee-for-service model as a result of the Affordable Care Act (ACA), health care workers in California will be called upon to develop new skills and fill new roles, according to a study led by UC San Francisco researchers.

“Ultimately, the ACA will have a greater effect on workplace culture, health care delivery systems, health care technologies and education than on absolute numbers of workers,” said author Joanne Spetz, PhD, professor at the UCSF Institute for Health Policy Studies and associate director for research at the UCSF Center for the Health Professions. “The reality is that most growth in health care jobs in California will be driven by the aging of the state’s population, ACA or no ACA. The more interesting and profound changes will be qualitative, not quantitative.”

The study’s authors analyzed state and national health care data and conducted in-depth interviews with health care leaders from across California. The leaders agreed that ACA implementation in California has increased the demand for services and is driving the need for new models of care. The leaders also see the ACA as driving change from a clinic- and hospital-based fee-for-service model of care to a model that emphasizes preventive care and positive patient outcomes.

“There is a new focus on measurement – of quality of care, cost of care and patient satisfaction,” said co-author Susan Chapman, RN, PhD, FAAN, a professor in the Department of Social and Behavioral Sciences at the UCSF School of Nursing. “As a result, health care organizations need to be attuned to patient interests and satisfaction as never before. This means that current and future health care workers will need better training in customer service skills, as well as more education in the use of technology to interpret data.”

The study also found that:

• The rate of technological innovation, such as remote health care and the use of mobile health apps, will continue to increase.
• Behavioral health services will need to be better integrated into primary care.
• Care navigators and coordinators will be in high demand to guide patients through the health care system – a role that could potentially be filled by medical assistants or licensed vocational nurses if they receive the right training.
• Employees will need to work to the full extent permitted by their licenses, which may mean that contracts will have to be renegotiated and regulations will need to change.

Linda Zorn, statewide sector navigator of the Health Workforce Initiative funded by the California Community Colleges Chancellor’s Office, said, “This research is vital to the California Community Colleges as we work to rapidly respond to health care workforce needs.”

“Employers are focused on educating and training the workforce of the future,” said Cathy Martin, vice president of workforce policy for the California Hospital Association, one of the funders of the study. “Our educational institutions must engage employers early and often when developing programs in order to ensure the programs meet current industry demand for workers and that they produce health professionals with the skills needed in the evolving health care field,” said Martin.

Labor-management partnerships will also play a role in developing innovative programs to help workers learn new skills, according to Rebecca Miller, director of workforce development for SEIU-United Healthcare Workers West. “As a labor union, we partner with the industry and help lead the retraining of current workers for the jobs of the future and help develop programs to bring new workers into the health care field with the skills that match the changing landscape,” said Miller. “Our union education fund is already heading in that direction and adapting to the changes we know are coming.”

Finally, said Spetz, “Leaders will have to adapt to this changing world, and health care workers at all levels will have to learn new leadership skills, including critical thinking, decision-making and providing constructive feedback. We’re looking at a world in which LVNs and medical assistants do care management, clerks move along the implementation electronic health record systems, and RNs become leaders and champions of these new systems.” Physicians will have to learn new collaborative skills as well, said Spetz, “such as working in teams and giving constructive feedback to colleagues.” 

Co-authors of the study are Shelley Oberlin of Health Systems Innovation Network and Renae Waneka, MPH, of UCSF.

The study was supported by funds from the California Community Colleges Chancellor’s Office, the California Hospital Association, the California Workforce Development Board, SEIU-UHW and the SEIU-UHW Joint Employer Trust.

The study can be viewed in its entirety at http://rnworkforce.ucsf.edu/publications/impact-2010-affordable-care-act-california-health-care-labor-force.

UC San Francisco (UCSF) is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. It includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy, a graduate division with nationally renowned programs in basic, biomedical, translational and population sciences, as well as a preeminent biomedical research enterprise and two top-ranked hospitals, UCSF Medical Center and UCSF Benioff Children’s Hospital San Francisco.