 Good morning. Good afternoon. Good evening. I'm saying that Because I'd like to welcome not only our Participants in this room in the World Economic Forum headquarters in Switzerland But also our online audience as this session future of work health and care is broadcast live So this warm way to open an online online event With good morning. Good afternoon. Good evening. I learned from Dr. Tedros Adonon the director general of the World Health Organization In his press conferences that I had to cover during the pandemic by the way, my name is Bianca Hocche The international correspondent based in Geneva for a global the largest TV network in Brazil And it's impossible to talk about our subject today without Remembering the pandemic this covid health crisis. We all know at least we have an idea About how hard it was for the healthcare workers to deal with this crisis Fatigue stress burnout lack of protective equipment and risk of infection death But the situation was already very complicated Even before that and the pandemic just highlighted the challenges We are talking about a sector undervalued and underfunded in High-income countries Workers are quitting because of different reasons including low payout As we see for example here in Switzerland Workers from low and middle income countries migrate searching better conditions and at the end There is a dangerous global shortage of workers to better understand the challenges and think about The possible solutions. We have here. He cardo batista late medical doctor and member of the Portuguese Parliament where he sits on the health committee. Thanks Howard Katon chief executive officer of the International Council of Nurses and Angelie bugger professor of medicine medical director at Mayo Clinic office of equity inclusion and diversity So my first question is for the three of you as per the World Health Organization There we will be an estimated the shortfall of 10 million healthcare workers worldwide by 2030 how to attract and retain Workforce I'd like if you could give a first perspective each one of you you can start he got it Well, thank you Bianca, and I'd like to greet my colleagues here on the panel also and everyone watching us here and at home but the truth is We do have those estimates, but in reality we do not know exactly how many healthcare workers We will be needing because there are so many Diverse challenges that we will be embracing but also opportunities such as digitalization, and I'll get to that more ahead today Due to the standardization of universal practices when it comes to health practice education We're seeing even in low and middle-income countries high quality healthcare professionals being trained While this is leading to a situation due to the lack of healthcare professionals across the world that richer countries are Attracting many of those health care workers to their own countries So we're seeing a transition from the public sector many to the private sector because a public sector is unable to pay what people are Expecting and many of those in the private sector and the public sector are leaving the country So going from domestic to international careers because they have better opportunities elsewhere So in reality a lot of Portuguese here in Switzerland Sadly from my country we export more nurses than we Train in our own countries. I can tell you between two thousand fifteen and two thousand twenty two We had thirteen thousand nurses that were trained and got into our nursing association and And fifteen thousand actually left the country. So it's actually a negative We have a deficit and so that but and that's Portugal Which is in the European Union if you go to other low and middle-income countries you can see the tremendous impact and the risks in terms of the gap and That can be created and enlarged We also have an issue where we don't have much data when it comes to the specialization of this healthcare worker So we talk about doctors nurses pharmacists But in detail we're missing a lot of the data But most importantly you mentioned the pandemic which is of course impossible to ignore The expectations of health care workers have changed dramatically The the idea of a balanced personal life is put top of the list for many health care workers after the pandemic And we see that in many countries where health care workers were treated as heroes, you know We're barely through the pandemic and people already forgotten the role that health care workers played and in the front in the front line of This of the battle against COVID-19 and that leads to a sense of Sometimes of despair of lack of acknowledgement And so I would say that we need to address this challenge by listening to the health care workers We can't we can't continue doing what we've done until now, which is a top-down approach from governments telling Healthcare workers what they're going to provide. We need to listen to health care workers What do health care workers expect to work within the organization? Is it a balanced personal life? Opportunities in terms of research and lifelong learning and so forth and digitization Is also an opportunity here not to just suggest to leave this comment not to make Healthcare less humane but exactly the opposite so that nurses doctors pharmacists and other health care workers have more time To be with the patient to have more connection with the patient from a human perspective And we can leave those repetitive basic tasks to machines So in a way we need to task shift to machines and make sure that humans are left with more time to take care of other humans I hope we have more time to go in detail to this topic How are your view and you are representing millions of nurses so Well, firstly to say as as a nurse to be part of an economic and growth summit I'm very pleased that our voice is here and is being is being heard the 10 million figure I think it's worse before the pandemic. We know that we had a shortage of six million nurses worldwide It was work that we did with the World Health Organization. We have an aging nursing workforce That's about another four million nurses and the impact of the pandemic the huge toll the physical and the mental health toll as as well This COVID effect we think could add another two to three million nurses We're seeing the evidence already of people leaving and quitting early. So just from a nursing perspective I'm looking at a number that's bigger than 10 10 million 12 12 million 12 13 12 13 Million on our latest evidence suggests that there isn't any signs yet of that Decreasing So what needs to be what needs to be done? In one way it's quite simple. It's quite simple. We are not investing enough in educating enough Nurses this dynamic of international Recruitment of countries who are short because they haven't educated enough nurses They're looking to the quick-fix solution go to other countries and they are often 67 high-income countries going to countries that can least afford to lose their nurses We need to educate more nurses, but we need decent work Throughout the pandemic Health workers as heroes who step forward who put their lives on the line But millions who had to wait for PPE who had to wait for a vaccine who had to face abuse and aggression in in the workplace As as as well decent work is something that we need to do and then leadership Whilst it's great to have nursing and health professionals voices as part of this discussion many organizations, you know, they don't have Chief nurses bringing that advice and that expertise. We think a lot of you know Nurses as as doers as deliverers of health care. Yes, they're great at that. But with nurses all health professionals Because they know delivery they know where the problems are they know where care isn't patient-centered where it's not safe They've got ideas about how that we can improve and join up care as well And I think seeing more nursing voices in leadership positions Government policy and in health institutions as well really important and the final point on this as well I think I'd say From all the work that we've done it. There isn't a single magic bullet for this. It's not just about educating more It's not just investing in leadership It's not just about better retention policies about doing all of those all of those things And when you do all of those things as well as strengthening improving nursing and health outcomes I'm in a majority in my profession because I'm one of only 10% 90% of the nursing profession are women We can actually go a long way to address Long-standing gender inequalities as well by investing in the nursing workforce. I'm sure Angelina knows very well this subject Please your view. Yes. Well, first of all, thanks to my co-panelists I'm just gonna build a little bit on you know what both of you have already shared before The fact is we are in a state of deficit and we had this prior to the pandemic and now we pulled back the sheets And it's magnified and we also know that we cannot recruit from a deficit for an ever-increasing demand within healthcare. So fundamentally, I'm just gonna like break it down for For the future workforce the two big areas where I feel the emphasis is whether it's physicians nurses Allied held administrators. We've got to create a better work experience and the second big pocket I see is value proposition because I know and and let's talk about the second bucket first Since we are on the topic of equity Well-being resilient systems, you know, I think it's time that we prioritize the humane Nature of our culture. We've got to infuse the healthcare culture with joy with focus on humanity And for that we need leadership. We need commitment at Mayo, for example, you know, we have a big group We we work on our culture proactively not just reactively. We want to be ready So we have a future back approach of how do we want our culture to evolve because we know at any given day We can have strategy But culture will eat strategy any day if we are not careful about how as leaders as health care Providers as other industries collaborating with healthcare providers, we are building the narrative for The value proposition. We know that this is the field where we have the immense potential to impact communities across the globe health of communities across the globe and I think fundamentally that's powerful having that capability of making a big difference with the length of Equity well-being joy resilient healthcare systems is powerful the second thing which I said was work experience Now we know that the workforce of 2030 is going to look very different We heard this morning 23% of the jobs are going to go away due to Digitization so we cannot recruit a future workforce that is not upscaled I think fundamentally healthcare has relied heavily in the past on a physical pipeline model for healthcare delivery And that may or we are pushing that to a platform model where there's seamless integration of physical digital Healthcare provision and what do we need to do for that? We need to get the workforce ready. We need to get them skilled I think for the incoming students and learners. There's a lot of Potential where we scale them in a way that they feel confident and competent with these changing landscapes But for the workforce that's currently in the in the industry for 20 years They are beginning to ask am I still relevant? Do I still contribute? So there's a lot of burnout setting in from that Propulsion of the workforce and I think we need to do a better job better job than what we are currently doing to upscale them and certainly, you know, it's been highlighted training Governance regulation incentives for integrating our enhanced AI capabilities and training programs Will be the way we are gonna build the workforce. That is more resilient. That is more ready And and we can do it collectively with a future back approach. Let's try maybe to learn a bit from Portugal Ricardo how Did port to go? Deal with the pandemic and how is the situation now? What can we take from Portugal from a health care workers perspective? We suffered the main the same the same phenomena as we saw in many countries of the world Where initially there was a huge recruitment of everyone available? You know the hero speech was put out there There were promises that health care workers would have Transformative career after the pandemic was over but that led to disappointment to be honest because after you know a couple years They went through the hardship those health care workers in the front line I went back as a volunteer to the medical to my medical hospital in my town and I was working with my colleagues and I saw how they were desperate honestly and Particularly in the most difficult moments of the pandemic And so I think we need to be very cautious of the way we manage expectations when it comes to the health workforce and The numbers that we just heard here are are going to be close to impossible to reach if we do not change the way we work and So I think we need to do many things at the same time to be honest One is of course more training. We need more healthcare workers That's a given which means more investment no doubt if we want to reach our goals However, we need to also change our health system which our disease systems towards being focused on Creating value for health which means focusing on health outcomes if we do not lower the demand for our health systems We can continue pumping in billions of dollars our health systems will not be able to respond We need to lower the demand the only way that we can have enough resources to treat those that need to be treated Is to make sure that those diseases that are preventable are prevented those diseases that are curable are cured That way we will have enough health worker force a workforce and Resources to treat those that actually do inevitably get sick no matter what we do and we also need as I was saying To focus on digitization which played a very important role in Portugal Facilitating for example as the first line of response Mainly our hotline our national health service hotline, which is run by nurses Played a very important triage rule making sure that people would not go to hospitals without need Needing so even some attempts in terms of using artificial intelligence driven tools to do that triage were also tested and so That shows that there's a tremendous way forward But we need to do it in a way that is responsible that has an Notion that there are tremendous biases behind a historical gender Another bias is when we apply artificial intelligence That's why in my new role here in Geneva as the end of this month as the new CEO of the International digital health and artificial intelligence collaborative. I dare we Thank you We will be focusing precisely on responsible AI in the sense that apply to health care in the sense that these technologies need to be developed in a way that Are in a way protect citizens from these biases and provide the best health outcomes For the citizen but for society at large by doing so as I said at the beginning We will be freeing time for compassionate care for the human connection and there's an amazing book called Compassionomics that actually measures the outcomes related to compassion and Patients that are treated in a compassionate patients that are treated in a compassionate way actually get better health outcomes And so incorporating that within a digital ecosystem, but also a larger health Ecosystem or well-being ecosystem delivers better results and that then leads to less need for Human talent that can be released in a way for those that will need them Okay, good point Howard yesterday nurses went on a strike I think in around half of England's hospitals, right? So even a country that is very extremely proud of its Public health system the NHS is suffering How to address this dissatisfaction? Not only of nurses, but also of doctors especially young doctors Go to the root causes this what we've seen in the UK We've seen it around the world an increase in strikes and disputes by nurses and health care workers The history of this firstly is that nurses and health workers around the world feel as though they have been undervalued for years they pay their conditions Below often the average for their economy working in very stretched health care systems Without the equipment without the staff to do the job and that's taken a huge strain on people And you imagine going to work every day where you feel professionally compromised You're not able to give the care to the quality of the safety that you have been Educated to which you know is part of your your professional Responsibility you step up for the pandemic. You're told that you are heroes That you are the most valuable asset that the country has you put your own life on the line often without the support and protection That we should that they should have expected and then afterwards when it comes down to a pay well all of a sudden No, no, no, we can't afford we've got a cost of living crisis You'll drive inflate you'll drive inflation all of these factors have come together to see this this this anger But also and this is really I think important that the center of improving the pay the conditions for nurses around the world They are making this absolutely a case about Patient safety when we do not have enough Ed enough people educated professionally. We know that the risks to patient of greater harm Increase we know around the world that the number of health care workers in different countries and different regions is related to Mortality that you can see this across all regions as well. So this is a safety This is a patient safety case But still we seem to have this hit this brick wall that when it comes to talking about investment in our health care systems We struggle to make the investment in the health care workforce. We use you we talk about capacity strengthening we talk about Resilience we talk about increasing coverage and access to health care. How are you going to do all of that? You can I do all of that through health care Workers investment in nursing and health care workers is not a cost. It's investment We need to think about it as a smart human capital investment. I look at these strikes and I see The nurses who where they have gone on strike a backlog of waiting times people not have been able to access Health care. I see health care systems having to spend millions to bring in agency workers nurses from overseas to fill gaps as well I see absentee levels that run into Millions and sometimes billions. We know that trillions has cost that the pandemic has cost the world I'm a simple nurse and I'm here in the have owned Environments the world But to me and to nurses it seems there is an overwhelming Economic case as well as a patient safety as well as a quality case For investing in nursing and health care workforce and we have to change that mindset And if we don't if we don't what will the consequences that be if there aren't nurses and there aren't health care workers Either we see people who suffer terribly in isolation on their own or frankly all of us as as friends as Family as mothers brothers husbands wives. We will have to pick up that care burden It's a dangerous crisis. Definitely and Angelie Your animation that equitable workforce is critical for long-term resilience, right? How to ensure This diversity this inclusion in the system. Yeah, well, thank you Bianca I'm gonna build on what you know, Howard sort of sowed the seeds for I you know Fundamentally equity inclusion and diversity is the is an investment. It is not a cost It is an investment and we are morally responsible for this for this to be Successful, I think two fundamental approaches are it needs to be authentic not tokenism And and we need to hold ourselves accountable and and to broad categories where I feel we can gain a lot of traction first is Commitment from the top leadership. I think that's very essential for these Initiatives to have the appropriate visibility have the appropriate Resourcing have the appropriate strategic Alignment with the rest of the strategy of the organization because this is not a Satellite of a planet sitting somewhere where stuff is happening So fundamentally having that leadership commitment from the top to the bottom and all the way around I think is Absolutely necessary for these initiatives to be up to be meaningful and to drive the impact that we want them to second thing with leadership commitment is accountability because Empty commitments don't lead to impact or don't lead to change and one way at Mayo Clinic For example, we do this is back in the pandemic when you know, I think it became abundantly clear that we cannot rely on iterative small programs We need a transformational shift in how we look at equity inclusion and diversity in healthcare And so we made a commitment from a board of hundred million dollars towards towards Racism and and really fostering anti-racism and we have Accountability metrics at all leadership levels across our structures to do this second I would say in addition to leadership is strategy and Organizational structure where DEI is not the you know the right thing to do for the organization It's absolutely the only thing to do for the organization in other words It is really knit into the fabric of the organization And and it's not a separate business unit. So just to give you an example of how that would happen in health care So for example, we have three shields at Mayo Clinic One is the clinical practice shield facing patients The other is research where we focus on research transformation and development and finally education So an example of how this is knit into the patient facing side is our digital and virtual Platforms where we will get into the patient's homes no matter where they are So through our enhanced digital capabilities, we are able to reach patients So we are increasing access to care and equity to care On the research side and collaboration again with our other business units such as the Center for Digital Health as well as Mayo Clinic Platform and thanks to improved data capabilities as well as a decentralized Clinical trials design. We are able to impact outcomes of patients Diverse group of patients whom we were not able to reach earlier and finally in education and training There is a lot of partnership in this work So we work with higher education with community organizations and building pathway and pipeline program So we get that diverse workforce that looks like the patients that we care for and you know This is the beginning we've got to then nurture this workforce this diverse workforce that we get in so a lot of policy structural change Supporting our workforce how it already mentioned that one example is through ERGs at Mayo Clinic We have greater than 35 employee resource groups with over 10,000 members enrolled in these resource groups Empowering the workforce through one lens of equity as well as empowering our patients through a lens of equity. That's what it takes I think we have time to open the floor to one quick question Who wants to take advantage of this opportunity and ask? Okay, we have here You've talked a lot about the challenges facing the healthcare workforce But I haven't heard much on behavioral health and the real emotional pressures that the health care workforce is facing in the US Upwards of 400 clinicians die by suicide Every year I love your thoughts on strategies that we should be thinking more about to address the mental health crisis facing the health care workforce We have one minute for this this answer We've just reported Recovered to rebuild on the latest evidence the impact on nursing we call the mental health impacts mass Traumatization, but there was a really really big message that came out from nurses who said we have had enough of being told to be more Resilient ourselves. It is our health systems that lack resilience the lack of staff the lack of equipment All of those things as well. That's where the resilience That's where the resilience needs to be So I think there's there's an important part of making sure that we don't look as though we're blaming individuals when the health systems But in terms of individuals, I think there's a whole Important piece around the culture that people you know this this this sometimes the competitive nature of health Organization the heroic nature that that if you if you speak out because you're not coping or if you see a Problem with an healthcare system it can look as though you're being Disloyal to the organization that you work for as well and the modeling of that behavior for senior leaders to To talk about their their mental health their ups and their their their downs And not to pin not to penalize people to do that but to support and encourage that sort of culture I think would go an awful long way to help with those issues and if I may quickly add David that I Think that's the biggest question right now and to paraphrase Howard what you just said I think we got to break this stigma, but we also got to create more resources right now We are very under-resourced specifically in the United States and across the globe Arguably and so creating in time, you know point-of-care resources for our providers So they aren't waiting weeks and months before they get access again This is another ripe area for virtual tools for really looking at those integrated models fine awards Just Building on what you were what everyone is saying really we the few countries and health systems that actually have been collecting data Have been focus focusing on patient reported outcomes and so forth what we need you know the proms We need the H. Croms, you know the healthcare workforce Outcome measurements and doing that in a systematic way so that we know in real time What is the sentiment of healthcare workers so that we can act and actually using tools as artificial intelligence to even predict? Potential sources of tension and of breakdown so we can act preventively so that we're not just reacting to these mental health Challenges that health systems are now facing and that have come to light with the pandemic although they were always there But not given enough attention and so hopefully Something good can come out of the pandemic, which is that finally we are discussing this important topic So I think it was a very important question. Thank you. Yeah Unfortunately, we Arrived at the end of the session future of work health and care with relevant remarks and takeaways The scenario is challenging, but there are ways to address the issues Thanks the participants here in the room our specialists. Thank you very much. Thank you