Health workforce planning is typically undertaken at national or subnational (provincial/state) levels due, in part, to the location of interested stakeholders and data custodians within systems, and the level at which healthcare decisions are made. In a federated system such as Canada, but also in the US and Australia, most of the policy levers that can be used to adjust health workforce supply, distribution and mix are at the provincial, state or territorial level, and as such, planning (where it exists) typically occurs at this level.
Planning capability at regional levels of geography, however, is increasingly necessary to ensure that the healthcare needs of defined populations can be met by locally available health workers. Indeed, leading HWP practices encourage approaches to be grounded in the unique realities of local health systems. Such approaches can inform the development of targeted health workforce recruitment, deployment and management strategies to address persistent deficiencies in workforce supply, distribution and mix.
Having identified health workforce planning as an essential input to the implementation of their broader comprehensive Primary Care Strategy, the Toronto Region (formerly the Toronto Central Local Health Integration Network), a regional health authority in a major urban centre in Canada, sought guidance from a recognized source of HWP expertise. The result was a partnership with researchers at the Canadian Health Workforce Network (CHWN) with the goal of co-developing an evidence-informed, fit-for-purpose approach to integrated primary care workforce planning. Recognizing that HWP is an iterative process that leverages both quantitative workforce and population health data and qualitative workforce intelligence elicited from key stakeholders, a multifaceted toolkit approach was recommended as most appropriate.
Monthly teleconferences and several in-person meetings between CHWN researchers and the Health Analytics team for the Toronto Region allowed for the integration of local input throughout the toolkit development process. The Toronto Region’s Primary Care Regional Council, composed of clinician leaders from each of the health authority’s subregions, was also consulted to gather qualitative intelligence during the toolkit development process. The Health Analytics team and Regional Council provided input into the policies and strategies framing their vision for integrated primary care within the region, their planning objectives, the research and policy questions they were seeking to address, and the key workforce challenges they were facing. Each of these guided the development of the different analytic tools to be included in the toolkit. This approach not only helped to build HWP capacity amongst the Health Analytics team, but also trust in the ensuing approach from clinical leaders and other key local stakeholders.
This integrated approach, described in further detail in the papers led by Chamberland-Rowe  and Simkin , was informed by a HWP framework, depicted in a simplified form in Fig. 1 , which expands upon an earlier model informing a pan-Canadian Health Human Resources Strategy . Briefly, this framework outlines an iterative process by which population health needs drive health workforce planning, the output being an appropriate mix of health workers, deployed and distributed across specific geographies in a manner that ultimately produces positive health, provider and system outcomes. The dynamic process of HWP must recognize the broader social, political, geographic, economic and technological context within which it is situated.Footnote 2
Although this framework was developed for a pan-Canadian approach to health workforce planning, as a guiding framework it emphasizes some of the key principles of high-quality HWP that can be incorporated at a regional level. Specifically, it emphasizes that HWP should:
be driven by the health and healthcare needs of specific populations;
acknowledge that health workforce deployment is both interprofessionally based and geographically circumscribed, and is situated within broader social, political and economic contexts; and
be informed by available evidence across each of these elements, utilizing the highest quality data to best align inputs, activities and outputs.
Indeed, further to the second point noted above, regional planners are able to make decisions related to workforce deployment that directly affect access to appropriate and acceptable care close to home. For instance, HWP tools can be used to determine the optimal shape, size and location of services when planning for new housing development (which often does not consider location of health services).