News and Updates
Workforce Staffing During Pandemic Influenza Briefing Paper Now Available
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The ability and willingness of health care workers to provide medical services to the sick and injured when needed is one of the foundations of our health and medical system. During a disaster - whether it is man-made, naturally occurring, or an emerging infectious disease outbreak - citizens will expect the medical community to meet their health care needs. However, history is replete with conflicting evidence as to whether health care workers are always willing to provide such care. In fact, the willingness to provide medical care has been an issue among practitioners since at least the early 1900s. For example, immediately after the 1918 influenza pandemic, the Canadian Medical Association (CMA) enshrined duty to care as part of its ethical mandate while the American Medical Association (AMA) applied duty to care as part of its ethical mandate as far back as 1846.(1) However, for both the CMA and the AMA, duty to care was subsequently removed from their code of ethics in 1926 and the early 1970s, respectively.(1) Reasons why duty to care was removed from the AMA code of ethics is postulated to be due to the rise of government and business interference into the practice of medicine and a general belief that infectious diseases had disappeared around the 1950s.(1)
In the 1980s when the acquired immune deficiency syndrome (AIDS) epidemic began and in 2003 when the severe acute respiratory syndrome (SARS) outbreak occurred, questions were raised about duty to care and to what extent health care workers must sacrifice their own safety to care for those in need. In Canada, during the SARS outbreak, some health care workers refused to report to work for fear of contracting the deadly illness while other health care workers left the profession, thus indicating an unwillingness or inability to care for patients in the face of risk. (2) Interestingly, following the SARS outbreak the CMA revised its Code of Ethics in 2004, but did not address physician duty to care.(2) With the looming threat of pandemic influenza, health-related organizations are confronted once again with the prospect that employees may refuse to report to work. In addition, health-related organizations face a strong likelihood that up to 30 to 40 percent of their workforce may be absent at any given time due to the influenza virus itself.(3) Yet, unlike SARS, which was limited in scope and was primarily an outbreak of health care institutions, an influenza pandemic will likely be marked by high transmission and illness rates on a global scale and, depending on illness characteristics, [may be marked] by subsequent high demands for health care and possibly by high mortality rates. (2) The likely high transmission rates, associated high morbidity, and potential for high mortality are all factors that may cause health care workers to refuse to report to work during an influenza pandemic, but on a much larger scale than experienced during the SARS outbreak. Therefore health-related organizations (e.g., hospitals, nursing homes, clinics, and public health agencies) must be aware of the factors that influence an employee's willingness to report to work during a pandemic. Consideration of these factors prior to a potential pandemic is necessary to ensure that the medical needs of the public can be met and that both employees and employers understand their rights, responsibilities, and professional duties associated with reporting to work during an influenza pandemic.The Litaker Group has developed a briefing paper on this topic to: (1) identify factors that are likely to influence whether or not health care workers report to work during an influenza pandemic; (2) provide strategies that health-related employers can implement to encourage employees to report to work during an influenza pandemic; and (3) provide specific recommendations to mitigate absence due to refusal to report to work. While this briefing paper is aimed primarily at hospitals, the information in this document is also relevant to nursing homes, specialty clinics, public health agencies, and other health care providers.
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