Healthforce Center at UCSF Director Sunita Mutha, MD, FACP, was featured in the UCSF Office of Research series, "Researcher of the Month." The article highlights Healthforce's role as the leading research organization producing information and evidence to understand the health care workforce.
By Shelley Wong
Founded in 1992, Healthforce Center at UCSF is known throughout California as the leading research organization producing information and evidence to understand the health care workforce. It is the only group of its kind in the nation attached to a health sciences university and is about team science in a way that is not often seen (learn about their projects and find their research publications).
“We are one foot in academia – which means we love the intellectual rigor at UCSF, our colleagues and the methodology and tools using evidence to drive policy solutions – and one foot in health care delivery. What that translates to for us is thinking about solving health care’s problems around workforce and capacity building,” says Sunita Mutha, MD, FACP, who is the director of Healthforce, a professor of clinical medicine, and an internist.
It is anticipated that California will soon face a shortfall of 4,100 primary care physicians, 600,000 home care workers, and one-third of the total number of psychiatrists needed. Earlier this year, the California Future Workforce Commission (co-chaired by University of California president Janet Napolitano and Dignity Health president and C.E.O. Lloyd Dean) released its final report based on Healthforce findings and recommendations.
The report’s broad recommendations to the state are to: (1) establish and scale a universal home care worker family of jobs; (2) expand the number of primary care physician and psychiatry residency positions; (3) scale the engagement of community health workers, promotores (Spanish-speaking community health workers working with Latinx populations), and peer providers; (4) maximize the role of nurse practitioners as part of the care team; (5) sustain and expand the Programs in Medical Education (PRIME) program across UC campuses; and (6) increase postbaccalaureate program slots for students reapplying to medical school from underserved communities.
“This is a blueprint for how California can think about addressing the workforce needs and big issues of healthcare for the next ten years in a coordinated way. It’s the first time that this has ever been done on this scale and the vast majority of the underlying research comes from work generated by researchers from Healthforce,” says Mutha. To take this research further, Healthforce helped the committee develop the evidence base to help decision-makers assess impact, estimating how one or several policies or programs using various levels of investment would close gaps.
Other major Healthforce research has focused on caring for California’s aging population – from identifying shortages in dental care in nursing homes or care for the elderly in rural or frontier areas – and addressing the substance use disorder epidemic with peer providers and less restrictive scopes of practice for nurse practitioners.
As an interprofessional team, Healthforce has historically concentrated their work in medicine, nursing, dentistry, and pharmacy. Mutha and her colleagues’ research on health professions and workforce trends have informed policies at the local, state, and federal levels. They consider who is doing a particular area of work well, what models exist, and how they can be best applied in a way that works financially. Their diverse group possesses wide-ranging strengths and includes faculty with unique skills and research backgrounds such as Associate Director of Research Joanne Spetz, PhD, who is a health economist.
The other side to Healthforce’s work is in leadership training programs. For ten years, Healthforce ran a program (funded by the Blue Shield of California Foundation) to develop a leadership pipeline for all of the federally qualified health centers in California who were eligible, along with tribal health and Planned Parenthood, which meant serving the most vulnerable populations.
“The impact I am most proud of is that we have changed the safety net in California. We had people who may not have had traditional opportunities – some of them were clinicians, some were administrators, and they came from all levels within an organization – and we had an audacious goal: to get them in the C-suite and keep them in the safety net,” says Mutha.
Over ten years, Healthforce trained over 350 people who Mutha calls “agents of change.” The program was designed to reinforce their focus on social justice origins of community health centers and serving communities.
“These people are now changing the way these organizations are running. They might be in a small organization working in a frontier part of California or in the largest community health center in California. We’ve trained people in this entire spectrum and many of them have moved into the C-suite and over eighty percent remain in the safety net,” says Mutha.
For over a decade, Mutha developed a body of research around health equity as well as a cultural competency curriculum training, which was deployed at all three Mayo Clinic sites.
“The populations I am most interested and passionate about are the ones that are marginalized for one reason or another. In the safety net leadership program, they were 70% Latino and around 80% women, and did not have opportunity for formal education. Some were undocumented and most were from immigrant families. I found it incredibly meaningful to know that you could take people who didn’t have a voice at the table, and give them skills, educate them, and give them the confidence to be able to sit at decision-making tables. And now some of them are CEOs,” Mutha says.
In its 19th year, Healthforce has what Mutha calls the “premier leadership training program for clinicians in California,” funded by the California Healthcare Foundation, and counts many UCSF Health leaders as alums. Mutha is proud of the work done within UCSF to invest in leadership training, citing the training of eighty faculty across campus sites in the fundamentals of leadership; the recent Clinical Leadership Accelerator, funded by the Executive Vice Chancellor and Provost; and a School of Medicine/Department of Medicine training program for department management services officers from a few years ago.
“We want to have an impact on the individual and the organization. We hope that with long-term investments, we can have an impact on the field, like the safety net field. But we know what matters is the ability to connect people and create networks. We do most of our trainings as a cohort and try to bring the best of what is relevant in the leadership arena and a deep understanding of health care and health care delivery,” says Mutha. “This work is unique, and it adds to the richness of what UCSF is about.”