Cultural adaptation programmes for foreign nurses, digitalisation of the health system, telemedicine, investment in artificial intelligence and more flexible working conditions are part of a strategy announced on Wednesday to attract workers to healthcare and retain the existing ones.

Issued by the People Management Division within the Health Ministry, the Health Work Force Strategy outlines the government's plans for this year and next to tackle the perennial shortage of doctors and nurses, upskill the current workers and provide them with better working conditions in a bid to not lose them to the private sector.

Foreign healthcare workers will be invited to attend adaptation programmes before they start working in Malta so that they are better prepared for the Maltese culture and the national health system.

With more than 11% of workers in the nursing profession being foreign, communication has been identified as one of the greatest barriers to workforce integration, the strategy notes.

"One of the main challenges in this area is that a number of patients, especially the elderly are able to communicate only in Maltese," the strategy says.

Training in geriatric care

The government has also embarked on efforts to enhance training for foreign nationals in care for the elderly, not only because the ageing population is increasing, but because healthcare workers from India and Pakistan, for instance, come from countries where the elderly are usually cared for at home, so the nurses there are sometimes not given geriatric care as a training priority.

The ministry will also be appointing cultural mediators from among experienced foreign employees to coach foreign recruits and help them adapt to the local environment.

The strategy lays out plans to have the ministry work in synergy with the education ministry and educational institutions like the University and MCAST, to adapt courses to emerging needs of the healthcare system - namely to a population that is growing in size and in age and will need to have more healthcare workers who are specialised in treating chronic illnesses.

Malta has been battling healthcare worker shortages for years, and matters became tougher when  foreign healthcare agencies embarked on efforts to poach nurses working in Malta.

The complement of nurses currently stands at around 4,000 but it is estimated at least 400 more are needed. The recent spike in population has stretched the resources.

"Pressure on health workforce planning is increasing as service demand is rising and consumer expectations are changing, while current funding and service arrangements are being stretched," the report says, adding that an increase in women in the workforce has created more demand for homes for the elderly, assisted living and community care because there are fewer people in the households to take care of elderly family members.

The strategy points out that while the government strives to retain seasoned and specialised professionals by incentivising them to work beyond the pensionable age, a shortage of certain professionals is inevitable.

"If we were to attract very highly specialised doctors to Malta to manage rare conditions, they would quickly become de-skilled due to the very limited numbers of such conditions," the strategy says.

"The model we are looking at is to ensure we have enough professionals to deal with the more common conditions and of course some specialised services. But when it comes to highly specialised care for rare or uncommon conditions, then we could make use of the emerging European Reference Networks."

Medical services on the internet

The strategy also vows to invest in telemedicine, digitalisation of services and artificial intelligence.

Telemedicine would allow professionals to provide services over the internet, so long as those services do not necessitate face-to-face contact between the doctor and the patient. And digitalisation would give digital access to patients' medical records, test results, hospital bookings and online services for prescriptions.

Artificial intelligence would be ushered in to perform more mundane chores and to free up time for healthcare workers, enabling them to focus on "high-value activities".

"Technology, however, demands the need to invest more time in staff training, including re-skilling of staff where duties have been replaced by AI," the strategy document says.

"Training of staff who will be operating the same AI is also paramount to deliver a seamless healthcare service."

Counselling support for health workers

The government is also planning on enhancing its counselling support for its healthcare workers to "create more awareness regarding self-care, resilience, coping mechanisms".

"The COVID-19 pandemic created an unprecedented situation for the health care professionals because of the increased pressure and stress, the possible infection risk to them and on their family members, increased workloads, fear of the unknown, lack of preparedness and personal protective equipment, physical and mental fatigue related to excessive workloads and life/death situations of patients, pressures from management, staff and relatives," it said.

"This experience has changed the way health care professionals practice and will continue practising."

Flexible working conditions

The ministry is also vowing to explore more flexible working conditions for its employees.

"Whilst it may seem that a large organisation which operates around the clock and which serves such a critical function as the delivery of healthcare is ill-placed to cater to its employees’ needs and offer flexible working arrangements, it is a must in today’s markets if it is to remain an attractive place to work in," it said.

"With some innovative thinking, the perceived disadvantages may also serve as advantages. For example, having such a large workforce that works around the clock makes it an ideal place to experiment with flexible working hours and rosters, since one is bound to find people who are willing to work at certain hours which others find less manageable."

It also suggests remote working for reviewing and writing clinical notes, accessing laboratory and radiology investigation results, writing referrals, writing prescriptions, performing administrative work, ordering supplies and undergoing training.

"This could have positive impacts on the requirements for parking, time spent on travelling, and space dedicated for administrative purposes within precious clinical areas," the strategy points out.