Where to from here?

Although this conceptual framework is easy to understand, the data requirements for the mathematical model that underpins the framework are complex and must be defined carefully. In our framework, simulations of the health system are used to provide needs-based estimates that are aimed at optimizing outcomes. This type of model builds on research conducted at the macro, meso, and micro levels in order to reflect the complexity of relationships in the health human resource process. The papers in this issue of the Journal provide insight into specific constructs of the model. At the macro level, Tomblin Murphy explores methodological challenges in HHRP research. She examines common assumptions and the validity of their use in modelling in all aspects of the proposed framework. Tourangeau and colleagues report on the impact of hospital nurse-staffing decisions on 30-day mortality rates. Their model adds to our knowledge of the relationships among the management, deployment, and utilization of nursing services and patient/population outcomes. Shamian and colleagues explore the relationship between hospital-level indicators of the work environment and aggregated indicators of health and well-being for registered nurses employed in acute-care hospitals in the province of Ontario. This paper contributes to our understanding of how management decisions regarding the work environment influence nurse outcomes. Manojlovich and Ketafian explore the conflict between the practice of nursing and the organizational structure of many hospitals. This study provides insight into the management aspects of how the work unit is organized and the process of care delivery. Zboril-Benson examines the reasons for nurse absenteeism in the province of Saskatchewan. Birch describes the need for the planning process to take into account demographic changes in both populations and provider groups. A major challenge in modelling health human resources is access to meaningful databases for planning purposes. Pringle describes a unique Ontario initiative currently underway to develop and validate a nurse-sensitive set of data that will be routinely collected and will enhance HHRP in that province. Since the science that underpins HHRP is complex and rapidly changing, few books have been written on the subject. Reflecting the dynamic nature of the science, Tomblin Murphy and Barrath provide an excellent review of "grey literature" and useful Web sites for those interested in HHRP.