Under no circumstances shall the European Observatory for Health Systems and Policies be held liable for any damage resulting from its use. This Open Access title is the sixth book in the Cambridge European Observatory on Health Systems and Policies series.
Skill-mix Innovation, Effectiveness and
Implementation
Introduction: why skill-mix?
Access to health services and the quality of health services are closely related to the density and skill mix of a country's health workforce (OECD, 2016; . World Health Organization. Little attention has been paid to determining the true composition and skill mix of the health workforce. WHO has published several reports on the health workforce, including skill mix or specific task shifts (World Health Organization).
Aims of this skill-mix volume
It did not distinguish between care sectors, circumstances or care contexts and concluded that more research is needed on the optimal mix of skills (Tsiachristas et al., 2015). In addition, it will analyze what factors and strategies exist to implement changes in the skill mix in healthcare organizations. Skill-mix innovations are examples of changes in skills, roles or clinical activities involving at least two professions and are characterized by three parameters: first, (perceived as) new in a country-specific context (novelty); second, interrupted with previous practice (disruptive); and third, aimed at improving at least one health outcome (focused on value), for example with positive effects on accessibility, quality, patient experience, care coordination and/or costs (Greenhalgh et al., 2004).
Policy relevance: why now?
The action plan recommends the assessment of skills mix gaps and proposes strategies to overcome these gaps. There is limited additional guidance and evidence on what constitutes an appropriate and sustainable skills mix, particularly for high-income countries and different healthcare sectors. The publication of an opinion on this topic showed how topical the issues of skills and health workforce mix are at EU level.
Skill-mix and the health workforce: definitions
Skill mix Changes in skills, competencies, roles or tasks within and across health professionals and health workers (including community-based staff, peers, informal carers) and/or teams Skill-mix typologies. In addition, to understand the extent and type of changes in the health workforce, a modified typology of skill mix innovations has been used for the study (Laurant et al., 2005; Friedman et al., 2014) (Table 1.1). Bridging capabilities are skill changes aimed at improving care across care settings to provide smooth, continuous delivery of services.
The diversity and skill-mix of health professions in Europe: a snapshot
A mix of skills for primary care and chronic care 11 intensity and work complexity, especially as many countries face increasing shortages of GPs and economic constraints. The shift to a broader mix of skills in primary care has enabled doctors to transfer various clinical and non-clinical duties to other professions, such as Advanced Practice Nurses/Nurse Practitioners with a master's degree or other postgraduate qualifications (e.g. Finland, Ireland, the Netherlands, the United Kingdom) or nurses with additional training but not at the master's level (e.g. Cyprus, Denmark, Estonia, Poland, Spain), community pharmacists (e.g. Switzerland, the United Kingdom), healthcare assistants (e.g. in Spain and the United Kingdom ), physician assistants (e.g. in the Netherlands and the United Kingdom) or medical assistants (e.g. in Austria, Germany and Switzerland) (Freund et al., 2015; . Skill mix for primary and chronic care 15 Maier, Aiken & Busse, 2017; Wismar, Glinos & Sagan, forthcoming). Of these, eight countries have passed new laws in the last decade, demonstrating the novelty of skill mix change (Maier, 2019).
Conceptual framework of the skill-mix study
Yet to date there has been no systematic synthesis of the evidence on the implications of skill mix changes on individual and population health outcomes or health system outcomes, including on the professions themselves, which is the overarching aim of this study. Specifically, this volume – which complements and builds on its companion volume, consisting of in-depth country case studies (Wismar, Glinos & Sagan, forthcoming) – conducts a systematic synthesis of the evidence on skill mix changes with a focus on skill mix innovations and outcomes. Education, regulation, payment policies and organizational strategies provide core elements of implementing skill mix innovations and reforms.
Methods
Skill mix for primary and chronic nursing 19 for skill mix) and/or as standard-of-care (traditional service delivery) at the time of the individual examination. 20 Skill-mix Innovation, Effectiveness and Implementation on a narrative synthesis of the most important outcome measures for each of the five care segments [see conceptual framework (OECD, 2017)]. Additional evidence on implementation and country reforms In addition to the overview of reviews, evidence from other sources is included in this volume, particularly focusing on the implementation of skill mix changes and the identification of country reforms.
Overview of this volume
Copenhagen, WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies. Copenhagen, WHO Regional Office for Europe on behalf of the European Observatory on Health Systems and Policies. General medical practitioners diagnose, treat and prevent diseases, illnesses, injuries and other physical and mental disabilities in people by applying the principles and procedures of modern medicine.
Overview of the evidence: skill-mix interventions, professions, care sectors
The evidence on changes in the skill mix in patients with chronic diseases is particularly rich, including a total of 78 systematic reviews and summarized in Chapter 6. For changes in the skill mix in chronic care, however, more than half of the reviews (43 out of 78 reviews) conducted meta-analyses. Areas covered Themes of mixed skills interventions a Occupations involved in mixed skills changes Long-term and.
Evidence on outcomes: what skill-mix interventions are promising?
Skill mix changes Objective(s) Areas covered Examples Chapters in book 2 Task reallocation (task reallocation/ care relocation). A skill mix modifies 51 dietary intakes of healthy foods (such as vegetables and fruits) and physical activity (Chapter 4). 53 skill changes, as mortality, depression and functional status remained inconclusive (Backhouse et al., 2017; Goeman, Renehan & Koch, 2016;.
Strength of the evidence and limitations
Changes in skill mix 59 In general, the reviews suggest that multiprofessional care models can have a positive effect on patients with mental health problems and multimorbidity (Chapter 6). Mixed skills interventions by multi-professional teams were commonly reported for transitional care and early discharge planning. It shows that there are several promising skills mix models to improve the quality of care and access to services.
Transferability of the findings
And finally, what communication strategies are effective to inform and involve patients, other health professions, managers and other key stakeholders to ensure the transfer and piloting of new skill mix models and their evaluation. Therefore, the transfer and implementation of a specific skill mix intervention is not only influenced by the governance and organization of a health system. These factors are critical for creating an enabling environment to support the implementation of skills mix innovations and reforms.
Conclusions
Maier CB, Kroezen M, Hartl K et al. health outcomes Workforce skills changes in primary and ambulatory care. Effectiveness of physical activity promotion based on primary care: systematic review and meta-analysis of randomized controlled trials. Effectiveness of home hospice in patients with heart failure: a systematic review and meta-analysis.
Introduction
Overview of the evidence on implementation
Evidence synthesis: the role of education and health workforce planning and skill-mix
No systematic review of skill mix and health workforce planning and implementation or other outcomes was identified (Chapter 9). However, it remains unclear to what extent it contributes to skills innovation in general. For healthcare professionals already employed, there are developments towards postgraduate training, continuing professional development and competency-based frameworks to support the adoption of changes in the skill mix.
Evidence synthesis: the role of policy and financing in implementing skill-mix changes
The lack of appropriate regulations and a clear legal framework also creates ambiguity regarding issues of responsibility for skill mix innovation. Countries should identify the impact of different funding models, including innovative payment schemes such as bundled payments, on the implementation of the skills mix. One factor with the potential for successful and sustainable uptake of skill mix innovation is adequate funding for new or improved job roles.
Evidence synthesis: organizational strategies to implement skill-mix changes
Another institutional factor such as team-based staff training in a specific health care setting may enhance staff participation in skill mix changes. Other payment schemes that can support changes in skill mixes are bundled payments or financial incentives for multiprofessional teamwork. The staff involved in skill-mix changes report a lack of support as an important barrier in organizations.
Strength of the evidence and limitations
To overcome such individual barriers when implementing skill mix innovations, it is effective to have interprofessional education sessions, developing common goals and using pilot projects for health professionals to familiarize themselves with the skill mix change. The very characteristics of skill mix innovation can be a facilitator if health care professionals perceive a positive effect in terms of professional development or reduced workload, or increased quality of patient care. While the opposite is true for barriers, skill mix innovation is poorly accepted if health professionals perceive their work to be overburdened or patient relationships to be at risk.
Policy lessons and recommendations
Implementation of skill mix changes 81 At the organizational level, developing a clear communication strategy and related change management positively influences the uptake of skill mix in practice, especially if it involves all professions in the process and explains the (perceived) added value of the skill mix innovation. To strengthen the implementation of skill mix, the specific context should be analyzed to influence local factors, personnel characteristics and organizational factors to adopt the most appropriate implementation strategies for the specific context. Lahtinen P, Leino-Kilpi H, Salminen L (2014), Nursing education in the European higher education area – variations in implementation.
Introduction
Keeping people healthy 85 4.2 Research evidence on the outcomes of skill mix changes that address prevention and health promotion. Ten reviews analyzed the outcomes of skill mix changes that focused on health promotion and prevention in healthy populations or population groups. However, some reviews provided information on the education of professionals involved in mixed skills interventions.
Skill-mix innovations and reforms: trends
As these changes affect the ways in which individuals acquire, interpret, and evaluate health information, they also affect the role of health care providers. As a result, pharmacists, patients and other healthcare professionals have been poorly accepted and resistant to its use. On the other hand, diabetes screening performed by pharmacists can be a challenge for the relationship between healthcare professionals, as it involves a change in their roles and requires optimization of communication between them regarding patient follow-up.
Conclusions and outlook
Effectiveness of interventions to promote healthy diet in primary care: systematic review and meta-analysis of randomized controlled trials. Impact of pharmacy care in the management of cardiovascular disease risk factors: a systematic review and meta-analysis of randomized trials. Pharmacist interventions to improve cardiovascular disease risk factors in diabetes: a systematic review and meta-analysis of randomized controlled trials.
IVY BOURGEAULT, CHRISTINE BOND, ROMY MAHRER-IMHOF, HANNAH BUDDE, BERND
- Introduction
- Evidence on outcomes based on an overview of reviews Twenty-eight reviews were identified that focused on skill-mix changes
- Skill-mix strategies addressing acute conditions Skill-mix interventions with a focus on transitional care
- Outcomes of skill-mix interventions Transitional care
Caring for people with acute conditions 131 with a decrease in mortality in patients with heart failure (Feltner et al., 2014). Nurse-led transitional care has been associated with improved treatment and medication adherence (Bryant-Lukosius et al., 2015). Transitional care interventions delivered by various professions have shown a significant decrease in readmission rates (Vedel & Khanassov, 2015) or mixed results (Rennke et al., 2013).
