An ideal-typical model for comparing interprofessional relations and skill mix in health care

Abstract

BackgroundComparisons of health system performance, including the regulations of interprofessional relations and the skill mix between health professions are challenging. National strategies for regulating interprofessional relations vary widely across European health care systems. Unambiguously defined and generally accepted performance indicators have to remain generic, with limited power for recognizing the organizational structures regulating interprofessional relations in different health systems. A coherent framework for in-depth comparisons of different models for organizing interprofessional relations and the skill mix between professional groups is currently not available. This study aims to develop an ideal-typical framework for categorizing skill mix and interprofessional relations in health care, and to assess the potential impact for different ideal types on care coordination and integrated service delivery.MethodsA document analysis of the Health Systems in Transition (HiT) reports published by the European Observatory on Health Systems and Policies was conducted. The HiT reports to 31 European health systems were analyzed using a qualitative content analysis and a process of meaning condensation.ResultsThe educational tracks available to nurses have an impact on the professional autonomy for nurses, the hierarchy between professional groups, the emphasis given to negotiating skill mix, interdisciplinary teamwork and the extent of cooperation across the health and social service interface. Based on the results of the document analysis, three ideal types for regulating interprofessional relations and skill mix in health care are delimited. For each ideal type, outcomes on service coordination and holistic service delivery are described.ConclusionsComparisons of interprofessional relations are necessary for proactive health human resource policies. The proposed ideal-typical framework provides the means for in-depth comparisons of interprofessional relations in the health care workforce beyond of what is possible with directly comparable, but generic performance indicators.

A call for action to establish a research agenda for building a future health workforce in Europe

“…It is also important to understand that health workforce needs may be different in hospital care, primary care, community or long-term care and in specific areas like rehabilitation [ 51 ] or public health [ 52 ]. Furthermore, there are significant differences and high variation in the composition of health workforces in Europe [ 33 , 49 , 53 – 56 ]. Whilst some of these particularities can be traced back to historical development, the underlying reasons and driving forces that create and perpetuate these differences remain largely unknown.…”

Conceptualizing skill mix in nursing and health care: An analysis

“…For instance, the use of political power by the medical profession may influence decisions related to the implementation of skill‐mix change. It is important to note that skill‐mix change can often result in a change to the traditional roles and functions of some professionals (Schönfelder & Nilsen, ). These role changes can cause confusion and disagreements that can challenge professionals’ identities and create a blurring of professional boundaries and interprofessional competition (Kroezen, van Dijk, Groenewegen, & Francke, ).…”

“…Despite an increased policy and clinical focus, analysis of the literature highlights a large variation in what is meant by skill mix and the way it is loosely defined (Dubois & Singh, ; Fulton et al, ; Schönfelder & Nilsen, ). The term appears to mean different things to various stakeholders (Bourgeault, Kuhlmann, Neiterman, & Wrede, ).…”

“…It is a contentious and complex issue that spans most health professional domains and jurisdiction. It often gives rise to unsettling discussions in relation to the readjustment of professional autonomy and boundaries for various health care professionals, thus resulting in conflict among practitioners and occupational groups (Dubois & Singh, ; Schönfelder & Nilsen, ).…”