Creating “Risky” New Roles in Healthcare: Identities, Boundary-Making, and Skilling Under Rationalization and Consumer Demand

Cain, Cindy; Taborda, Caty; Frazer, Monica

doi:10.1177/0730888420983396

Cited by 8 publications

(12 citation statements)

References 80 publications

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“…Even though new roles are sometimes not well accepted by existing staff in the team, 11,[13][14][15][16] and established hierarchies can be a barrier to their implementation, 1 the satisfaction survey shows that physicians are satisfied with the new role introduction. They particularly appreciate the reduction in consultation time and the improvement in the quality of consultations, and that this reduction in time spent on administrative tasks allows them to devote themselves to other care activities, as well as to research.…”

Section: Discussionmentioning

confidence: 99%

“…1 Several studies notice that new roles are not always well accepted by existing staff in the team. 11,[13][14][15][16] Other research show the payment system is identified as another potential barrier to task shifting, for instance, if reimbursement is only possible when a procedure is done by a concrete category of health worker. 17 Task shifting in Europe has been majorly centered in the growth of tasks assumed by nurses that were formerly performed by physicians.…”

Section: Introductionmentioning

confidence: 99%

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Implementation of clinical assistants in a pediatric oncology department: An impact analysis

Mas

Calvo

Pavon

et al. 2023

Health Serv Manage Res

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Bureaucratic and administrative tasks associated with health care provision have historically fallen on health care professionals, which is one among the factors contributing to low job satisfaction and lower productivity. Incorporating new professional roles that help to better respond to the needs of both patients and professionals can increase the quality and efficiency of service provision. This article aims to evaluate the impact of the clinical assistant’s introduction in the Sant Joan de Déu Barcelona Children’s Hospital’s pediatric oncology department, in terms of (i) displacement of activity loads carried out by this new professional role and the consequent time freed up for physicians, (ii) physicians’ satisfaction and (iii) efficiency of the new care model. This is an observational and retrospective study using administrative data based on the type of activity performed by clinical assistants and the measurement of the time freed up in favor of the physicians. The potential skill mix productivity increase, survey of physicians’ satisfaction, and reduction in costs with the new model was analyzed. During the first year of its implementation in the pediatric oncology department, clinical assistants have performed 13,553 requests (69% of the total), representing a total saving of 266.83 hours or 6.67 workweeks of 40 hours. They performed 74% of outpatient surgical requests in the oncology department, 87% of day hospital requests and 54% of total requests in the outpatient consultations area. Physicians are overall satisfied with the new role and think they can use the time gained to do other things such as research or improving the quality of care. The role change allows reducing the cost per request by 56% in relation to the conventional model. In conclusion, the introduction of clinical assistants in the oncology department could be efficient to the extent that it displaces a significant part of the bureaucratic and administrative tasks previously performed by health care professionals and thus enables to reduce the cost of these processes. This delegation allows them to work more closely to the maximum of their competences and the physicians to have more time for higher added value clinical tasks and increase professional satisfaction.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Implementation of clinical assistants in a pediatric oncology department: An impact analysis

Mas

Calvo

Pavon

et al. 2023

Health Serv Manage Res

View full text Add to dashboard Cite

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“…The impact of this context on delivery is perhaps unsurprising. Community health workers in the United States, for instance, have previously described how the ‘agenda less’ relationships they built with clients were undermined by embedded neoliberal health‐care structures and targets (Cain et al., 2021 , pp. 353–385) that commonly align with a logic of choice (Mol, 2008 ).…”

Section: Discussionmentioning

confidence: 99%

Constituting link working through choice and care: An ethnographic account of front‐line social prescribing

Griffith

Pollard

Gibson

et al. 2022

Sociology Health & Illness

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Link worker social prescribing has become a prominent part of NHS England's personalisation agenda. However, approaches to social prescribing vary, with multiple discourses emerging about the potential of social prescribing and different interpretations of personalisation. The transformational promise of social prescribing is the subject of ongoing debate, whilst the factors that shape the nature of front-line link working practices remain unclear. Based on 11 months of in-depth ethnographic research with link workers delivering social prescribing, we show how link workers' practices were shaped by the context of the intervention and how individual link workers navigated varied understandings of social prescribing. Following the work of Mol, we showhow link workers drew differentially on the interacting logics of choice and care and trace a multiplicity in front-line link working practices within a single intervention. However, over time, it appeared that a logic of choice was becoming increasingly dominant, making it harder to deliver practices that aligned with a logic of care. We conclude that interpreting personalisation through a logic of choice could potentially undermine

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“…Even though new roles are sometimes not well accepted by existing staff in the team [14,18,[19][20][21], a satisfaction survey conducted specifically in the oncology department shows that physicians are satisfied with the new role introduction. Physicians particularly appreciate the reduction in consultation time and the improvement in the quality of consultations, and that this reduction in time spent on administrative tasks allows them to devote themselves to other care activities, as well as to research.…”

Section: Discussionmentioning

confidence: 99%

“…Clinical assistants made 13,553 requests in the outpatient area, which represents 69.93% of the total number of requests subject to the study period (19,381). Table 1 breaks down the administrative activity of the outpatient area according to the types of requests and their corresponding time spent.…”

Section: Types Of Requests Madementioning

confidence: 99%

Implementation of Clinical Assistants in a Pediatric Oncology Department: an Activity and Clinical Time Release Analysis

Mas¹,

Calvo²,

Pavon³

et al. 2021

Preprint

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Background: There is a high bureaucratic and administrative burden associated with health care tasks (test requesting, visits scheduling, supporting documents provision) that has historically largely fallen on health care professionals, which is one among the factors contributing to low job satisfaction and lower productivity. Incorporating new professional roles that help to better respond to the needs of both patients and professionals can increase the quality and efficiency of service provision. Objective: To evaluate the impact of the clinical assistant’s introduction in the Sant Joan de Déu Barcelona Children’s Hospital’s pediatric oncology department, in terms of displacement of activity loads carried out by this new professional role and the consequent time freed up for physicians. Methodology: Observational and retrospective study using administrative data based on the analysis of the type of activity performed by clinical assistants and the measurement of the time freed up in favor of the physicians, based on in situ timekeeping, to approximate the potential skill mix productivity increase. Results: Since its implementation in the pediatric oncology department, clinical assistants have performed 13,553 requests (69.93% of the total), representing a total saving of 266.83 hours or 6.67 workweeks of 40 hours. They performed 74.25% of outpatient surgical requests in the oncology department, 87.5% of day hospital requests and 54.13% of total requests in the outpatient consultations area. Conclusion: The introduction of clinical assistants in the oncology department could be efficient to the extent that it displaces a good part of the bureaucratic and administrative tasks previously performed by health care professionals. This delegation allows them to work more closely to the maximum of their competences and the physicians to have more time for higher added value clinical tasks. In terms of efficiency, this role change enables to optimize the clinical process, reducing the cost by 56% compared to the conventional model.

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Creating “Risky” New Roles in Healthcare: Identities, Boundary-Making, and Skilling Under Rationalization and Consumer Demand

Cited by 8 publications

References 80 publications

Implementation of clinical assistants in a pediatric oncology department: An impact analysis

Implementation of clinical assistants in a pediatric oncology department: An impact analysis

Constituting link working through choice and care: An ethnographic account of front‐line social prescribing

Implementation of Clinical Assistants in a Pediatric Oncology Department: an Activity and Clinical Time Release Analysis

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