From staff-mix to skill-mix and beyond: towards a systemic approach to health workforce management

Abstract

Throughout the world, countries are experiencing shortages of health care workers. Policy-makers and system managers have developed a range of methods and initiatives to optimise the available workforce and achieve the right number and mix of personnel needed to provide high-quality care. Our literature review found that such initiatives often focus more on staff types than on staff members' skills and the effective use of those skills. Our review describes evidence about the benefits and pitfalls of current approaches to human resources optimisation in health care. We conclude that in order to use human resources most effectively, health care organisations must consider a more systemic approach - one that accounts for factors beyond narrowly defined human resources management practices and includes organisational and institutional conditions.

The impact of fluoride application training: survey of trained dental nurses from King's College Hospital NHS Trust

“…6,9 Whereas dentists may be used to delegating to hygienists and perhaps therapists, this study suggests that there is significant organisational change required to delegate clinical tasks to a dental nurse. All of this activity involved 'role delegation' by a dental practitioner or consultant in dental public health in clinical and community settings respectively.…”

“…Furthermore there is increasing emphasis on delivering fluoride varnish in community settings. 1,7,8 Given the low complexity of the task trained dental nurses, as the largest workforce group in dentistry, 9 are ideally placed to assist.…”

“…All of this activity involved 'role delegation' by a dental practitioner or consultant in dental public health in clinical and community settings respectively. 9 Most nurses reported there were relevant resources available with the vast majority (90%, n = 32) having fluoride varnish available to them; however, fewer nurses had surgery time allocated for this treatment, referrals from dentists or involvement in community programmes. Other barriers included having no dental public health consultant locally to take responsibility for a community programme in line with GDC guidance 3 and problems with professional indemnity or consent.…”

“…12 Issues of appropriate remuneration were also raised by the nurses, which is something that must be incorporated into human resource management of extended duty nurses where there is role enhancement, otherwise there is the potential for disillusionment. 9 If we are looking for the multi-professional dental team to provide efficient, effective and cost-effective oral health treatment then we must ensure skills acquired are being used efficiently and effectively and remunerated appropriately.…”

Informing mental health policies and services in the EMR: cost-effective deployment of human resources to deliver integrated community-based care

“…This also makes it possible to address co-morbidity, to improve access to mental and physical health care and use a patient-centred approach, which ultimately reduces the stigma of mental illness (7,10,12). One of the key innovations required is to develop and deliver an appropriately skilled workforce within the primary care system, through skill mix (13)(14)(15)(16) and/or task-shifting (17)(18)(19) supported by an evidence-based system of collaborative or integrated care (20)(21)(22).…”