Healthcare assistants in general practice: practical and conceptual issues of skill-mix change

Bosley, Sara; Dale, Jeremy

doi:10.3399/bjgp08x277032

Cited by 82 publications

(81 citation statements)

References 33 publications

(52 reference statements)

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“…5,6 However, differences in power and status, as well as a lack of clarity about who should do what, makes delegating tasks a challenge. [7][8][9] Teams struggle with poor role clarity and confusion over responsibility for clinical tasks. 10 -15 Team struggles over who should do which tasks may contribute to work-related burnout, a psychological state characterized by emotional exhaustion, lack of enthusiasm, and feelings of ineffectiveness.…”

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confidence: 99%

Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs)

et al. 2018

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Purpose: Appropriate delegation of clinical tasks from primary care providers (PCPs) to other team members may reduce employee burnout in primary care. However, (1) the extent to which delegation occurs within multidisciplinary teams, (2) factors associated with greater delegation, and (3) whether delegation is associated with burnout are all unknown.Methods: We performed a national cross-sectional survey of Veterans Affairs (VA) PCP-nurse dyads in Department of VA primary care clinics, 4 years into the VA's patient-centered medical home initiative. PCPs reported the extent to which they relied on other team members to complete 15 common primary care tasks; paired nurses reported how much they were relied on to complete the same tasks. A composite score of task delegation/reliance was developed by taking the average of the responses to the 15 questions. We performed multivariable regression to explore predictors of task delegation and burnout. Results: Among 777 PCP-nurse dyads, PCPs reported delegating tasks less than nurses reported being relied on (PCP mean

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confidence: 99%

Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs)

et al. 2018

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“…Nurses and doctors may be reluctant to share tasks with or to trust nonclinically trained health care workers (Bosley & Dale, 2008). However, our experience suggests the opposite.…”

Section: Discussionmentioning

confidence: 91%

Care Guides

Adair

Christianson

Wholey

et al. 2012

Journal of Ambulatory Care Management

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Lay persons ("care guides") without previous clinical experience were hired by a primary care clinic, trained for 2 weeks, and assigned to help 332 patients and their providers manage their diabetes, hypertension, and congestive heart failure. One year later, failure by these patients to meet nationally recommended guidelines was reduced by 28%, P < .001. Improvement was seen in tobacco usage, blood pressure control, pneumonia vaccination, low-density lipoprotein cholesterol levels, annual eye examinations, aspirin use, and microalbuminuria testing. Care guides served an average of 111 patients at an annual per patient cost of $392. Further testing of this model is warranted.

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“…Por ejemplo, los actos de enfermería suelen ser más baratos que los actos médicos, pero al cabo del día la comparación puede no ser tan clara, según la productividad (número de actos) de ambos profesionales 36 . Además, las fronteras entre profesionales son siempre discutibles, y no sólo entre médicos y enfermeras, sino también entre médicos y farmacéuti-cos, entre enfermeras y auxiliares clínicos y entre estos y los administrativos, y entre enfermeras y trabajadores sociales por poner sólo unos ejemplos [33][34][35][36][37][38][39][40][41] .…”

Section: ¿Por Qué Los Médicos Son Reacios a Delegar Responsabilidad Yunclassified

El debate profesional acerca de la escasez de médicos

Gérvas

Bonis

2008

Rev. Esp. Salud Publica

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Desconocemos la mejor respuesta a los problemas que plantea la carencia de médicos (en número y especialidad) pero quizá lo importante no sea la carencia en sí, sino la falta de un debate profesional que redefina qué es "ser médico". En este texto se consideran cuatro cuestiones profesionales clave, acerca de: 1/ la sobre-formación de lo médicos cuando la demanda se ha expandido para incluir problemas menores, 2/ el predominio de los encuentros directos médico-paciente en un mundo en que dominan las telecomunicaciones y los encuentros indirectos, 3/ la necesidad de delegar poder y responsabilidad a otros profesionales sanitarios, aprovechando el desarrollo tecnológico y una necesaria redefinición de roles, y 4/ el excesivo énfasis en el diagnóstico, con el consiguiente peligro de iniciar cascadas con daño innecesario al paciente. Todo ello exige cambios en la formación de pre y postgrado, mejoras en la organización de servicios para potenciar el uso de las telecomunicaciones y el análisis y re-diseño de los lími-tes entre profesionales, niveles, instituciones y sectores sociosanitarios.Palabras clave: personal sanitario, oferta. ABSTRACT Professional Debate on Shortage of PhysiciansWe do not know the best answer to problems due to shortage of physicians (absolute number and by specialities) but perhaps what is important is the lack of a professional debate about what means "to be" a physician. In this paper we address four key professional questions: 1/ the overtraining of physicians when health demand now includes minor problems, 2/ predominance of physician-patient direct encounters in a world of telecommunications and indirect encounters, 3/ the need to delegate power and responsibilities to other health professionals as a consequence of new technology developments and changes in role-design, and 4/ too much emphasis in diagnosis with the danger to initiate cascades with its side-effects. Practical answers to these questions require changes in pre and postgraduate education, improvement in health services organization to profit the use of telecommunications and analysis and re-design of the limits in between professions, levels of care, institutions and health and social sectors.

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Healthcare assistants in general practice: practical and conceptual issues of skill-mix change

Cited by 82 publications

References 33 publications

Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs)

Task Delegation and Burnout Trade-offs Among Primary Care Providers and Nurses in Veterans Affairs Patient Aligned Care Teams (VA PACTs)

Care Guides

El debate profesional acerca de la escasez de médicos

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