Reconfiguring health workforce: a case-based comparative study explaining the increasingly diverse professional roles in Europe

Abstract

BackgroundOver the past decade the healthcare workforce has diversified in several directions with formalised roles for health care assistants, specialised roles for nurses and technicians, advanced roles for physician associates and nurse practitioners and new professions for new services, such as case managers. Hence the composition of health care teams has become increasingly diverse. The exact extent of this diversity is unknown across the different countries of Europe, as are the drivers of this change.The research questions guiding this study were: What extended professional roles are emerging on health care teams? How are extended professional roles created? What main drivers explain the observed differences, if any, in extended roles in and between countries?MethodsWe performed a case-based comparison of the extended roles in care pathways for breast cancer, heart disease and type 2 diabetes. We conducted 16 case studies in eight European countries, including in total 160 interviews with physicians, nurses and other health care professionals in new roles and 600+ hours of observation in health care clinics.ResultsThe results show a relatively diverse composition of roles in the three care pathways. We identified specialised roles for physicians, extended roles for nurses and technicians, and independent roles for advanced nurse practitioners and physician associates. The development of extended roles depends upon the willingness of physicians to delegate tasks, developments in medical technology and service (re)design. Academic training and setting a formal scope of practice for new roles have less impact upon the development of new roles. While specialised roles focus particularly on a well-specified technical or clinical domain, the generic roles concentrate on organising and integrating care and cure.ConclusionThere are considerable differences in the number and kind of extended roles between both countries and care pathways. The main drivers for new roles reside in the technological development of medical treatment and the need for more generic competencies. Extended roles develop in two directions: 1) specialised roles and 2) generic roles.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1898-0) contains supplementary material, which is available to authorized users.

Impact de l’expérimentation de coopération entre médecin généraliste et infirmière Asalée sur l’activité des médecins

“…Il se peut que le design de l'expérimentation Asalée ne permette pas de maximiser les gains potentiels d'efficacité productive d'une coopération MG-IPA. D'une part, en raison de l'hétérogénéité de fonctionnement et d'intensité de la coopération entre les binômes déjà mise en évidence (Fournier et al, 2018 ;Afrite et al, 2019), et d'autre part, en raison d'un périmètre restreint de coopération prévu par l'expérimentation qui, bien qu'innovant dans le contexte français, reste très limité au regard des possibilités mises en oeuvre dans d'autres pays (de Bont et al, 2016). Les infirmières, surtout les infirmières de pratiques avancées, pourraient assurer une plus grande part de l'activité des MG avec la même qualité et la même efficacité (Martínez-González et al, 2015 ;Morilla Herrera et al, 2016).…”

“…En parallèle, la relative faiblesse du temps médical rapporté au temps de travail total des MG (de l'ordre de 70 %) [Verger et al, 2017] et la tendance à la dégradation de ce ratio offrent pourtant des leviers d'augmentation de ce temps médical disponible (Bras, 2011). Face à la baisse de l'offre de travail des MG et de leur temps directement dédié aux patients, de 8 Document de travail n° 77 -Irdes -Avril 2019 Impact de l'expérimentation de coopération entre médecin généraliste et infirmière Asalée sur l'activité des médecins nombreux pays de l'Organisation de coopération et de développement économiques (OCDE) ont favorisé l'intégration des systèmes de soins primaires, la coopération interprofessionnelle et la délégation des tâches entre les médecins et les autres professionnels de santé afin d'améliorer l'efficience de l'offre de soins (Delamaire et Lafortune, 2010 ;Groenewegen et al 2015 ;de Bont et al 2016).…”

Primary care workforce development in Europe: An overview of health system responses and stakeholder views

“…Following systematic reviews of the literature [68] and ethnographic work [69], surveys were developed to explore which professionals were involved in the delivery of care, the different tasks within the care pathway to which they contributed, the external and internal drivers for workforce change, the patients' experiences of and satisfaction with care, and healthcare utilisation. Within each country up to twelve hospitals, together with primary care centres in their area, providing care for the three target conditions, were recruited to the study.…”

“…The primary care model in England is an archetype of primary care [9] provided in centres staffed by multiprofessional teams led by GPs with strong gatekeeping functions. Task shifting and new roles for nurses and for a number of other healthcare providers, for instance pharmacists, have been introduced [69]. In contrast, Germany operates an ambulatory care model based on office-based specialists and generalists with poorly developed team approaches and gatekeeping function, although some pilot projects have established integrated, community-centred models [74].…”

A Suggested Professional Development Plan for Specialist Doctors Taking Leading Roles in the Establishment of Quality Healthcare

“…[1] In this proposed plan the domains are broadly classified under the heading of four broad divisions.…”