Changing skill mix within
teams delivering integrated
health services
Antoinette de Bont, April 3rd 2014
MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munros
Agenda
• The need for an integrated planning model for
the workforce
– New professional roles can increase fragmentation of
care;
– The development of new professional roles in Europe
– Drivers for new professional roles
• Evidence for better care with new professional
roles
• How the MUNROS study can contribute
MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munros
New professional roles in Europe
Existing professions that
specialize
• in a very specific clinical area:
– Extended roles.
– Diabetes Nurse
• in specific technical skills
– Technical roles.
– Dialysis technician
• in new health care services
– Advanced roles.
– Case manager
New professions
• with legal autonomy
and clinical
responsibility to work
that used to be done
by doctors.
– Advanced nurse
practitioner
MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munros
Where do the EU stand
• New professions in Netherlands, England and
Scotland.
• Extended roles and new technical roles in
Germany, Italy, the Czech Republic and Turkey.
• Very few new professional roles in Norway
and Poland.
MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munros
Drivers that
encourage
hamper
• Dedicated policies to
encourage skill mix
change;
• The emergence of new
services in response to
technical services;
• Educational programs
• Payment systems that
put physicians center
stage
• Hierarchical differences
between physicians and
nurses
Skill mix
MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munros
Evidence for the better
• Out of Forty five evaluation studies of
specialist nurses (SNs) and advanced nurse
practitioners (ANPs):
– 57% of the SN evaluation studies and 66% ANP
studies reported improvements in quality of care.
– 80% of the SN evaluation studies and 57% ANP
studies reported improvements in patient
satisfaction.
– 60% of the SN evaluation studies reported
reduction in health care utilization.
MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munros
How Munros can contribute
• An integrated model to plan all professional
roles in a care pathway based upon empirical
evidence about:
– The quality of care;
– The costs of care;
– The substitution of task;
– The integration of care;
• Our pathways: diabetes II, breast cancer and
acute myocardial infarct.
MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munros
Acknowledgement
• We wish to thank the European Commission
for funding this research programme ‘Health
Care Reform: The iMpact on practice,
oUtcomes and cost of New ROles for health
profeSsionals (MUNROS), under the European
Community’s Seventh Framework Programme
(FP7 HEALTH-2012-INNOVATION-1) grant
agreement number HEALTH-F3-2012305467EC .
MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munros