The impact on practice, costs and
outcomes of New Roles for health
professionals in Europe (MUNROS)
Antoinette de Bont/ associate
professor/ Erasmus University
Rotterdam
Agenda
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Introduction to the study
Development of new professionals roles
Drivers and barriers to new professional roles
Conclusions about the impact
PA INVEST 2014, Amsterdam, October 30 November 1 2014
Aim
Aims
• Detail the nature, scope and contribution of
the new professional roles.
• Evaluate their impact on clinical practice and
outcomes.
• Identify their scope to improve the integration
of care.
PA INVEST 2014, Amsterdam, October 30 November 1 2014
What we did
• We have described the key features of the health
delivery systems in nine countries of the EU.
• We have determined the drivers for skill mix changes
based upon routine available data and policy
documents.
• We have described the skill mix in daily practice in 16
care pathways: AMI (6), Breast Cancer (6) and
Diabetes II (4).
PA INVEST 2014, Amsterdam, October 30 November 1 2014
Agenda
•
•
•
•
Introduction in to the study
Development of new professionals roles
Drivers and barriers to new professional roles
Conclusions about the impact
PA INVEST 2014, Amsterdam, October 30 November 1 2014
SPECIALIZATION OF CARE
 Developments in medical technology and training
 Developments in information technology
INTEGRATION OF HEALTH SERVICES
 Improve quality of care / patient outcomes
 Increase share in health services
SPECIALIZATION OF CARE
 Developments in medical technology and training
 Developments in information technology
INTEGRATION OF HEALTH SERVICES
 Improve quality of care / patient outcomes
 Increase share in health services
Traditional care delivery
with one specialist within a care
organization responsible for the
care delivery to a patient,
supported by general nursing,
technical and/or administrative
staff
Physician-centred care
SPECIALIZATION OF CARE
 Developments in medical technology and training
 Developments in information technology
INTEGRATION OF HEALTH SERVICES
 Improve quality of care / patient outcomes
 Increase share in health services
Multiple specialists
Traditional care delivery with one
specialist within a care organization
responsible for the care delivery to
a patient, supported by general
nursing, technical and/or
administrative staff
Physician-centred care
within a care organization involved
in care delivery to a patient,
simultaneously and/or
consecutively, based on the
required expertise, supported by
specialized nursing, technical
and/or administrative staff
Expertise-centred care
SPECIALIZATION OF CARE
 Developments in medical technology and training
 Developments in information technology
 Improve quality of care / patient outcomes
 Increase share in health services
INTEGRATION OF HEALTH SERVICES
Integrated care
Co-ordination of care delivery to a
patient with new
general
professional roles within a
care organization (e.g. expansion of
services) and/or between care
organizations (e.g. primary and
secondary care)
Traditional care delivery with one
specialist within a care organization
responsible for the care delivery to
a patient, supported by general
nursing, technical and/or
administrative staff
Physician-centred care
Multiple specialists within a care
organization involved in care
delivery to a patient,
simultaneously and/or
consecutively, based on the
required expertise, supported by
specialized nursing, technical
and/or administrative staff
Expertise-centred care
SPECIALIZATION OF CARE
 Developments in medical technology and training
 Developments in information technology
 Improve quality of care / patient outcomes
 Increase share in health services
INTEGRATION OF HEALTH SERVICES
Integrated care
Co-ordination of care delivery to a
patient with new general
professional roles within a care
organization (e.g. expansion of
services) and/or between care
organizations (e.g. primary and
secondary care)
Traditional care delivery with one
specialist within a care organization
responsible for the care delivery to
a patient, supported by general
nursing, technical and/or
administrative staff
Physician-centred care
Patient-centred care
Specialized, integrated
care pathway
Multiple specialists within a care
organization involved in care
delivery to a patient,
simultaneously and/or
consecutively, based on the
required expertise, supported by
specialized nursing, technical
and/or administrative staff
Expertise-centred care
SPECIALIZATION OF CARE
 Developments in medical technology and training
 Developments in information technology
 Improve quality of care / patient outcomes
 Increase share in health services
INTEGRATION OF HEALTH SERVICES
Integrated care
Patient-centred care
Co-ordination of care delivery to a
Specialized, integrated
care pathway
patient with new
general
professional roles within a
care organization (e.g. expansion of
services) and/or between care
organizations (e.g. primary and
secondary care)
SUBSTITUTION
Physician-centred care
NEW PROFESSIONS
& NEW ROLES
Traditional care delivery with one
specialist within a care organization
responsible for the care delivery to
a patient, supported by general
nursing, technical and/or
administrative staff
Multiple specialists within a care
organization involved in care
delivery to a patient,
simultaneously and/or
consecutively, based on the
required expertise, supported by
specialized nursing, technical
and/or administrative staff
Expertise-centred care
SPECIALIZATION OF CARE
 Developments in medical technology and training
 Developments in information technology
 Improve quality of care / patient outcomes
 Increase share in health services
INTEGRATION OF HEALTH SERVICES
Integrated care
Patient-centred care
Co-ordination of care delivery to a
patient with new general
professional roles within a care
organization (e.g. expansion of
services) and/or between care
organizations (e.g. primary and
secondary care)
Specialized, integrated
care pathway
SUBSTITUTION
Physician-centred care
NEW PROFESSIONS
& NEW ROLES
Traditional care delivery with one
specialist within a care organization
responsible for the care delivery to
a patient, supported by general
nursing, technical and/or
administrative staff
Multiple specialists within a care
organization involved in care
delivery to a patient, based on the
required expertise, supported by
specialized nursing, technical
and/or administrative staff
Expertise-centred care
SPECIALIZATION OF CARE
 Developments in medical technology and training
 Developments in information technology
Agenda
•
•
•
•
Introduction in to the study
Development of new professionals roles
Drivers and barriers to new professional roles
Conclusions about the impact
PA INVEST 2014, Amsterdam, October 30 November 1 2014
• New professional roles largely depend on
individual willingness of an established
professional.
–Need to work close together to be
recognized as knowledgeable and
competent;
–Do the dirty work;
–Go beyond qualifications to “get the
job done”
• New professional roles thrive within
organisations, when they:
–Increase efficiency;
–Contribute to documentation work;
–Offer patient centered care;
Agenda
•
•
•
•
Introduction in to the study
Development of new professionals roles
Drivers and barriers to new professional roles
Conclusions about the impact of new
professional roles
PA INVEST 2014, Amsterdam, October 30 November 1 2014
• The impact of new professional roles is
SMALL but SIGNIFICANT.
• Small:
– Few new professionals in new roles.
– Physicians set the rules.
– New professions are not well yet connected to
institutional agents
• Significant:
– New professions do work physicians and
nurses used to do (especially in out-patient
care).
– Health care organizations can and do create
new roles.
Implications
• Prevent competition between new
professional roles (Advanced Nurse
Practitioners, Emergency Physicians)
• Get connected: with PAs in other
organizations, networks of hospitals, etc.
• Be careful to develop local guidelines that
regulate qualifications; It is better to refer to
national guidelines.
PA INVEST 2014, Amsterdam, October 30 November 1 2014
PA INVEST 2014, Amsterdam, October 30 November 1 2014
• 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 .