MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munros

Changing skill mix within teams delivering integrated

health servicesAntoinette 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 EuropeExisting 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• Dedicated policies to

encourage skill mix change;

• The emergence of new services in response to technical services;

• Educational programs

hamper• 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-F3-2012-305467EC .