The impact on practice, costs and outcomes of New Roles for health professionals in Europe (MUNROS) Antoinette de Bont Erasmus University Rotterdam European Junior Doctors, 17th January 2015, workshop task shifting

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.

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).

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) Patient-centred care Specialized, integrated care pathway 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 INTEGRATION OF HEALTH SERVICES  Improve quality of care / patient outcomes  Increase share in 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) Patient-centred care Specialized, integrated care pathway 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 INTEGRATION OF HEALTH SERVICES  Improve quality of care / patient outcomes  Increase share in health services SUBSTITUTION NEW PROFESSIONS & NEW ROLES

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) Patient-centred care Specialized, integrated care pathway 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, 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 INTEGRATION OF HEALTH SERVICES  Improve quality of care / patient outcomes  Increase share in health services SUBSTITUTION NEW PROFESSIONS & NEW ROLES INCREASING SKILL-MIX CHANGE

New professional roles thrive within organisations, when they: – Increase efficiency; – Contribute to documentation work; – Offer patient centered care;

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”

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.

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-F EC.