1. Aim: Describe how new health care professionals are deployed
iMpact on practice oUt comes and costs of New ROleS for health professionals
Professor Christine Bond, University of Aberdeen
on behalf of MUNROS team
Aim: Describe how new health care professionals are deployed
Explore effect of skill mix on costs and outcomes
Make recommendations for workforce planning

2. Project overview high prevalence significant morbidity and mortality
national guidelines
acute, chronic and surgical condition
Mapping health system integration, skill mix and competencies
Understanding health systems
Mapping skill mix
Methodology and Study Design
Case studies
Questionnaire design
Data Collection, Management and Analysis
Impact on clinical practice and organisation of care
Outcomes: the Patient Experience
Outcomes: Process, Productivity and Clinical Effect
Changes in Costs and Benefits
Translation into Policy: Delivering Impact
New Professional Roles and the Integration of Care
Management of Human Resources and Successful Workforce Planning
Scientific Structure, Policy Engagement, Impact and Dissemination
Heart disease
(STEMI)
Breast cancer
Type2 diabetes

3. Project overview high prevalence significant morbidity and mortality
national guidelines
acute, chronic and surgical condition
SURVEYS and ROUTINE DATA
-12 hospitals (teaching; large general; other general; city/urban/small town/rural)
-Associated general practices
-Health care professionals/-Health care managers: Demographics, Educational qualifications, Hours worked, Perceptions of integration and specialisation, Drivers and barriers, Factors influencing decisions, What they do!
-Patients: Demographics, health care utilisation, experiences, satisfaction, perceptions
Mapping health system integration, skill mix and competencies
Understanding health systems
Mapping skill mix
Methodology and Study Design
Case studies
Questionnaire design
Data Collection, Management and Analysis
Impact on clinical practice and organisation of care
Outcomes: the Patient Experience
Outcomes: Process, Productivity and Clinical Effect
Changes in Costs and Benefits
Translation into Policy: Delivering Impact
New Professional Roles and the Integration of Care
Management of Human Resources and Successful Workforce Planning
Scientific Structure, Policy Engagement, Impact and Dissemination
Heart disease
(STEMI)
Breast cancer
Type2 diabetes

4. Task list: breast cancer example
Stage
Area of activity
Task
Diagnosis
Imaging ultrasound
Imaging mammogram
Do mammogram
Radiological interpretation
Clinical interpretation
Admin. Work eg result reporting
Imaging MRI
Biopsy
Assessment
Inform patient
Carrying out surgery/managing therapy
Surgery
Chemotherapy
Radiation therapy
Endocrine
Biological
Follow up/managing complications
Palliative care

5. Early findings Care pathways and team composition are changing
External drivers are mostly professional influences and need for service redesign
Professionals also highlighted new legal rights
Managers make team composition decisions on staff skills and competences, staff experience and regulation
Budgets and perceptions of patient preferences least important
Patients are satisfied
Experience of care suggests it is not ‘patient centred’
Care feels integrated but doctor is often still seen as ‘main’ provider
Next steps
Inter and intra country comparison
Cost effectiveness and clinical effectiveness
Recommendations for optimal team
Workforce planning tool

6. Issues for research Engaging clinical colleagues
Differences in health systems, definitions, terminology across European countries
Distinguishing exact contribution to health care delivery to quantify substitution
Dynamic workforce context
Generalisability beyond three conditions

7. Acknowledgements We thank
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 .
All those who supported and guided this work both within the MUNROS research project team and as external associates.
All the MUNROS research and project partners for their continuing collaboration in this research.