1. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros MUNROS is funded by the European Commission FP7 programme, HEALTH-F3-2012-305467EC. Project co-ordinators Prof Bob Elliott, r.elliott@abdn.ac.uk and Prof Christine Bond, c.m.bond@abdn.ac.ukr.elliott@abdn.ac.ukc.m.bond@abdn.ac.uk www.abdn.ac.uk/munros The Impact of New Professional Roles on Clinical Practice and the Organisation of Care: Emerging results from Managers and Professionals in Scotland Jonathan Gibson, Stephen Birch and Matt Sutton iHea Congress, Milan, 2015

2. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Background Spending on workforce is the largest single item of health care expenditure in EU member states. Size and composition of the health care workforce are key drivers of expenditures and performance. Changes workforce in many European countries in response to measures to contain health care expenditures and increasing demands for health care. Working patterns changing due to social pressures, gender equality (e.g. for child care) feminisation of the workforce and working time legislation. innovative developments in health workforce skills. New health professions have been introduced and enhanced roles for established professions have been developed. These new professional roles have potential to contribute to increased efficiency in service delivery.

3. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Aims of Research Investigate the impact of new professional roles on clinical practice and the organisation of care.

4. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Aims of Research Investigate the impact of new professional roles on clinical practice and the organisation of care. The analysis will aim to systematically compare the differences in: The new professional roles, their continuity and the changes in roles of established professions, including those of physicians; The integration and fragmentation of the care path Perceptions of barriers to and facilitators and incentives for skill mix

5. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Methods Analysis of data from 2 surveys. Questionnaires distributed to healthcare managers and professionals in three care pathways: AMI, Breast Cancer and Type 2 Diabetes. 12 Hospitals and 60 GP Primary Care Sites across 9 countries: – Scotland – England – Italy – Netherlands – Norway – Germany – Poland – Czech Republic – Turkey Current presentation based on preliminary results from professionals and managers working in the Heart Disease pathway in Scotland.

6. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Methods Results from: – Aberdeen Royal Infirmary – Raigmore Hospital – Monklands Hospital – Haimyres Hospital – Ninewells Hospital and Medical School

7. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros 1) The new professional roles, their continuity and the changes in roles of established professions, including those of physicians

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

9. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros 2) The integration and fragmentation of the care path

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

11. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros DomainStatementProfessionals (n=29) Manager (n=3) Leadership Managers articulate clearly the goals and objectives; staff understand their role in furthering those objectives and work together toward them. 2.893.67 Staff cooperation across organisations Staff members cooperate across organisations: “I know whom to call when I need assistance. Others are willing to help. We share the same goals and standards.” 3.342.67 Staff cooperation within the organisation Staff members cooperate within the organisation: “I know whom to call when I need assistance. Others are willing to help. We share the same goals and standards.” 3.761.73 Care coordination across organisations Patient care is well managed between professionals across organisations; reliable, timely patient data are provided across organisations. 3.033.33 Care coordination within the organisation Patient care is well managed between professionals within the organisation; reliable, timely patient data are provided within the organisation. 3.343.33 Service cooperation between organisations Staff share problem solving, benchmark their performance, and coordinate administrative and support efforts between organisations. 2.933 Service cooperation within the organisation Staff share problem solving, benchmark their performance, and coordinate administrative and support efforts within the organisation. 3.173 Common goals Local priorities and needs are integrated with higher level goals. 3.073.33

12. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Specialisation, Integration and Fragmentation Sequential Tasks Consultant or specialist Junior/ResidentGeneral Practitioner Physician Associates / Assistant Advanced / Independent Nurse A x x B x x C xx x x D x xx E x x F x x G x

13. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Specialisation, Integration and Fragmentation Sequential Tasks Consultant or specialist Junior/ResidentGeneral Practitioner Physician Associates / Assistant Advanced / Independent Nurse A x x B x x C xx x x D x xx E x x F x x G x

14. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Specialisation, Integration and Fragmentation Sequential Tasks Consultant or specialist Junior/ResidentGeneral Practitioner Physician Associates / Assistant Advanced / Independent Nurse A x x B x x C xx x x D x xx E x x F x x G x

15. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Specialisation, Integration and Fragmentation Sequential Tasks Consultant or specialist Junior/ResidentGeneral Practitioner Physician Associates / Assistant Advanced / Independent Nurse A x x B x x C xx x x D x xx E x x F x x G x

16. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros 3) Perceptions of barriers to and facilitators and incentives for skill mix changes

17. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros External factors driving staff mix changes Workforce policies such as European Working Time Directive Payment systems for health care professionals Shifting influences within health care professional groups whereby e.g. nurses have gained more influence Redesign of health services New technology for managing diseases New legal rights for professionals Need for audit trail

18. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros External factors driving staff mix changes Professionals top 3: 1.New technology for managing diseases 2.Shifting influences within health care professional groups whereby e.g. nurses have gained more influence 3.Redesign of health services Managers top 3: 1.Staff pay levels 2.New legal rights for professionals 3.New technology for managing diseases

19. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros External factors driving staff mix changes Professionals bottom 3: 1.Payment systems for health care professionals 2.New legal rights for professionals 3.Need for audit trail Managers bottom 3: 1.Shifting influences within health care professional groups whereby e.g. nurses have gained more influence 2.Redesign of health services 3.Workforce policies such as European Working time directives.

20. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Health Care Managers – Staff allocation influential factors Factors: Budgetary/cost consideration Cost effectiveness Experience of staff Patient preferences Professional influence/opinions Regulations Skills and competences Workforce availability

21. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Health Care Managers – Facilitators and barriers to change Factors: Information technology Management support Medical technology Professional support Qualification requirements Regulation and legislation Staff satisfaction Staff pay level

22. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros New Professional Roles? Opportunities for new role? Like new role? NoYesTotal No 8311 Yes 41115 Total 121426

23. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Concluding thoughts and going forward Notable differences between the health care professionals and health care managers. Opposing views on external factors and integration measures. Data collection now underway across the countries. Final data set will allow analysis between care pathways (within hospitals), within countries (between hospitals) and between countries.