Time: Mon 3 p.m.-4:15 p.m.
Room N28
Chair:
Robert Elliott (University of Aberdeen)
Organizer (1): Robert Elliott (University of Aberdeen)
Session Description (278 words)
Spending on workforce is the largest single item of health care expenditure in EU member states. The size and composition of the health workforce are key drivers of expenditure levels and the performance of health care systems. In several EU member states the workforce is being reconfigured with the introduction of new professions, such as Nurse Practitioners and Physician Assistants and extensions to the roles of established professions. This session will report the first results from a large collaborative research project into the role and contribution of the new professions and the changing role and contribution of the established professions. The collaboration is across nine European countries and is funded by the EC.
The three presentations will focus on different aspects of the research. They will all feature data gathered from the nine countries in the collaboration: the Czech Republic, England, Germany, Italy, the Netherlands, Norway, Poland, Scotland and Turkey.
The presentation by Gibson, Birch and Sutton will report the results of two surveys, of health professionals and their mangers. It will report the tasks undertaken by new and established health professions and how this changing skill mix differs between countries. It will identify the role of economic and institutional factors in accounting for inter-country differences. The presentation by Ruggeri and Coretti will report patient’s responses to the changing workforce skill mix and the impact of these changes on patient’s satisfaction and health outcomes. The third presentation by Askildson and Islam will use routine and register data from the nine countries to assess the impact on clinical processes and clinical outcomes. It will evaluate whether the changes observed have impact on the productivity of the secondary care sector.
Key Terms: health workforce, new health professions, changing roles for health professionals,
Session Disclosure:
This research is funded under EC FP7
- The Impact of the New Professional Roles on Clinical Practice and the Organisation of Care: Emerging Results.
Presenter: Jon Gibson (The University of Manchester. Manchester Centre for Health Economics)
Abstract (272 words)
Expenditure on health care is the largest single item of public spending in each EU country and, within that, workforce expenditure forms the largest individual constituent. Innovation in workforce management and development is therefore a vital component of advances in both patient care and cost efficiency. In a number of countries new professional roles and enhanced roles for existing professions have been created to improve health care integration and skill mix. The driving factors behind new role creation and the impact of new roles on outcomes such as job satisfaction, however, have not been thoroughly examined.
We present the preliminary results from two surveys conducted in 12 hospital sites in each of 9 European countries; one survey targeting health care professionals and the other targeting health care managers, as part of the wider MUNROS project. Three care pathways are examined by each survey: breast cancer, acute myocardial infarction and type II diabetes.
The aims of the study include examining new professional roles, their continuity and any potential changes in the roles of established professions; the integration and fragmentation of the care path, as well as the perceptions of barriers and facilitators for skill mix change.
Across both health managers and professionals we enquire about changes to staff skill mix and the degree of care integration within the pathway that they work. We further query health professionals about the opportunities to undertake new health roles and their overall satisfaction with their professional role. For managers we investigate the decision making process and key factors that influence staffing choices. We present the emerging results from the surveys for each country and offer preliminary comparisons.
Biographical Details:
Gibson, J., Birch, S*, and Sutton, M..
All Manchester Centre for Health Economics, The University of Manchester, Manchester, England (UK). and
*Department of Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Ontario, (Canada)
Key Terms: Health workforce, professional roles, staff satisfaction, integration of care, skill mix
Authors (3): Jon Gibson (University of Manchester. Manchester Centre for Health Economics) , Matt Sutton (University of Manchester. Manchester Centre for Health Economics) and Steve Birch (McMaster University. Department of Clinical Epidemiology & Biostatistics)
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Funding Sources:
Project funded within the program FP7-HEALTH.2012.3.2-1: Improving the organisation of health service delivery
- The impact of new health professionals on patients’ satisfaction and health outcomes: evidence from the MUNROS European Project.
Presenter: Silvia Coretti (Universitàcattolica del SacroCuore . Post-graduate school of health economics and management)
Abstract (427 words)
Background.
Spending on workforce is the largest item of health care expenditure in European Countries. However, the size and composition of the health care workforce strongly affect not only the expenditure levels but the performance of health care systems in terms of access to and quality and acceptability of care. In recent years many European countries have undertaken healthcare reforms establishing new professional roles, enhancing task substitution or extending traditional roles, with the ultimate purpose of both improving the quality of care and controling health care costs. The quality of care that patients receive and their satisfaction with this care is determined both by the quality of the workforce in terms of skills, experience and motivation and the integration of healthcare facilities.
Aim.
The aim of this study is to investigate to what extent the changes that occurred in the workforce composition in recent years affect patients’ satisfaction and health outcomes, within clinical pathways for the management of three conditions, namely heart disease, diabetes and breast cancer.
Methods.
Data will be collected within Work Package 6 of MUNROS European Project (Health Care Reform: the iMpact on practice, oUtcomes and costs of New roles for health pROfeSsionals). The MUNROS consortium comprises nine Universities located in the following countries: Scotland, Germany, Netherlands, Italy, Poland, Czech Republic, Turkey, Norway, England.
A structured questionnaire will be administered to patients being treted along the three clinical pathways in both primary and secondary care settings. Data will be gathered from12 hospital along with their associated primary care centers in each country, six of these hospitals will employ new professional (case group) and six will employ only traditional roles (control Group). Approximately 30 patients for each center recruited will be enrolled. The questionnaire for patients’ data collection is made up of five sections investigating the patient’s: i) health state; ii) care received iii) experience of care received; iv) use of healthcare services; v) and some general questions. A data entry and analysis protocol common for the nine partners has been built. Aggregate data will be analyzed through descriptive statistics, measures of association and regression analysis.
Reported results
The following will be reported: patient’s satisfaction with waiting times, time spent with health professionals, the perceived quality and continuity of care, and counselling and support received.The relationship betweeen the above and the presence of new professional roles will be reported. The relationship between the patient’s health state and contact with new professionals will also be explored and reported as will the realationship between the severity of the patients conditions and the range of health professionals seen.
Biographical Details:
M Ruggeri, Post-graduate School of Health Economics and Management (ALTEMS), UniversitàCattolica del SacroCuore, Roma (Italy) and Istituto di PoliticaEconomica, UniversitàCattolica del SacroCuore, Milano (Italy)
S Coretti, Istituto di PoliticaEconomica, UniversitàCattolica del SacroCuore, Milano (Italy)
Key Terms: Health workforce, professional roles, patient satisfaction, integration of care
Authors (2): Silvia Coretti (Universitàcattolica del SacroCuore . Post-graduate school of health economics and management) and Matteo Ruggeri (Universitàcattolica del SacroCuore . Post-graduate school of health economics and management)
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Funding Sources:
Project funded within the program FP7-HEALTH.2012.3.2-1: Improving the organisation of health service delivery
- New Professional Roles and Hospital Processes, Productivity and Health Outcomes in European countries
Presenter: Jan Erik Askildson (University of Bergen. Uni Research RokkanCentre )
Abstract (489 words)
European countries are changing skill mix within teams delivering health services: extending the roles of existing health professions and introducing new ones. Examples are nurses and pharmacists can now prescribe medicines, and new professions like Advanced Practicing Nurses (APN) and Physician Assistants (PA) have been created to take on new roles and roles previously delivered by doctors. The MUNROS project undertakes a systematic evaluation of the impact of these ‘new professional roles’ on practice, outcomes and costs in a range of different health care settings. Using policy documents and routine statistical data we have divided the nine participating countries, representing health systems in Europe, into three categories: countries with new professions - Netherlands, England and Scotland; countries with extended roles and new technical roles - Germany, Italy, the Czech Republic and Turkey, countries with very few new professional roles, Norway and Poland.
This presentation applies to Work Package 7 of the MUNROS project that aims to collect routine and register data on hospital processes, productivity and health outcomes, as well as to extract data from individual patient records from 8 participating countries (except Poland). The objectives of this WP include: (i) to assess the impact of the new professional roles (new roles mean undertaking roles that have traditionally been carried out by another profession as a formal part of his/her job) on processes and clinical outcomes, (ii) to study how the new roles have changed the clinical outcomes (CO) and processes outcomes (PO) and (iii) to evaluate whether this change has an impact on the productivity in secondary care settings.
Using cross-country hospital-level routine data, we first study, whether variations in the health outcomes across hospitals (within and between countries) depend on the hospitals where the new professional roles, e.g., advanced practicing nurses (APNs) have been employed (i.e. a treatment group) in delivering care along the same pathways, and compared to hospitals where they are not (a control group). Hospital-level data on AMI/heart attack and Breast Cancer ‘mortality within 30 days’ will be used as an outcome variable. As a process indicator we also use hospital inpatient length of stay (LOS) for AMI/heart attack and Breast Cancer patients. Besides, more detailed analyses will be performed by using multi-level regression approach for the countries where high level individual patient-level register data at are available. Register data analyses in this presentation will be based on high quality data from the Norwegian Patient Register.
Existing research into the contribution of specialist nurses (SNs) and advanced nurse practitioners (ANPs), shows that 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. We expect that the new professional roles would have different impact on hospital processes, productivity and health outcomes in our participating countries, depending on aforesaid three health systems categories.
Biographical Details:
Jan Erik Askildsen & M. Kamrul Islam,
Uni Research Rokkan Centre & University of Bergen, Bergen, Norway
Key Terms: health workforce, new health profession roles, routine and register hospital data, health workforce productivity, health outcomes
Authors (2): Jan Erik Askildson (University of Bergen. Uni Research RokkanCentre ) and Kamrul Islam (University of Bergen. Uni Research RokkanCentre )
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Funding Sources:
Project funded within the program FP7-HEALTH.2012.3.2-1: Improving the organisation of health service delivery