the impact on practice, costs and outcomes of new roles for health professionals in europe (munros)...
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The impact on practice, costs and outcomes of New Roles for health
professionals in Europe (MUNROS)
Antoinette de Bont/ associate professor/ Erasmus University
Rotterdam
Agenda• Introduction to the study• Development of new professionals roles• Drivers and barriers to new professional roles• Conclusions about the impact
PA INVEST 2014, Amsterdam, October 30 - November 1 2014
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.
PA INVEST 2014, Amsterdam, October 30 - November 1 2014
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).
PA INVEST 2014, Amsterdam, October 30 - November 1 2014
Agenda• Introduction in to the study• Development of new professionals roles• Drivers and barriers to new professional roles• Conclusions about the impact
PA INVEST 2014, Amsterdam, October 30 - November 1 2014
SPECIALIZATION OF CAREDevelopments in medical technology and training
Developments in information technology
SPECIALIZATION OF CAREDevelopments in medical technology and training
Developments in information technology
INTE
GRA
TIO
N O
F H
EALT
H S
ERVI
CES
Im
prov
e qu
ality
of c
are
/ p
atien
t out
com
es I
ncre
ase
shar
e in
hea
lth s
ervi
ces
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
SPECIALIZATION OF CAREDevelopments in medical technology and training
Developments in information technology
INTE
GRA
TIO
N O
F H
EALT
H S
ERVI
CES
Im
prov
e qu
ality
of c
are
/ p
atien
t out
com
es I
ncre
ase
shar
e in
hea
lth s
ervi
ces
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 CAREDevelopments in medical technology and training
Developments in information technology
INTE
GRA
TIO
N O
F H
EALT
H S
ERVI
CES
Im
prov
e qu
ality
of c
are
/ p
atien
t out
com
es I
ncre
ase
shar
e in
hea
lth s
ervi
ces
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)
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 CAREDevelopments in medical technology and training
Developments in information technology
INTE
GRA
TIO
N O
F H
EALT
H S
ERVI
CES
Im
prov
e qu
ality
of c
are
/ p
atien
t out
com
es I
ncre
ase
shar
e in
hea
lth s
ervi
ces
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 CAREDevelopments in medical technology and training
Developments in information technology
INTE
GRA
TIO
N O
F H
EALT
H S
ERVI
CES
Im
prov
e qu
ality
of c
are
/ p
atien
t out
com
es I
ncre
ase
shar
e in
hea
lth s
ervi
ces
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 CAREDevelopments in medical technology and training
Developments in information technology
INTE
GRA
TIO
N O
F H
EALT
H S
ERVI
CES
Im
prov
e qu
ality
of c
are
/ p
atien
t out
com
es I
ncre
ase
shar
e in
hea
lth s
ervi
ces
SUBSTITUTION
NEW
PROFESSIO
NS
& N
EW RO
LES
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 CAREDevelopments in medical technology and training
Developments in information technology
INTE
GRA
TIO
N O
F H
EALT
H S
ERVI
CES
Im
prov
e qu
ality
of c
are
/ p
atien
t out
com
es I
ncre
ase
shar
e in
hea
lth s
ervi
ces
SUBSTITUTION
NEW
PROFESSIO
NS
& N
EW RO
LES
INCREASIN
G SKILL
-MIX CHANGE
Agenda• Introduction in to the study• Development of new professionals roles• Drivers and barriers to new professional
roles• Conclusions about the impact
PA INVEST 2014, Amsterdam, October 30 - November 1 2014
• 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”
• New professional roles thrive within organisations, when they:–Increase efficiency;–Contribute to documentation work;–Offer patient centered care;
Agenda• Introduction in to the study• Development of new professionals roles• Drivers and barriers to new professional roles• Conclusions about the impact of new
professional rolesPA INVEST 2014, Amsterdam, October 30 -
November 1 2014
• 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.
Implications
• Prevent competition between new professional roles (Advanced Nurse Practitioners, Emergency Physicians)
• Get connected: with PAs in other organizations, networks of hospitals, etc.
• Be careful to develop local guidelines that regulate qualifications; It is better to refer to national guidelines.
PA INVEST 2014, Amsterdam, October 30 - November 1 2014
PA INVEST 2014, Amsterdam, October 30 - November 1 2014
• 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 .
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