the impact on practice, costs and outcomes of new roles for health professionals in europe (munros)...

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.


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).


Agenda• Introduction in to the study• Development of new professionals roles• Drivers and barriers to new professional roles• Conclusions about the impact


SPECIALIZATION OF CAREDevelopments in medical technology and training

Developments in information technology



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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



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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



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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)



Multiple specialists within a care organization involved in care

delivery to a patient, simultaneously and/or






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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










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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)












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SUBSTITUTION

NEW

PROFESSIO

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& 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)






delivery to a patient, based on the required expertise, supported by





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SUBSTITUTION

NEW

PROFESSIO

NS

& N

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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


• 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.


• 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 .