Reconfiguring health workforce: a case-based comparative study explaining the increasingly diverse professional roles in Europe.
Over the past decade the healthcare workforce has diversified in several directions with formalised roles for health care assistants, specialised roles for nurses and technicians, advanced roles for physician associates and nurse practitioners and new professions for new services, such as case managers. Hence the composition of health care teams has become increasingly diverse. The exact extent of this diversity is unknown across the different countries of Europe, as are the drivers of this change. The research questions guiding this study were: What extended professional roles are emerging on health care teams? How are extended professional roles created? What main drivers explain the observed differences, if any, in extended roles in and between countries?



We performed a case-based comparison of the extended roles in care pathways for breast cancer, heart disease and type 2 diabetes. We conducted 16 case studies in eight European countries, including in total 160 interviews with physicians, nurses and other health care professionals in new roles and 600+ hours of observation in health care clinics.



The results show a relatively diverse composition of roles in the three care pathways. We identified specialised roles for physicians, extended roles for nurses and technicians, and independent roles for advanced nurse practitioners and physician associates. The development of extended roles depends upon the willingness of physicians to delegate tasks, developments in medical technology and service (re)design. Academic training and setting a formal scope of practice for new roles have less impact upon the development of new roles. While specialised roles focus particularly on a well-specified technical or clinical domain, the generic roles concentrate on organising and integrating care and cure.



There are considerable differences in the number and kind of extended roles between both countries and care pathways. The main drivers for new roles reside in the technological development of medical treatment and the need for more generic competencies. Extended roles develop in two directions: 1) specialised roles and 2) generic roles.
Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands. debont@bmg.eur.nl.
Antoinette
0000-0002-0745-4537
A
de Bont
Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
Job
J
van Exel
Postgraduate School of Health Economics and management (ALTEMS), Universita Cattolica del Sacro Cuore School of Economics, Milan, Italy.
Silvia
S
Coretti
Faculty of Economics and Administrative Sciences, TOBB University of Economics and Technology, Ankara, Turkey.
Zeynep Güldem
ZG
Ökem
Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
Maarten
M
Janssen
Uni Research Rokkan Centre, Bergen, Norway.
Kristin Lofthus
KL
Hope
Faculty of Management, the University of Warsaw, Warsaw, Poland.
Tomasz
T
Ludwicki
Faculty of Economics and Management, Technische Universität Berlin, Berlin, Germany.
Britta
B
Zander
Third Faculty of Medicine, Charles University, Prague, Czech Republic.
Marie
M
Zvonickova
Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland.
Christine
C
Bond
Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, Netherlands.
Iris
I
Wallenburg
D001943:Breast Neoplasms / Q000628:therapy; D003695:Delivery of Health Care / Q000458:organization & administration; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D005060:Europe; D006282:Health Personnel; D006331:Heart Diseases / Q000628:therapy; D006801:Humans; D010348:Patient Care Team; D024382:Professional Role; D000078329:Workforce
Advanced roles; Comparative study; Europe; Extended roles; Health care teams; Health workforce; Skill mix