Background • Demand on health services is increasing

– population demography – new treatments – Increased expectations

• All public finances are under pressure • Expenditure on health is largest single item of public

spend – workforce costs largest component

• Can changes in workforce provide a solution? • New professions and professional roles emerging • Are these efficient and effective? • What is the optimal model and how to achieve this?

Project Aims • Identify most important of new professional roles

• Detail nature and scope of new roles

• Identify impact on clinical practice and outcomes

• Conduct economic evaluation to establish cost effectiveness of new roles

• Identify scope of new roles to improve integration of care and optimal models for delivery of health care

• Explore consequences for management of human resources and workforce planning

• Research conducted in a range of different health care settings within European Union and Associate Countries.

Aberdeen Team The Aberdeen Team comprises:

• Project co-ordinators: Bob Elliott (HERU) and Christine Bond (Head of Centre of Academic Primary Care, University of Aberdeen)

• Professor Steven Heys, Head, Division of Applied Medicine, Co-Director of the IMS, Professor of Surgical Oncology.

• Mr Simon Shemilt, NHS Grampian, Aberdeen. Lead role in NHS Grampian medical workforce planning and re-design

• Professor Ioannis Theodossiou, University of Aberdeen Business school; Professor, Department of Economics

• Supported by Shona Christie and Alison Horne (HERU), the Project Co-ordinating Centre

Our Partners

Project Phases Lead Partner and Support Partner 1. Mapping health system

integration, skill mix and competencies

WP 1: Scotland and Turkey

WP 2: Netherlands and Norway

2. Methodology and Study Design

WP 3: Netherlands and Scotland

WP 4: Scotland and Netherlands

3. Data Collection, Data Management and Analysis

WP 5: England and Germany

WP 6: Italy and Poland

WP 7: Norway and Czech Republic

WP 8: Netherlands and Norway

4. Translation into Policy: Delivering Impact

WP 9: Germany and Scotland

WP 10: England and Italy

WP 11: Scotland 5. Scientific Coordination

WP 12: Scotland

Structure of Research

Phase 1: Mapping Health System Integration, Skill Mix

and Competencies: WP 1 and 2

• Purpose:

Describe key features of the health delivery systems across Europe

Provide a context for the subsequent analysis

Identify the potential for generalising the results of this project to the countries of the EU

• Methods:

Collect Routinely available data

Collect new data

Review of literature and policy documents

• Conducted at European level (countries of the EU, associate and applicant countries)

Phase 1: Mapping cont’d

• Key features of health delivery systems

Characteristics ( nationalised/private, financing

mechanisms, incentives and barriers, per capita health

spend, employment share across health and social

services)

Workforce (demography e.g. gender, age, nationalities,

relative pay, HCP identities, density, and HCP ratios)

Infrastructure (how care is delivered, by whom, what

sectors, health outcomes, integration of care)

Phase 1 Cont’d

• Partners to

Describe skill mix of the health workforce in the primary

and secondary care sectors

Identify the new professional roles, the numbers working

in them and the clinical areas of employment

Identify the contribution of the new professional roles to

the delivery of health care

Describe regulation, qualifications, competencies

Phase 1 Cont’d

• Identify and evaluate a framework for mapping the skills and competencies of the health workforce

• Collect secondary data required for the economic evaluation in WP8

• Review Project Membership in light of the evidence gathered

• Produce reports:

Health Care Delivery Systems in Europe

New Professional Roles and Health Workforce Skill mix in Europe

Cost and Effects of Health Service Redesign in Europe

Phase 2. Methodology and Study Design

WP 3: Case studies • Purpose: to inform WP4 questionnaire design • Select from among the clinical areas identified in WP2 two

specific care pathways as the focus of the research to be undertaken in this project

• Conduct case studies in two sites per partner country Interviews, focus groups, documentary analysis

Phase 2 Cont’d

WP 4: Questionnaire design • Develop the empirical framework for the project by: Developing the questionnaires and accompanying

documentation Agreeing sampling frames for WP5,6,7 12 hospital sites and associated 1o care

Finalising the detailed study protocol to be submitted to either national or local ethical committees (as appropriate) for approval.

Phase 3. Data Collection, Data Management , Analysis

WP 5: Understanding impact on clinical practice and organisation of care

• Questionnaire survey of health care professionals and managers

organisation of care, professionals involved, skills and competencies deployed, risk management approaches, perceptions of barriers and facilitators

• Extract and process the data, build databases, analyse data

• Produce report: ‘The impact of the new professional roles on clinical practice and the organisation of care’.

Phase 3 Cont’d

WP 6: Understanding outcomes Part 1: the patient experience

• Questionnaire survey of patients

experience, and satisfaction, perceived outcomes, preferences

• Extract and process the data, build databases, analyse data

• Produce report: 'The impact of the new professional roles on patient experience and satisfaction'.

Phase 3 Cont’d

WP 7: Understanding outcomes part 2: process and productivity indicators and clinical effect

• Collect and analyse new data on hospital processes, productivity and health outcomes which can be used to assess the impact of the new professional roles

• Standard clinical measures, mortality, morbidity, patient safety data (AEs, HAIs)

• Process measures eg consultation data, LOS, number of visits, locations of encounters

• Produce a report: Impact of the New Professional Roles on clinical and Process Outcomes and Productivity

Phase 3 cont’d

WP 8: Understanding changes in costs and benefits • Undertake an economic evaluation to model the costs

and effects associated with the new professional roles.

• Distinguish whether employing the new professional roles has or might result in cost containment

• Investigate the balance of cost and benefits and to identify incentives for an increased role for the new professional roles.

• Analyses by country and by condition

• Establish the efficiency of the new professional roles

Phase 4. Translation into Policy: Delivering Impact WP 9: New professional roles and the integration of care

• Synthesise the results of the previous analysis

• Detail how the new professional roles might be employed to improve the integration of care within care pathways.

• Describe new optimal models of care for the selected care pathways

• Identify solutions to barriers identified at organisational and team level informed by examples of good practice

• Produce examples of care integration and of the costs associated with financing these pathways

Phase 4 Cont’d

WP 10: Management of human resources and successful workforce planning

• Build a workforce planning model for each care pathway

• Provide a skill mix benchmark for previously identified optimal

models of care

• Specify information requirements of the models for improved workforce planning

• Output will be an accessible work planning tool

• Final Report: Health Care Reform: the Impact on Practice, Outcomes and Costs of New Roles for Health Professionals

Overview WP1 High level European data

WP2 Detailed country data

WP3 case studies

WP 4 Planning

WP5,6,7 Questionnaires and outcomes

WP8 Economic modelling

WP9 Integration of care

WP10 Planning

tool

Delivering impact

Data collection

Design

Mapping

Timetable of Activity

Spread of expertise

Health Economics

Public Health

Medicine

Pharmacy

Nursing

Health Services Research

Business

Health Care Management

Workforce

Statistics

Partners

Germany, Technische Universitat Berlin

The Netherlands, Erasmus University Rotterdam

Italy, Universita Cattolica Del Sacro Cuore

Poland, Uniwersytet Warszawski

Czech Republic, Univerzita Karlova V Praze

Partners Cont’d

Economic Policy Research Foundation of Turkey

Norway, Uni Research, Bergen, Norway

England, University of Manchester

Progress to Date

• Established Expert Advisory Board

• Established Project web-site

• Drafted Template for Engagement and Dissemination

• Established Project Management Team, now meeting monthly

• Project Coordinating Centre established and supporting Co-ordinator/s

• Phases 1 and 2 underway

Impact to be achieved by

• Establishing a high level Expert Advisory Board. Will facilitate and advise on high level engagement with key European stakeholders and International Organisations including the EC.

• Establishing Country Expert Advisory Groups (CEAGs)

• Engaging key stakeholders in each partner through series of Practitioner and Policy Workshops and Country Stakeholder Workshops

• Disseminating key results of the research through International Conferences and presenting at the leading scientific conferences

Expert Advisory Board (EAB)

• Mr Mark Cormack, Chief Executive Officer, Health Workforce Australia

• Mark Pearson, Head of the Health Division, Directorate of Employment, Labour and Social Affairs, Organisation for Economic Co-operation and Development

• David Benton, Chief Executive Officer, International Council of Nurses,

• Katja Neubauer, Deputy Head of Unit, EC Directorate-General for Health and Consumers Healthcare Systems Unit

Acknowledgements

• We thank:- – 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 .

– All those who supported and guided this work both within the MUNROS research project team and as external associates. In particular we would like to thank [...]

– Research participants including... [...] – All the MUNROS research and project partners for their

continuing collaboration in this research: [...]