Skill-Mix and Policy Change in the Health Workforce: Nurses in Advanced Roles

James Buchan and Lynn Calman

No 17, OECD Health Working Papers from OECD Publishing

Abstract: An important potential contribution to the efficient use of the health workforce, is the possibility of ‘skill mix’ changes. ‘Skill mix’ is a relatively broad term which can refer to the mix of staff in the workforce or the demarcation of roles and activities among different categories of staff. Most of the policy attention on using skill-mix changes to improve health system performance has been on the mix between physicians and nurses. Skill-mix changes may involve a variety of developments including enhancement of skills among a particular group of staff, substitution1 between different groups, delegation up and down a unidiscipliniary ladder, and innovation in roles. Such changes may be driven by a variety of motives including service innovation, shortages of particular categories of worker (especially in inner cities or rural areas), quality improvement, and a desire to improve the cost- effectiveness of service delivery. There are large differences in reported physician/nurse ... Il existe un moyen susceptible de contribuer de manière importante à l’utilisation rationnelle des personnels de santé, à savoir la modification de « l’éventail des qualifications ». « L’éventail des qualifications » est un concept relativement vaste qui renvoie soit à l’éventail des personnels qualifiés, soit à la séparation des rôles et des activités réservés aux différentes catégories de personnel. Parmi les pistes envisagées dans l’utilisation des modifications de l’éventail des qualifications pour améliorer les performances des systèmes de santé, c’est la substitution du personnel infirmier aux médecins qui a le plus retenu l’attention. Les modifications de l’éventail des qualifications peuvent se traduire par des résultats divers, tels que le relèvement des qualifications au sein d’un groupe professionnel donné, une substitution2 entre différents groupes, une délégation des actes vers le haut et vers le haut au sein de la hiérarchie d’une même discipline ou des innovations au ...

Date: 2005-02-24
New Economics Papers: this item is included in nep-hea
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