Contested professional role boundaries in health care: a systematic review of the literature

Abstract

BackgroundAcross the Western world, demographic changes have led to healthcare policy trends in the direction of role flexibility, challenging established role boundaries and professional hierarchies. Population ageing is known to be associated with a rise in prevalence of chronic illnesses which, coupled with a reducing workforce, now places much greater demands on healthcare provision. Role flexibility within the health professions has been identified as one of the key innovative practice developments which may mitigate the effects of these demographic changes and help to ensure a sustainable health provision into the future. However, it is clear that policy drives to encourage and enable greater role flexibility among the health professions may also lead to professional resistance and inter-professional role boundary disputes. In the foot and ankle arena, this has been evident in areas such as podiatric surgery, podiatrist prescribing and extended practice in diabetes care, but it is far from unique to podiatry.MethodsA systematic review of the literature identifying examples of disputed role boundaries in health professions was undertaken, utilising the STARLITE framework and adopting a focus on the specific characteristics and outcomes of boundary disputes. Synthesis of the data was undertaken via template analysis, employing a thematic organisation and structure.ResultsThe review highlights the range of role boundary disputes across the health professions, and a commonality of events preceding each dispute. It was notable that relatively few disputes were resolved through recourse to legal or regulatory mandates.ConclusionsWhilst there are a number of different strategies underpinning boundary disputes, some common characteristics can be identified and related to existing theory. Importantly, horizontal substitution invokes more overt role boundary disputes than other forms, with less resolution, and with clear implications for professions working within the foot and ankle arena.

Nurses’, physicians’ and radiographers’ perceptions of the safety of a nurse prescribing of ionising radiation initiative: A cross-sectional survey

“…This fluidity has, as happened in the case of the nurse prescribing of ionising radiation initiative that we report here, been enabled by government policies and initiatives that facilitate a redefinition of roles and responsibilities of those in allied health professions (King et al 2015) to enhance patient care and reduce the public cost of healthcare (Fairman et al 2011, Department of Health 2011. The re-definition of occupational boundaries has involved the allied health occupations taking on roles formerly undertaken by physicians.…”

“…Along with challenges to medicine's authority over the past few decades there has been an increasing fluidity in the healthcare division of labour in many Western countries prompting analyses of role boundaries in healthcare (King et al 2015). This fluidity has, as happened in the case of the nurse prescribing of ionising radiation initiative that we report here, been enabled by government policies and initiatives that facilitate a redefinition of roles and responsibilities of those in allied health professions (King et al 2015) to enhance patient care and reduce the public cost of healthcare (Fairman et al 2011, Department of Health 2011.…”

Interrater reliability of Algo used by non-occupational therapist members of homecare interdisciplinary teams

“…According to literature, role flexibility in the interdisciplinary team is a potential avenue to meet the challenges of this increasing population's needs. [31] An initiative such as Algo, allowing non-OTs to work in collaboration with OTs in straightforward situations, is an interesting option to allow recommendations of clinically equivalent adaptations to elders experiencing bathing difficulties in their homes. Algo could be used, for example, in situations where homecare rehabilitation human resources are scarce, a problem encountered in many countries.…”

Radiation Therapists' Perceptions of Advanced Practice in Alberta

“…Health care services across the world are challenged with providing timely and effective services to an aging population, due to an increase in chronic and complex health care conditions, rapidly emerging technologies, increasing population and economic inflation [1][2][3][4]. Advanced practice (AP) has successfully been integrated amongst health care professionals to address this increased demand.…”