The best person (or machine) for the job: Rethinking task shifting in healthcare

Schalkwyk, May C I van; Bourek, Aleš; Kringos, Dionne; Siciliani, Luigi; Barry, Margaret M.; Maeseneer, Jan De; McKee, Martin

doi:10.1016/j.healthpol.2020.08.008

Cited by 58 publications

(54 citation statements)

References 97 publications

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“…Rearranging the allocation of tasks and skills and improving cooperation between healthcare workers and within the medical professions are key areas of innovation in the health workforce [ 8 , 23 , 29 , 35 ]. In rheumatology, the debate is most advanced in the USA and Anglo-Saxon health systems.…”

Section: Introductionmentioning

confidence: 99%

“…Opportunities for cooperation were confirmed by a cross-sectional study which explored cooperation between general practitioners and several other healthcare providers in two German federal states in 2017 [ 36 , 37 ]. Implementation may be challenging, as GPs perceived cooperation with rheumatologists as important, but inadequate and in need of improvement [ 35 ].…”

Section: Introductionmentioning

confidence: 99%

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Work situation of rheumatologists and residents in times of COVID-19

et al. 2021

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Background and objective The work situation is an important dimension of professional life and wellbeing, and a policy lever to strengthen recruitment and retention. This study aims to explore the work situation of physicians and residents in internal medical rheumatology, considering the impact of the coronavirus pandemic COVID-19. Methods A questionnaire-based online survey was conducted in early 2021 at the Hannover Medical School, supported by the German Society of Rheumatology. Target groups were all rheumatology physicians and residents in Germany. The main areas of investigation included work hours, task delegation, and collaboration; workload and mental health issues; discrimination and sexual harassment experiences; and the impact of COVID-19. Descriptive statistical analysis was performed for the standardized items and qualitative content analysis for the free-text information. Results The respondents (n = 101) expressed positive attitudes towards cooperation and task delegation to medical assistants, especially those specialized in rheumatology, while attitudes towards cooperation with GPs pointed to blockades. There was a strong mismatch between actual and desired work hours both in the group of women and in the group of men. 81% rated their workload as high or very high; every sixth rheumatologist has suffered from stress or burnout syndromes at least once in the past. Experiences of gender discrimination and sexual harassment/violence were frequently reported, mostly by women. COVID-19 was an amplifier of stress, with major stressors being digitalization and increased demand for communication and patient education. Conclusion There is an urgent need to improve the work situation of rheumatologists and reduce stress and mental health risks.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Work situation of rheumatologists and residents in times of COVID-19

et al. 2021

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“…Bisher spielen hoch spezialisierte kleine Fachgebiete wie die Rheumatologie auch international kaum eine Rolle in den Debatten um Fachkräftesicherung und verbessertes Management der Personalressourcen; das gilt für die Politik wie für die Forschung [ 23 , 30 ]. Diese Fachgebiete sind aber von einem steigenden Fachkräftemangel im Gesundheitssystem in besonderer Weise betroffen.…”

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Fachkräfteentwicklung in der Rheumatologie

et al. 2021

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Hintergrund und Fragestellung Fachkräftemangel in der Rheumatologie in Deutschland ist als Versorgungsproblem erkannt. Die Gesundheitspolitik hat mit neuen Planungszielen reagiert, aber es fehlen effektive Interventionsstrategien. Ziel dieser Studie ist ein systematischer berufsstruktureller Überblick, um die Grundlage für Interventionen zu verbessern und Möglichkeiten für ein effektives Fachkräftemanagement aufzuzeigen. Methode Die WHO National Health Workforce Accounts (NHWA) dienen als konzeptioneller Rahmen. Ausgewählt werden 4 Indikatoren: Personalbestand, Arbeitsmarktbewegungen, Komposition und Weiterbildung. Die Exploration von Entwicklungstrends stützt sich auf vergleichende Analysen von Altersgruppen und Zeitreihen. Die Erhebung nutzt öffentliche Statistiken und andere Sekundärliteratur; die Auswertung erfolgt deskriptiv. Ergebnisse In Deutschland sind 1076 Ärzt*innen mit einer Facharztqualifikation oder Schwerpunktbezeichnung in der internistischen Rheumatologie ärztlich tätig. Die absolute Zahl verdoppelte sich seit 2000 deutlich (91 %), aber mit einem demografischen Bias. Im Zeitraum 2000 bis 2019 stieg die Zahl der über 50-Jährigen deutlich, aber die der unter 50-Jährigen nur um 9 %; seit 2010 sind die Zahlen in der Gruppe 40 bis 50 Jahre rückläufig. Im Jahr 2019 waren mehr Rheumatolog*innen im Rentenalter als unter 40-Jährige ärztlich tätig. Seit 2015 schwächt sich der steigende Trend insgesamt ab, aber am stärksten im Krankenhaussektor; die Weiterbildungen lassen keine konstante Steigerung erkennen. Schlussfolgerungen Berufsstrukturelle Trends zeigen, dass die gesundheitspolitischen Planziele mit den verfügbaren Humanressourcen nicht zu erreichen sind. Gefordert ist ein besseres Fachkräftemanagement, insbesondere durch Innovation der Weiterbildung, Aufgabenverschiebung und verbesserte Geschlechtergerechtigkeit.

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“…Our de nition of TS/S did not explicitly include task redistribution directly to patients or arti cial intelligence systems. 6 However, patient self-care and arti cial intelligence may be su ciently distinct from conventional TS/S to merit separate conceptual frameworks.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 Conceptual frameworks offer an essential theoretical synthesis of a given phenomenon, however, there are no conceptual frameworks to identify commonalities among the contexts and conditions suited to TS/S programmes. 5,6 A conceptual framework for the conditions and contexts suited to TS/S programmes could re ne the development and implementation of TS/S programmes and research globally.…”

Section: Introductionmentioning

confidence: 99%

Conceptual Framework for Task Shifting and Task Sharing: An International Delphi Study

Orkin

Rao

Venugopal³

et al. 2020

Preprint

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BackgroundTask shifting and sharing (TS/S) involves the redistribution of health tasks within workforces and communities. Conceptual frameworks lay out the key factors, constructs, and variables involved in a given phenomenon, as well as the relationships between those factors. Though TS/S is a leading strategy to address health worker shortages and improve access to services worldwide, a conceptual framework for this approach is lacking.MethodsWe used an online Delphi process to engage an international panel of scholars with experience in knowledge synthesis concerning TS/S and develop a conceptual framework for TS/S. We invited 55 prospective panellists to participate in a series of questionnaires exploring the purpose of TS/S and the characteristics of contexts amenable to TS/S programmes. Panellist responses were analysed and integrated through an iterative process to achieve consensus on the elements included in the conceptual framework. ResultsThe panel achieved consensus concerning the included concepts after three Delphi rounds among 15 panelists.The COATS Framework (Concepts and Opportunities to Advance Task Shifting and Task Sharing) offers a refined definition of TS/S and a general-purpose statement to guide TS/S programmes. COATS describes that opportunities for health system improvement arising from TS/S programmes depending on the implementation context, and enumerates eight essential conditions and important considerations for launching TS/S interventions.ConclusionThe COATS Framework offers an essential theoretical and conceptual model for TS/S programmes. The COATS Framework is comprehensive and adaptable, and can guide refinements in policy, programme development, evaluation, and research to improve TS/S globally.

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The best person (or machine) for the job: Rethinking task shifting in healthcare

Cited by 58 publications

References 97 publications

Work situation of rheumatologists and residents in times of COVID-19

Work situation of rheumatologists and residents in times of COVID-19

Fachkräfteentwicklung in der Rheumatologie

Conceptual Framework for Task Shifting and Task Sharing: An International Delphi Study

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