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RE-THINKING OUR HEALTH ROLES. Sandra G. Leggat Professor Health Services Management. “Traditional conceptualisations of medicine, nursing, physiotherapy… are unlikely to be sufficiently flexible to address 21st century needs”. - PowerPoint PPT Presentation
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RE-THINKING OUR HEALTH ROLES
Sandra G. Leggat
Professor Health Services Management
Re-thinking our Health Roles
“Traditional conceptualisations of
medicine, nursing, physiotherapy… are unlikely to be sufficiently flexible to
address 21st century needs”. Masterson A, Humphris D. New role development: taking a strategic approach. In: Humphris D, Masterson A, editors. Developing New Clinical Roles: a guide for health professionals. London: Harcourt International; 2000.
Review of the issues
Why aren’t the proposed solutions likely to be effective?
Considerations for the future
The issues…
Skills shortages
Facilitating care across system & professional boundaries
Perceived inefficiency with waste & duplication
Potential to improve quality & safety
Potential to enhance value for money
The hospital is the “…key battleground for the various forces arrayed in the division of labour in health care”
Dingwall, R., Rafferty, A. M. & Webster, C. 1988 An Introduction to the Social History of Nursing. Routledge, London Pages.
Do we have sufficient health workers?
Region Health workers/1,000 pop’n
North America 10.9
Europe 10.4
Western Pacific 8.5
South & Central America 2.8
Middle East & North Africa 2.7
Asia 2.3
Sub-Sahara Africa 0.98
WHO 2004
Proposed solutions1. Role extension (e.g. ‘multi-skilled’
community allied health professional)
2. Role development to ‘fill the gaps’ (e.g. physician assistant)
3. Role development to combine tasks in different ways (e.g. diagnosis specific support worker)
4. Role substitution (e.g. nurse practitioner)
5. Role functional flexibility (e.g. care support worker)
‘Best practice’ work design
The research has identified 2 approaches to work design.
Job Characteristic Model (JCM) suggests that skill variety, task identity, task significance, autonomy and feedback are the important characteristics to consider in work design. (Hackman & Oldham 1976)
Sociotechnical Systems Approach (STS) provides a set of normative principles aimed at work groups that require the social and technical subsystems to be designed jointly (Cherns 1976)
JCM work design
JCM Characteristics Allied Health Doctors Nurses
Use of skills
Complete process
Impact
Autonomy
Feedback
Health roles becoming less attractive
Skill variety decreasing with ‘prescribed practice’ – e.g. Map of Medicine
Specialisation & episodic care limits task identity
Less task significance with increasing emotional management
Conflict between individual autonomy and teamwork
Decreasing feedback for some workers
STS work design
STS Characteristics Allied Health Doctors Nurses
Control/Ownership
Skill variety
Load
Security
Contact
Training
Efficiency
Quality
Flexibility
Communicate
Health system structure impedes STSSTS Health system
High technical interdependence; work should be designed at group level
Health care tends to be craft production
Greater operational uncertainty; decision making should be devolved to employees
Australian, State and Territory Governments set conflicting incentives (financial, policy, performance)
Different parts of system & organisations need different work designs
Professional bodies administer codes of conduct which complement formal regulation, or provide for self-regulation
Methods of working should be minimally specified
More than 20 bodies accredit education & training, & over 90 registration boards
Analysis of proposed solutionsExtension Fill gaps Combine
tasksSubstitution Flexibility
Use of skills + ≠ ≠ + +
Process + ≠ + ≠ +
Impact + + + + +
Autonomy + ≠ ? ≠ ≠
Control + ≠ + ≠ ≠
Load ≠ ≠ ≠ ≠ ≠
Security ≠ ≠ ≠ ≠ ≠
Social + ≠ ? ≠ +
Quality ? ≠ + ? +
Costs + ≠ + + +
Implications Health sector trends suggest our health system
will have less ability to meet work design best practice
Resulting in (continued?) reduction in the attractiveness of health professional jobs
Role extension, role development combining tasks & role functional flexibility appear to be most consistent with requirements for effective work design
Current Model New Model?
Roles are fixed in the short term
Roles are flexible in the short term
Individualistic work roles More focus on social interactions
Inflexible HR & registration processes
Personal role crafting, based on learning & privileging
Formal, inflexible siloed educational models
Accessible skill ladders, interdisciplinary learning modules
Lack of financial incentives Facilitating financial incentives
ReferencesCherns AB (1976) The principles of sociotechical design. Human Relations 29: 783-92
Duckett SJ (2005) Health workforce design for the 21st century. Australian Health Review 29(2): 201
Duckett SJ (2005) Interventions to facilitate health workforce restructure. Australia and New Zealand Health Policy 2: 14
HackmanJR & Oldham GR (1976) Motivation through the design of work. Organizational Behaviour and Human Performance 16: 250-79
Leggat SG (2007) Health professional education: perpetuating obsolescence? Australian Health Review 31(3): 325
Nadin SJ, Waterson PE & Parker SK (2001) Participation in job redesign: an evaluation of the use of a sociotechnical toll and its impact. Human Factors and Ergonomics in Manufacturing 11(1): 53-69.
Parker SK, Wall TD & Cordery JL (2001) Future work design research and practice: towards an elaborated model of work design. Journal of Occupational and Organizational Psychology 74: 413-40
Productivity Commission (2005) Australia’s Health Workforce. Commonwealth of Australia
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