1. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros MUNROS is funded by the European Commission FP7 programme, HEALTH-F3-2012-305467EC. Project co-ordinators Prof Bob Elliott, r.elliott@abdn.ac.uk and Prof Christine Bond, c.m.bond@abdn.ac.ukr.elliott@abdn.ac.ukc.m.bond@abdn.ac.uk www.abdn.ac.uk/munros On Health Care Reform: the iMpact on practice, oUtcomes and costs of New roles for health pROfeSsionals Antoinette de Bont, Iris Wallenburg and the MUNROS team lead by Professor Elliot and Professor Bond. Presentation to Zorgplatform, Utrecht,3rd December 2014

2. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Agenda The aim of the study Development of new professionals roles Drivers and barriers to new professional roles Conclusions about the impact

3. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Aims of the study Detail the nature, scope and contribution of the new professional roles. Evaluate their impact on clinical practice and outcomes. Identify their scope to improve the integration of care.

4. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Project PhaseLead Partner and Support PartnerWork packages included 1. Mapping health system integration, skill mix and competencies Scotland and TurkeyWP 1 Understanding health systems Netherlands and NorwayWP 2 Mapping skill mix 2. Methodology and Study Design Netherlands and ScotlandWP 3 Case studies Scotland and NetherlandsWP 4 Questionnaire design 3. Data Collection, Data Management and Analysis England and GermanyWP 5 Impact on clinical practice and organisation of care Italy and PolandWP 6 Outcomes: the Patient Experience Norway and Czech RepublicWP 7 Outcomes: Process, Productivity and Clinical Effect Netherlands and NorwayWP 8 Changes in Costs and Benefits 4. Translation into Policy: Delivering Impact Germany and ScotlandWP 9 New Professional Roles and the Integration of Care England and Italy WP 10 Management of Human Resources and Successful Workforce Planning ScotlandWP 11 Scientific Structure, Policy Engagement, Impact and Dissemination 5. Scientific Coordination ScotlandWP 12 Scientific Co-ordination Structure of Research

5. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros MUNROS is funded by the European Commission FP7 programme, HEALTH-F3-2012-305467EC. Project co-ordinators Prof Bob Elliott, r.elliott@abdn.ac.uk and Prof Christine Bond, c.m.bond@abdn.ac.ukr.elliott@abdn.ac.ukc.m.bond@abdn.ac.uk www.abdn.ac.uk/munros Traditional care delivery with one specialist within a care organization responsible for the care delivery to a patient, supported by general nursing, technical and/or administrative staff Physician-centred care INCREAS SHARE IN HEALTH SERVICES  Improve quality of care / patient outcomes SPECIALIZATION OF CARE  Developments in medical technology and training  Developments in information technology

6. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros MUNROS is funded by the European Commission FP7 programme, HEALTH-F3-2012-305467EC. Project co-ordinators Prof Bob Elliott, r.elliott@abdn.ac.uk and Prof Christine Bond, c.m.bond@abdn.ac.ukr.elliott@abdn.ac.ukc.m.bond@abdn.ac.uk www.abdn.ac.uk/munros Traditional care delivery with one specialist within a care organization responsible for the care delivery to a patient, supported by general nursing, technical and/or administrative staff Physician-centred care Multiple specialists within a care organization involved in care delivery to a patient, simultaneously and/or consecutively, based on the required expertise, supported by specialized nursing, technical and/or administrative staff Expertise-centred care INCREAS SHARE IN HEALTH SERVICES  Improve quality of care / patient outcomes SPECIALIZATION OF CARE  Developments in medical technology and training  Developments in information technology

7. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros MUNROS is funded by the European Commission FP7 programme, HEALTH-F3-2012-305467EC. Project co-ordinators Prof Bob Elliott, r.elliott@abdn.ac.uk and Prof Christine Bond, c.m.bond@abdn.ac.ukr.elliott@abdn.ac.ukc.m.bond@abdn.ac.uk www.abdn.ac.uk/munros Production centred care Co-ordination of care delivery to a patient with new general professional roles within a care organization (e.g. expansion of services) and/or between care organizations (e.g. primary and secondary care) Traditional care delivery with one specialist within a care organization responsible for the care delivery to a patient, supported by general nursing, technical and/or administrative staff Physician-centred care Multiple specialists within a care organization involved in care delivery to a patient, simultaneously and/or consecutively, based on the required expertise, supported by specialized nursing, technical and/or administrative staff Expertise-centred care INCREAS SHARE IN HEALTH SERVICES  Improve quality of care / patient outcomes SPECIALIZATION OF CARE  Developments in medical technology and training  Developments in information technology

8. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros MUNROS is funded by the European Commission FP7 programme, HEALTH-F3-2012-305467EC. Project co-ordinators Prof Bob Elliott, r.elliott@abdn.ac.uk and Prof Christine Bond, c.m.bond@abdn.ac.ukr.elliott@abdn.ac.ukc.m.bond@abdn.ac.uk www.abdn.ac.uk/munros Production centred care Co-ordination of care delivery to a patient with new general professional roles within a care organization (e.g. expansion of services) and/or between care organizations (e.g. primary and secondary care) Patient-centred care Specialized, integrated care pathway Traditional care delivery with one specialist within a care organization responsible for the care delivery to a patient, supported by general nursing, technical and/or administrative staff Physician-centred care Multiple specialists within a care organization involved in care delivery to a patient, simultaneously and/or consecutively, based on the required expertise, supported by specialized nursing, technical and/or administrative staff Expertise-centred care INCREAS SHARE IN HEALTH SERVICES  Improve quality of care / patient outcomes SPECIALIZATION OF CARE  Developments in medical technology and training  Developments in information technology

9. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros MUNROS is funded by the European Commission FP7 programme, HEALTH-F3-2012-305467EC. Project co-ordinators Prof Bob Elliott, r.elliott@abdn.ac.uk and Prof Christine Bond, c.m.bond@abdn.ac.ukr.elliott@abdn.ac.ukc.m.bond@abdn.ac.uk www.abdn.ac.uk/munros Production centred care Italy, Germany Patient-centred care Netherlands, Scotland Turkey, Norway Physician-centred care The Czech Republic Poland Expertise-centred care INCREAS SHARE IN HEALTH SERVICES  Improve quality of care / patient outcomes SPECIALIZATION OF CARE  Developments in medical technology and training  Developments in information technology

10. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros New professional roles thrive within organisations, when they: – Increase efficiency; – Contribute to documentation work; – Offer patient centered care;

11. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros New professional roles largely depend on individual willingness of an established professional. – Need to work close together to be recognized as knowledgeable and competent; – Do the dirty work; – Go beyond qualifications to “get the job done”

12. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros The impact of new professional roles is SMALL but SIGNIFICANT. Small: – Few new professionals in new roles. – Physicians set the rules. – New professions are not well yet connected to institutional agents. Significant: – New professions do work physicians and nurses used to do. – Health care organizations can and do create new roles.

13. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros

14. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros

15. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros

16. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros Next steps Measure the distribution of tasks in the three care pathways in 12 hospitals and 12 primary care clinics in each country. Measure patients experiences in the three care pathways in 12 hospitals and 12 primary care clinics in each country. Compare the costs and outcomes. Develop task- based workforce planning model.

17. MUNROS is funded by the European Commission FP7 programme www.abdn.ac.uk/munroswww.abdn.ac.uk/munros We wish to thank the 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.