1. The impact on practice, costs and outcomes of New Roles for health professionals in Europe (MUNROS) Antoinette de Bont/ associate professor/ Erasmus University Rotterdam

2. Agenda Introduction to the study Development of new professionals roles Drivers and barriers to new professional roles Conclusions about the impact PA INVEST 2014, Amsterdam, October 30 - November 1 2014

3. Aim Aims 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. PA INVEST 2014, Amsterdam, October 30 - November 1 2014

4. What we did We have described the key features of the health delivery systems in nine countries of the EU. We have determined the drivers for skill mix changes based upon routine available data and policy documents. We have described the skill mix in daily practice in 16 care pathways: AMI (6), Breast Cancer (6) and Diabetes II (4). PA INVEST 2014, Amsterdam, October 30 - November 1 2014

5. Agenda Introduction in to the study Development of new professionals roles Drivers and barriers to new professional roles Conclusions about the impact PA INVEST 2014, Amsterdam, October 30 - November 1 2014

6. SPECIALIZATION OF CARE  Developments in medical technology and training  Developments in information technology

7. SPECIALIZATION OF CARE  Developments in medical technology and training  Developments in information technology INTEGRATION OF HEALTH SERVICES  Improve quality of care / patient outcomes  Increase share in health services

8. 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 SPECIALIZATION OF CARE  Developments in medical technology and training  Developments in information technology INTEGRATION OF HEALTH SERVICES  Improve quality of care / patient outcomes  Increase share in health services

9. 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 SPECIALIZATION OF CARE  Developments in medical technology and training  Developments in information technology INTEGRATION OF HEALTH SERVICES  Improve quality of care / patient outcomes  Increase share in health services

10. Integrated 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 SPECIALIZATION OF CARE  Developments in medical technology and training  Developments in information technology INTEGRATION OF HEALTH SERVICES  Improve quality of care / patient outcomes  Increase share in health services

11. Integrated 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 SPECIALIZATION OF CARE  Developments in medical technology and training  Developments in information technology INTEGRATION OF HEALTH SERVICES  Improve quality of care / patient outcomes  Increase share in health services

12. Integrated 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 SPECIALIZATION OF CARE  Developments in medical technology and training  Developments in information technology INTEGRATION OF HEALTH SERVICES  Improve quality of care / patient outcomes  Increase share in health services SUBSTITUTION NEW PROFESSIONS & NEW ROLES

13. Integrated 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, based on the required expertise, supported by specialized nursing, technical and/or administrative staff Expertise-centred care SPECIALIZATION OF CARE  Developments in medical technology and training  Developments in information technology INTEGRATION OF HEALTH SERVICES  Improve quality of care / patient outcomes  Increase share in health services SUBSTITUTION NEW PROFESSIONS & NEW ROLES INCREASING SKILL-MIX CHANGE

14. Agenda Introduction in to the study Development of new professionals roles Drivers and barriers to new professional roles Conclusions about the impact PA INVEST 2014, Amsterdam, October 30 - November 1 2014

15. 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”

16. New professional roles thrive within organisations, when they: – Increase efficiency; – Contribute to documentation work; – Offer patient centered care;

17. Agenda Introduction in to the study Development of new professionals roles Drivers and barriers to new professional roles Conclusions about the impact of new professional roles PA INVEST 2014, Amsterdam, October 30 - November 1 2014

18. 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 (especially in out-patient care). – Health care organizations can and do create new roles.

22. Implications Prevent competition between new professional roles (Advanced Nurse Practitioners, Emergency Physicians) Get connected: with PAs in other organizations, networks of hospitals, etc. Be careful to develop local guidelines that regulate qualifications; It is better to refer to national guidelines. PA INVEST 2014, Amsterdam, October 30 - November 1 2014

24. 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.