Determining and Implementing Optimal Skill Mix of Health Professionals: A Comparative Examination of Finland, Germany, Spain, the Russian Federation and the U.K.
Health Sciences University of Ottawa Ottawa, Canada
Social and Policy Sciences University of Bath Bath, U.K.
Sociology McMaster University Hamilton, Canada
Swedish School of Social Science University of Helsinki Helsinki, Finland
Skill-mix initiatives focus on changing professional roles directly or indirectly.
Direct initiatives look at enhancement (by extending roles or skills), substitution,
delegation and innovation (by introducing a new type of worker). Indirect
initiatives, however, modify the interface between services ? that is, where care
is provided; they consider transfer (by moving the provision of a service from
one health care setting to another), relocation (by shifting the location of a
service without changing the people who provide it) and liaison (by using
specialists in one health care sector to educate and support staff working in
another sector). In this paper, we report on a comparative examination of skill mix initiatives in Finland, Germany, Spain, the Russian Federation and the U.K. undertaken for the European Observatory of the WHO.
We found that the optimal skill mix has been determined in different ways in different
European contexts and has been implemented in diverse ways, according to the
context. Skill-mix initiatives have sometimes been driven by the need or desire
to change the professional roles of established professions or to introduce new
professional roles. At other times, the initiatives have been driven by the need
or desire to pursue a new strategic direction for health systems that required a
shift in existing professional roles. Among five European countries that
represent different types of welfare and health care systems ? Finland,
Germany, Spain, the Russian Federation and the United Kingdom ? the most
extensive deployment has taken place in the United Kingdom, followed by
Finland; in Germany, Spain and the Russian Federation, it has taken place to a
much lesser extent. Across all five countries, the initiatives that targeted
changes in professional roles typically included modifications to structural
factors ? particularly, legislation, regulation of the scope of practice,
certification, education and training (usually the first to be modified), and often
also collective financing and the public provision of services.