An international perspective on organisational strategies to foster skill-mix changes in healthcare

• Published in: European journal of public health 2019-11, Vol.29 (Supplement_4)
• Main Authors: Kroezen, M, Dussault, G, Gericke, C, Kuhlmann, E
• Format: Article
• Language: English
• Subjects: Barriers; Health care; Health services; Information systems; Innovations; Intervention; Liability; Literature reviews; Organizational aspects; Public health; Reviews
• ISSN: 1101-1262; 1464-360X
• DOI: 10.1093/eurpub/ckz185.314

Abstract Background The implementation of skill-mix innovations in healthcare organisations is a complex process which many factors affect, positively or negatively. Facilitators are factors which stimulate or expand skill-mix change, whereas barriers are factors that limit or restrict skill-mix change. This study provides an overview of the most common facilitators and barriers. Methods An overview of systematic reviews was conducted as part of a larger project studying skill-mix innovations. 20 reviews on organisational-level factors related to the implementation of skill-mix innovations were included. The evidence from the reviews was supplemented with country case studies. Results Organisational factors, such as physical proximity of services involved in the skill-mix or well-functioning information systems, are often discussed in the literature on skill-mix implementation at organisational level. The same applies to individual factors, such as required knowledge levels or (lack of) trust. Process factors and characteristics of the skill-mix intervention seem to play a less important role, even though coaching and support for professionals seem to facilitate the implementation process. The institutional environment mainly seems to have a hampering effect, especially related to a lack of financing, reimbursement issues or perceived fears of liability. Often, the implementation of skill-mix interventions at organisational level is approached by focusing on specific facilitators and barriers, yet little attention is paid to structural approaches. Conclusions There is no single appropriate strategy for implementing skill-innovations that will fit all organisations. Managers must adopt an optimal strategy when implementing skill-mix, usually involving a combination of approaches best suited to local factors, to their specific organisational context and to the individuals involved.