RE-THINKING OUR HEALTH ROLES

1. RE-THINKING OUR HEALTH ROLES Sandra G. Leggat Professor Health Services Management

2. “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 Re-thinking our Health Roles

3. 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.

4. Do we have sufficient health workers? WHO 2004

5. Role extension (e.g. ‘multi-skilled’ community allied health professional) Role development to ‘fill the gaps’ (e.g. physician assistant) Role development to combine tasks in different ways (e.g. diagnosis specific support worker) Role substitution (e.g. nurse practitioner) Role functional flexibility (e.g. care support worker) Proposed solutions

6. ‘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)

7. JCM work design

8. 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 Health roles becoming less attractive

9. STS work design

10. Health system structure impedes STS

11. Analysis of proposed solutions

12. 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

14. References • Cherns 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