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Changing the skill-mix of the health care workforce

机译：改变医护人员的技能组合

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Objective: Changing workforce skill-mix is one strategy for improving the effectiveness and efficiency of health care. Our aim was to summarise available research into the success or failure of skill-mix change in achieving planned outcomes. nnMethods: A systematic search for existing reviews of research into skill-mix was conducted. Databases searched included: MEDLINE, CINAHL, PsychINFO, Cochrane Library, HMIC, Centre for Reviews and Dissemination, and Department of Health Research Findings Register. Search terms included keywords defining the type of publication, clinical area, type of health personnel and the focus of the article (role change, skill-mix, etc.). English language publications from 1990 onwards were included. Two reviewers independently identified relevant publications, graded the quality of reviews and extracted findings. In addition, the wider literature was scanned to identify which factors were associated with the success or failure of skill-mix change. nnResults: A total of 9064 publications were identified, of which 24 met our inclusion criteria. There was a dearth of research, particularly for role changes involving workers other than doctors or nurses. Cost-effectiveness was generally not evaluated, nor was the wider impact of change on health care systems. The wider literature suggested that factors promoting success include: introducing 'treatments' of proven efficacy; appropriate staff education and training; removal of unhelpful boundary demarcations between staff or service sectors; appropriate pay and reward systems; and good strategic planning and human resource management. Unintended consequences sometimes occurred in respect of: staff morale and workload; coordination of care; continuity of care; and cost. nnConclusions: In order to make informed choices, health care planners need good research evidence about the likely consequences of skill-mix change. The findings from existing research need to be made more accessible while the dearth of evidence makes new research necessary.
机译：目标：改变劳动力的技能组合是提高卫生保健的有效性和效率的一种策略。我们的目的是总结有关实现计划成果的技能组合变更成败的现有研究。 nnMethods：进行了系统搜索现有的技能组合研究综述。搜索的数据库包括：MEDLINE，CINAHL，PsychINFO，Cochrane图书馆，HMIC，评论和传播中心以及卫生研究结果注册处。搜索词包括定义出版物类型，临床领域，卫生人员类型和文章重点（角色变更，技能组合等）的关键字。包括1990年以后的英语出版物。两名审稿人独立确定了相关出版物，对审稿的质量进行分级并提取了调查结果。此外，还对更广泛的文献进行了扫描，以确定哪些因素与技能组合变更的成败有关。 nn结果：共鉴定到9064种出版物，其中24种符合我们的纳入标准。缺乏研究，特别是对于涉及医生或护士以外的工人的角色变更。通常没有评估成本效益，也没有评估变革对医疗保健体系的更广泛影响。更广泛的文献表明，促进成功的因素包括：引入行之有效的“疗法”。适当的员工教育和培训；取消工作人员或服务部门之间无用的界线；适当的薪酬和奖励制度；以及良好的战略规划和人力资源管理。有时会在以下方面产生意想不到的后果：员工士气和工作量；护理协调；护理的连续性；和成本。 nn结论：为了做出明智的选择，医疗保健计划者需要有关技能组合变更可能带来的后果的良好研究证据。在缺乏证据的情况下，有必要进行新的研究，以便使现有研究的结果更易于获取。

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  • 来源
    《Journal of Health Services Research & Policy》 |2004年第s1期|p.28-38|共11页
  • 作者

    Bonnie Sibbald Jie Shen Anne McBride;

  • 作者单位

    National Primary Care Research and Development Centre, University of Manchester, Williamson Building, Oxford Road, Manchester M13 9PL, UK;

    Health Organisations Research Centre, Manchester School of Management, University of Manchester Institute of Science and Technology, Manchester, UK;

    Health Organisations Research Centre, Manchester School of Management, University of Manchester Institute of Science and Technology, Manchester, UK;

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  • 正文语种 eng
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  • 关键词

    skill-mix; health care;

    机译：技能组合;保健;

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