5.4 Scope of practice and task shifting

Healthcare systems worldwide are grappling with workforce shortages. Scope of practice and task shifting offer solutions by expanding roles and redistributing tasks among healthcare teams. These strategies aim to maximize efficiency and improve access to care, especially in underserved areas.

Task shifting isn't without risks. It requires careful implementation, considering local context and existing capabilities. While it can increase access and empower workers, concerns about quality of care and professional resistance must be addressed. Successful models combine policy changes, training, and supportive supervision.

Scope of practice and task shifting

Defining key concepts

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• Scope of practice encompasses range of services, procedures, and actions healthcare professionals can legally perform based on education, training, and licensure
• Task shifting redistributes tasks among healthcare workforce teams, typically from highly qualified to less qualified workers
• Healthcare workforce optimization maximizes utilization of available human resources to improve efficiency, access, and quality of care
• World Health Organization (WHO) endorses task shifting to address global health workforce crisis and achieve universal health coverage

Implementation contexts and considerations

• Task shifting often implemented in response to healthcare worker shortages (resource-limited settings, underserved areas)
• Can occur between different types of healthcare professionals (physicians to nurses) or from professionals to community health workers
• Successful implementation requires careful consideration of local context, healthcare needs, and existing workforce capabilities
• Cultural attitudes towards healthcare professions and traditional hierarchies influence acceptance and success of task shifting initiatives

Benefits and risks of task shifting

Potential benefits

• Increased access to healthcare services (underserved areas, specific populations)
• More efficient use of healthcare resources
• Potential reduction in overall healthcare costs
• Empowerment of lower-level healthcare workers and community members
  • Increases job satisfaction and retention
• Addresses healthcare worker shortages in resource-limited settings

Potential risks and challenges

• Potential compromises in quality of care if tasks shifted to workers with inadequate training or supervision
• Resistance from higher-level healthcare professionals (concerns about job security, professional autonomy)
• Legal and ethical concerns regarding liability and accountability for patient outcomes
• Possible exacerbation of existing inequalities
  • Risk of creating two-tiered system of care (lower-skilled workers primarily serving disadvantaged populations)
• Cultural barriers and traditional hierarchies may impede acceptance of task shifting

Task shifting strategies across systems

High-income vs. low- and middle-income countries

• Implementation varies widely between high-income and low/middle-income countries
  • Driven by different healthcare needs and resource constraints
• High-income countries: Implementation of advanced practice nursing roles
  • Nurses perform tasks traditionally reserved for physicians (prescribing medications)
• Low/middle-income countries: Wider adoption to address specific health crises
  • Sub-Saharan Africa: Task shifting for HIV/AIDS care (nurses and community health workers taking on physician roles)

Factors influencing implementation

• Extent of task shifting correlates with level of healthcare worker shortage
• Strength of professional organizations in healthcare system affects acceptance
• Integration into national health policies and strategies varies across countries
  • Impacts sustainability and scale-up of initiatives
• Successful models often combine policy changes, training programs, and supportive supervision structures

Regulation and governance for safe task shifting

Regulatory frameworks and guidelines

• Essential to define expanded roles and responsibilities of healthcare workers involved in task shifting
• Clear guidelines and protocols delineate which tasks can be shifted and under what circumstances
• Accreditation and certification processes ensure workers have necessary competencies for expanded roles
• Legal frameworks may need adjustment to protect healthcare workers from liability issues

Quality assurance and monitoring

• Governance structures oversee implementation, monitoring, and evaluation of task shifting initiatives
• Continuous quality assurance mechanisms monitor safety and effectiveness of task-shifted services
• Stakeholder engagement crucial in developing and implementing task shifting policies
  • Includes professional associations and regulatory bodies
• Regular evaluation and adjustment of task shifting strategies based on outcomes and feedback