Role Clarification Processes for Better Integration of Nurse Practitioners into Primary Healthcare Teams: A Multiple-Case Study

Cet article s'intéresse aux processus de clarification des rôles professionnels lors de l'intégration d'une infirmière praticienne spécialisée dans les équipes de première ligne au Québec.Role clarity is a crucial issue for effective interprofessional collaboration. Poorly defined roles can become a source of conflict in clinical teams and reduce the effectiveness of care and services delivered to the population. Our objective in this paper is to outline processes for clarifying professional roles when a new role is introduced into clinical teams, that of the primary healthcare nurse practitioner (PHCNP). To support our empirical analysis we used the Canadian National Interprofessional Competency Framework, which defines the essential components for role clarification among professionals. A qualitative multiple-case study was conducted on six cases in which the PHCNP role was introduced into primary care teams. Data collection included 34 semistructured interviews with key informants involved in the implementation of the PHCNP role. Our results revealed that the best performing primary care teams were those that used a variety of organizational and individual strategies to carry out role clarification processes. From this study, we conclude that role clarification is both an organizational process to be developed and a competency that each member of the primary care team must mobilize to ensure effective interprofessional collaboration.IRSC, MSS

Human resources for health policies: a critical component in health policies

In the last few years, increasing attention has been paid to the development of health policies. But side by side with the presumed benefits of policy, many analysts share the opinion that a major drawback of health policies is their failure to make room for issues of human resources. Current approaches in human resources suggest a number of weaknesses: a reactive, ad hoc attitude towards problems of human resources; dispersal of accountability within human resources management (HRM); a limited notion of personnel administration that fails to encompass all aspects of HRM; and finally the short-term perspective of HRM. There are three broad arguments for modernizing the ways in which human resources for health are managed: • the central role of the workforce in the health sector; • the various challenges thrown up by health system reforms; • the need to anticipate the effect on the health workforce (and consequently on service provision) arising from various macroscopic social trends impinging on health systems. The absence of appropriate human resources policies is responsible, in many countries, for a chronic imbalance with multifaceted effects on the health workforce: quantitative mismatch, qualitative disparity, unequal distribution and a lack of coordination between HRM actions and health policy needs. Four proposals have been put forward to modernize how the policy process is conducted in the development of human resources for health (HRH): • to move beyond the traditional approach of personnel administration to a more global concept of HRM; • to give more weight to the integrated, interdependent and systemic nature of the different components of HRM when preparing and implementing policy; • to foster a more proactive attitude among human resources (HR) policy-makers and managers; • to promote the full commitment of all professionals and sectors in all phases of the process. The development of explicit human resources policies is a crucial link in health policies and is needed both to address the imbalances of the health workforce and to foster implementation of the health services reforms

From staff-mix to skill-mix and beyond: towards a systemic approach to health workforce management

Throughout the world, countries are experiencing shortages of health care workers. Policy-makers and system managers have developed a range of methods and initiatives to optimise the available workforce and achieve the right number and mix of personnel needed to provide high-quality care. Our literature review found that such initiatives often focus more on staff types than on staff members' skills and the effective use of those skills. Our review describes evidence about the benefits and pitfalls of current approaches to human resources optimisation in health care. We conclude that in order to use human resources most effectively, health care organisations must consider a more systemic approach - one that accounts for factors beyond narrowly defined human resources management practices and includes organisational and institutional conditions

Cross-national comparisons of human resources for health - what can we learn?

After a long period of neglect, the issue of human resources for health (HRH) has recently emerged as a core component on the international health agenda, with policy makers increasingly eager to learn from experience elsewhere. This article investigates systematically the opportunities and challenges associated with the use of cross-national comparisons of HRH policies and practices. It reviews the evidence in favour of using international comparative studies on HRH, discusses emerging opportunities for developing a cross-national research agenda to guide HRH policies in Europe, and highlights obstacles which may hinder the implementation of comparative studies on HRH. While demonstrating many opportunities offered by the comparative approach to improve understanding of human resources processes in the health sector, this article also emphasizes the dangers of simplistic pleas for the transfer of human resource policies without taking into account the context-specific factors and the generative capacity of the social actors in the design and implementation of policy changes

Renouveau managérial dans le contexte des réformes des services de santé : mirage ou réalité ?

Managerialism and reforms of health services: mirage or reality? In using data drawn from two case studies targeting two Canadian provinces, this paper examines both discursive strategies and practices associated with the renewal of the management of public services. It looks to determine how both managerialist discourses and techniques have been integrated into reforms and to what extent they have altered or perpetuated the existing dynamics in terms of accountability and management. Our analysis suggests that, into the context of Canadian public services, antibureaucratic claims driven by the managerial ideology have translated into a bureaucratic persistence and a new technology of control associated with a strong focus on performance measurement and analytic tool.Résumé. En s'appuyant sur deux études de cas correspondant à deux provinces canadiennes, cet article examine les stratégies discursives et les pratiques associées aux réformes des services publics. Il étudie comment les discours et techniques managérialistes ont été mobilisés dans la mise en œuvre de ces réformes, comment ils ont été incorporés dans les pratiques et les discours organisationnels et dans quelle mesure ils ont contribué à modifier ou à perpétuer les dynamiques existantes d'imputabilité et de gestion. Les conclusions dénotent que la revendication antibureaucratique et l'idéal d'une nouvelle administration sous-jacents à la nouvelle idéologie managériale se seront traduits dans les services publics canadiens par une persistance bureaucratique et l'émergence d'une nouvelle technologie du contrôle misant essentiellement sur le renforcement des capacités analytiques des décideurs et l'instrumentation de la mesure des performances.La renovación de la gestión de los servicios de salud : el control en cuestión ? Apoyándose en dos estudios de casos en dos provincias canadienses, este artículo examina las estrategias discursivas y las prácticas asociadas a las reformas de los servicios públicos. Estudia de qué manera los discursos y técnicas de gestión han sido mobilizados para la puesta en práctica de estas reformas, de qué manera han sido incorporados en las prácticas y en los discursos organizacionales y en qué medida han contribuido a modificar o a perpetuar las dinámicas ya existentes de imputabilidad y de gestión. Las conclusiones indican que la reivindicación antiburocrática y el idéal de una nueva administración subyacentes en la nueva ideología de gestión se vieron traducidos en los servicios públicos canadienses por una persistencia burocrática y por la aparición de una nueva tecnología del control basada esencialmente en el fortalecimiento de las capacidades analíticas de quienes deciden y la instrumentación de la medición de las prestaciones.Dubois Carl-Ardy. Renouveau managérial dans le contexte des réformes des services de santé : mirage ou réalité ?. In: Sciences sociales et santé. Volume 21, n°4, 2003. pp. 41-71