OECD Health Working Papers

This series is designed to make available to a wider readership health studies prepared for use within the OECD. Authorship is usually collective, but principal writers are named. The papers are generally available only in their original language - English or French - with a summary in the other.

English, French

Skill-Mix and Policy Change in the Health Workforce

Nurses in Advanced Roles

  1. An important potential contribution to the efficient use of the health workforce, is the possibility of ‘skill mix’ changes. ‘Skill mix’ is a relatively broad term which can refer to the mix of staff in the workforce or the demarcation of roles and activities among different categories of staff. Most of the policy attention on using skill-mix changes to improve health system performance has been on the mix between physicians and nurses.
  1. Skill-mix changes may involve a variety of developments including enhancement of skills among a particular group of staff, substitution1 between different groups, delegation up and down a unidiscipliniary ladder, and innovation in roles. Such changes may be driven by a variety of motives including service innovation, shortages of particular categories of worker (especially in inner cities or rural areas), quality improvement, and a desire to improve the cost- effectiveness of service delivery.
  1. There are large differences in reported physician/nurse ...


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