How can optimal skill mix be effectively implemented and why?

Key messages

Skill-mix initiatives focus on changing professional roles – directly and indirectly. They change roles directly through extension of roles or skills, delegation, and the introduction of a new type of worker; they change them indirectly through modifications of the interface between services – that is, where care is provided.

Skill-mix initiatives may be motivated both by qualitative considerations (such as quality improvement, professional development and quality of work-life concerns) and quantitative considerations (such as shortages, maldistribution and cost–effectiveness).

Policy instruments that support the effective implementation of skill-mix initiatives include:

• modifying or introducing new professional roles through the development of different organizational and regulatory arrangements, including regulating professional scopes of practice and overcoming institutional barriers;
• supporting new or enhanced professional roles through collective financing and altered financial incentives; and
• ensuring the educational foundations (competence and capacity) for the new and expanded professional roles.

Across all initiatives, it is essential that the professional organizations affected and the government support new professional roles.

Skill-mix initiatives must be driven by need and must be sensitive to the health system and health professional; one-size-fits-all approaches are not helpful.