Overview

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.