Optimizing Scopes of Practice: New Models of Care for a New Health Care System
In December 2012 the Canadian Academy of Health Sciences undertook a major assessment dealing with a critically important element to improve the sustainability of health care in Canada in the future: scopes of practice. The issue was identified during a Forum on the Future of Health Care in Canada at its annual meeting in 2011. The assessment was conducted by an 11-member Expert Panel, co-chaired by Dr. Sioban Nelson, University of Toronto and Jeffrey Turnbull, Ottawa Hospital. Question What are the scopes of practice that will be most effective to support innovative models of care for a transformed health care system to serve all Canadians?’ To systematically approach the question the Expert Panel, working with the Canadian Health Human Resources Network Project Team, developed a guiding conceptual framework of macro, meso and micro influences on scopes of practice. They extracted findings from 125 sources of literature on scopes of practice interventions to see their impact; interviewed 50 Canadian and international experts in the field, and worked closely with the Expert Panel over an 18-month period to discuss the key findings and generate recommended actions. Key Research Findings Over the course of this Assessment, we identified an emerging consensus that optimizing scopes of practice, paired with evolving models of shared care can provide a multidimensional approach to shift the health care system from one that is characteristically siloed to one that is collaborative and patient-focused. The report highlights the barriers and enablers related to optimal scopes of practice using the macro (structural), meso (institutional/organizational) and micro (practice) framework. Key Message A common characteristic of scopes of practice/models of care innovations are that they circumvent largely macro level structural barriers. Report recommendations largely address this level as they were seen as having the greatest impact on change. Conclusions from Analysis There is a need for the implementation of an integrative, structural framework that supports the optimization of health care professional scopes of practice and innovative models of care.
- FLEXIBILITY – empowering the collaborative practice team to determine the relative responsibilities of the different practitioners based upon community need.
- ACCOUNTABILITY – ensuring the optimization of scopes of practice through an accreditation process within a professional regulatory environment.
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