Skill-mix is an attribute of the health care system as a
whole. It follows that optimum skill-mix is dependent on
context and may vary from service to service, and
organisation to organisation. Policy-makers and
managers need rst to analyse carefully the nature of
the problem they wish to resolve and consider whether a
skill-mix change is the best solution. In making that
decision, it may help to ask:
. Is the treatment or service to be delivered capable of
improving outcomes for patients? Evidence from
clinical trials should be the gold standard but is not
always available. Where the evidence base is weak,
patient outcomes will need to be monitored to see
whether the anticipated bene ts are achieved.
. Are the workers competent to deliver that treatment
or service? Ensure appropriate training is available.
. Are there any regulatory restrictions that prevent
workers from undertaking the new task or role? If so,
can these restrictions be lifted?
. Do pay and reward systems actually reward – or at least
not penalise – workers and employers who make the
desired change? If not, then revise the systems.
. What is the likely impact of change on other services
and service sectors? Plan the discontinuation of old
services; identify the new activities which will take
their place; actively manage this process; and watch
for unintended consequences.
. What is the likely impact of change on staff
working with the person (or people) whose role is
to change? Who will gain and who will lose through
change? Employ good human resource management
skills to facilitate change and be alert to unintended
consequences.