MUNROS

MUNROS: Health Care Reform: the iMpact on practice, oUtcomes and costs of New roles for health pROfeSsionals

This project is undertaking a systematic evaluation of the impact of these ‘new professional roles’ on practice, outcomes and costs in a range of different healthcare settings within European Union and associate countries. It details the nature, scope and contribution of the new professional roles, evaluates their impact on clinical practice and outcomes, and identifies their scope to improve the integration of care. It conducts economic evaluation to identify the cost-effectiveness of the new professional roles, identifies optimal models for delivery of healthcare and the consequences of these for management of human resources and workforce planning. Study design is cross-sectional and multi-level. A mixed methods approach combines analysis of routinely collected data and primary data generated through interviews and questionnaires to health professionals, managers and patients. Data analysis employs multi-level modelling techniques.

 

Outcome and Translation

The project demonstrated that across the nine countries and three conditions studied there is variation in the extent to which the wider health care team is involved in patient care. Where the extended team is involved patients are satisfied, clinical outcomes are similar to more traditional care and there are potential cost savings. The results have been disseminated through a variety of approaches (e.g. invited talks, contributions to complementary projects, conference presentations, briefing papers) and are informing policy development at the highest level, at the OECD, EC and individual countries.

   

The MUNROS Project conference was held on the 6th February 2017.

 

HERU researchers involved in this research project: Robert Elliott, Hanne Bruhn, Daniel Kopasker  and Sebastian Heidenreich

 

External collaborators: C Bond (Centre of Academic Primary Care, University of Aberdeen); A de Bont (Erasmus University); R Busse (Technische Universität Berlin); M Ruggeri (Università Cattolica del Sacro Cuore); M Mijal (University of Warsaw); H Svobodová (Charles University Prague); G Okem (Economic Policy Research Foundation of Turkey); JE Askildsen (Uni Research Norway) and M Sutton (University of Manchester).

munros

Click here for further details on this project

 

Publications

Tsiachristas, A., Wallenburg, I., Bond, C. M., Elliot, R. F., Busse, R., van Exel, J., Rutten-van Molken, M. P. and de Bont, A. (2015) 'Costs and effects of new professional roles: evidence from a literature review', Health Policy, 119(9), 1176-1187.

Bond, C., Bruhn, H., de Bont, A., van Exel, J., Busse, R., Sutton, M., Elliott, R.F. and the Munros team (2016) 'The iMpact on practice, oUtcomes and costs of New roles for health pROfeSsionals' [protocol], BMJ Open, 6, e010511.

de Bont, A., van Exel, J., Coretti, S., Okem, Z. G., Janssen, M., Hope, K. L., Ludwicki, T., Zander, B., Zvonickova, M., Bond, C., Wallenburg, I. and and the MUNROS Team (led by Elliott, R.F. and Bond, C.). (2016) 'Reconfiguring health workforce: a case-based comparative study explaining the increasingly diverse professional roles in Europe', BMC Health Services Research, 16(1), 637.

Maier, C.B., Köppen, J., Busse, R. and the MUNROS Team (led by Elliott, R.F. and Bond, C.) (2018) 'Task shifting between physicians and nurses in acute care hospitals: cross-sectional study in nine countries', Human Resources for Health, 16(1), 24.

 

Köppen, J., Maier, C.B., Busse, R., Bond, C., Elliott, R.F., Bruhn, H., McLaggan, D., Zvonickova, M., Hodyc, D., Svobodová, H., Sutton, M., Gibson, J., McBride, A., Zander, B., Coretti, S., Ruggeri, M., van Exel, J., de Bont, A., Luyendjk, M., Askildsen, J.E., Islam, M.K., Opsahl, J., Sobczak, A., Dykowska, G., Winter, M., Ostrowska, S., Mijal, M., Basihos, S., Dogan, M. and Güldem Ökem, Z. (2018) 'What are the motivating and hindering factors for health professionals to undertake new roles in hospitals? A study among physicians, nurses and managers looking at breast cancer and acute myocardial infarction care in nine countries', Health Policy, 122(10), 1118-1125.

 

Maier, C.B., Batenburg, R., Birch, S., Zander, B., Elliott, R.F. and Busse, R. (2018) 'Health workforce planning: which countries include Nurse Practitioners and Physician Assistants and to what effect?', Health Policy, 122(10), 1085-1092.

 

Ruggeri, M., Drago, C., Moramarco, V., Coretti, S., Köppen, J., Islam, K., Gibson, J., Busse, R., van Exel, J., Sutton, M., Askildsen, J.E., Bond, C. and Elliott, R.F. (2018) 'New professional roles and patient satisfaction: evidence from a European survey along three clinical pathways', Health Policy, 122(10), 1078-1084.

 

Birch, S., Gibson, J., McBride, A. and the MUNROS Team (led by Elliott, R.F. and Bond, C.) (2020) 'Opportunities for, and implications of, skill mix changes in health care pathways: Pay, productivity and practice variations in a needs-based planning framework', Social Science and Medicine, 250(April), 112863.

 

Kopasker, D., Islam, M. K., Gibson, J., Lau, Y.-S., Sutton, M., Askildsen, J. E., Bond, C. and Elliott, R.F. (2020) 'Skill mix and patient outcomes: a multi-country analysis of heart disease and breast cancer patients', Health Policy, 124(10), 1074-1082.

 

Presentations

Bond, C. (2013) ‘MUNROS project: overview’, Stakeholder Workshop, Karolinum of the Charles University, Ovocny Trh. 3, Prague, 26th September 2013.

de Bont, A. and MUNROS Team (led by Elliott, R.F. and Bond, C.) (2014) 'Changing skill mix within teams delivering integrated health services', EU Chronic Care Summit, Brussels, 3rd April 2014.

Archibald, D., Bond, C. and Elliott, R.F. (2014) 'Identifying the drivers of new professional roles in European health systems', Health Economics in the Age of Longevity: a Joint iHEA & ECHE Congress, Trinity College, Dublin, 13-16 July 2014.

Tsiachristas, A., Wallenburg, I., de Bont, A., Archibald, D., Bond, C. and Elliott, R.F. (2014) ‘Costs and effects of health service redesign: evidence from a literature review’ Health Economics in the Age of Longevity: a Joint iHEA & ECHE Congress, Trinity College, Dublin, 13-16 July 2014.

Elliott, R.F. (2014) 'MUNROS: challenging terrain for economists', Workshop to mark 60th birthday of Jan Erik Askildsen, Department of Economics, University of Bergen, 14 November 2014.

de Bont, A., Wallenburg, I. and MUNROS Team (led by Elliott, R.F. and Bond, C.)(2014) 'On health care reform: the iMpact on practice, oUtcomes and costs of New roles for health pROfeSsionals’', Working Group on Health Workforce, Brussels, 24 November 2014.

de Bont, A., Wallenburg, I. and MUNROS Team (led by Elliott, R.F. and Bond, C.) (2014) 'On health care reform: the iMpact on practice, oUtcomes and costs of New roles for health pROfeSsionals', Zorgplatform, Utrecht, 3rd December 2014.

Elliott, R.F. (2014) 'MUNROS project - the iMpact on practice, oUtcomes and costs of New roles for health pROfeSsionals', Joint Action Health Workforce Planning and Forecasting, Conference on improving planning methodologies and data across Europe, Rome, Italy, 4 December 2014.

de Bont, A. and the MUNROS Team (led by Elliott, R.F. and Bond, C.), (2015) 'Invited presentation about the MUNROS project for EC Directorate-General for Health Healthcare Systems Unit - Workforce Team', Summit on Innovation for Active and Healthy Ageing, Brussels, Belgium, 9-10 March 2015.

de Bont, A. and the MUNROS Team (led by Elliott, R.F. and. Bond, C.) (2015) 'New professional roles in Europe', International Sociological Association (ISA) RC52, Professions Bonds and Boundaries: Visioning a Globalising, Managed and Inclusive Professionalism, Università Cattolica del Sacro Cuore, Milan, Italy, 19-21 March 2015.

Bond, C. and the MUNROS Team (led by Elliott, R.F. and Bond, C.), (2015) 'MUNROS overview presentation', 15th International Health Workforce Conference, Royal College of Physicians, London, England, 12-13 May 2015.

Ökem, G. and the MUNROS Team (led by Elliott, R.F. and Bond, C.), (2015) 'New professional roles in care pathways in diabetes II, breast cancer and acute myocardial infection in some selected European countries and Turkey: initial results of MUNROS project', 9th International Congress on Quality in Healthcare, Accreditation and Patient Safety, Antalya, Turkey, 13-16 May 2016.

Bond, C. and the MUNROS Team (led by Elliott, R.F. and Bond, C.) (2015) 'The iMpact on practice, oUtcomes and costs of New ROles for health care professionalS: results from the MUNROS study', 44th Annual Scientific Meeting of Society for Academic Primary Care (SAPC), Evidence and Innovation in Primary Care, University of Oxford, Oxford, England, 8-10 July 2015.

Elliot, R.F. (2015) 'The impact of the new professional roles on clinical practice and the organisation of care: emerging results. Organised session', International Health Economics Association (iHEA) 11th World Congress, Milan, Italy, 12-15 July 2015.

Zvoníčková, M., Svobodová, H., Vlček, F. and the MUNROS Team (led by Elliott, R.F. and Bond, C.), (2015) 'Expanding role of paramedical staff in the Czech Republic and in selected European countries', Way to Modern Nursing XVII, Motol Teaching Hospital, Prague, Czech Republic, 17 September 2015.

de Bont, A., Bond, C. and the MUNROS Team (led by Elliott, R.F. and Bond, C.), (2015) 'The MUNROS project: exploring the introduction of new professions and professional roles', Joint meeting EU Chief Medical Officers and Chief Nursing Officers, Luxemburg, 12 October 2015.

de Bont, A. and the MUNROS Team (led by Elliott, R.F. and Bond, C.), (2015) 'The impact on practice of new roles for health professionals: MUNROS study', 20th World Organization of National Colleges, Academies and Academic Associations of General Practitioners/Family Physicians (WONCA) Europe Conference, Istanbul, Turkey, 22-25 October 2015.

Elliot, R.F. and Bond, C. (2016) 'The MUNROS Study: changing health care roles in breast cancer care', Scottish Cancer Trials Breast Group Meeting, Hilton Hotel, Edinburgh Airport, Edinburgh, 28 January 2016.

Sutton, M. and the MUNROS Team (led by Elliott, R.F. and Bond, C.), (2016) 'Towards a more efficient use of health human resources OECD', Organisation for Economic Co-operation and Development (OECD) Workshop, OECD Conference Centre, Paris, France, 27 June 2016.

Elliot, R.F., Bond, C. and Sutton, M. (2016) 'New roles for health professionals: findings from the MUNROS project', European Union Directorate Knowledge Hour, Presentation to invited members of Directorate General Research and Employment, Brussels, Belgium, 6 September 2016.

Elliott, R.F. (2017) 'MUNROS project overview', MUNROS Project Conference, Royal College of Surgeons, Edinburgh, 6 February 2017.

Heidenreich, S., Skåtun, D., Ryan, M., Van Exel, J., Elliott, R.F. and Bond, C. (2017) 'Patients’ preferences for specialised health professionals in follow-up care: a cross-country and cross-disease comparison', 5th International Choice Modelling Conference, Cape Town, South Africa, 3-5 April 2017.

Kopasker, D., Islam, K., Gibson, J., Lau, Y.-S., Sutton, M., Askildsen, J.E., Bond, C. and Elliott, R.F. (2019) 'Skill mix and patient outcomes: a multi-country analysis of heart disease and breast cancer patients', Health Economists' Study Group (HESG) Winter 2019 Meeting, Centre for Health Economics (CHE), University of York, York, England, 7-9 January 2019.

Kopasker, D., Islam, K., Gibson, J., Lau, Y.-S., Sutton, M., Askildsen, J.E., Bond, C. and Elliott, R.F. (2019) 'Skill mix and patient outcomes: a multi-country analysis of heart disease and breast cancer patients', Scottish Health Economics. Showcasing Health Economics in Scotland: Research of International Excellence That Addresses Policy Priorities in Scotland and Beyond, Discovery Point, Dundee, 3 October 2019.