If changing skill mix is the answer, what is the question?

Area of Science:

• Health Services Management
• Healthcare Workforce Planning
• Organizational Behavior in Healthcare

Background:

• Skill mix is frequently proposed to address health service staffing and resource challenges.
• Health sector reforms often involve or relate to changes in the skill mix of healthcare professionals.

Purpose of the Study:

• To define skill mix and present a typology for assessing it.
• To examine contextual, political, social, and economic factors influencing skill mix decisions.
• To explore how varying spans of managerial control impact skill mix assessments and changes.

Main Methods:

• Analysis of skill mix through case studies in diverse international settings (Costa Rica, Finland, Mexico, UK, USA).
• Examination of drivers for skill mix reviews, contextual constraints, and managerial control spans.
• Qualitative exploration of skill mix assessment realities in different healthcare contexts.

Main Results:

• Skill mix challenges are universal, but solutions and resources vary significantly across different countries and settings.
• Contextual factors substantially affect health service managers' ability to assess and alter skill mix.
• The extent of national, regional, or local management control over influencing factors is a key determinant.

Conclusions:

• Skill mix is not a one-size-fits-all solution; context significantly impacts its assessment and implementation.
• Local managerial span of control and organizational flexibility are critical for successful skill mix changes.
• Organizations must thoroughly evaluate the problem and context before considering skill mix changes, asking 'If changing skill mix is the answer, what is the question?'