出版社：Utrecht University, Maastricht University, Groningen University
摘要：Finding more efficient, innovative and responsive ways of engaging the health workforce to manage patients is key to ensuring integrated care. Systems that are transforming their services to be more integrated must ensure that health professionals are ready to fill the new roles assigned to them in prevention and pro-active patient management, manage health and care rather than disease and cure, work in teams across professions and sectors, work along a continuum of care, protect and advocate the most vulnerable, ensure equitable service delivery, optimize communication that has an emphasis on compassion and empathy and develop more than one vertical expertise. Securing a health workforce that “wants and feels” and has the theoretical knowledge and skills to work more efficiently and effectively is not enough in ensuring integrated health services. What is needed is a guarantee that health professionals who enter the workplace will apply their knowledge and skills with sound judgment (i.e. that they will have competencies) and that they will refine and maintain these over the course of their career (consolidate competencies). To date the focus on competencies has been limited to looking at education institutions (i.e. college and universities) where initial exposure to competencies takes place. Indeed important strides have been taken since the Lancet review on transforming health professional education to be more competency-oriented. The lack of a clear definition on what competencies are, how they are governed and strengthened beyond initial training settings has however resulted in misplacing competencies of the health workforce as merely a problem for training institutions. Without a deeper exploration into what competencies are and how they can be strengthened at both the service and systems level important conversations on the relevance of competencies to health systems have been missed. This has been explored in our paper for the World Health Organization Regional Office for Europe "Strengthening a competent health workforce for the provision of coordinated/ integrated health services" (http://www.euro.who.int/en/health-topics/Health-systems/health-service-delivery/publications/2015/strengthening-a-competent-health-workforce-for-the-provision-of-coordinated-integrated-health-services). A systematic review of the literature was conducted resulting in the identification of 5 core competencies for integrated care. Their consolidation over the course of a health professional's career is conceptualized and a framework proposed that addresses actors and their responsibilities at both the service delivery level and the systems level. 13 important entry points for the assurance and improvement of competencies. Having done this, the paper shows how competencies are the responsibility of a range of stakeholders - service managers, policy makers, regulatory bodies, and patient and professional associations- and how they can work more closely with each other. Most notably the paper proposes that accountability for the consolidation of competencies of the health workforce lies with executives of health services. Without such clarity of roles and responsibilities, governance of the health workforce will continue to be challenged by poor accountability, corruption, limited involvement of communities in policy-making, ineffective management strategies and ultimately poor health outcomes. A workshop is proposed to discuss: - what participants think of the five proposed integrated care competencies listed; - what the participant's experiences with the five proposed integrated care competencies in their individual countries are; - the proposed conceptual framework for competency consolidation and the identified 13 entry points; and - experiences with barriers/facilitators and opportunities for implementation of the competencies and the entry points. The workshop will take a particular focus on the service delivery level and discuss examples and tools for the service-specific entry points for governing competency consolidation.
关键词：competencies ; health ; workforce ; systems-approach
