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Examples of workforce innovation

Successful innovations to address workforce shortages have examined the way that health clinicians work and the models of care used and applied.

In this step we will learn about evidence based innovations, including role substitution (sometimes called job substitution) and service delivery models that have the potential to make the best use of the health workforce.

Innovative solutions

We heard Gloria speak about how physician assistants are used to cover medical workforce shortages in Uganda. Role substitutions have been used in many countries as an innovative solution to health workforce shortages. This involves looking at the way clinicians work and the skills that are needed.

Examining the requirements and mix of skills, the way that jobs are designed and the models of care utilised are some of the innovative health and workforce reforms that can be adopted.

Nurse practitioners

Nurse practitioners have been used to address clinical workforce shortages, provide a service where none exists and is very cost-effective. In rural settings advanced nurse practitioners work with patients and families so that patients have access to timely care without the need to travel.

In the National Health System in the United Kingdom and United States, nurses have been used to perform endoscopy procedures to reduce delays to diagnosis and shorten waiting lists. However, this has met with resistance in some countries where attempts have been made to introduce this innovation. The evidence suggests that the same outcomes can be achieved and international standards attained with good acceptance from patients (Hui et al 2015).

Allied health assistants

Pharmacists can also work in extended practice roles. They can undertake simple immunisation and provide advice on treatment solutions for minor injuries, such as wounds and illnesses such as cold and flu. Clinical pharmacists working in acute care settings are trained in patient counselling and medication reviews and work closely with doctors to ensure that adverse drug interactions are avoided. Allied health assistants work with health professionals to assist in managing patient treatment plans, the equipment and to perform other supervised tasks.

Physician assistants

To address shortages in medical practitioners, physician assistants practise a limited scope of medicine working as members of a multidisciplinary team. The physician assistant will usually work under the delegation and supervision of a medical practitioner. Physician assistants are used to address workforce shortages in a number of countries including India, Africa, Canada and The Netherlands (Lovink et al 2017).

Alternative settings

Delivery of services in alternative settings can also address workforce shortages. Hospital in the home, for example has been successfully used in rural and urban settings. Highly skilled acute nurses deliver treatments in the home to those normally requiring admission to a hospital ward. These highly skilled and independent practitioners visit patients daily in their home to administer treatment, monitor vital signs and put in place remedial action, if necessary. This model of care creates additional bed capacity in the hospital and frees up medical clinicians to treat new patients.

Community health workers

Community health workers can help address the shortage of health workers, improve access and save costs (Javanparast et al 2018). Community health workers take on a broad range of roles including basic clinical services and diagnostic procedures such as pap smears and immunisation, counselling, education and health promotion.

Innovation initiatives must be needs-based and outcome-oriented. The ultimate aim is to improve population health. Workforce innovations must therefore be supported by evidence-based research.

Your Task

Watch the following video on the nurse practitioner.

This is an additional video, hosted on YouTube.

This is an advanced role for the nurse. It also demonstrates a new model of health care.  Do you agree that we need more nurse practitioners? Share your thoughts with others on the course.


Hui et al. (2015). Comparison of colonoscopic performance between medical and nurse endoscopists: a non-inferiority randomised controlled study, Asia British Medical Journal, 54(7). Retrieved from:

Javanparast, S., Windle, A., Baum, F. (2018). Community health worker programs to improve healthcare access and equity: Are they only relevant to low- and middle-income countries? International Journal of Health Policy and Management, 7(10), 943–954. Retrieved from:

Lovink et al (2017). Effects of substituting nurse practitioners, physician assistants or nurses for physicians concerning healthcare for the ageing population: a systematic literature review, JAN 73(9), 2084-2102. Retrieved from:

Martínez-González et al. (2014). Substitution of physicians by nurses in primary care: a systematic review and meta-analysis, BMC Health Services Research, 14(214). Retrieved from:

SARRAH. (2018). Transition toolkit to remote and rural practice produced by Services for Rural and Remote Allied Health. Retrieved from:

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