13 research outputs found
Exploring the SHIFT-SHARE Framework: Conversations on Strategic Task Shifting and Sharing in Healthcare
Get PDFTask shifting and task sharing are workforce optimisation strategies in healthcare delivery, valuable in resource-constrained settings. They involve the delegation and collaborative distribution of specific tasks among different cadres of healthcare professionals to maximize efficiency and extend service reach. My poster displays the Strategic Healthcare Implementation Framework for Task Shifting, Sharing and Resource Enhancement (SHIFT-SHARE), built through my PhD research at the Usher Institute. With its six cyclical stages: Environmental Scanning, Priming, Risk Signal, Capacity Building, Monitoring and Evaluation, and Maintenance and Diffusion, SHIFT-SHARE is a practical approach to task reallocation and workforce optimisation in resource-constrained settings. SHIFT-SHARE draws on popular change management theories, including Lewin's Three-stage Model, Kotter's Eight-step Process of Leading Change, principles of Lean Management and Diffusion of Innovation, alongside implementation frameworks such as the RE-AIM, CFIR, and the Calderdale Framework. The framework development has been informed by fieldwork in India, where task shifting and sharing implementations across primary care, emergency medical services, and mental health sectors have been examined. Ongoing stakeholder experiences and feedback from these real-world applications continue to refine the framework's components. The poster facilitates engagement with attendees through prompts around the SHIFT-SHARE, enabling identification of task shifting and sharing opportunities within participants’ own programs or services. These discussions allow for real-time mapping of implementation considerations using the framework-based approach
Task shifting healthcare services in the post-COVID world:A scoping review
Get PDFTask shifting (TS) is the redistribution of healthcare services from specialised to less-qualified providers. Need for TS was intensified during COVID-19. We explore what impact TS had on service delivery during the pandemic and examine how the pandemic affected TS strategies globally. We searched five databases in October 2022, namely Medline, CINAHL Plus, Elsevier, Global Health and Google Scholar. 35 citations were selected following the PRISMA-ScR guidelines. We analysed data thematically and utilised the WHO health systems framework and emergent themes to frame findings. We uncovered instances of TS in countries across all income levels. 63% (n = 22) of the articles discussed the impact of TS on healthcare services. These encompassed services related to mental healthcare, HIV, sexual and reproductive health, nutrition and rheumatoid diseases. The remaining 37% (n = 13) focused on how the pandemic altered strategies for TS, particularly in services related to mental healthcare, HIV, hypertension, diabetes and emergency care. We also found that studies differed in how they reported TS, with majority using terms "task shifting", followed by "task sharing", "task shifting and sharing" and "task delegation". Our analysis demonstrates that TS had a substantial impact across healthcare systems. Modifying roles through training and collaboration strengthened workforce and enhanced diagnostic services. Strategic leadership played a crucial role in the process. More research on the financial aspects of TS during pandemics is required. Stakeholders generally accepted TS, but transferring staff between healthcare programs caused unintended disruptions. The pandemic reshaped TS, moving training, patient care and consultations to digital platforms. Virtual interventions showed promise, but digital access remained a challenge. Healthcare organisations adapted by modifying procedures, pathways and staff precautions. We recommend refining strategies for TS, and expanding on it to address workforce shortages, improve access, and enhance services, not only during crises but also beyond.</p
Mapping the Global Landscape of Task Shifting and Sharing: A Bibliographic Analysis from 1970 to 2022
Get PDFTask shifting and sharing (TS/S) are strategies for redistributing healthcare services from more specialised to less-qualified providers. It aims to optimise service delivery, particularly in resource-constrained settings with workforce shortages. Our paper provides an overview of the global landscape of TS/S research, examining the geographic distribution, publication trends, variation in descriptors for TS/S and the disease focus of articles on TS/S. We searched five databases in October 2022, namely Medline, CINAHL Plus, Elsevier, Global Health and Google Scholar. Our bibliographic analysis included 2,072 articles related to TS/S. We extracted data on the countries where the studies were based, the terminology used to describe task redistribution, and the specific disease focus of the publications. The findings were then visualised and analysed to uncover trends and insights. The results revealed that TS/S research has been most extensively conducted in certain African and South Asian countries, particularly South Africa, India, Uganda, Kenya and Malawi. The terminology used to describe task redistribution varied, with “task shifting” being the most common term (66.0%), followed by “task sharing” (24.0%), “task delegation” (6.0%), and “task shifting and sharing” (3.9%). The disease focus of the publications was diverse, with HIV (n=450) and depression (n=375) being the most studied conditions, A major proportion of articles (42.5%) did not carry a disease focus, instead concentrated on broader health systems strengthening and policy issues. In conclusion, our study offers insights into the global landscape of TS/S research, highlighting the geographic disparities, terminology nuances and disease-specific applications. We believe our findings can inform future research and practice, including the need for standardisation of terminology, targeted implementation efforts, expansion of disease-specific applications and a focus on comprehensive systems strengthening. By addressing these considerations, stakeholders can optimise the impact of TS/S strategies and improve healthcare delivery and outcomes globally
PRSIMA-ScR flow diagram of search and selection process of citations.
No full textPRSIMA-ScR flow diagram of search and selection process of citations.</p
Examples of the impact of the pandemic on strategies for task shifting.
No full textExamples of the impact of the pandemic on strategies for task shifting.</p
PRISMA-ScR checklist for reporting data.
No full textTask shifting (TS) is the redistribution of healthcare services from specialised to less-qualified providers. Need for TS was intensified during COVID-19. We explore what impact TS had on service delivery during the pandemic and examine how the pandemic affected TS strategies globally. We searched five databases in October 2022, namely Medline, CINAHL Plus, Elsevier, Global Health and Google Scholar. 35 citations were selected following the PRISMA-ScR guidelines. We analysed data thematically and utilised the WHO health systems framework and emergent themes to frame findings. We uncovered instances of TS in countries across all income levels. 63% (n = 22) of the articles discussed the impact of TS on healthcare services. These encompassed services related to mental healthcare, HIV, sexual and reproductive health, nutrition and rheumatoid diseases. The remaining 37% (n = 13) focused on how the pandemic altered strategies for TS, particularly in services related to mental healthcare, HIV, hypertension, diabetes and emergency care. We also found that studies differed in how they reported TS, with majority using terms “task shifting”, followed by “task sharing”, “task shifting and sharing” and “task delegation”. Our analysis demonstrates that TS had a substantial impact across healthcare systems. Modifying roles through training and collaboration strengthened workforce and enhanced diagnostic services. Strategic leadership played a crucial role in the process. More research on the financial aspects of TS during pandemics is required. Stakeholders generally accepted TS, but transferring staff between healthcare programs caused unintended disruptions. The pandemic reshaped TS, moving training, patient care and consultations to digital platforms. Virtual interventions showed promise, but digital access remained a challenge. Healthcare organisations adapted by modifying procedures, pathways and staff precautions. We recommend refining strategies for TS, and expanding on it to address workforce shortages, improve access, and enhance services, not only during crises but also beyond.</div
Global distribution of task shifting in healthcare services delivery since the onset of COVID-19 pandemic.
No full textGlobal distribution of task shifting in healthcare services delivery since the onset of COVID-19 pandemic.</p
Can anonymisation become disempowering? Rethinking ethics for low-risk global health research
Get PDFAnonymisation is intended to confer protection in research, yet in research where disclosure poses minimal threat, blanket anonymisation may disempower participants who explicitly seek recognition. Drawing on fieldwork examining task shifting and sharing in India, we present an example where the leadership of a non-profit questioned why they must stay anonymous, viewing research participation as a rare chance to share learnings, document impact, and build credibility; opportunities otherwise constrained by funding and capacity limitations. Looking through an epistemic injustice lens, we argue that mandatory anonymisation policies reflect global north institutional assumptions about protection rather than the preferences of participants, potentially perpetuating patterns where researchers advance their goals whilst organisations whose knowledge forms their evidence remain invisible. While anonymisation is critical for sensitive research where disclosure could do harm, we call for flexible ethical guidelines that empower participants to make informed choices regarding recognition if risks are minimal. We recommend tiered consent processes which allow participants to select their levels of identification, differentiate between organisational and individual visibility, and use context-dependent frameworks like the Global Ethical Research toolkit to move towards proportionate, context-dependent decisions that truly protect those we study
Examples of task shifting in healthcare services delivery since COVID-19 pandemic.
No full textExamples of task shifting in healthcare services delivery since COVID-19 pandemic.</p
Conceptualisation of the SHIFT–SHARE: A New Strategic Healthcare Implementation Framework for Task Shifting, Sharing and Resource Enhancement
Get PDFHealthcare systems challenged by chronic workforce shortages use task shifting and task sharing as tools to transfer certain services from providers with a high skill base to providers typically with fewer skills or qualifications. The World Health Organization’s global guidelines on task shifting advised countries to develop regulatory and implementation frameworks to expand task shifting for urgent public health issues. These frameworks direct, structure and support interventions by considering various factors that may affect their success. This paper outlines the process undertaken to develop a new implementation framework for task shifting and sharing, called the SHIFT-SHARE. We describe the framework and discuss our next steps to validate and refine it. SHIFT-SHARE draws on change management theories, particularly those of Lewin and Kotter, along with Lean Thinking and Diffusion of Innovation theory. It is further complemented by theoretical constructs of popular implementation frameworks, such as the Practical, Robust Implementation and Sustainability Model, Consolidated Framework for Implementation Research, Calderdale Framework and others. SHIFT-SHARE has six cyclical stages, namely (1) Environmental Scanning, (2) Priming, (3) Risk Signal, (4) Capacity Building, (5) Monitoring and Evaluation, and (6) Maintenance and Diffusion. Clinical safety, patient-centredness, ethical considerations and stakeholder feedback underpin every stage of SHIFT-SHARE. Following further development and refinement, our hope is that this framework can be used as a strategic planning tool to systematically redistribute tasks between different cadres of care providers, optimise resource usage, improve care access and quality, and introduce stability in service provision
