Factors influencing the development, recruitment, integration, retention and career development of advanced practice providers in hospital health care teams: a scoping review

BACKGROUND

Advanced practice providers (APPs), including physician assistants/associates (PAs), nurse practitioners (NPs) and other non-physician roles, have been developed largely to meet changing healthcare demand and increasing workforce shortages. First introduced in primary care in the US, APPs are prevalent in secondary care across different specialty areas in different countries around the world. In this scoping review, we aimed to summarise the factors influencing the development, recruitment, integration, retention and career development of APP roles in hospital health care teams.

METHODS

We conducted a scoping review and searched Ovid MEDLINE, Ovid Embase, Ovid Global Health, Ovid PsycINFO and EBSCOhost CINAHL to obtain relevant articles published between Jan 2000 and Apr 2023 that focused on workforce management of APP roles in secondary care. Articles were screened by two reviewers independently. Data from included articles were charted and coded iteratively to summarise factors influencing APP development, recruitment, integration, retention and career development across different health system structural levels (macro-, meso- and micro-level).

RESULTS

We identified and analysed 273 articles that originated mostly from high-income countries, e.g. the US (n = 115) and the UK (n = 52), and primarily focused on NP (n = 183) and PA (n = 41). At the macro-level, broader workforce supply, national/regional workforce policies such as work-hour restrictions on physicians, APP scope of practice regulations, and views of external collaborators, stakeholders and public representation of APPs influenced organisations' decisions on developing and managing APP roles. At the meso-level, organisational and departmental characteristics, organisational planning, strategy and policy, availability of resources, local experiences and evidence as well as views and perceptions of local organisational leaders, champions and other departments influenced all stages of APP role management. Lastly at the micro-level, individual APPs' backgrounds and characteristics, clinical team members' perceptions, understanding and relationship with APP roles, and patient perceptions and preferences also influenced how APPs are developed, integrated and retained.

CONCLUSIONS

We summarised a wide range of factors influencing APP role development and management in secondary care teams. We highlighted the importance for organisations to develop context-specific workforce solutions and strategies with long-term investment, significant resource input and transparent processes to tackle evolving healthcare challenges.

Empowering or addicting? An analysis of the effects of team members–supervisor relationships on job satisfaction in healthcare

Patient-centredness relies on integrated care, which requires teamwork to be effectively implemented. Positive relationships between team members and supervisors are crucial to enhance health professionals’ satisfaction with their job and, consequently, to increase their commitment to organizational excellence. However, the positive effects of team members–supervisor exchange may dilute when the team is endowed with autonomy at work. The article proposes a moderation analysis aimed at collecting evidence of the implications of team members–supervisor relationships on job satisfaction (JS) with team autonomy (TA) as a moderating variable. Results of the study suggest that positive exchanges between team members and supervisors enhance health professionals’ satisfaction with their job. However, TA acts as a negative and statistically significant moderator. Good exchanges between team members and their supervisor seem to lose their positive effects on JS when health professionals are provided with a greater self-determination to accomplish their organizational activities. Tailored management interventions should be designed to sustain teamwork when increased autonomy at work is assigned to health professionals.

What professionals consider when designing a modular service architecture?

Purpose

The purpose of this paper is to explore how functional and appropriateness arguments influence the adoption of modularity principles during the design of a professional service architecture.

Design/methodology/approach

Action design research was conducted to examine the design process of a modular service architecture for specialised elderly care by a multi-professional group. Data collection methods included, partly participatory, observations of the interactions between professionals during the design process, interviews and document analysis. Data analysis focussed on the emerging design choices and the arguments underlying them.

Findings

A wide range of both functional and appropriateness considerations were enlisted during the design process. The three core modularity principles were adapted to varying degrees. In terms of the design outcome, the interdependencies between the modularity principles necessitated two trade-offs in the modular design. A third trade-off occurred between modularity and the need for professional inference where services were characterised by uncertainty. Appropriateness was achieved through the professionals reframing and translating the abstract modularity concept to reconcile the concept’s functionality with their professional norms, values and established practices.

Originality/value

The study adds to service modularity theory by formulating three trade-offs that are required in translating the core modularity principles into a functional set of design choices for a multi-professional service environment. Moreover, the inherent intertwinedness of the core modularity principles in professional services requires an iterative design process. Finally, the authors saw that the ambiguity present in the service modularity concept can be used to develop a design that is deemed appropriate by professionals.