An alternative methodology for clinical skill-mix review: a pilot case study with a primary health care team

Abstract

Clinical skill mix is acknowledged to be one solution to the problem of providing high quality health care within a framework of restricted resources within the British National Health Service (NHS), but there are methodological difficulties inherent in its effective implementation. Of particular relevance here is the problem of taking accurate measurements of clinical outcomes following a set of treatment inputs, which contributes to the inconclusive and disappointing results of skill-mix reviews. This paper considers an alternative methodology which, rather than looking at clinical and fiscal outcomes as the primary indices of a successful skill mix, focuses on the relevance of task inputs within a given clinical domain. Using a psychometrically valid and reliable instrument, health care practitioners in a large primary health care team were asked to evaluate both the importance of a range of job tasks to the provision of quality care within their primary care role and their performance on them. Any perceived skill deficits thus revealed could inform either the commissioning of further training to improve performance levels or, alternatively, the future selection of staff to compensate for skills shortfall. The technique, although at an early stage of development for use in this way, is none the less potentially valuable for conducting skill mix-reviews and informing planning and education.