Conceptualisation of the SHIFT–SHARE: A New Strategic Healthcare Implementation Framework for Task Shifting, Sharing and Resource Enhancement

Abstract

AbstractHealthcare 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.