Public-private partnerships in the Potuguese health sector.

In Portugal, the PPP in the healthcare sector appeared only at the dawn of the new century, with the central feature of including clinical activities within its scope. Currently--except for one hospital--the Portuguese PPP experience can only be assessed in terms of conceptual model and tender processes. The analysis showed that, based on arguments associated with non-contractible investment and ex-post renegotiation opportunities, hospitals with higher technological complexity should exclude clinical activities from the PPP contract, and also that, despite the time-consuming process, the PPP can be considered a success in price competition dimension. The analysis also showed that, assessing the performance of the single PPP hospital in Portugal with two comparable units, there is no evidence that the best or worst results are correlated with the legal status and with the established management model.

How can a country learn from the experience of another? Expanding nurses' scope of practice in Portugal: lessons from England.

INTRODUCTION: The composition of the Portuguese health workforce suggests an inefficient combination of nurses and physicians. Evidence indicates that, under specific circumstances, nurses can provide equivalent care to that delivered by physicians. England has a broader experience in developing policy-led initiatives in this field from which Portugal can learn. The study explores this issue, aiming to assist in informing policy formulation. METHODS: The study analysed English policies which led to the enhancement of nurses' roles between 2000 and 2010. A literature review and interviews with selected informants were carried out. RESULTS: In 2000, the British government adopted a new policy for the health sector. A "working differently" strategy was subsequently developed. An increase in demand as well as the failure to improve access, efficiency and quality of service were the drivers for change. The strategy was fostered by the idea of building roles around patients and several tools were developed in order to trigger change, in which different stakeholders performed a central role. In spite of the registered progress, by the end of 2010, some issues remained unresolved, namely the lack of a specific framework to regulate nurses' expanded functions. CONCLUSION: This study provides Portuguese policy-makers with useful knowledge for defining a strategy to expand nurses' scope of practice, by proposing a general framework of key aspects to be taken into account.

Health professionals moving to... and from Portugal.

The mobility of health professionals in the European Union is a phenomenon which policy-makers must take into account to provide the conditions to adjust for demand and supply of health services. This paper presents the case of Portugal, a country which at the same time imports and exports health workers. Since the early 1990s Portugal became a destination country receiving foreign health care professionals. This situation is now changing with the current economic situation as fewer immigrants come and more Portuguese emigrate. Foreigners coming to Portugal do so in part for similar reasons that bring Portuguese to want to emigrate, mainly the search for better work conditions and professional development opportunities. The emigration of Portuguese health professionals is also stimulated by the difficulty for recently graduated nurses, dentists and diagnostic and therapeutic technicians to find employment, low salaries in the public and private sectors, heavy workloads, remuneration not related to performance and poor career prospects. The paradoxes described in this study illustrate the consequences of the absence of a policy for the health professions. Strategies based on evidence, and on an integrated information system that captures the dynamic evolution of the workforce in health are not only necessary but also a good investment.

Nurses in advanced roles: a review of acceptability in Portugal.

OBJECTIVE: This paper focuses on the policy context for the deployment of nurses in advanced roles, with particular reference to Portugal. The health sector in Portugal, as in all countries, is labour intensive, and the scope to utilise nurses in more advanced roles is currently being debated. METHODS: Mixed methods were used: an analysis of international data on the nursing workforce; an analysis of documents and media articles; interviews with key-informants; an online survey of managers, and a technical workshop with key-informants. CONCLUSIONS: The limited evidence base on nurses in advanced roles in Portugal is a constraint on progress, but it is not an excuse for inaction. Further research in Portugal on health professionals in innovative roles would assist in informing policy direction. There is the need to move forward with a fully informed policy dialogue, taking account of the current political, economic and health service realities of Portugal.

Nurses in advanced roles: a review of acceptability in Portugal / Enfermeiros em funções avançadas: uma análise da aceitação em Portugal / Las enfermeras de competencias avanzadas: una revisión de aceptación en Portugal

OBJECTIVE: This paper focuses on the policy context for the deployment of nurses in advanced roles, with particular reference to Portugal. The health sector in Portugal, as in all countries, is labour intensive, and the scope to utilise nurses in more advanced roles is currently being debated. METHODS: Mixed methods were used: an analysis of international data on the nursing workforce; an analysis of documents and media articles; interviews with key-informants; an online survey of managers, and a technical workshop with key-informants. CONCLUSIONS: The limited evidence base on nurses in advanced roles in Portugal is a constraint on progress, but it is not an excuse for inaction. Further research in Portugal on health professionals in innovative roles would assist in informing policy direction. There is the need to move forward with a fully informed policy dialogue, taking account of the current political, economic and health service realities of Portugal.

OBJETIVO: este artigo foca o contexto político da implementação de competências avançadas em enfermagem, com ênfase no caso português. O setor da saúde em Portugal, assim como em outros países, usa mão de obra intensa, e a prática de enfermeiros com competências avançadas está atualmente em debate. MÉTODOS: abordagem de métodos mistos com análise de dados internacionais sobre a mão de obra em enfermagem, documentos e notícias na mídia, entrevistas com informantes-chave, questionário online e um workshop técnico com informantes-chave. CONCLUSÕES: existe base de evidência limitada sobre enfermeiros com funções avançadas em Portugal, o que é um entrave ao progresso, mas não uma desculpa para a inércia. Mais estudos conduzidos em Portugal, abordando funções inovadoras para profissionais da saúde, ajudariam a informar e direcionar políticas na área. É necessário avançar para informar, de forma plena, o diálogo político, levando em consideração a realidade atual em termos políticos, econômicos e do sistema de saúde em Portugal.

OBJETIVO: Este estudio se focaliza en el contexto político del desarrollo de competencias avanzadas de enfermería, con énfasis en el caso portugués. El sector de la salud en Portugal, como en todos los países, es intensivo en mano de obra, y la posibilidad de utilizar enfermeros en funciones más avanzadas está actualmente en debate. MÉTODOS: Fue utilizado una aproximación mixta: análisis de datos internacionales sobre la fuerza de trabajo de enfermería; análisis de documentos y noticias; entrevistas con informadores clave; un cuestionario online y una oficina técnica con informadores clave. CONCLUSIONES: La limitada base de evidencia sobre la extensión de competencias de los enfermeros en Portugal es un obstáculo para el progreso pero no es una excusa para la inacción. Investigación adicional sobre profesionales de la salud en papeles innovadores podría ayudar a informar y direccionar la decisión política. Es necesario avanzar con un diálogo político plenamente informado, considerando la realidad político económica actual y el sistema de servicios de salud en Portugal.