Facilitators and barriers to implementing task shifting: Expanding the scope of practice of clinical technologists in the Netherlands

Maarten de Haan*, Yvonne van Eijk-Hustings, Monique Bessems-Beks, Carmen Dirksen, Hubertus J. M. Vrijhoef

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review


Despite recent studies confirming task shifting is both safe and effective, its implementation has proven difficult in practice. So too in the Netherlands, where legal barriers enforcing strict professional boundaries have historically limited task shifting. In recent years, Dutch policymakers have experimented with temporary expanded scopes of practice (ESP) for several professional groups, with the aim to facilitate task shifting in order to increase the overall effectiveness and efficiency of health care. The Clinical Technologist (CT), is an emerging new professional group that has received such a temporary ESP pending an evaluation. This paper reports the qualitative findings of the implementation process of providing CTs with an temporary ESP. Data collection consisted of 69 semi-structured interviews, 3 focus group interviews and 9 participant observations, conducted between September 2015 and October 2017. Analysis was conducted through an 'editing analysis style' whereby data were categorized using the conceptual framework of Grol & Wensing's implementation model. The study suggests that social features are of great importance when implementing task shifting. In situations with few social barriers, organizational and administrative barriers seem to be less dominant, thereby expediting the overall implementation process. Consequently, we recommend that policymakers should prioritize social features over organizational features when implementing task shifting. (C) 2019 Elsevier B.V. All rights reserved.

Original languageEnglish
Pages (from-to)1076-1082
Number of pages7
JournalHealth Policy
Issue number11
Publication statusPublished - Nov 2019


  • Task shifting
  • Professional roles
  • Implementation
  • Evaluation research
  • Health policy

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