Maintenance Notice

Due to necessary scheduled maintenance, the JMIR Publications website will be unavailable from Monday, March 11, 2019 at 4:00 PM to 4:30 PM EST. We apologize in advance for any inconvenience this may cause you.

Who will be affected?


Currently submitted to: JMIR Nursing

Date Submitted: May 15, 2020
Open Peer Review Period: May 14, 2020 - Jul 9, 2020
(currently open for review)

Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.

Expanded roles, staff skills, and blurring professional boundaries: Impact of healthcare organisation ethos and structure on frontline staff

  • Rosemary Davidson; 
  • David Ian Barrett; 
  • Lorna Rixon; 
  • Stanton Newman; 


Co-ordinated Care (CC) and TeleHealth (TH) services have the potential to deliver quality care to chronically ill patients. They can both reduce the economic burden of chronic care and maximise the delivery of clinical services. Such services require new behaviours, routines and ways of working directed at improving health outcomes, administrative efficiency, cost effectiveness and user (patient and health professional) experience. As part of a multinational project exploring the use of CC and TH, questionnaires were sent to service managers and frontline practitioners. These questionnaires gathered quantitative and qualitative data related to organisational issues in the implementation of CC and TH. Three analytical stages were followed: Preliminary analysis allowing a direct comparison of responses of service managers and frontline staff to a range of organizational issues; Secondary analysis to establish statistically significant relationships between baseline and follow-up questionnaires; Qualitative analysis of free text responses of service managers and frontline staff. Both frontline practitioners and managers highlighted that training, tailored to the needs of different professional groups and staff grades, was a crucial element in the successful implementation of new services. Frontline staff were markedly less positive than managers in their views regarding the responsiveness of their organisation and pace of change. The data presented provides evidence that the set-up of healthcare services are positively associated with outcomes in a number of areas, particularly tailored staff training, rewards for good service, staff satisfaction and patient involvement.


Please cite as:

Davidson R, Barrett DI, Rixon L, Newman S

Expanded roles, staff skills, and blurring professional boundaries: Impact of healthcare organisation ethos and structure on frontline staff

JMIR Preprints. 15/05/2020:20282

DOI: 10.2196/preprints.20282


Download PDF

Request queued. Please wait while the file is being generated. It may take some time.

© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.