Task Shifting
PhD Serena Alvino, Dott. Paolo Michelutti
Task Shifting concept and main applications
Task shifting refers to the rational redistribution of roles and responsibilities among health professionals, as well as between professionals, patients, informal carers and technologies. This approach aims to make optimal use of available skills and resources to ensure effective, safe and sustainable care delivery.
Initially developed in response to workforce shortages, task shifting is now recognised as a broader strategy to enhance health system resilience, adaptability and responsiveness to evolving population needs.
According to the European Expert Panel on effective ways of investing in Health, task shifting can also address health workforce burnout, improve patient experience and contribute to financial sustainability[1].
Three main forms of task shifting have been identified:
enhancement (expanding roles within existing professions),
substitution/delegation (transferring tasks across professional boundaries),
and innovation (creating new roles or integrating technological solutions).
Tasks can be reallocated to individuals with different qualifications or even upward to more specialised staff, depending on context-specific requirements.
The evidence demonstrates that, under the right conditions, many tasks traditionally reserved for certain professions can be performed equally well, or even more effectively, by others, provided that legal, regulatory and training frameworks are adapted accordingly.
TaSHI project
The TaSHI project[2], funded under the EU’s third Health Programme, aimed to advance task shifting policies by analyzing and piloting task shifting strategies across five European countries in primary care, mental health and telemedicine. It developed practical tools, training materials and case studies to support EU Member States in implementing health workforce reforms. The project fostered stakeholder collaboration and provided evidence-based recommendations to address healthcare workforce challanges and enhance system efficiency.
In the context of the TaSHI project, task shifting was explored not only as a theoretical framework but as a practical, evidence-informed method. Through a series of pilot implementations across five EU countries, the project demonstrated how task shifting can be operationalised, identifying prerequisites such as regulatory adaptation, interprofessional training and cultural acceptance.
The project’s outputs, including a guidebook, case studies and a set of recommendations, provide a structured pathway for countries and organisations to implement and scale up task shifting practices effectively and sustainably.
One of the key enablers highlighted by the TaSHI project is the creation of interprofessional training that fosters collaborative practice and shared skills across different professional boundaries.
The TaSHI curriculum, developed in partnership with stakeholders and tested in three European countries (Italy, Estonia and Norway) was specifically designed to encourage interprofessional learning.
Grounded in adult learning theories and the Knowledge–Process–Practice model[3], the curriculum features two main modules:
- Fundamentals of task shifting
- and Tailoring task shifting to context and conditions.
It not only covers knowledge and skills but also focuses on attitudes and behavioural changes which are essential for helping professionals embrace new roles and work together effectively across various disciplines.
Training activities were centred around team-based learning, scenario discussions and reflective exercises, giving participants the chance to navigate role boundaries, negotiate shared responsibilities and build mutual trust.
Evaluation results from the pilot implementations showed that participants experienced a boost in confidence, openness and readiness to engage in task shifting initiatives. Importantly, interprofessional training was found to reduce resistance to change and address legal or cultural concerns about the redefinition of scopes of practice.
In general, the recommendations from the TaSHI project stress that training providers and educational institutions need to break down professional silos and systematically integrate task shifting into continuing professional development (CPD) and formal education. Interprofessional education should be promoted not just as a teaching method but also as a strategic tool for health system innovation, enhancing workforce resilience, improving care coordination and ultimately leading to better patient outcomes.
Lastly, the project highlights the necessity of aligning interprofessional training with national qualification frameworks, utilizing micro-credentials and open-access materials to encourage scalability.
Integration of a Learning Outcome about Task Shifting into the EU Curriculum
Through its close dialogue with the associated partner PROMIS and the Italian Ministry of Health and its initiatives, SI4Life learnt about TaSHI project; given the articulate and wide-spanning nature of the project and its evident relevance in the EU framework, TEAMCARE partners reckon that a general awareness on the topic of Task Shifting might have proven especially useful for the CBIT expert. In order to know more about this topic, in September 2024, SI4Life, a leader of EU Curriculum development, organized an online meeting with the TaSHI project coordinator - Eszter Kovacs from Semmelweis University in Budapest - who explained the project and illustrated the results achieved.
Following this meeting, although the IFC was already delivered by then, partners decided to include as a new LO, hooking it to an existing competency of the IFC, whose title is “To foster task shifting process, being aware of its impact and being able to take part in task delegation, sharing and shifting to other professionals, patients or machines”
It introduces the concept of Task Shifting to professionals working in CBIT by:
defining skill-mix and the main elements of task shifting approach, the main EU reference documents, as well as the conditions relevant for task shifting;
outlining facilitators and barriers for task shifting, as well as the clinical and legal risks
fostering the analysis of the possible application of task shifting in the national/regional/local context, tailoring task shifting to rules and conditions and the evaluation of the impact of task delegation, sharing and shifting to other professionals, patients or machines.
[1] Expert Panel on effective ways of investing in Health (EXPH), Task shifting and health system design, 26 June 2019; https://health.ec.europa.eu/system/files/2019-11/023_taskshifting_en_0.pdf
[2] For more information on the TaSHI project please visit the project’s website https://tashiproject.eu/
[3] Shaw T, Barnet S, Mcgregor D, Avery J. Using the Knowledge, Process, Practice (KPP) model for driving the design and development of online postgraduate medical education. Med Teach. 2015 Jan;37(1):53–8. doi: 10.3109/0142159X.2014.923563