From Theory To Practice: Improving The SHIFT-SHARE Framework With Stakeholder Insights From India

Background: Task shifting and sharing (TS/S) are strategies to transfer tasks from more to less specialised caregivers to address workforce shortages. Using theoretical constructs from popular change management theories, implementation frameworks and tools, we conceptualised a new strategic framework for TS/S called the SHIFT-SHARE. This study aims to validate and refine SHIFT-SHARE, informed by existing interventions and feedback from stakeholders in India, a nation with large populations and acute provider shortages. Methods: This mixed-methods study employs semi-structured interviews, focus group discussions and non-participatory observations with stakeholders from healthcare centres, non-profits and capacity-building institutions. Participants, recruited via convenience and snowball sampling, include those involved in TS/S, managers and leadership, trainers, auditors, funders, academicians and patients. With 102 participants recruited, the study assesses alignment between SHIFT-SHARE and practices, keeping participants blind to the framework to avoid bias during interviews and observations. During group discussions, SHIFT-SHARE is presented for feedback on feasibility and applicability. Data is analysed thematically. Ethics approval was obtained from the Edinburgh Medical School Research Ethics Committee, and written informed consent was obtained from participants. Findings: All participants appreciated the purpose and structure of SHIFT-SHARE. They recommended integrating prompts for service organisers to streamline TS/S. Challenges to implementing TS/S were identified, such as lack of documentation and policies for protecting and incentivising providers undertaking additional tasks, leading to inadequate motivation. Sociocultural factors, such as language and caste, impact TS/S in rural areas. Most interventions lack mechanisms for evaluating the quality of shifted or shared services. Hands-on skills-based tasks are easier to transfer than those requiring theoretical foundations. These are initial findings and we continue to consolidate them as the study progresses. Interpretation: The study demonstrates support for SHIFT-SHARE, highlighting its potential to improve planning of services via task redistributions and identifies best practices in implementing TS/S. Strengths of this study include comprehensive stakeholder engagement. Limitations include the potential for selection bias due to purposive sampling. This study underscores the importance of stakeholder engagement in improving frameworks, providing a structure for policymakers and administrators to systematically integrate TS/S into care models.