Views on task shifting implementation in Norwegian health policy and among health service managers – a mixed methods study

Abstract Introduction The World Health Organization promotes task shifting to enhance access and efficiency in health systems and mitigate the shortage of health professionals. Such global recommendations are adapted to national health policies and are to be implemented in local contexts. The Norwegian government propose guidance for task shifting, and implementation largely depends on the views and practices of health service managers. This study includes the views on task shifting in Norwegian health policy and among health service managers, asking; what are the responsibilities of managers in implementation, and what actors should they include in task shifting? Methods A mixed‑methods approach captured both the guidance in health policy documents and the situated views among managers. The qualitative part was analysis of guidance on task shifting in three Norwegian health policy documents from 2023 to 2024: a white paper, an Official Norwegian Report, and an operationalization of hospital waiting times reduction. In September 2024, we conducted a cross-sectional study in Western Norway, including 139 health service managers. The documents were analyzed by content analysis, and the survey by descriptive statistics and correlation analysis. Results More task shifting was endorsed both in the policy documents and among managers. The government recommended building competences at the bottom levels of the workforce, primarily among skilled workers. Task shifting could also include technology, patients and non-governmental organizations. Most of the health service managers focused on utilizing competencies at the top levels of the workforce, e.g. by shifting tasks from physicians to nurses. The policy recommended three areas of managerial responsibilities: strategic competency planning, patient safety and leading staff. To managers, strategic competence planning was done annually, patient safety was less salient, while leading staff were important. Managers were positive overall about implementing task shifting despite organizational challenges. Discussion/conclusions The views on task shifting in policy documents and among managers differed on what actors to include. Being in the early stage of the implementation process may explain why the managerial areas of responsibility were less prominent in the managers’ responses. However, views were overall positive towards involving multiple actors more than today.