Task shifting in surgery: Lessons from an Indian Heart Hospital.

We present a case study that illustrates task shifting, the transfer of activities from senior to junior colleagues, in the context of cardiac surgery at the Narayana Health City Cardiac Hospital (NH) in India. The case discusses the factors driving the adoption of task shifting at NH and identifies the implications of task shifting for surgeon training, surgical capacity, and procedure costs. A comparison of the outcomes of two senior surgeons with similar experience, workload, and patient profiles--but varying in their level of task shifting--suggests that shifting of lower complexity tasks by senior surgeons to trained junior colleagues does not negatively impact in-hospital mortality and post-procedure length of stay. The study concludes with a discussion of task shifting's potential to improve access to affordable tertiary care in resource-constrained settings.