Reality or rhetoric: Is Allied Health clinical supervision really all that?

Mrs Janelle Roby1, Mrs Rebekah Reurich1, Dr Sue Fitzpatrick1

1Illawarra Shoalhaven Local Health District, Wollongong, Australia

Background:The complex demands of modern healthcare and clinical governance has resulted in increasing demand for effective clinical supervision (CS) for Allied Health professionals (AHP’s).  A growing body of literature has explored models and frameworks for delivering effective clinical supervision, however, how this translates in experience and value for AHP’s warrants exploration.

Clinical supervision for AHP’s in the Illawarra Shoalhaven Local Health District (ISLHD) is supported by a mandatory policy outlining principles of CS, and this research sought to explore their experience.

The themes uncovered will be shared in our presentation as we answer the question: Is a clinical supervision policy for AHP’s reality or rhetoric?

Methods: A cross sectional series of thirteen action research focus groups were held across nine rural and regional sites.  Participant experiences were recorded in view of the groups on butcher’s paper.  Demographic data was captured via a de-identified questionnaire. Theming was conducted by the moderators alongside an independent researcher.

Results: Sixty-seven participants from ten allied health professions attended the focus groups, with broad representation of professional levels/experience. Three central domains which affect experience of CS were identified being people, performance and process; which sit within the multidirectional meta-theme of culture.  A model has been proposed to demonstrate this interplay.

The existing ISLHD policy was updated and a district portfolio created for the ongoing development of AHP CS.

 

Conclusion: A collaboratively developed and organisationally endorsed policy is important in engaging AHP’s in clinical supervision, however, its implementation including culture and the identified CS domains need careful consideration to ensure the policy and experience is effective and valuable for participants.

It is hoped that sharing this process with conference participants will continue the discourse around clinical supervision and facilitate a shift from rhetoric into a valuable resource.


Biography:

Janelle Roby is a Senior Physiotherapist and Disability Liaison Clinician with the Illawarra Shoalhaven Local Health District (ISLHD).  She holds a Masters in Health Leadership and Management and a Bachelor of Physiotherapy.

Rebekah Reurich is a Senior Social Worker with the Illawarra Brain Injury Service in the Illawarra Shoalhaven Local Health District.  She holds a Master of Social Work degree.

Dr Sue Fitzpatrick is the Illawarra Shoalhaven Local Health District Executive Director of Allied Health and the former

ISLHD Speech Pathology Head of Department.  She is a Doctor of Health Science having completed her thesis in the field of clinical supervision.

The Metro South Health Allied Health Assistant Learning and Development Project

Mr Jeremy Lindsay1

1Metro South Hosptial And Health Service, Brisbane, Australia

Background: Perceived inconsistent and/or insufficient allied health assistant (AHA) learning and development is commonly reported by allied health professionals (AHP/s) as a barrier to enhanced task delegation to AHAs, and may prevent optimal utilisation of AHAs, with potential service efficiency, and quality of care implications.

Aims:The MSH AHA Learning and Development Project began in 2016 and was aimed to address the lack of a clear and coordinated MSH AHA learning and development plan, which had resulted in fragmentation of the AHA training procedures and resources across the different MSH locations and services. The project aims to produce a new framework to improve the structure and consistency of AHA learning and development, optimising AHA clinical practice, and driving excellence in allied health service delivery across MSH.

Methods: Project activities to date have included: email based surveys of AH professional directors to map the MSH AHA workforce; literature review and benchmarking of existing learning and capability frameworks; AHA focus groups to evaluate and select most appropriate framework; and surveys of AHA learning and developing needs.

Results: Project outcomes include: formation of the MSH AHA Network; creation of the MSH AHA Intranet (QHEPS) page, development and publication of MSH AHA Capability Development Framework (CDF) with Learning and Development planning resource; and implementation of the inaugural MSH AHA Learning and Development Forum in May 2018.

Next steps include: Implementation and evaluation of the AHA CDF; gap analysis of existing AHA learning and development resources; sourcing and/or development of new resources to fill gaps identified.

Future directions: Implementation of the Allied Health Professional Office Queensland AHA framework audit tool, and a specific evaluation of current AHP delegation practices.


Biography:

Jeremy Lindsay is a registered Physiotherapist with 14 years clinical work experience within Queensland and the UK. He has worked in allied health workforce develop roles at both Metro South Hospital and Health Service, and in the Department of Health at the Allied Health Professions’ Office of Queensland. Through this work he has developed an interest in the use of allied health assistant roles, allied health professional expanded scope roles, and interdisciplinary clinical education to support the delivery of efficient, high quality, patient-focused care.

Allied Health Rural Generalist Training Program – Experiences from the top end

Ms Justine Williams1, Ms Renae Moore1

1Top End Health Services, Casuarina, Australia

Introduction: The Allied Health Rural Generalist Pathway is a strategy to build the capacity, value and sustainability of allied health services and multi-disciplinary teams in rural and remote areas.  The components of an allied health rural generalist pathway are:

  1. Service models that address the challenges of providing the broad range of healthcare needs of rural and remote communities,
  2. Workforce and employment structures that support the development of rural generalist practice capabilities, and
  3. an education program tailored to the needs of rural generalist practitioners.

This paper provides an overview of the application of the Allied Health Rural Generalist Training Program in the Top End from 2017 to date, shares the key learnings of our journey so far and our plans for the program moving forward.

Implementation: In 2017, the Top End Health Services committed to funding four rural generalist training positions for up to two years on a rolling funding basis. The initial cohort, with trainees from the professions of podiatry, pharmacy and speech pathology, commenced in July 2017 and concluded their traineeship in December 2018. A further trainee, a physiotherapy graduate joined the program in April 2018.

Discussion of Challenges & Opportunities: The vast geography of the Top End combined with small and disparate populations covered by the Top End Health Services of the Northern Territory provide great challenges in delivering comprehensive integration of care close to homes.   Unique challenges experienced with this program have included engagement with the many stakeholders about the strategy, the scope of the service development projects and “isolation” of the graduates from their professional colleagues.  Learnings from the initial cohort will be applied to the next cohort of graduates due to commence in early 2019.


Biography:

Renae’s professional background is a speech pathologist with experience in remote, rural and urban settings across health, education and community sectors. Renae has been actively involved in rural and remote allied health issues at a local, State/Territory and national level throughout her career More recently, Renae has worked in a variety of senior policy and project roles across aboriginal health, early childhood intervention, aged and disability; and workforce strategy; including the position of Principal Allied Health Advisor for NT Health. Currently, Renae is the Executive Director Allied Health with Top End Health Services.

Justine Williams is the TEHS Allied Health Workforce Development Officer. She has worked for many years as an Occupational Therapist, Team Leader and Manager in a variety of health settings in the Northern Territory.  She is based in Darwin and has had oversight of the Allied Health Rural Generalist Training Program since 2017.

Allied Health succession planning practices in Large Health District: A descriptive study

Ms Kate Vickers1,2, Dr. Nazlee Siddiqui2, Ms Sue  Colley1, Ms Leann Lancaster1

1South Western Sydney Local Health District, Liverpool, Australia, 2The Unviersity of Tasmania, Rozelle, Australia

Introduction: Succession planning (SP) is an effective strategy to manage workforce shortages and high staff turn-over. The SP process includes: strategic planning; desired skills and needs identification; development processes; mentoring and resources. In a large Local Health District, Allied Health (AH) has informal SP processes in place for workforce planning and development. This study aims to (1) evaluate if AH informal SP practices meet this process; (2) identify if AH staff perceive a district-wide SP program meets their needs.

Method: A descriptive qualitative design using focus group discussion was utilised for the study. Two groups of participants were sampled, which included drivers of SP (n = 9), that is AH managers and receivers of SP (n = 10), that is staff progressing their careers. Data was analysed using thematic analysis.

Results: Strategic planning, desired skills identification and development processes were inconsistently informally implemented within the district. However, implementation was dependent on manager’s attitude and the availability of development opportunities which focused predominantly on managerial and leadership positions. Two areas that were viewed as inadequate were mentoring and resource allocation to support SP, particularly for highly specialised clinical positions. All participants demonstrated limited awareness and knowledge of the district-wide formal SP program. Receivers of SP, identified the program has potential to meet their development needs if the barriers above are well managed. Drivers of SP identified that there is lack of opportunity to translate the management skills learned in the district-wide program.

Conclusion: Current and desired AH SP practices reflect the recommended processes of SP. The perception is that the current district-wide formal SP program does not meet the needs of AH but has potential to do so. Development and maturing of informal SP processes needs to occur to reach district-wide consistency with a shift in focus towards highly-specialised clinical position.


Biography:

Kate Vickers has been a speech pathologist for 15 years and is currently the Allied Health Workforce and Development Officer for South Western Sydney Local Health District. She has been in the Workforce and Development Officer role for over 5 years and in that time has focused on projects for workforce redesign, staff development and education. She is also undertaking a Masters of Health Management, specialising in organisational development.

Mapping rural workforce outcomes from a longitudinal study of allied health graduates

Associate Professor Leanne Brown1, Associate Professor Tony Smith2, Dr Luke Wakely1, Mrs Rebecca  Wolfgang1, Mrs Alexandra Little1, Dr Julie Burrows1

1University of Newcastle Department of Rural Health, Tamworth, Australia, 2University of Newcastle Department of Rural Health, Taree, Australia

Background: The allied health workforce in Australia is unevenly distributed and under-represented in rural and remote areas. The University of Newcastle Department of Rural Health (UONDRH), which is funded under the Commonwealth’s Rural Health Multidisciplinary Training program, supports student placements in rural northern NSW. Students can participate in short-term placements of 2-8 weeks, up to full-year attachments in a range of rural locations. These rural immersion experiences, provide students with an opportunity to live and study in a multi-disciplinary environment, engage with the local community, and participate in interprofessional education. This longitudinal study aims to track the workforce outcomes of allied health students undertaking a rural immersion placement experience with the UONDRH.

Method: Allied health students, from medical radiation science, nutrition and dietetics, physiotherapy, occupational therapy, physiotherapy and speech pathology, undertaking one or more placements in a UONDRH sites were invited to participate. Students had the option of participating in one or more study components: (i) an end-of-placement survey; (ii) end of placement semi-structured interview and (iii) a follow-up survey at 1, 3 and 5-years post-graduation. Workforce outcome data has been summarised, with mapping of the work locations of graduates at 1, 3 and 5-years post-graduation.

Results: A total of 476 students who graduated between 2011-2017, consented to follow-up surveys. Graduates were surveyed at 1-year (n=253), 3-years (n=140) and 5-years (n=65) post-graduation and their workplace locations mapped. The proportion of graduates whose employment was based in a rural or remote location were 42% at 1-year, 37% at 3-years and 24% at 5-years.

Conclusion: Initial outcomes show good rural return with ongoing tracking to provide further insights into the contribution of the UONDRH program to the rural and remote allied health workforce in Australia.


Biography:

Leanne Brown has worked as a rural academic for over 15 years, based at the University of Newcastle Department of Rural Health in Tamworth NSW.  She is an Advanced Accredited Practicing Dietitian with eight years experience in the metropolitan health sector before going rural. She is leading research into the allied health workforce in rural and remote Australia.

Clinical Supervision and Allied Health practice: What are we doing? And does it make a difference?

Mr Kim Nguyen1, Dr Imelda Burgman1, Dr Anne Vertigan1

1Hunter New England Local Health District, New Lambton, Australia

Background: Clinical Supervision (CS) is an essential component of clinical governance, and a measure of clinical performance and effectiveness. The research investigated CS practice in Hunter New England Local Health District (HNE Health) for dietitians, occupational therapists, physiotherapists, podiatrists and speech pathologists; and explored the perceptions of these allied health professionals on the impact of CS on patient outcomes.

Methods: A mixed methods sequential design was employed. Phase One: A customised online survey including the Manchester Clinical Supervision Scale-26. The survey was partly completed by 201 participants, with 166 participants fully completing the survey. Phase Two: 15 semi-structured interviews were conducted and analysed using grounded theory, with iterative analysis of 88 free text survey responses, and survey responses on CS style and perceived patient outcomes.

Results: Phase One: CS arrangements included face to face, group and peer supervision, with most (86%) provided on site. Most CS sessions were an hour in length (54%) and occurred monthly (39%). CS was considered effective by the majority (71%) of respondents. Less than a third (27%) had received CS training. Phase Two: Two main themes emerged from the data. Conditions for effective CS had six subthemes: management support; networks & experts: flexibility & choice; dedicated time; supervisor & supervisee training: and supervisee input & collaboration. Effective CS for positive patient outcomes included effective CS subthemes of reflection, clinical reasoning, sharing of resources/information and development of skills/knowledge. Positive patient outcomes were identified by the subthemes of functional improvement, consistency of clinical care and meeting patient goals/desired outcomes.

Conclusions: CS was effective for the majority of participants, and was demonstrated to lead to positive patient outcomes of functional improvement, consistency of clinical care and facilitation of patient health care goals. This is the first known research determining a direct link between CS and patient outcomes.


Biography:

Since 2014, Kim has been the Executive Director Workforce & Executive Director Allied Health, for the Hunter New England Local Health District, NSW.  In 2012, he became President of the NSW Occupational Therapy Council, Health Professional Council Authority. This was a statutory appointment by Governor of NSW.  Kim is a Conjoint Senior Lecturer, School of Health Sciences, Faculty of Health and Medicine, University of Newcastle. He is a Fellow, Australia Institute of Management, a Fellow, Royal Society for Public Health, and an Associate Fellow, Australasian College of Health Service Management. Kim has a Bachelor of Applied Science (Occupational Therapy), a Graduate Diploma in Public Health, and a Graduate Diploma of Human Resource Management.

A/Prof Anne Vertigan is the manager of speech pathology for John Hunter Hospital and Belmont Hospital in Newcastle Australia, and Conjoint Associate Professor in the School of Medicine and Public Health at the University of Newcastle Australia. She graduated from Latrobe University in Melbourne with a Bachelor of Applied Science in Speech Pathology, a Master of Business Administration from the University of Newcastle and a PhD through the University of Queensland. Anne’s clinical load includes acute inpatients, voice disorders, chronic cough/PVFM, laryngectomy and dysphagia. She is the speech pathologist in the Severe Asthma Clinic at John Hunter Hospital and chair of the Hunter New England Allied Health Research Network. Research interests include voice disorders, chronic cough/PVFM and voice & upper airway disorders in asthma. Anne has conducted several research projects in the area of chronic cough and PVFM and published the first text book on speech pathology management of these conditions.

Learning all the time: Articulating the value of an allied health education program

Ms Molly Galea1

1Northern Health, Melbourne, Australia

An effective staff education program will maintain a skilled allied health workforce, reduce clinical errors and retain staff. To maintain funding and staff engagement, the allied health program needs to consistently deliver and demonstrate its value to busy allied health practitioners and overstretched health services

In 2016. Allied Health Education undertook a review of our education program. We have instigated a number of ways to implement continuous improvement of our program, and to quantify and demonstrate our value.

Since 2016, we have used session evaluations, an annual survey, and impact evaluation to demonstrate the contribution of the Allied Health professional development program, and address our organisation’s need for skilled, supported staff.  We engage in an ongoing loop – evaluation, change, communication and delivery  – which continuously quantifies our value to both learners and the organisation.

Northern Health Allied Health Education and Research has gone from an average satisfaction rating of 70% to 92% in two years, while increasing our annual education attendance from  72 staff at 7 training sessions to 323 attending 39 sessions.

Educators need to measure and articulate the impact of allied health education. Continuing professional education has a vital role, particularly in times of service stress, in ensuring high quality care, reflective practice, staff retention and resilience, building the reputation of the organisation to attract new staff, succession planning, and preventing burnout and its associated costs. We are developing a way of articulating that to our two “customer groups” – both the staff who attend our training, and the services that release clinicians from direct service delivery to attend.


Biography: 

Molly Galea is an Allied Health Education Lead at Northern Health.

Early career workforce development for Advanced Musculoskeletal Physiotherapy (AMP) roles

Mrs Louise Wellington1, Mrs Maree Raymer1, Mr Pat Swete Kelly1

1Metro North Hospital And Health Service, Herston, Australia

Background: Advanced musculoskeletal physiotherapy (AMP) roles have demonstrated value and high levels of support in specialist outpatient services but workforce readiness may limit their sustainability. This project aimed to 1) investigate the barriers and enablers to early career musculoskeletal practice development in Queensland and 2) identify the essential elements of an early career musculoskeletal (MSK) education and training pathway to prepare for role specific education and training for AMP roles.

Method: The project used explanatory mixed methodology. Quantitative data was collected initially from physiotherapists and service managers via structured surveys and subsequent focus group consultations provided further detail.

Results: Physiotherapists (n=361) and service managers (n= 27) identified workplace (lack of musculoskeletal rotations and protected time for education and training), financial (direct and indirect costs of education and lack of support and perceived financial return) and personal barriers. Factors enabling an early career musculoskeletal pathway included availability of specific clinical experiences at the individual’s own or other facilities, individual professional support, flexible work arrangements and financial support for education and training. Physiotherapists working in AMP roles identified the required elements of an early career MSK pathway are 1. Structured clinical experiences (Essential: MSK/Orthopaedic outpatient; Orthopaedic Inpatient and related secondary contact roles; Desirable: Pain, Rheumatology, Cardio-respiratory, Geriatrics and Community experience) 2. Relevant professional development 3. Professional support (supervision and mentorship) and 4. Relevant post graduate Masters qualification (or equivalent).

Discussion: Four essential elements of a pathway for physiotherapists to acquire the early career musculoskeletal practice expertise required for future AMP roles have been identified, along with barriers and enablers for each element of the pathway. These factors have important implications for health services for the design of an early career education and training pathway which would precede more role specific education to support the sustainability of AMP roles.

Acknowledgements: This project was funded by the Allied Health Professions’ Office of Queensland


Biography:

Currently working at RBWH in an advanced practice role, screening the orthopaedic and neurosurgical waitlist.

Realising our value through Workforce Development: Developing an Indigenous health workforce

Dr. Alison Nelson1,2

1The Institute for Urban Indigenous Health, Windsor, Australia, 2The University of Queensland, St Lucia, Australia

Background: Developing an effective health workforce in Indigenous health requires an inter-disciplinary, integrated approach across schools, universities and workplaces. It also requires a multi-pronged approach of developing pathways for Indigenous students into health careers. Often the education, training and university sectors fragment the system which makes the development of a workforce in Indigenous health even more complex. To address this, the Institute for Urban indigenous Health (IUIH) has been developing its health workforce over the past 8 years, through a dedicated and integrated ecosystems approach.

Method:  The IUIH has developed a systematic and integrated workforce development pipeline to ensure a focussed and intentional approach to developing health professionals from health service users to school-based trainees to university graduates.  This includes in-reach strategies into schools and universities as well as outreach opportunities for training and placements within IUIH’s network.

Results: IUIH’s workforce initiatives have resulted in growth from 1 allied health professional employed in 2010 to over 70 in 2019 and 30 students/year placed in 2010 to 370 students/year placed in 2018. Fourteen graduates who has undertaken placements with IUIH were employed in 2018/19. IUIH’s school-based training program in allied health and fitness assisting targets young people with significant barriers to academic success with the aim of changing life trajectories. 85% of trainee graduates have continued to employment, with  71% continuing through to university studies.  Several key learnings from this work will be presented including the importance of cultural mentors, pastoral care and graduate support, as well as key leadership from Indigenous allied health professionals and management. In particular real case examples of success stories will be presented.

Conclusion: The development of a culturally responsive workforce in Indigenous health and a growth in allied health positions within Indigenous health services can be achieved and maintained with strong partnerships across schools, universities and Indigenous workplaces when integration and Indigenous leadership are key drivers. IUIH has developed a workforce pipeline model to reflect this.


Biography:

Dr Alison Nelson (B. Occ Thy, M.Occ Thy (research), PhD) is an occupational therapist with extensive research, teaching and practice experience working alongside urban Aboriginal and Torres Strait Islander people. Alison has completed both a research Master’s degree and PhD in the areas of service delivery and perceptions of health for urban Aboriginal and Torres Strait Islander children and young people, and she has published widely in these fields. Alison is currently the Director for Organisational  Development at the Institute for Urban Indigenous Health where she brings together her experience working in both clinical and academic settings.   Alison has a particular interest in developing practical strategies which enable non-Indigenous students, researchers and practitioners to understand effective ways of working alongside Aboriginal and Torres Strait Islander Australians.

Supporting an allied health workforce to facilitate complex implementation projects: lessons learned from the SIMPLE project

Dr Adrienne Young1, Prof Heather Keller2, Ms Rhiannon Barnes1, Ms Jan Hill3, Dr Merrilyn  Banks1, A/Prof Tracy Comans4, Dr Jack Bell5

1Royal Brisbane And Women’s Hospital, Herston, Australia, 2University of Waterloo, Waterloo, Canada, 3Princess Alexandra Hospital, Woolloongabba, Australia, 4Metro North Hospital and Health Service, Herston, Australia, 5The Prince Charles Hospital, Chermside, Australia

Aim: Allied health clinicians are often recruited to project positions to facilitate the implementation of complex interventions into practice. Facilitation is a key implementation strategy, but how it might be operationalised, particularly by clinicians, has not been well explored. This study aims to advance understanding of implementation science, by describing the function of novice clinician facilitators, and barriers and enablers they experience while implementing a new model of care for managing hospital malnutrition.

Methods: Semi-structured interviews were undertaken with local facilitators (six dietitians, one occupational therapist; each funded 0.2FTE for six months) involved in implementing The SIMPLE Approach (Systematised Interdisciplinary Malnutrition Pathway Implementation and Evaluation) in six hospitals in Queensland, Australia. A hybrid approach to analysis was used, with deductive framework approach used to identify facilitator activities, and inductive analysis to identify barriers and enablers to fulfilling their role.

Results: Key functions of the facilitator role over the six-month project were building relationships and trust; understanding the problem and stimulating change through data; negotiating and implementing the change; and measuring, sharing and reflecting on success. Facilitators appeared to focus efforts on the ‘clarifying and engaging’ stage, and experienced challenges in building an improvement team and creating a common vision for change.  ‘Dedicated role, time and support’ was identified as a theme encompassing key barriers and enablers to successful facilitation, with time referring to adequate duration of implementation phase and need for protected time from clinical tasks.

Conclusions: When implementing complex interventions within short project timelines, it is critical that novice clinician facilitators are given adequate and protected time within their role, and have access to regular support from peers and experienced facilitators. Without these structures in place, facilitators may experience difficulties in building trust and relationships, co-designing strategies with teams, and developing capacity for change, compromising the success of implementation.


Biography:

Dr Adrienne Young is an Accredited Practicing Dietitian, and is currently Principal Research Fellow, Allied Health Professions at the Royal Brisbane and Women’s Hospital. Her PhD research on improving nutritional intake of older medical inpatients has been of interest nationally and internationally, with Adrienne awarded the Health Practitioner Researcher of the Year at the Royal Brisbane and Women’s Hospital research symposium in 2018, and New Researcher Award at the International Congress of Dietetics in 2012. Adrienne has continued to research in the area of malnutrition in older people, with recent work also focused on workforce development to prepare allied health professionals to translate research into their practice.

NAHC Conferences

2007, Hobart (7th NAHC)

2009, Canberra (8th NAHC)

2012, Canberra (9th NAHC)

2013, Brisbane (10th NAHC)

2015, Melbourne (11th NAHC)

2017, Sydney (12th NAHC)

2019, Brisbane (13th NAHC)

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