What enables high performance dispersed teams of health professionals in community settings?: An exploratory study

Ms Annette Zucco1, Professor David Greenfield2, Ms Wendy Geddes1, Mr Ken Hampson1

1South Western Sydney Local Health District, Bankstown, Australia, 2University of Tasmania, Rozelle, Australia

Background: Allied health professionals, at South Western Sydney Local Health District, work in dispersed teams in the community. This arrangement enables services to be delivered across significant distances with continuous physical separation, while requiring individuals to work as a cohesive team. High performance healthcare teams are associated with excellent clinical and patient outcomes, innovation and greater staff satisfaction. This study explores the factors that enable high performance of dispersed allied health teams.

Methods: An exploratory, qualitative study was conducted. Recruitment occurred using non-random purposive sampling from Drug Health, Mental Health and Primary and Community Health services. These services were chosen because they operate from various community locations utilising a dispersed team structure. Semi-structured interviews were conducted with service managers. An inductive thematic analysis was undertaken.

Results: There were 13 study participants, who managed teams with nine to 23 members dispersed across two to ten community sites. Team performance was shaped by three components: dispersed team structure, challenges of managing a dispersed team, and enabling a high performance dispersed team. Geographical distance and the ability to adapt to meet community need were reported as distinct features of a dispersed team. Participants described four management challenges: addressing day-to-day logistics, developing team connection, ensuring clinical care across numerous sites, and ensuring effective operational management. Participants described seven characteristics of high performance teams: communication, leadership, trust, resolving conflict, commitment to team goals, accountability, collective orientation to results, and effort. Two further characteristics important for dispersed health teams were identified: clinical governance, including supervision of clinical practice, and the opportunity for team face-to-face interaction.

Discussion and implications: High performance dispersed teams are built on a foundation of strong relationships. In order to be high performing, dispersed teams need to: deliver a service that meets community need, acknowledge and overcome the challenges of being dispersed, and work together to develop high performance team characteristics.


Biography: 

Annette Zucco is an occupational therapist who has worked in paediatrics for the majority of her career. She is currently Head of Department of Occupational Therapy, Primary and Community Health at South Western Sydney Local Health District. Annette completed a Master of Health Service Management (University of Tasmania) in 2018. She has an interest in developing high performance health care teams.

Faster, fairer, stronger: Subacute physiotherapy workforce redesign – methodology, implementation and outcomes

Alana Jacob1, Uyen Phan1, Katherine  Hodgson1, Dr. Catherine Granger1,2

1Allied Health, Physiotherapy, Melbourne Health, Melbourne, Australia, 2Physiotherapy Department, The University of Melbourne, Melbourne, Australia

Background: Physiotherapy services face multiple competing demands including increasing patient numbers and complexity, with finite staffing resources. This project aimed to implement a comprehensive subacute workforce redesign at Melbourne Health using existing resources. The target was to improve patient and staff outcomes primarily through responsive allocation of resources (right patient, right care, right time).

Method: Implementation involved establishment of governance and steering committees including organisational key stakeholders; pre/post patient and staff satisfaction surveys with focus on frustration lists and areas for improvement; mapping of current and future processes; service benchmarking; and review of staff workload. Data were utilised to inform the new model for implementation.

Results: Prior to implementation, 77 patients were surveyed and the main area for improvement identified was ‘time waiting for therapy’, 39 staff (physiotherapists, EP’s and AHA) were surveyed and main areas for improvement identified were ‘job satisfaction’, ‘stress and fatigue’, and ‘communication’. Top staff frustrations were ‘limited leave cover’, ‘leave planning’, and ‘duplication of paperwork’. Based on findings, a new model was implemented across 2018. Changes included: a standardised prioritisation tool across inpatients and community therapy service; an ‘early starter staff role’ and team huddles to improve communication regarding staffing and workload across the department; creation of workflow processes for staff to assist across teams; streamlined processes and paperwork to reduce duplication; enhanced electronic communication systems for management of leave and improved mechanisms for requesting and offering assistance.

Discussion: Innovative workforce models are required to meet the changing demands. A comprehensive redesign of subacute services, utilising a ‘ground-up’ approach was implemented. Preliminary results indicate staff and patient areas for improvement were met. Evaluation is currently in progress and full post-evaluation results will be presented at the conference. The learnings from the development and implementation of this redesign could be applied to other disciplines and organisations.


Biography:

Alana Jacob is the Manager of Physiotherapy and Exercise Physiology at The Royal Melbourne Hospital. She has extensive experience managing acute and subacute inpatient and outpatient services across the public and private sector. Alana has a clinical background as a Physiotherapist and has completed a MBA majoring in Health and Human Services Management. Alana has a passion for improving patient outcomes by working with teams to improve systems and processes within the healthcare network.

Optimising the impact of allied health: Learning from the Victorian Allied Health Workforce Research Project

Professor Susan Nancarrow1, Dr Alison Roots1, Ms Gretchen Young2, Ms Katy O’Callaghan3, Dr Annie Banbury1, Dr Anna Moran4

1Southern Cross University, Coolangatta, Australia, 2Young Futures, Brisbane, Australia, 3Outpost Consulting, Brisbane, Australia, 4University of Melbourne, Albury / Wodonga, Australia

The Victorian Department of Health & Human Services commissioned a three year, Allied Health (AHP) Workforce Research Program (2015-18), to generate new qualitative and quantitative information to capture, describe and explore the key workforce issues facing the AHP workforce in Victoria.

 

A three-tiered, mixed methods approach was used to obtain data using an environmental scan (n=27 professions), survey of organisations and individual clinicians and focus groups with clinicians (n=11 purposively selected AHPs). Questions explored the size, location, skill set, recruitment and retention issues, and organisational contexts. Individual clinician data captured information about education and training, the nature and location of work, job satisfaction and career pathways. Focus groups were used to explore issues highlighted in the survey responses. Survey data were analysed descriptively. Qualitative data were extracted from notes using a framework to analyse themes of workforce capacity, capability, and engagement.

 

In total, 7399 survey participants from 11 disciplines (exercise physiology, dietetics, medical laboratory science, audiology, AH assistants, speech pathology, sonography, physiotherapy, social work, psychology, occupational therapy) responded to the survey (response rates ranged from 14% to 50%). Over 100 AHPs participated in focus groups. This presentation describes the five key themes emerging from the survey data and considers ways that AHPs can work proactively to address these issues, namely;

  1. AHP roles are poorly understood by the public and other health care providers
  2. AHPs undersell their attributes and need to be clear about their value proposition
  3. AHPs come from multiple career pathways
  4. The AHP workforce paradox: managing AHP oversupply alongside unmet community need
  5. 5. The “youthfulness” of the allied health workforce and implications for workforce development

Biography:

Susan is Professor of Health Sciences at Southern Cross University. Susan has nearly 20 years’ international experience as a health services researcher with expertise in health workforce reform, service delivery and organisation. In particular, she works with health services to help them think differently about how they organise and deliver care to provide solutions to enhance health care from the patient’s perspective. She is particularly committed to regional and rural health issues, community health, and capacity building. Recent research projects have explored the use of the NBN to provide telehealth to keep older people independent at home; primary health care integration; the use of social media to engage with health service users; and the recent Victorian Allied Health Workforce Research Project.

Creating a useful and sustainable Allied Health activity dashboard

Ms Tanya Trevena1

1Ballarat Health Services, Ballarat, Australia

Background: The Allied Health Activity Dashboard evolved rapidly due to several concurrent expectations and concerns being placed on the service. These included our service purchasers not knowing if they were getting ‘what they paid for’, our team members not consistently recording their workforce/daily/clinic activity, and the existing reporting files requiring high-level excel knowledge, with several (likely) corrupt calculator files being used throughout the process. In order to advocate for more allied health staff, we needed a more efficient, accurate and useful tool to demonstrate who was working where, and where we meeting targets.

Method of project implementation: Implementation of the project, and resulting dashboard has been multi-factorial as there were several system, human, information technology and cultural aspects to analyse, consider, update and implement. The overall project was given a timelines (almost a year), with activity ‘clustered’ into similar bite-sized activities. Analysis, collaboration with key system-level teams, clinical champions and training were the key factors for success.

Project results: The project has resulted in one standardised, automatically populated dashboard. Key Performance Indicators (KPIs) such as time or occasions of service are all mapped to disciplines, as well as at the team-level. New definitions, processes, manuals and training have been implemented, models of care have, and will continue to be reviewed, errors are reported and corrected, and the clinicians are better at capturing their work.

Outcomes and implications: The Allied Health team, and in particular, its leadership team now have clean data; a consistent set of expectations and rules to follow for data management; a commitment to improving efficiencies and workforce utilization; and we now have a way to identify if we are over or under-serving our service purchasers (through the KPIs). The new level of transparency has its own risks, and is now the focus of the leadership team.


Biography:

Tanya has over fifteen years’ experience in health care, specialising in workforce development, project management, leadership and business acumen. These experiences have been in allied health, cancer and palliative care, clinical support services, telehealth and rural health. Tanya completed an MBA in 2017 and has since developed an interest in data management, finance and sustainable leadership. Key areas of strength include curiosity, a love of learning, a drive to make a difference to the health of communities, and building dynamic teams. In her spare time, Tanya likes to ski, read, watch movies, stay fit and explore the world.

Are you ready for this? – reflecting on the implementation journey of electronic medication management system (eMMS)

Mrs Bryanna  Lawrie1, Ms Heidi  Wong1, Miss Sarah  Fuller2

1Children’s Health Queensland, Brisbane, Australia, 2Clinical Excellence Queensland, Brisbane , Australia

Background: Previous literature had captured doctors’ and nurses’  views and perceptions on eMMS but none focused specifically on pharmacy staff despite our heavy involvement. This study aims to describe pharmacy staff’ change journey through the implementation of eMMS at a tertiary paediatric hospital early 2018.

Method: All pharmacy staff were invited to participate in a series of three online surveys released at 3 different time points during eMMS go-live period (namely pre-training, post-training/pre go-live and post go-live). The surveys were designed, distributed and collated using SuveryMonkey™ and results were further analyzed using Excel™.

Results: Respondents for survey 1 (n = 69), survey 2 (n= 60) and survey 3 (n = 50) included pharmacists, pharmacy interns, pharmacy assistants and pharmacy administration officers of age range from 18 to 45 years. Some overall trends were identified:

  • Confidence and proficiency in the use of eMMS increased by 20% post training and was sustained post go-live
  • Apprehension towards ieMR Advanced increased by 10% after training but the actual impact to individual workload decreased by 10% post go-live
  • Perceived level of support increased by 10% with each respective survey with pharmacy being heavily involved in the implementation

Discussion: Our research highlights the importance of practical and relevant end-user training in improving staff’ confidence and proficiency in using eMMS. Individuals’ age, role, prior change experience, use of social media, project involvement, amount of training also influenced their readiness towards eMMS implementation. Using eMMS implementation as an example, our research provided insights on considerations and factors that may contribute to successful change management.


Biography:

Bree currently works as resident pharmacist at Queensland Children’s Hospital after completing her internship at Children’s Hospital at Westmead. Bree was seconded to the ieMR Advanced project to provide staff training on the new system. With human resource management background, Bree decided to undertake this project to observe the change journey that pharmacy takes during implementation of Cerner ieMR

Student power: Utilising student resourced services to meet the growing demand for outpatient speech pathology services in an acute hospital setting

Miss Lucy Lyons1, Mrs Jackie  Moon1

1Mater Health, Brisbane, Australia

A key focus for Mater Speech Pathology team has been to grow our capacity to deliver complex, high acuity outpatient services in the hospital setting. This is in response to increased waiting lists in core, high acuity speech pathology outpatient clinics because of a growing number of referrals for specialist areas of practice (e.g. vocal cord dysfunction, Modified Barium Swallow studies). This growth resulted in increasing delays for patients accessing speech pathology services beyond recommended/evidence based timeframes.

A competing priority for the Mater Speech Pathology service was to continue to care for underserviced groups with chronic conditions in response to community needs and in alignment with Mater’s tradition and values. These patient cohorts include those with voice and fluency disorders. Public hospital services for these groups are increasingly limited. Until 2018, Mater had a part time speech pathologist (0.6FTE) servicing these populations.

In light of increased volume of outpatient referrals, competing service priorities, and fixed staffing levels, Mater Speech Pathology remodelled outpatient service pathways and workforce. The 0.6FTE of clinician resources previously used to service people with voice and fluency disorders were reallocated to higher acuity, more complex outpatient services (e.g. instrumental swallowing assessment). An immediate reduction in outpatient waiting lists for these complex conditions was seen. All patients referred for high acuity outpatient services are now seen within recommended timeframes.

This reallocation of staffing resources created a significant gap in services available for people with voice and fluency disorders. This caused considerable dissatisfaction amongst patients, advocacy groups and referrers. In response to this feedback and hospital service benchmarking, Mater approached Australian Catholic University (ACU). ACU identified that these areas of practice were priorities for student education. ACU agreed to fund a low acuity speech pathology student resourced outpatient clinic using a 0.2FTE clinical educator to supervise 4 students simultaneously.

The trial results of the clinic are favourable. Waiting lists for these services have significantly reduced and patient feedback regarding the student delivered services has been positive. Students and ACU also positively evaluated the clinic and their learning outcomes. The Mater/ACU student clinic is now running continuously and permanently.


Biography:

Lucy is the Speech Pathology Lead and Allied Health Lead for Neurosciences at Mater Health. She has a passion for embedding new models of care to optimise patient outcomes and service efficiency. Lucy has also held numerous Clinical Education Support Officer roles across Queensland and has witnessed the growth and value of student resourced clinical services.

Meeting growing demand: A review of a nutrition allied health assistant role in a cancer setting

Ms Belinda Steer1, Ms Carmen  Puskas1, Ms Melanie Fairweather1, Ms Jacqueline Black1, Ms Jenelle Loeliger1

1Peter Maccallum Cancer Centre, Melbourne, Australia

The Peter Mac Nutrition Department implemented a nutrition-focused Allied Health Assistant (AHA) role in 2010 primarily to improve inpatient malnutrition screening and referral to the dietitian. Since then, the role has expanded (without increasing EFT) to include screening and simple interventions in other clinical areas such as speech pathology. A review was completed in 2018 to evaluate this role.

A mixed-methods approach, including a survey of key stakeholders of the AHA service and a review of screening data was undertaken.

The survey (n=20) indicated that the most valued AHA tasks were inpatient malnutrition screening, day therapy simple interventions, and inpatient simple interventions. Most respondents (81%) indicated that the AHA completing simple interventions in day therapy was very useful, and 100% felt additional AHA time in day therapy would be very useful. Despite 68% of respondents indicating having the AHA in radiotherapy clinic was very useful, 32% indicated it was somewhat useful with these tasks not being as highly valued here compared to other clinical areas. Most respondents (84%) supported further expansion of the AHA role into speech pathology. Malnutrition screening data indicated the average monthly screening rate reduced from 74% in 2016 to 55% in 2017, well below the target of 80%. This was coupled with an increase by ~30% in the number of patients who required malnutrition screening in 2017.

This review indicates that malnutrition screening should remain a key focus for the AHA role, however other tasks are highly valued, especially in the day therapy setting. The scope of this AHA role needs refining to ensure that screening targets can be met, whilst other areas of high need are being serviced and optimal patient care is being achieved.


Biography:

Belinda Steer is Head of the Nutrition and Speech Pathology Department at Peter MacCallum Cancer Centre in Melbourne. She has over 15 years experience as a clinical dietitian, including over 10 years specialising in oncology nutrition. and has a passion for providing high quality, patient-centred care.

Managing maternity leave and return to work for Allied Health Professionals in Queensland Health Hospitals – strategies and issues

Ms Julie Hulcombe1, Professor Sandra Capra1, Professor Gillian Whitehouse1

1University Of Queensland, St Lucia, Australia

Background

The majority (79%) of Allied Health Professionals (AHP) employed in Queensland Health are female. The implementation of entitlements to accommodate childcare responsibilities through maternity leave and flexible work arrangements (FWA) on return to work is thus a significant part of managers’ roles.  This aim of this study was to investigate AHP managers’ views on the implementation and impact of these policies.

Method

This was a qualitative study of AHP managers across six professional groups, in seven QH hospitals, varying in size and location. The targeted professional groups included Dietetics, Medical Imaging, Occupational Therapy, Physiotherapy, Speech Pathology, and Social Work. These professions were chosen as they varied in gender mix, workforce size and type of work, including hours of work. Data were collected through a survey and an in-depth interview. Respondents were provided with the topics of the interview prior and each was approximately one hour.  Interviews were recorded, transcribed and thematically analysed. Survey data were summed. Appropriate ethics were obtained.

Results

Of the 40 AHP managers invited to participate, 21 (53%%) agreed to participate in the study.  On average 35% (11-62%) of the total headcount in their departments were employed part-time (under FWA). Strategies and issues which emerged included some perverse consequences of the policy for gender equity and management workload; a “muddling through” approach by some managers; lack of normalisation of FWA through job redesign and/or cultural change; and perceived consequences for other employees.

Discussion

Normalising the right to request FWA for AHP in QH will require organisational support and resources for a more strategic approach.  This would include work redesign and change management strategies.  Earlier and clearer communication with staff on return to work arrangements and counselling with regard to possible impact on careers will be critical.


Biography:

Julie Hulcombe PSM is an Accredited Practising Dietitian (APD), an Adjunct Associate Professor with QUT and presently a part-time doctoral student at the University of Queensland (UQ). She had an extensive career with Qld Health most recently as the Chief Allied Health Officer, Department of Health, Queensland.   She is a past President of the Dietetic Association of Australia (DAA), and has been the Chair of the DAA Dietetic Credentialing Council and the National Allied Health Advisors Committee.

Delegate before you detonate – Optimising use of the assistant workforce

Raymond Kopeshke1

1Mater Hospital Brisbane, South Brisbane , Australia

Background

AHA assistants are increasingly being utilised to manage service demands and increasing pressures on resources. Such pressures lead to a review of the relevancy and comprehensiveness of the OTA competencies.

A conversation with an OT who queried ‘if’ and ‘how’ they could delegate a new task to an OTA, due to increasing service demands, prompted the project. Further investigation revealed that the OTA competencies had not undergone recent review and that OTA scope was potentially not being optimised.

Method

This project was undertaken using the A3 improvement methodology. Extensive collaboration with both OTs and OTAs occurred throughout the process in either one-to-one or group formats. The aim of these sessions was to revise the existing competencies and identify additional tasks that could be delegated to the assistant workforce.

Results

26 additional tasks were identified by the OT Department. Reasons for not delegating these tasks prior to this project were also identified to help understand the barriers to OTs delegating tasks as part of their standard practice. Such barriers included uncertainty regarding suitability of tasks for delegation, time required for training and lack of written competencies.

Discussion

This project identified how to safely increase the scope of AHA’s in the OT setting. The methodology utilised, is generic and could be adopted for other professions.

The project has helped optimise OT/OTA efficiency, patient access to OT services and service sustainability. However, the operational inefficiency that results from waiting for an annual review to delegate new tasks is something that the OT department would like to avoid in the future.  Therefore future work will now focus on creating a standard work process for OTs to delegate new tasks as part of everyday practice.


Biography:

Ray Kopeshke is the senior Occupational Therapist for Neurosciences at Mater Hospital Brisbane and has over 15 years clinical experience. As part of his current role at Mater Hospital, he coordinates a team of occupational therapy and allied health assistants and is responsible for their development and training in clinical-based competencies. A recent focus of his has been on expanding the scope of the assistant workforce to improve patient access, patient experience and quality of care.

DASH – Dynamic Allocation of Staff Hours

Ms Kath Feely1, Mr Robert Mehan1, Ms Georgina Jones1, Ms  Belinda Cary1, Ms Jessica Knight1

1St Vincent’s Hospital, Melbourne, Fitzroy, Australia

Aim: To develop a standardised tool that enables provision of equitable physiotherapy services that respond to daily fluctuations in acute clinical demand.

Method: Acute physiotherapy services at St Vincent’s Hospital Melbourne (SVHM) were aligned to inpatient units with fixed staffing profiles.  A root cause analysis with key stakeholders identified there was no accessible data measuring daily demand or capacity and that teams only managed demand internally.  The Dynamic Allocation of Staff Hours (DASH) electronic tool was developed to capture and communicate daily clinical demand and capacity to inform the department and organisation’s Daily Management System.  Physiotherapy workflow was redesigned to move staff from areas with capacity to those with high demand.

Results: Since September 2017 physiotherapists have moved between teams 31% of the time.  This reduced unmet physiotherapy contacts from 8% pre implementation to 1% (Dec 2017) and 2% (April 2018).  There have been increased contacts for acute patients waiting subacute care from 30% (Jan 2018) to 21% (June 2018).  The increased functional training likely contributed to a reduction in average subacute length of stay from 18 days (June 2017) to 14.5 days (January 2018) and 16 days (June 2018). This reduction demonstrated a 7 – 19% improvement and saving of 33 – 84 subacute bed days (n=25).  We now have a flexible and equitable physiotherapy service that can react on a daily basis to changes in hospital demand.  In July 2018 DASH was rolled out to all Allied Health teams at SVHM.  Allied Health can now report their daily “outlook” by 9.30am to inform the Daily Management System.

Significance of the findings to Allied Health: The DASH tool and model can be adapted for Allied Health to improve daily service provision by identifying staff capacity and moving it to areas of high demand in a public hospital setting.


Biography:

Kath Feely has worked as a Physiotherapist in Public Health in Victoria for 20 years.  She is passionate about using data to evaluate and improve service delivery.

12

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)

Conference Managers

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