PREPARE for Practice: A statewide Allied Health workforce survey

Dr Belinda Gavaghan1, Ms Liza-Jane McBride1, Professor Lisa Nissen2, Professor  Patsy Yates3, Ms Michelle Rochin2, Mr Peter Buttrum4, Ms Michelle Stute5, Ms Julie  Hulcombe2

1Allied Health Professions’ Office Of Queensland, Clinical Excellence Queensland, Brisbane, Australia, 2School of Clinical Sciences, Queensland University of Technology, Brisbane, Australia, 3School of Nursing, Queensland University of Technology, Brisbane, Australia, 4Royal Brisbane and Women’s Hospital, Brisbane, Australia, 5Metro North Hospital and Health Service, Brisbane, Australia

Background: Allied health expanded scope of practice roles can assist health services to meet escalating service demands, rising costs and changing community expectations. Recent investment in new allied health models of care have resulted in a confusing array of advanced practice titles, profiles and roles, with corresponding uncertainty as to the scope and level of allied health professional practice. The aim of this study is to investigate patterns of practice activity within and across the allied health professions.

Method: A cross-sectional electronic survey of Queensland Health allied health professionals was undertaken using a modified version of the Advanced Practice Role Delineation tool based on the Strong Model of Advanced Practice. Survey questions explored domains of allied health practice, including clinical management, education, research and leadership. Descriptive analysis was undertaken to explore characteristics of the allied health workforce and scores for individual items and domains. Domain means were calculated within and across health services, allied health practitioner levels and between professional groups.

Results: A sample of 2575 Queensland public sector allied health professionals completed the survey (response rate of 27%). While participation in clinical care activities was consistently high, contribution to education, research and leadership varied considerably across allied health practitioner levels, professional groups and health service areas. However, allied health professionals practicing at an advanced level were identified and delineated front the group based on high scores across all domains of the Strong Model of Advanced Practice.

Discussion: A variety of practice activities and participation in domains of practice were identified within and across allied health professions and geographical areas. Findings will be used to develop targeted strategies to build workforce capacity and capability to enhance contributions to clinical, research and management for all allied health professionals.


Biography:

Dr Belinda Gavaghan is currently A/Director at the Allied Health Professions’ Office of Queensland. Her research focuses on allied health workforce reform and redesign, and particularly the development, implementation and evaluation of new and innovative models of care that optimise scope of practice for allied health professionals. Belinda has degrees in speech pathology (Hons) and public health. She has over 15 years experience as a speech pathologist in public and private healthcare settings and is a graduate of the NSW Public Health Training Program

Developing a 5-year SA pharmacy workforce roadmap

Ms Sharon Goldsworthy1

1SA Pharmacy, Adelaide, Australia

Aim: To describe the development of a long term strategic workforce planning roadmap.

Methodology: SA Pharmacy Executive with a workforce strategist, following the international workforce planning standard, established a workforce planning project. The majority of our workforce falls into 3 main workgroups; assistants, early career pharmacists and leadership. Across sites three to four staff champions, led by a workforce portfolio lead, were nominated for each workgroup. Champions in their relative workgroup reviewed the raw staffing demographic data, building questions for a staff survey to test theories/assumptions arising from the data. Champions additionally engaged our workforce in completing the online survey. Survey results and demographic data were used to write an objective workforce data story identifying emergent themes. With the goal of attracting and retaining workforce, themes were workshopped by additional staff, developing, refining and risk assessing strategies ensuring that executive approved the sound final strategies. Executive used a prioritisation tool to further inform the 5-year Workforce Roadmap which outlines the process we have undertaken, the strategies, their priority and timelines to achieve.

Results: A 79% survey response yielded persuasive evidence to inform our Roadmap. Key messages were flexibility to move within the organisation, flexibility in hours worked, access to promotional opportunities, and opportunities to develop/learn and expand.

Conclusion: SA Pharmacy has established a Workforce Roadmap setting the strategic direction for the next five years. The Roadmap serves to meet identified needs and priorities of staff and the health sector promoting a flourishing and contemporary workforce.


Biography:

Sharon is the Associate Director of Pharmacy, Central Adelaide Local Health Network for The Queen Elizabeth & Glenside Hospitals and Hampstead Centre. She is the SA Pharmacy Workforce Portfolio Lead and a trained Facilitator. She undertook a Pharmacy degree at the South Australian Institute of Technology and Clinical Pharmacy Masters Degree at the University of South Australia. She is a Fellow of the Society of Hospital Pharmacists of Australia.

The Allied Health workforce paradox: The coexistence of oversupply and unmet need

Professor Susan Nancarrow1, Dr Anna Moran2

1Southern Cross University, Coolangatta, Australia, 2University of Melbourne, Albury / Wodonga, Australia

In 2005, the Australian Productivity Commission predicted an impending allied health (AHP) shortfall. Subsequently, numerous new allied health training courses have been introduced nationally for almost every discipline. Thus, over the past decade, the supply of AHPs has increased exponentially for some disciplines, without a commensurate increase in positions for new graduates. In Victoria alone, occupational therapy graduates increased by 39% between 2010 and 2015; dietetics by 95% (2010 – 16); and speech pathology by 221% (2010 – 13).

This paper reports the results of the Victorian Allied Health Workforce Research Project, which involved an environmental scan of 27 allied health disciplines and in-depth analysis of 11 disciplines in Victoria between 2015 and 2018. A primary concern of the majority of professions was the impending over-supply of AHPs. However, the in-depth analysis presented a far more complex picture of supply and demand for AHPs in Victoria. There was strong evidence of new graduates in some disciplines experiencing difficulty finding employment; large numbers of applications for junior positions; and high proportions of participants agreeing that “there are too many graduates in my profession”. Despite these findings, there was also evidence of large pockets of unmet need for AHPs services in specific segments of the community (particularly paediatrics and chronic disease management) as well as in regional and rural areas. The challenges AHP face are to ensure funding models support appropriate AHP distribution; that new graduates receive adequate supervision and support in the workplace; and they can access appropriate career pathways.

The allied health workforce paradox of AHP oversupply coinciding with unmet service need is compounded by a lack of AHP workforce planning tools and business models to support the provision of allied health services where they are most needed.


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.

Planning for the future: assessment of research capacity in health professions

Ms Sharon Lee1,2, Dr Karen  Byth-Wilson1,2, Professor Victoria Flood1,2

1Western Sydney Local Health District, Westmead, Australia, 2University of Sydney, Camperdown, Australia

Background: Research should inform clinical decision-making and evidence-based practice for health care professionals (HCPs).  To build research capacity and plan for future workforce development among HCPs, there is a need to measure the levels of research capacity and identify the gaps and needs of HCPs. The aim of this study was to assess the research culture and capacity of HCPs (allied health, nursing and medical) in Western Sydney Local Health District, Australia.

Methods: A research capacity and culture tool (RCCT) survey was electronically distributed to all health staff in WSLHD, in 2016-17.  A Likert scale measured self-reported research capacity at the individual (14 items), team (19 items) and organisational levels (18 items), with measures of 1 indicating lowest skill/success and 10 indicating highest skill/success. In secondary analysis, the overall average median scores in each domain (individual, team and organisation) were calculated, and compared across professions, and adjusted for age and gender.

Results: A total of 393 health staff were included based on sufficient data about profession and RCCT items. Participants were allied health (46.3%), nursing (35.4%) and medical staff (18.3%), with 76% females and most people aged 35-54 years (54%). Medical (MD) staff scored significantly higher in individual and team average median scores than allied health (AH) and nursing (N) staff (Individual: 6.3 (MD) vs 5.4 (AH), 4.6 (N), p<0.0005; Team: 5.7 (MD) vs 4.2 (AH), 4.3 (N), p=0.01), after adjusting for age and gender. However, there were no differences between the three professions for organisational responses.

Conclusion: This study suggests that individual and team research capacity for medical, allied health and nursing professionals are at different stages of development. Planning for research capacity building is likely to benefit from tailoring to the specific needs of each profession, and this work is informing initiatives in a large public health organisation.


Biography:

Sharon is the clinical trials manager at Western Sydney Local Health District and is currently enrolled in a Masters of Research at The University of Sydney. Her Masters degree is investigating research capacity among health professional in a public health organisation.

 

Electronic reporting of allied health cancer care interventions in regional Queensland

Mrs Martine  Waters1, Mr Neil Brebner1, Ms Alicia Chaplain2

1Queensland Health, Brisbane, Australia, 2Allied Health Professions Office Queensland, Brisbane, Australia

There is little evidence documenting skill set requirements for allied health cancer care clinicians in regional areas.  Routine data collection counts occasions of service, but lacks information about interventions carried out. The aim of this project was to electronically capture the interventions undertaken by regional allied health cancer care clinicians, to quantify task frequency and identify potential skill sharing capabilities between clinicians.

Partnering with two regional Queensland public cancer care centres and the Allied Health Professions Office Queensland, a subset of 42 SNOWMED_CT_AU medical terminology intervention codes were selected and incorporated into the allied health cancer care services routine activity capture information system MOSAIQ®.

Customised reports were developed to describe the type and frequency of clinical interventions by facility and discipline. Focus groups were held with clinicians to gain feedback on strategies to improve the accuracy and process of data collection.

Sixteen allied health clinicians from 6 disciplines across 3 facilities electronically recorded descriptive intervention tasks as part of routine activity data collection.  Interim analysis of a one month data snapshot showed that nutrition therapy, screening, counselling and lymphoedema management were the most frequent tasks undertaken.   There was evidence of skill sharing between disciplines with 21 of the interventions (50%) recorded as being delivered by more than one discipline group.

This detailed data informs team leaders of the recruitment attributes required in their facility and guides skill succession planning to increase capacity of existing human resources. The findings highlight a potential for clinicians to gain experience in required skills in a non-cancer setting. Future steps for this project will include: collecting a 6 month data set; validating the task list within a broader context of cancer Statewide; understanding cancer specific skillsets and knowledge acquisition pathways; and understanding barriers and enablers to clinician confidence in the application of core skills in a cancer setting.


Biography:

Martine has been an accredited practicing dietitian since 2000. She has an extensive clinical background in both metro hospitals and regional centres including rural outreach. Martine is currently studying clinical redesign and works as a workforce development Officer for Cancer Care. She has collaborated with Allied health Professions Office Queensland and regional cancer care facilities to implement and pilot electronic data capture of allied health intervention terminology in cancer care to inform local workforce planning. Martine holds a chair on the Statewide Cancer Network Executive Steering Committee and through a statewide allied health clinical cancer care reference group, she focuses on professional collaboration between HHS’s to develop pathways and infrastructure to facilitate consistent clinical standards promoting improved service integration for patients.

Hidden talents: The multiple career backgrounds of allied health professionals

Professor Susan Nancarrow1, Dr Rosalie Boyce3,4, Dr Anna Moran2

1Southern Cross University, Coolangatta, Australia, 2University of Melbourne, Albury / Wodonga, Australia, 3University Hospital Geelong, Barwon Health and Southwest Healthcare, Geelong and Warrnambool, Australia, 4University of Queensland, Brisbane, Australia

The 21st Century career is sometimes described as encompassing “portfolio careers”, involving multiple interruptions, different roles and multiple employers. However, allied health professions (AHP) are largely examined from a linear perspective, ignoring the potential for previous roles and the skills and expertise these may bring to the workforce.

This paper reports on the previous careers of 7399 AHPs from 11 disciplines (occupational therapy, physiotherapy, psychology, allied health assistants, social work, audiology, medical laboratory science, exercise physiology, dietetics, sonography and speech pathology) who participated in Victorian Allied Health Workforce Research project, a three year project commissioned by the Victorian Department of Health and Human Services from 2015-18.

An important goal of the study was to understand AHP career pathways. To explore this, we asked all survey respondents whether they had worked in a previous career, defined as having worked full-time for more than 6 months in another role, and asked about the nature of this role. This paper describes the scale and diversity of the previous careers of AHPs.

The results show that AHPs come from enormously diverse backgrounds. The most diverse workforces, with more than 50% of respondents reporting a previous career, were exercise physiology, social work, psychology, allied health assistants and sonography. Between 20 – 50% of the physiotherapy, medical laboratory science, dietetics, audiology, occupational therapy and speech pathology workforces reported a previous career. Physiotherapy was the least diverse (22%), while 69% of psychologists reported previous careers, the largest proportion of whom had come from teaching backgrounds; and 80% of allied health assistants.

This paper explores the rich diversity of the AHP workforce, and looks at ways that the structure of work, alongside the growth of technologies such as E-credentialing and micro-credentialing may enable these skills to be recognised and embedded into existing allied health careers.


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.

From the ground up: Designing care and supporting workforce readiness within a paediatric inpatient service

Ms Merridy Moore1, Ms Karina Coffey1, Mr Angus Campbell1, Ms Julia Blackshaw1

1Western Health, St Albans, Melbourne, Australia

Background

Western Health recently opened the newly constructed Joan Kirner Women’s and Children’s Hospital (JKWCH). With the introduction of Neonatal Intensive Care Unit (NICU) beds, JKWCH became a level 6a health service, the first tertiary centre for maternity and paediatrics in Melbourne’s west.

This change necessitated a redesign of the Paediatric Allied Health model of care and Allied Health (AH) workforce competency and capability.  The redesign of the Paediatric AH model of care has also been influenced by the recent roll-out of the NDIS in western Melbourne.

Method

Extensive research and consultation was completed to ensure that AH was positioned to support JKWCH core business. This included reviewing risks and opportunities in the pre-existing model of care; benchmarking with other services; establishing the core business of a tertiary health service including the interface between health care (hospital) and disability care (NDIS) and a review of research and practice guidelines to inform the model of care.  Developing the model of care included extensive consultation with key stakeholders across the organisation.

Providing safe and effective care to children and families in NICU beds required an assessment of existing competencies and capabilities of staff to determine current skills and potential skill gaps within the workforce. Allied Health disciplines developed competency packages where appropriate, and workforce education was supported internally and by establishing external networks with AH teams with established NICU services.

Results

Paediatric AH at Western Health has a new model of care supporting a competent and capable workforce, who is well prepared to provide best care to the Western Melbourne Community in a new fit-for-purpose building.

Discussion

The introduction of a new clinical service, in conjunction with opening a new fit-for-purpose building, provided a unique opportunity for AH to review the model of care and develop relevant workforce competencies. Key considerations and learning will be discussed.


Biography:

Angus (Gus) trained as a Physiotherapist in Albury, NSW; has a Graduate Certificate in Paediatric Physiotherapy. He is a physiotherapist working in the newborn services unit, high-risk infant follow-up program and outpatients at Sunshine Hospital, Melbourne, and has previously worked in a similar role at the Royal Women’s Hospital, Melbourne. He was a Allied Health project officer supporting the women’s and children’s service transition to the Joan Kirner Women’s and Children’s at Sunshine Hospital in 2018-19.

Reshaping the allied health workforce mix- What should it look like and what is the value?

Ms Anne Maree Buttner1, Mrs Lisa Boustead1

1Mater Group, South Brisbane , Australia

Over a three year period, the Allied Health workforce mix at Mater Health has been reshaped for a sustainable service into the future. This presentation will outline the methodology, outcomes achieved, learning’s from the initiative as well as raising further questions regarding what is the ideal Allied Health workforce profile to achieve financial sustainability whilst supporting value based healthcare.

Background

Following the evaluation of Allied Health job levels in Queensland in 2007, the proportion of Allied Health professionals at advance levels significantly increased. By 2014, Mater’s workforce profile included greater than 50% of staff at advanced levels. In light of financial pressures, the increasing cost and demand for health services and the predicted shrinking of the working population, it was recognised that the Allied Health workforce profile at Mater needed to change.

Methodology

A literature review, environmental scan and analysis of current tasks undertaken by Mater’s Allied Health staff indicated the need for greater utilisation of assistant roles in scope and number, while also expanding the scope of Allied Health professionals. A new Allied Health workforce profile including a target to increase the assistant workforce to 20%was endorsed following staff consultation.   Roles have subsequently been redesigned and strategies implemented including staff education, competency development and delegation frameworks to achieve the workforce profile.

Significant change towards the desired workforce profile has been achieved and an evaluation of its value undertaken. Barriers encountered to achieving the workforce profile will also be discussed. The initiative raises further questions regarding the ideal workforce profile into the future taking into account the factors above as well as emerging trends in acute models of care.


Biography:

Anne Maree Buttner has been a Director of Allied Health Services for more than 20 years working in two acute health care organisations, one in the public sector, the other a private not for profit organisation delivering both private and public services. She has also held roles as Director of Corporate Services and Director of Strategic and Master Planning within public health organisations.

Allied Health recruitment and retention strategic planning

Ms Kate Vickers1, Ms Sue  Colley1

1South Western Sydney Local Health District, Liverpool, Australia

Background: A consistent and significant issue facing the Allied Health workforce is the recruitment and retention of skilled staff. Factors such as a female workforce and competitive job markets are resulting in high frequency of temporary and part time positions, a high staffing turn over and difficulties filling senior positions. Therefore, a key priority for a large metropolitan local health district (LHD) is to develop a strategies that ensure strong recruitment and retention processes. To achieve this, this study aimed to improve recruitment and retention of a skilled workforce through the incorporation of AH feedback into strategic workforce initiatives.

Method: A qualitative descriptive study was conducted using a voluntary pre-and post-implementation survey of Allied Health staff in a large metropolitan LHD. The results of the pre-implementation survey conducted in 2015 were utilised to inform workforce strategic planning for the next 4 year period. The post-implementation survey will be conducted in early 2019 with current Allied Health staff of the same LHD.

Results: A total of 404 Allied Health staff responded to the invitation to participate in the pre-implementation study. Factors improving recruitment and retention included education and training opportunities, reputation of AH and the LHD, supervision, communication and career promotion opportunities. In the future, staff wanted to see the LHD address education and training particularly in management and clinical specialty skills and career promotion. Strategies included implementation of leadership training; expansion of clinical supervision processes; staff recognition, maturing of governance structures to promote career progression and development of research positions and support.

Discussion: Trends influencing recruitment and retention of skilled staff such as education and training and development of career opportunities were incorporated into the 4-year workforce strategic plan. The post-implementation survey will be conducted in early 2019 to determine improvements in recruitment and retention of a skilled AH workforce.


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.

Understanding Allied Health services: Capacity and demand

Ms Julie-Anne Ross1, Ms Angela Wood1, Ms Kathy Grudzinskas1, Ms Wendy McCallum1

1Princess Alexandra Hospital, Brisbane, Australia

Background: Allied health services have much to offer in the provision of safe, efficient, patient centred care that supports health service targets and key performance indicators. However, we increasingly struggle with capacity to meet growing demand. The absence of clear frameworks for allied health staffing levels and lack of awareness regarding capacity and demand often leads to unrealistic expectations, high workloads and compromises the health and well-being of our staff.

Method: The first step to address these concerns was to establish and document a true picture of allied health services, current activity and factors that impact on capacity to meet demand.    A multi-faceted approach involved development of:

  • An allied health service profile which articulated detailed allied health staffing at a Division, service and ward and/or clinic level
  • An allied health dashboard for analysis of allied health activity and staffing at a Division, service and ward/clinic level by profession
  • A workload review to identify current allied health work practices and factors that impact on capacity to meet demand

Results & Discussion: Analysis of the allied health service profile, allied health dashboard and workload review has informed:

  • Open and transparent discussions regarding current and optimal models of service delivery in allied health professions
  • Regular executive, divisional and finance performance meetings
  • Advocacy for allied health services to best support patient needs
  • Workload management strategies including identification and understanding of high and low value activity, prioritisation strategies and wellness initiatives

The de-identified service profile, dashboard and workload review results will be shown, and lessons learnt from the ongoing journey discussed.  Future opportunities include addition of waitlist activity, bed numbers, alignment of research activity, mapping of activity to DRGs, targeted clinical redesign of allied health services to meet demand and disinvestment.

Conclusion: This initiative has been invaluable in providing a clear understanding of allied health services, capacity and demand.  Staff have permission to determine and implement optimal allied health models of care and services, without limitations of historical arrangements. The vision is this work will form the basis for an Allied Health Business Planning Framework.


Biography:

Julie-Anne Ross is an Occupational Therapist who works in Allied Health Workforce Development at the PA Hospital.  She has experience within the public sector in workforce development, clinical skills and management.

Angela Wood is an Occupational Therapist (OT) working in an Allied Health Workforce Development role for Metro South Hospital and Health Service, based at Princess Alexandra Hospital.  Angela has over 20 years healthcare experience in the public, private, corporate and not-for-profit sectors in Australia and the United Kingdom.  On completion of a Master of Health Science (Health Services Management) she developed a passion for supporting and developing health professionals, and developing and implementing innovative models of care to meet the current and future health needs of our community.  Angela has recently completed a Graduate Certificate in Clinical Redesign and a University of Toronto ‘train the trainer’ program on Collaborative Practice through Interprofessional Teamwork.  Research includes utilisation of the support workforce for best patient outcomes and the contribution of effective teamwork to patient care.

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)

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