Audit of allied health assistant roles: suggestions for improving quality in rural settings.

PROBLEM: There is considerable potential for allied health assistant roles to address rural workforce shortage, but there is also a need to ensure quality of these roles. DESIGN: A total of 41 allied health assistant trial roles were audited using an intensive onsite audit by independent clinicians. SETTING: Queensland public health services across rural/regional and metropolitan settings. KEY MEASURES FOR IMPROVEMENT: Audit ratings of rural/regional and metropolitan positions were compared on indicators of training, supervision, performance, duties and scope of practice as measured through multiple sources. STRATEGIES FOR CHANGE: Appropriately targeted in-service training may facilitate more effective utilisation of rural allied health assistants. EFFECTS OF CHANGE: Metropolitan and rural/regional audits showed consistency across qualifications, provision of duty statements and formal supervision arrangements. However, rural positions were not able to provide comparable levels of in-service training and supervision, and rural positions reflected a more restricted scope of practice. LESSONS LEARNT: Training in reflective practice may be a step to realising the potential of this crucial and emerging sector of the rural health workforce.

The Queensland Health Ministerial Taskforce on health practitioners' expanded scope of practice: consultation findings.

OBJECTIVE: Queensland Health established a Ministerial Taskforce to consult on and make recommendations for the expansion of the scope ofpractice of allied health roles. This paper describes the findings from the stakeholder consultation. METHODS: The Ministerial Taskforce was chaired by the Assistant Minister for Health and included high-level representation from allied health, nursing, medicine, unions, consumers and universities. Widespread engagement was undertaken with stakeholders representing staff from a wide cross-section of health service provision, training and unions. Participants also tendered evidence of models incorporating full-scope and extended scope tasks undertaken by allied health professionals. RESULTS: The consultation incorporated 444 written submissions and verbal feedback from over 200 participants. The findings suggest that full scope of practice is often restricted within the Queensland public health system, resulting in underuse of allied health capacity and workforce inefficiencies. However, numerous opportunities exist to enhance patient care by extending current roles, including prescribing and administering medications, requesting investigations, conducting procedures and reporting results. The support needed to realise these opportunities includes: designing patient-centred models of service delivery (including better hours of operation and delegation to support staff); leadership and culture change; funding incentives; appropriate education and training; and clarifying responsibility, accountability and liability for outcomes. The taskforce developed a series of recommendations and an implementation strategy to operationalise the changes. CONCLUSIONS: The Ministerial Taskforce was an effective and efficient process for capturing broad-based engagement for workforce change while ensuring high-level support and involving potential adversaries in the decision-mking processes. What is known about the topic? Anecdotal evidence exists to suggest that allied health professionals do not work to their full scope of practice and there is potential to enhance health service efficiencies by ensuring practitioners are supported to work to their full scope of practice. What does this paper add? This paper presents the findings from a large-scale consultation, endorsed by the highest level of state government, that reinforces the perceptions that allied health professionals do not work to full scope of practice, identifies several barriers to working to full scope and extended scope of practice, and opportunities for workforce efficiencies arising from expanding scope of practice. The top-down engagement process should expedite the implementation of workforce change. What are the implications for practitioners? High-level engagement and support is an effective and efficient way to broker change and overcome intraprofessional barriers to workforce change policies. However, practitioners are often prevented from expanding their roles through an implied need to 'ask for permission', when, in fact, the only barriers to extending their role are culture and historical practice.

Pilot implementation of allied health assistant roles within publicly funded health services in Queensland, Australia: results of a workplace audit.

BACKGROUND: Allied health assistants provide delegated support for physical therapists, occupational therapists and other allied health professionals. Unfortunately the role statements, scope of practice and career pathways of these assistant positions are often unclear. To inform the future development of the allied health assistant workforce, a state-wide pilot project was implemented and audited. METHODS: New allied health assistant positions were implemented in numerous settings at three levels (trainee level, full (standard) scope and advanced scope level). Six months after implementation, 41 positions were audited, using a detailed on-site audit process, conducted by multiple audit teams. RESULTS: Thematically analysed audit findings indicated that both the full (standard) scope and the advanced scope positions were warranted, however the skills of the allied health assistants were not optimally utilised. Contributing factors to this underutilization included the reluctance of professionals to delegate clinical tasks, inconsistencies in role descriptions, limitations in training, and the time frame taken to reach an effective skill level. CONCLUSIONS: Optimal utilisation of assistants is unlikely to occur while professionals withhold delegation of tasks related to direct patient care. Formal clinical supervision arrangements and training plans should be established in order to address the concerns of professionals and accelerate full utilisation of assistants. Further work is necessary to identify the key components and distinguish key features of an advanced allied health assistant role.

Defining the role and scope of practice of allied health assistants within Queensland public health services.

BACKGROUND: The uptake and utilisation of allied health assistants as professional support staff has been variable across disciplines and jurisdictions. Although they are potentially very important in the current health workforce context, there is little agreement on their roles or the most suitable methods to define these roles. METHOD: Based on a review of literature, existing role descriptions and focus groups, a Delphi survey process was undertaken. This process comprising three rounds of discussion and clarification via email, with between 107 and 188 participants, was undertaken to define and establish consensus on allied health assistant roles at three levels. RESULTS: Three cycles of editing, qualitative feedback and rating of agreement with statements resulted in substantial clarification of roles and a meaningful degree of consensus regarding the role and scope of such positions. High levels of agreement were not reached for more high-level or contested clinical tasks. CONCLUSIONS: The Delphi process resulted in key tasks and roles being defined and contentious aspects clearly identified. The process facilitated engagement with workforce members most closely affected by these questions. It was a useful means of drawing together the opinions of the workforce and informing implementation trials to follow.