Clinical innovation and scope of practice regulation: a case study of the Charlie Teo decision.

The issue of regulation of scope of practice (SOP) has recently been highlighted through the high-profile case of New South Wales-based neurosurgeon, Mr Charles Teo and specifically the finding of 'unsatisfactory professional conduct' by the NSW Health Care Complaints Commission (HCCC) in Teo, Charles (2023) NSWMPSC 2 (12 July 2023). The HCCC decision went to two issues in Teo's practice: (1) his decision to perform a surgery not within the SOP of his profession [at 238]; and (2) his failure to gain patient informed consent for that surgery [at 245]. This paper explores the findings against Teo with respect to SOP and recommends a nuanced approach to the regulation of clinical innovation and SOP evolution.

How can scope of practice be described and conceptualised in medical and health professions? A systematic review for scoping and content analysis.

BACKGROUND: The term scope of practice (SOP) refers to the limits of a health professional's knowledge, skills and experience and reflects all tasks and activities they undertake within the context of their professional role. Inconsistency in definitions of SOP contributes to uncertainty and confusion regarding professional practice boundaries and potentially impacts societal access to safe, effective and efficient healthcare options. The aim of this paper is to understand the conceptual diversity that may exist in terminology used to describe medical, nursing/midwifery and allied health SOP within an Australian practice context exemplar. METHODS: A systematic review for scoping and content analysis of SOP definitions and concepts, involving inductive thematic analysis and synthesis of published and grey literature. RESULTS: The initial search strategy yielded 11,863 hits, of which 379 were suitable for inclusion. Data coding identified various SOP terms and definitions and the emergence of six, conceptual elements underpinning the theoretical construct. These were subsequently proposed as a preliminary conceptual model ('Solar') to explain how the six conceptual elements may be applied across various professions, clinical settings and jurisdictions to better understand and address current and evolving SOP issues. CONCLUSION: The findings of this study highlight limited consistency in SOP definitions and terminology within a single jurisdiction, and the conceptual complexity of the underlying theoretical construct. Further research is required to build on the proposed 'Solar' conceptual model and create a universal SOP definition across jurisdictions, to enhance understanding of the importance of SOP to workforce policy, clinical governance, service models and patient outcomes.

Improving access for the vulnerable: a mixed-methods feasibility study of a pop-up model of care in south-eastern Melbourne, Australia.

Access to appropriate health and social care is challenging for vulnerable populations. We used a 'pop-up' delivery model to bring community-based services in contact with communities with poor access to health and social care. Our aim was to examine whether pop-up events improve access to essential health and social support services for selected vulnerable communities and increase collaboration between community-based health and social services. Set in south-eastern Melbourne, two pop-up events were held, one with people at risk of homelessness attending a community lunch and the other with South Sudanese women helping at-risk youth. Providers represented 20 dental, housing, justice, employment and mental health services. We made structured observations of each event and held semi-structured interviews with consumers and providers. Pre-post surveys of managers assessed acceptability and perceived impact. We reached 100 community participants who had multiple needs, particularly for dentistry. Following the events, participants reported increased knowledge of services and access pathways, community members spoke of increased trust and partnerships between service providers were fostered. The pop-up model can increase provider collaboration and provide new options for vulnerable populations to access needed services. 'Bringing the service to the person' is a compelling alternative to asking consumers to negotiate complex access pathways.

What Factors Do Allied Health Take Into Account When Making Resource Allocation Decisions?

BACKGROUND: Allied health comprises multiple professional groups including dietetics, medical radiation practitioners, occupational therapists, optometrists and psychologists. Different to medical and nursing, Allied health are often organized in discipline specific departments and allocate budgets within these to provide services to a range of clinical areas. Little is known of how managers of allied health go about allocating these resources, the factors they consider when making these decisions, and the sources of information they rely upon. The purpose of this study was to identify the key factors that allied health consider when making resource allocation decisions and the sources of information they are based upon. METHODS: Four forums were conducted each consisting of case studies, a large group discussion and two hypothetical scenarios to elicit data. A thematic content analysis commenced during post-forum discussions of key factors by forum facilitators. These factors were then presented to an expert working party for further discussion and refinement. Transcripts were generated of all data recordings and a detailed thematic analysis was undertaken by one author to ensure coded data matched the initial thematic analysis. RESULTS: Twelve factors affecting the decision-making of allied health managers and clinicians were identified. One of these factors was disendorsed by the expert working party. The 11 remaining factors can be considered to be key decision-making principles that should be consistently applied to resource allocation. These principles were clustered into three overarching themes of readiness, impact and appropriateness. CONCLUSION: Understanding these principles now means further research can be completed to more effectively integrate research evidence into health policy and service delivery, create partnerships among policy-makers, managers, service providers and researchers, and to provide support to answer difficult questions that policy-makers, managers and service providers face.

How Do Allied Health Professionals Define and Apply Equity When Making Resource Allocation Decisions?

An ethnographic study was conducted in 2 stages to understand how allied health professionals define and apply equity when making resource allocation decisions. Participants were allied health managers and clinicians from Victoria, Australia. Stage 1 included 4 semi-structured forums that incorporated real-life case studies, group discussions, and hypothetical scenarios. The project's steering committee began a thematic analysis during post-forum discussions. Stage 2 included a key stakeholder working party that further discussed the concept of equity. The forum recordings were transcribed verbatim, and a detailed thematic analysis ensured the initial thematic analysis was complete. Several domains of equity were discussed. Participants would readily identify that equity was a consideration when making resource decisions but were generally silent for a prolonged period when prompted to identify what they meant when using this term. The findings indicate that asking allied health professionals to directly state how they define and apply equity to their decision-making could be too difficult a task, as this did not elicit rich and meaningful discussions. Future research should examine individual domains of equity when applied to resource allocation decisions.

Girls (and Boys) Just Want to Have Fun: A Mixed-Methods Examination of the Role of Gender in Youth Mentoring Relationship Duration and Quality.

This prospective, mixed-methods study examined the role of gender in youth mentoring relationship duration and quality. Participants were 67 gender-matched pairs of adult mentors and youth participating in community-based mentoring programs as well as the youths' guardians. Mentors and youth completed surveys and qualitative interviews at multiple time points. At baseline, male youth reported stronger relationships with their guardians. Analysis of the survey data from the 3-month follow-up revealed that male mentors and youth reported stronger mentoring relationship quality. Male matches were more likely to last at least 1 year. Further, male youth whose matches lasted at least 1 year reported better relationships with their guardians at baseline and reported stronger mentoring relationships after 3 months, compared to both females whose matches lasted greater than a year, and females whose matches lasted less than 1 year. Examinations of the qualitative interviews from a sub-sample of matched pairs (n = 29) showed that male and female youth and male mentors held similar expectations for the relationship, mainly to engage in fun activities, while female mentors were more often looking for a close relationship to develop quickly, which resulted in a disconnect between female mentees' and female mentors' expectations. Findings highlight the importance of developmentally appropriate relationships for youth and suggest that mentoring programs may be able facilitate longer, more effective matches for girls by tempering female mentors' expectations for how close and quickly those relationships will develop.

Evaluation of a protocol for prevention of facility-acquired heel pressure ulcers.

OBJECTIVE: We sought to determine whether identification of comorbidities (in addition to daily Braden scale assessment and early aggressive pressure reduction interventions) would impact the development of facility-acquired pressure ulcers (FAPU) of the heel. METHODS: Patients admitted to a 333-bed community hospital located 20 miles west of Chicago. Overall, 70 medical records were reviewed, while 242 adult patients (46 in the intervention groups and 196 in the control groups) and 24 nurses participated in the study. The study was conducted in 4 phases, including a retrospective chart audit, 2 prospective interventions, and a product evaluation. Phase 1 entailed a retrospective chart review of patients who were admitted with or developed heel pressure ulcers over a 2-year period to identify factors most predictive of skin breakdowns. Phase 2 included two 10-day aggressive assessment and tailored intervention periods. Phase 3 involved prevalence day assessments of effectiveness of interventions as compared to patients on control nursing units. Phase 4 involved a staff survey comparing effectiveness and satisfaction of the current and trial heel pressure-relieving products. FINDINGS: Risk factors for development of heel ulcers during hospital stay or prior to admission included type 2 diabetes mellitus (T2DM), peripheral vascular disease (PVD), low albumin, and Braden scale score. During implementation of phase 2 (two 10-day assessment and tailored intervention periods), no heel FAPU were associated with the intervention. During the phase 3 FAPU prevalence assessment, 3 patients had facility-acquired heel ulcers; 2 were in the control group and would have met inclusion criteria if included in the intervention. One patient was in the intervention group but was not following the protocol. During phase 4, there were significant preferences for the trial heel pressure relief device on effectiveness, as well as patient and staff satisfaction. CONCLUSION: A pressure ulcer prevention protocol that incorporated accurate assessment of risk factors (Braden Scale and comorbidities) with frequent documentation of heel skin integrity had a positive impact on the incidence of heel FAPU. In addition, early aggressive implementation of pressure-reducing and pressure-relieving devices was effective in reducing FAPU rates.