Continuing differences between health professions' attitudes: the saga of accomplishing systems-wide interprofessionalism.

OBJECTIVE: To compare four health professions' attitudes towards interprofessional collaboration (IPC) and their evaluations of a programme aimed at enhancing IPC across a health system. DESIGN: Questionnaire survey. SETTING: Australian Capital Territory health services. PARTICIPANTS: Sample of medical (38), nursing (198), allied health (152) and administrative (30) staff. INTERVENTION: s) A 4-year action research project to improve IPC. MAIN OUTCOME MEASURE: Questionnaire evaluating the project and responses to the 'Attitudes toward Health Care Teams' and 'Readiness for Interprofessional Learning' scales. RESULTS: Significant professional differences occurred in 90% of the evaluation items. Doctors were the least and administrative staff most likely to agree project aims had been met. Nurses made more favourable assessments than did allied health staff. Doctors made the most negative assessments and allied health staff the most neutral ratings. Improved interprofessional sharing of knowledge, teamwork and patient care were among the goals held to have been most achieved. Reduction in interprofessional rivalry and improved trust and communication were least achieved. Average assessment of individual goals being met was agree (31.9%), neutral (56.9%) and disagree (11.2%). On the two attitude scales, allied health professionals were most supportive of IPC, followed by nurses, administrators and doctors. CONCLUSIONS: Although overall attitudes towards IPC were favourable, only a third of participants reported that project goals had been achieved indicating the difficulties of implementing systems change. The response profiles of the professions differed. As in the previous research, doctors were least likely to hold favourable attitudes towards or endorse benefits from social or structural interventions in health care.

Assisting role redesign: a qualitative evaluation of the implementation of a podiatry assistant role to a community health setting utilising a traineeship approach.

BACKGROUND: Increasing demands for podiatry combined with workforce shortages due to attrition, part-time working practices and rural healthcare shortages means that in some geographic areas in Australia there are insufficient professionals to meet service demand. Although podiatry assistants have been introduced to help relieve workforce shortages there has been little evaluation of their impact on patient, staff and/or service outcomes. This research explores the processes and outcomes of a 'trainee' approach to introducing a podiatry assistant (PA) role to a community setting in the Australian Capital Territory (ACT) Government Health Service Directorate. METHOD: A qualitative methodology was employed involving interviews and focus groups with service managers, qualified practitioners, the assistant, service users and consumer representatives. Perspectives of the implementation process; the traineeship approach; the underlying mechanisms that help or hinder the implementation process; and the perceived impact of the role were explored. Data were analysed using the Richie and Spencer Framework approach. RESULTS: Although the impact of the PA role had not been measured at the time of the evaluation, the implementation of the PA traineeship was considered a success in terms of enabling the transfer of a basic foot-care service from nursing back to podiatry; releasing Enrolled Nurses (ENs) from foot-care duties; an increase in the number of treatments delivered by the podiatry service; and high levels of stakeholder satisfaction with the role. It was perceived that the transfer of the basic foot-care role from nursing to podiatry through the use of a PA impacted on communication and feedback loops between the PA and the podiatry service; the nursing-podiatry relationship; clinical governance around the foot-care service; and continuity of care for clients through the podiatry service. The traineeship was considered successful in terms of producing a PA whose skills were shaped by and directly met the needs of the practitioners with whom they worked. However, the resource intensiveness of the traineeship model was acknowledged by most who participated in the programme. CONCLUSIONS: This research has demonstrated that the implementation of a PA using a traineeship approach requires good coordination and communication with a number of agencies and staff and substantial resources to support training and supervision. There are added benefits of the new role to the podiatry service in terms of regaining control over podiatric services which was perceived to improve clinical governance and patient pathways.

A four-year, systems-wide intervention promoting interprofessional collaboration.

BACKGROUND: A four-year action research study was conducted across the Australian Capital Territory health system to strengthen interprofessional collaboration (IPC) though multiple intervention activities. METHODS: We developed 272 substantial IPC intervention activities involving 2,407 face-to-face encounters with health system personnel. Staff attitudes toward IPC were surveyed yearly using Heinemann et al's Attitudes toward Health Care Teams and Parsell and Bligh's Readiness for Interprofessional Learning scales (RIPLS). At study's end staff assessed whether project goals were achieved. RESULTS: Of the improvement projects, 76 exhibited progress, and 57 made considerable gains in IPC. Educational workshops and feedback sessions were well received and stimulated interprofessional activities. Over time staff scores on Heinemann's Quality of Interprofessional Care subscale did not change significantly and scores on the Doctor Centrality subscale increased, contrary to predictions. Scores on the RIPLS subscales of Teamwork & Collaboration and Professional Identity did not alter. On average for the assessment items 33% of staff agreed that goals had been achieved, 10% disagreed, and 57% checked neutral. There was most agreement that the study had resulted in increased sharing of knowledge between professions and improved quality of patient care, and least agreement that between-professional rivalries had lessened and communication and trust between professions improved. CONCLUSIONS: Our longitudinal interventional study of IPC involving multiple activities supporting increased IPC achieved many project-specific goals. However, improvements in attitudes over time were not demonstrated and neutral assessments predominated, highlighting the difficulties faced by studies targeting change at the systems level and over extended periods.

Interprofessional education in health sciences: the University of Queensland Health Care Team Challenge.

Successful transition of students to competent work-ready health professionals requires an ability to work in health care teams. Poor communication and teamwork practice has been implicated as a contributing source of error affecting patient safety. Traditional university curriculum structures severely limit the time that students from different professions can spend together, learning about and from each other (interprofessional education [IPE]). IPE initiatives need to focus on whole-of-system impacts and organisational sustainability. The Health Care Team Challenge (HCTC) is a high-profile leadership strategy that engages students, academic staff, practising professionals, policymakers and industry in a whole-of-system approach to IPE and interprofessional practice. Interprofessional student teams compete at a live public event for a cash prize for the best management plan centred on a complex clinical case study. National and international HCTCs are planned for future years.

Beyond organisational design: moving from structure to service enhancement.

The Australian health care industry prior to the 1990s was notable for its relative stability and uniformity in relation to organisational design. Since then, new organisational designs have proliferated and a diversity of approaches is evident. The new fluidity in organisational design is particularly evident amongst the allied health professions. The aim of this paper is two-fold. Firstly, to summarise recent changes in organisational design as they relate to the allied health professions and secondly, to move beyond design issues to focus on service level enhancement in an organisational change context. This later aim is achieved by presenting data from an in-depth study of one institutions experience with wide-ranging organisational reforms. The recent formation of the National Allied Health Organisational Structures Network (NAHOSN) has given energy to the impetus of placing a research-based framework around the change experiences reported by Allied Health groups. An objective of the network is to foster research, rather than rely on commentary and anecdote, in the often highly contested arena of organisational design and reform.

Modes of organising at two health services organizations: a case study approach.

This paper applies a case study methodology to examine the development of two distinct models of organising allied health professionals within two health service organizations. In particular, it explores options in modes of organising. Case study data reflected that in one case a single stakeholder entity was achieved through the development of quasi-shareholder roles for allied health discipline leaders. In contrast, the second case included multiple small weak stakeholders who had competing visions regarding both identity and resource allocation. The emergence of these two distinct forms of organising within allied health has implications for policy and practice.