Allied Health Assistant Implementation Program · 2018-02-22 · Allied Health Assistant...

Allied Health Assistant

Implementation Program

Stage Three – Metropolitan Community & Ambulatory Services

North East Hub

Final Report April 2015

Incorporating Austin Health, Darebin Community Health and Nillumbik Health

Auspiced by North-East Primary Care Partnership

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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services

1. Steering Committee & Working Group

The North-East Primary Care Partnership worked to establish a Project Steering Committee in order to commence this project and subsequently formed the Expression of Interest submission. Throughout the project, the committee members provided advice, scope variation endorsements, strategic guidance and monitoring of the Allied Health Assistant Implementation Project (AHA Implementation Project). The following staff members were invited to be members of the steering committee: Executive Sponsor: Julie Watson (NEPCP Executive Officer) Senior Managers: Juliet Thorn - Austin Health - Aged Care Community Programs Jenny Collins - Austin Health - Health Independence Programs Sharon Sherwood - Austin Health – North East Area Mental Health Services Carolyn Jones - Darebin Community Health Sean Spencer - Nillumbik Health Project Staff: Sally Russell (Project manager) Karen Dundules (Project officer) The steering committee then nominated relevant staff members to participate in the Project Working Group. .

Austin Health Darebin Community Health Nillumbik Health

Marina Nasso Michelle Long Amanda McAliece Juliette Chapman

Paul Bohan Vicki Georgaklis John Moran

2. Acknowledgements This project was completed with the generous assistance from the following:

• The Victorian Department of Health and Human Services (DHHS) (formerly Victorian Department of Health), who provided funding for the project team, and assembled the Program Implementation team to guide the teams through the methodology with patience and valuable expertise.

• The Steering Committee, whose insight into the potential of the project and recognition of the benefits of

collaboration between health networks enabled the opportunity to participate in the project.

• The Working Group and staff, who voluntarily participated in the project. Their commitment beyond their everyday work demands was a demonstration of vision, insight and clear recognition of the valuable contributions that optimising the use of allied health assistants can have with client care and service quality.

• Executive Sponsor, Julie Watson, for her continued support and vision for this work beyond the life of the project.

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3. Abbreviations

ACAS Aged Care Assessment Service

ACCP Aged Care & Community Programs

AH Austin Health

AHA Allied health assistant

AHP Allied health professional

CCS Continuing Care Service – Mental Health

CM Case manager

CMP Case Management Packages

DCH Darebin Community Health

DHHS Department of Health and Human Services

EP Exercise physiologist

LGA Local government area

MSTS Mobile Support & Treatment Service

NCM Nurse Case Manager

NEPCP North East Primary Care Partnership

NH Nillumbik Health

OP Outpatients

OT Occupational therapy

Psych Psychologist

PT Physiotherapy

RITH Rehabilitation in the Home

TCP Transition Care Program

SP Speech pathologist

SW Social worker

YEPS Youth Early Psychosis Service

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4. Table of Contents

1. Steering Committee & Working Group .......................................................................... 2 2. Acknowledgements ......................................................................................................... 2 3. Abbreviations .................................................................................................................. 3 4. Table of Contents ............................................................................................................ 4 5. Executive summary ......................................................................................................... 5 6. The Allied Health Assistant Implementation Program ................................................. 6 7. North East Primary Care Partnership demographics ................................................... 7 8. Background ..................................................................................................................... 7 9. Project management ....................................................................................................... 7 10. Methodology ................................................................................................................. 8 11. Results and Analysis ................................................................................................. 10 12. Key issues and solutions .......................................................................................... 23 13. Strategic workforce goals and outcomes ................................................................ 23 14. Strategic plan for integrating the AHA workforce ................................................... 24 15. AHA Strategic Workforce Plan .................................................................................. 24 16. Conclusion ................................................................................................................. 32 17. References .................................................................................................................. 32 18. Appendices ................................................................................................................. 32

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5. Executive summary

The allied health workforce is an essential component of the ambulatory health workforce. The demand for allied health services is expected to continue to increase with the ageing population. The AHA Implementation Program (Stage 3) is a DHHS health workforce strategic direction aimed at the support workforce for Allied Health Professionals (AHPs). It recognises that the demand for allied health workers will outstrip the supply unless significant steps are taken to reconfigure it. This project is designed to contribute to the process of maximising the capacity of the clinical workforce, with a focus on allied health. The overall aims of the program are to: • Increase the AHA workforce • Utilise AHAs to their full scope of practice to increase the allied health workforce capacity • Make the most of highly skilled clinicians • Improve access to allied health services, and • Grow a sustainable allied health workforce. The first two stages of this program targeted rural and regional health services (Stage 1) and acute/inpatient health services (Stage 2). The final stage has focused on community and ambulatory care services, with the NEPCP coordinating participation in this stage on behalf of Austin Health, Darebin Community Health and Nillumbik Health. Data Collection Staff participated in a range of data collection and engagement elements under the direction and facilitation of the NEPCP project team. • Workforce Survey

Staff demographics were gathered, along with level of confidence of AHPs in delegating tasks to their support workforce (AHAs). It was found that AHPs & AHAs are satisfied and stimulated by their current work roles. The survey further indicated that there are gaps with formal training and professional development to progress AHA-specific skills.

• Focus Groups These groups, held across the NE hub, identified tasks that AHAs currently performed, and other tasks that AHPs performed that could be delegated. The identified tasks informed the Quantification Survey. Challenges and benefits associated with increasing the AH support workforce were raised.

• Quantification Survey AHPs documented the time spent undertaking tasks that could have been delegated to AHAs. This assisted in identifying key areas of focus for strategic planning specific to each program area.

Key Findings The final phase of the project involved the blending of results from the Workforce survey, Quantification Survey, Focus groups and other consultations in order to identify future direction for the programs, and create strategic plans relevant to each program area. Key opportunities identified included: • Continued partnership to create consistency of governance structures and AHA positions across

organisations • Further training for AHPs and case managers in the AHA Supervision and Delegation Framework • Development of key competencies of AHA roles • Delegation pathways that are clear and supported by clinical governance • Specific goals and strategies for program areas to increase the capacity of the existing AHA workforce.

Additional funding has been endorsed from the NEPCP to continue the collaborative approach used during this stage of the project. This role is expected to lead the ongoing foundational work in developing consistency and resources of the AHA role throughout the PCP.

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6. The Allied Health Assistant Implementation Program Allied health services represent a significant component of primary, community and acute health care. Increasing the size and utilisation of the allied health assistant (AHA) workforce is one of a suite of activities being used to improve the system’s capacity to meet the community’s health needs into the future. Since 2008 the Department of Health (the department) has implemented a range of initiatives to address barriers to the uptake of the AHA role. In February 2012 the department released the Supervision and delegation framework for allied health assistants (the framework). The framework seeks to actively improve the sector’s understanding of the AHA role and will support the increased uptake and utilisation of the role across Victoria. As part of the department’s health workforce and reform implementation agenda (2012-2016), Health Workforce is implementing a targeted initiative, the AHA Implementation Program, to assist health and community services to strategically position themselves to build their AHA and allied health workforce capacity for the future in a sustainable way. The AHA Implementation Program is underpinned by the framework and is being undertaken in three stages. Table 1: Stages of the AHA Implementation Program Stage one: In 2012-13, the department embarked on the first stage of the program, focussing on increasing the uptake and utilisation of AHAs in rural and regional areas. This stage involved 16 sub-regional clusters; involving over 1000 allied health and community service staff from 86 organisations across rural-regional Victoria. Stage two: Stage two of the program was implemented in 2012-13 and 2013-14 and focused on acute and subacute settings in 11 major metropolitan health services. This stage involved 31 sites and almost 2000 allied health staff and sought to expand the number and proportion of AHAs in participating organisations’ allied health services. Participating organisations were also encouraged to consider their community health and ambulatory service arms in the engagement and consultation processes as part of stage two of the program where appropriate. Stage three: Stage three (2013-14 and 2014-15) focuses on community health and ambulatory service settings in metropolitan areas and seeks to increase the uptake and utilisation of AHAs in community health and primary care sectors. The implementation of a skilled and flexible AHA workforce that is able to operate under the direct, indirect or remote supervision of an AHP will help to alleviate some of the demand pressure on community allied health services and will help to improve access, continuity and availability of care. The program uses the 'Victorian Assistant Workforce Model (allied health)' (the Model) which is founded on a robust data collection and analysis methodology and change management process developed and piloted by Alfred Health in 2009-2011. The Alfred Health and Monash Health program teams, on behalf of the department, have coordinated and monitored the program, trained project staff in implementing the Model and provided ongoing mentoring and support to participating organisations in all three stages of the program. Participation by AHP staff and AHAs in the forums, focus groups and data collection surveys has been essential to the successful implementation of the program in the North East PCP catchment. The consultation-based methodology is designed to increase participating AHPs’ understanding of the AHA role and the benefits that AHAs can bring to the delivery of allied health services in North East PCP catchment and forms a critical part of building AHP ownership and involvement of any changes. The consultation process underpins the successful implementation of the strategic goals and outcomes. The strategic goals and outcomes outlined in this report have been developed based on analysis of the data and consideration of current and future service needs. This document includes key actions identified through the methodology, and is based on the consultations that have occurred with key stakeholders during the program.

http://docs.health.vic.gov.au/docs/doc/87B365A392B0332CCA25799E007F8ACE/$FILE/framework-for-web-060612.pdf


http://docs.health.vic.gov.au/docs/doc/3B8961B7CCC81B13CA257A80000E1556/$FILE/Stage%20three%20information%20sheet-v04.pdf

http://docs.health.vic.gov.au/docs/doc/3B8961B7CCC81B13CA257A80000E1556/$FILE/Stage%20three%20information%20sheet-v04.pdf

http://docs.health.vic.gov.au/docs/doc/Guidelines-to-scope-and-introduce-new-allied-health-assistant-roles

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This report provides an evidence base for the introduction of AHA roles within North East PCP catchment leading into the next 4-5 years. This can be staged through short, medium and long term goals. Additionally, the implementation plan will assist the development and growth of allied health services and the associated workforce at North East PCP catchment in an informed and strategic way, as funding becomes available through local reallocations or potential future funding rounds (both state and national).

7. North East Primary Care Partnership demographics The North East Primary Care Partnership catchment area encompasses Darebin, Banyule and Nillumbik local government areas. It is relatively advantaged on most economic indicators and health status measures (North East Primary Care Partnership, 2013). However, further analysis of the data demonstrates areas of higher disadvantage due to:

• higher than average social housing, • projected age increase in the >55 years age bracket, • significant population of Aboriginal and Torres Strait Islander people, • pockets of culturally diverse populations and • high prevalence of diabetes and chronic disease risk factors.

These factors will continue to influence the pressures placed on hospital, community and ambulatory health services. Subsequently, community and ambulatory services within the NEPCP catchment have partnered together to address common issues, goals and strategies to overcome current and foreseeable challenges. Three key organisations from the catchment participated in the project: Austin Health, Darebin Community Health and Nillumbik Health. Other organisations showed an interest in the outcomes of the project, but due to a variety of circumstances did not participate. Results of the project will be shared within the catchment. It is expected that information will be generalisable as workforce similarities exist between several organisations.

8. Background Austin Health, Darebin Community Health and Nillumbik Health expressed a shared interest in participating in Stage Three of the project. Agencies reported the following opportunities / benefits being motivation for their participation:

• Localised opportunity to contribute to workforce innovation strategies that may be adopted statewide • Collaborative approach to support AHA & AHP discussion • Reflection on current situation with view to improving outcomes for clients • Integration of AHA workforce to support generic case management roles • Training and scope of practice opportunities for AHAs • Possibility of positive unintended outcomes • New workforce potential and new career structure for staff • New recruitment opportunities • Improvement in service delivery, and subsequent outcomes for consumers

Austin Health, as a provider of acute inpatient services and participant in Stage Two, combined with Steering group members’ experience in previous stages, identified the potential growth in the AHA workforce in community health and ambulatory care services.

9. Project management The project manager and project officer were employed from within Austin Health and Darebin Community Health respectively. Both staff members reported to the NEPCP Executive Officer for the duration of the project. The Department of Health provided $70,000 for project implementation, for the funding towards the salaries of both project staff. The project manager was Grade 4 at 0.4EFT, with the project officer Grade 2 at 0.2EFT. Both staff members were recruited in time for the commencement of Stage 3. Both staff members attended six separate training days scheduled throughout the project.

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Members of the Project Steering Committee were involved in the Expression of Interest, recruitment and strategic planning phases. The steering committee met on two occasions during the project. The first was to endorse a project scope variation to allow the incorporation of nurse case managers in a concurrent component of the project. Members of the steering committee also attended a DHHS strategic planning session. The project team also met with each member individually to ratify task lists and commence strategic planning. The second meeting was for the endorsement of this final report. The Working Group was established based on advice from steering group members. Each program area was represented by a champion, with the group meeting on seven occasions throughout the project. Additional delegates from Darebin Community Health and Austin Health – HIP were identified during the project to replace Working Group members who departed during the life of the project. They were the conduits for communication with clinical staff, and facilitated the completion of critical elements of the project

10. Methodology Participants The following program areas and teams participated in the project.

Austin Health Darebin

Community Health

Nillumbik Health Health

Independence Programs (HIP)

North East Area Mental Health

(NEAMHS)

Aged Care & Community

Programs (ACCP)

Rehabilitation Services (RITH/OP)

Continuing Care Service (CCS)

Aged Care Assessment Service

(ACAS)

General Allied Health team

Adult team Specialist Clinics & Intervention

Services - Pain Management Team

Mobile Support & Treatment Service

(MSTS)

Case Management Packages (CMP) Health Wise team

Specialist Clinics & Intervention

Services - Memory Youth Early Psychosis Service

(YEPS)

Transition Care Program (TCP)

Living Well team

Child & Family team Complex Care

Management - Community Link

Child & Family team

Table 2: Participating teams and programs in the NE Hub The AHA Supervision and Delegation Framework states that the delegation and supervision of AHAs should be conducted by an AHP. While the framework does not explicitly define the term ‘Allied Health Professional’, it is widely considered that nurses do not fall into this category as they have a separate clinical and advocacy framework. Initially, only case manager (CM) roles filled by AHPs were considered in the scope of this project, and these are the only roles that have been included in the Stage 3 Program Data for DHHS. However, given the potential for these teams to be fully staffed with AHP, and the desire to maximise the reliability and accuracy of the data, the steering committee was presented with the option to include nurse case managers (NCM) in the project. This option was recommended and endorsed by the steering committee; hence, NCMs also participated in data collection and are included in the strategic planning and reporting phase.

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The clinical professions examined in this project are: Case Management (AHPs and Nurses), Counselling (Psychology- and Social Work- trained), Exercise Physiology, Nutrition & Dietetics, Occupational Therapy, Physiotherapy, Podiatry, Social Work, Speech Pathology and Psychology. Data Collection There were four elements of data collection: Element 1: Workforce Survey – July 2014 A Workforce Survey (Staff Satisfaction Survey), created by the Department of Health Program Implementation Team, was distributed to the Project staff via Survey Monkey. Project Staff circulated the link to all staff (including case managers with nursing clinical background) in all participating programs. Opening times for the survey was extended, combined with reminders from program champions, in order to improve the response rate. Element 2: Focus Groups - July 2014 A total of 13 focus groups were held across all participating program areas. All staff (AHAs, AHPs and NCMs) were invited to attend. Each focus group was multi-disciplinary with representatives from multiple teams. It was intended that this would provide opportunities to share experiences about working with AHAs. NEAMHS currently have no AHAs employed, so discussion was facilitated by the project team and included AHPs with previous AHA experience. The questions posed were:

• What clinical tasks are AHAs currently performing in your profession or service? • What clinical tasks in your profession or service would AHAs be unable to perform? • What tasks in your profession or service could an AHA perform? • How much time in your day would these tasks free up? • What are the potential benefits with increased use of AHAs by AHPs? • Identify reasons that AHPs do not utilise AHAs more frequently. • What are some disadvantages of increasing the AHA workforce and some possible solutions?

The aim of the focus groups was to identify tasks currently performed by AHAs, combined with tasks AHPs currently perform, that are appropriate to delegate to AHAs. This formed the basis of the task list for the Project Quantification Survey. Additional information was identified in relation to challenges associated with delegating tasks to AHAs and potential benefits of increasing the AHA workforce, as well as some areas of unmet demand. Element 3: Baseline staffing, vacancies and waiting lists – September 2014 Baseline staffing EFT data for all participating programs was captured prior the Quantification survey and entered into a custom built Microsoft Access database. Additional information relating to waiting list times for teams/disciplines was also included. Element 4: Quantification Survey – October 2014 Two task lists were generated based on focus group information: a Clinicians’ Quantification Survey for use by AHPs in direct clinical roles, and a Case Managers’ Quantification Survey which was designed for use by all clinicians in case management roles. Individuals reported the time spent per day performing tasks that could have been safely delegated to an AHA. Tasks were allocated to practice categories that were identified in previous stages of the project. This data was entered into a Microsoft Access database which is held and aggregated centrally at the department, as well as local information being retained within the hub. A pilot survey was completed at Nillumbik Health in early October. Minor changes were made, and all remaining program areas completed quantification by the end of October 2014. Surveys remained de-identified,

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but a numbering system was implemented and a list of names provided to each team leader to ensure the correct staff members received and returned the surveys. Both quantification surveys are included in the Appendix 1. Strategic Planning The data presented in this report includes a conversion factor. The Allied Health Staffing Factor is a model developed and utilised by Alfred Health Allied Health to convert clinical activity into EFT requirements in order to assist with the budgeting process (Department of Health, 2014). The Alfred/Monash Program team have developed a staffing factor of 1.52 and this has been applied where proposed AHA hours or EFT has been identified. The staffing factor accounts for clinical and non clinical aspects of a role, including paid breaks, leave and public holidays. Where time is presented in hours or EFT, the conversion factor has been applied. Extensive consultation was undertaken throughout the project with each program area. The focus groups and other discussions yielded rich qualitative data that formed much of the basis for the strategic plan. Data from the quantification survey supported the directions indicated through this consultation.

11. Results and Analysis Teams that participated in this stage of the project varied considerably from Stage Two. The nature of the community and ambulatory workforce includes a strong focus on clinicians working within multidisciplinary teams, as opposed to discipline specific departments. Some teams in scope also consisted of case management roles, where roles call for generic, rather than discipline-specific position descriptions. Baseline Staffing

Staffing type for NE Hub AHP NCM AHA

Total

AHA as a percentage of workforce

Physical number of staff (excludes vacant positions)

130 25 13 168 7.7%

EFT (includes vacancies)

87 20 9.5 108 8.7%

Table 3: Staff in the NE Hub As indicated in Table 3, the current AHA workforce represents an average of 8.7% of the total AHP and NCM workforce EFT across all three organisations, though this varied widely with Austin at 7.6%, Darebin at 7.1% and Nillumbik at 19.5%. Figure 1 demonstrates the representation of disciplines participating in the NE Hub, according to the number of staff. Physiotherapy (PT) and occupational therapy (OT) had the highest representation, followed by NCM. This reinforces the importance of recognising potential workforce configuration.

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Figure 1: Hub workforce percentage by number of staff per discipline

Workforce Survey A NE Hub response rate of 83.9% was achieved for the Workforce Survey. Due to the small size of some teams or disciplines in several programs, results were grouped to preserve anonymity of respondents. Trends within and between teams or disciplines were not able to be identified, and results are generalised hub-wide. The combined results suggest staff in the hub have a high level of job satisfaction, and agree that work is stimulating, despite limited access to AHAs.

Skills and Training

AHPs who have access to an AHA to assist in clinical tasks 53%

AHPs somewhat or extremely confident in referring clinical tasks to AHAs 77%

AHAs who perceive they have sufficient training and support in their current role 91%

AHPs somewhat or extremely confident in skills of AHAs to meet clinical demands 77%

AHPs somewhat or extremely satisfied with the use of AHAs in their profession 83%

Role Satisfaction

AHPs who find their job somewhat or extremely satisfying 87%

AHPs who find their daily roles stimulating 88%

AHAs who find their job satisfying or very satisfying 91%

AHAs who find their job stimulating 75%

Physiotherapy 19%

Occupational Therapy 18%

Nurse case managers (NCM)

15% Social Work

11%

AHA 8%

Podiatry 6%

Exercise Physiology 1%

Speech Therapy 6%

Counselling 6%

Nutrition & Dietetics 5%

Psychology 5%

NE Hub Workforce

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Table 4: NE Hub workforce findings The tasks most reported as being delegated to AHAs included group sessions, equipment provision, administration tasks and stock management.

Figure 2: Hub current AHA tasks

The current AHA tasks varied across the organisations, with a number of additional tasks that could be delegated to AHAs also specified. These included:

• Speech therapy tasks • Training for use of motorised mobility and public transport • Assisting with resource production • AHA training • Phoning clients for appointments • Cleaning equipment • Management of invoices

0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%

Current AHA Tasks in NE Hub

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Staff Focus groups A total of 13 focus groups were held, with 8 AHAs and 91 AHPs/NCMs attending. This represented an attendance rate of 59% for the NE Hub. All teams were represented except the Aged Care Assessment Service. This team’s needs were addressed by seeking feedback from the program manager and staff about additional tasks to add to the Quantification Survey. Questions sought information about potential benefits of increased use of AHAs, reasons that AHAs may not be used, and some challenges associated with increasing the AHA workforce. The following tables represent the key themes and verbatim comments raised during the focus groups

Common benefits Comments

Use and development of full scope of practice

Opportunities for AHP to work to full scope of practice Increased opportunity for skill development and professional development

Increased satisfaction for AHP and AHA’s

Increased variety for AHP & AHA’s Flexibility with AHA, rather than administration only

Improved quality of care/ Facilitate Best Practice

Increased time for assessment and treatment More time with complex clients Increased intensity/frequency of therapy Increased variety for clients Work to full needs of client, rather than priorities only Decreased risk with two staff in groups

Improved access

Potential to incorporate other disciplines Decrease waiting lists Increase throughput/activity May decrease non attendances

Enhanced integration of service

Opportunities for interdisciplinary care Increased efficiency to discharge Continuity of care across programs

Opportunities for service development

Time for service development Assist with research/ systematic reviews Scope for more programs Creates a richer and more integrated service

Table 5: Potential benefits of increasing the AHA workforce Further questions reported on AHA training and support and skills levels, AHP confidence delegating tasks and satisfaction with AHA use. An increase in the AHA workforce was met with some perceived challenges outlined below. As a result of findings identified in Stage One, the Department funded a number of training sessions to address AHAs’ and AHPs’ knowledge of the Supervision and Delegation Framework. Anecdotally the hub did not have significant numbers of participants, and limited knowledge and understanding of the framework was evident.

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Identified challenges Comments

Effect on AHP roles

Potential to limit AHP workforce growth Potential de-skilling of AHP workforce Potential for less client contact, increased paperwork Potential for “double-handling” of tasks

Time for delegation

Time required for supervision and delegation Time for clinicians to plan and train AHA in tasks Time to delegate, co-ordinate and supervise AHA

Perceived skills of AHA/ AHP

Lack of clarity of AHA skills and competencies Lack of experience working with AHAs Graduates AHPs require chance to develop skills Knowledge of what/how to delegate Differences in usage of AHAs based on perceived skills

Access to AHA

AHAs are already at capacity AHAs are sometimes located at other sites or physical environment is at capacity AHAs are sometimes shared between disciplines

Client related reasons

Client may be too complex, requiring clinician assessment Too complicated, and AHA not having knowledge Client not comfortable having another staff member involved

Organisational structure Supervision structure/matrix may be complex because of multiple sites and teams

Effect on quality of service More people involved, therapeutic goals may not be achieved

Table 6: Challenges identified with increasing AHA workforce Quantification Results – Hub-wide data Tasks identified during the focus groups formed the basis of the Quantification Survey, which was subsequently ratified by program managers and champions. See Appendix 1 for the separate Quantification Surveys (Task Lists) devised for discipline-based programs, and case management based programs. All teams participated in one week of data collection from 6th – 31st October 2014, with an overall NE Hub response rate of 90.9%. Hub data was generalised across all three organisations, and further analysed by program area to assist with the identification of trends and patterns. Clear consistencies emerged across most teams where Podiatrists and Nutrition & Dietetics disciplines were involved. These disciplines quantified substantial hours that could be delegated to an AHA, in comparison to their overall EFT, and is most likely explained by the limited access to AHAs these disciplines currently experience. Furthermore, analysis of the tasks identified highlight the potential to have significant impact, with AHA competencies is a relatively small number of tasks.

NCM represented the largest cohort of responses within the hub, and the delegable EFT was also substantial (6.91 EFT). NCM represent a cohort that currently has no formal supervision and delegation pathways to AHAs.

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Figure 3: Hub identified delegable time by discipline * Conversion factor has been applied

Overall the Hub demonstrated the highest delegable hours in clinical reporting, administration and treatment categories. This is anecdotally consistent with results from other hubs in this stage.

Figure 4: Hub delegable time by practice category *Conversion factor has been applied

0.11

1.29

4.34

0.70

6.91

3.53 2.86

1.12 1.91 1.61

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Austin Mental Health, consisting of 3 teams (CCS, YEPS and MSTS) clearly identified a role for a support workforce, with 8.66EFT attributable to AHA delegable time. These particular teams are met with challenges associated with identifying the most suitable support workforce due to the high number of NCM.

Figure 5: Hub delegable hours by team * Conversion factor has been applied

1.6 2.07 0.83 0.92

8.66

0.76 0.8 0.52

1.95 2.52

0.98 1.7

1.08

0%5%10%15%20%25%30%35%40%

0.01.02.03.04.05.06.07.08.09.0

10.0Hours*

Hub Delegable hours* by team

Delegable EFTIdentified

Delegable time as % ofAHP/NCM EFT

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Quantification results – Program Specific Quantification data was used to guide strategic planning, and also to provide supporting evidence for the creation of new AHA roles already proposed and approved. Austin Health Health Independence Programs - Chronic and Complex Care Management The HIP Pain management team have embraced an opportunity during team restructuring to incorporate an AHA role. Data provided quantifiable evidence of the need and scope of an AHA role (0.85 EFT of the 0.92 noted earlier in Figure 5). Further analysis of the practice categories demonstrates a clear focus on treatment and administration. The quantification task list was set up in such a manner that allows generation of a HIP specific task list, with subsequent competencies and capabilities to be identified. This will form a component of the strategic plan.

Figure 6: Specialist clinics (pain) delegable time * Conversion factor has been applied

1.45

10.87

2.90

0.72 0.00

5.31

0.00

3.38

0.00

2.66

0.72

4.11

0.00

2.00

4.00

6.00

8.00

10.00

12.00

Assessment Treatment ClinicalReporting

Researchand Quality

Equipmentand

Environment

Admin

Hours*

Pain Clinic - Delegable Hours* by Practice Category

Physiotherapy

Psychology

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Austin – Health Independence Programs - Rehabilitation services Rehabilitation services is currently based across two campuses, with AHP staff crossing between campuses, but AHA staff remaining site-specific. High treatment and administration practice categories were quantified. The quantifiable delegation, teamed with disparity between the support roles at each campus highlights the importance of developing key competencies for clinical treatment. Through discussions in focus groups, this would open up the opportunities for increased client contact based on need rather than clinician availability (unmet demand). The majority of delegable tasks were identified by OT and PT, though the opportunity for a multi- or interdisciplinary role has the potential to improve the team cohesion, as well as enabling the opportunity for support for disciplines such as SW. Complementing this strategic direction is consistency of the AHA roles across the two sites, allowing greater flexibility of the existing AHA workforce.

Figure 7: Identified delegable hours for HIP - Therapy services *Conversion factor has been applied

Figure 8: Austin HIP by practice category

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Occupational Therapy Physiotherapy Social Work Speech Therapy

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Identified AHA Hours* by Discipline for HRC vs Talbot

Austin Health -HRC

Austin Health -Talbot

0.000.200.400.600.801.001.201.401.601.80

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Austin - Aged Care Community Programs – TCP and ACAS The Transition Care Program and Aged Care Assessment Service have identified the potential for a shared AHA (equating to 1.56EFT), and increasing the use of AHAs for OT with a focus on associated core competencies and capabilities. The concurrent aspect of the project quantified the potential for the whole team to have access to AHAs, though clinical pathways for referral for use with NCM continues to be an important area for strategic planning.

Figure 9: ACAS and TCP identified delegable hours by practice category *Conversion factor has been applied

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20.00

25.00

ACAS and TCP delegable time by practice category

Administration

Equipment and Environment

Research and Quality

Clinical Reporting

Assessment

Treatment

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Austin – NE Mental Health Services Quantification of the tasks in the case management workforce within mental health demonstrated a clear need for support (as indicated in Figure 5). Further analysis of the quantification results gives evidence of the practice categories, and subsequent tasks that could be delegated to assist with identification of a suitable support workforce.

Figure 10: NEAMHS delegable tasks by practice categories

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Mental Health Delegable Hours* by Practice Category

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Darebin Community Health Darebin Community Health (DCH) teams are spread across 3 sites. Team members may have an AHA within their team, however not co-located, posing challenges for delegation and supervision of AHA tasks. This has been a major logistical factor considered during strategic planning. A solution, such as site based AHAs would require significant changes to the AHP and AHA workforce teams, positions and processes.

Figure 11: AHA delegable hours identified by DCH * Conversion factor has been applied

Quantification data supported the emerging pattern of high delegable AHA hours, with corresponding high percentage of discipline EFT for Podiatry and Nutrition & Dietetics. Podiatry currently has 0.4 AHA EFT, whilst Nutrition and Dietetics have no access to the AHA support workforce. Similarly to other programs, delegable time represented blocks of time attributed to tasks such as instrument sterilisation for podiatry, emphasising that competency in a small number of tasks has the potential to have significant impact on workload. DCH differed from the other organisations in that the Counselling team was within scope of the project. The counselling team consists of counsellors with a psychology or social work clinical background, and currently have no access to the AHA support workforce. Though data reflects low AHA delegable tasks identified by counsellors, this has been in part attributed to staff knowledge, training and experience working with AHAs. Data and stakeholder consultation has identified the potential benefits of offering training to these currently under-supported disciplines. Similarly to other organisations participating in the project, strategic planning has placed an emphasis on ensuring that all AHPs are aware of and confident in the use of the AHA Supervision and Delegation Framework.

28.98 26.69 29.46

98.77

41.79 45.76

0

10

20

30

40

50

60

0

20

40

60

80

100

120% Hours*

Delegable AHA hours* - Darebin Community Health

AHA DelegableHours Identified

Delegable timeas % ofDiscipline EFT

22


Nillumbik Health Nillumbik Health consists of two teams, Child & Family and Adult, and is relatively small (5.2EFT of AHPs). Quantification data from both teams was combined and demonstrated similar themes to programs. Significant delegable AHA hours was identified for Nutrition and Dietetics and Podiatry. Further analysis of the Quantification survey revealed specific tasks that attributed the bulk of the time, eg instrument sterilisation, group work and administration. This suggests that delegation to AHAs or an alternative support workforce, teamed with correlating competencies, may be suitable for sterilisation and administrative tasks. AHAs may be used in blocks of time to support existing group programs for both disciplines.

Figure 10: AHA delegable hours - Nillumbik Health * Conversion factor has been applied

Focus groups and discussions with staff at Nillumbik Health highlighted potential unmet demand in the areas of chronic mental health conditions and progressive neurological disorders. These themes have been incorporated into the strategic plan for Nillumbik Health.

4.23

6.04

11.23

7.73

9.78

2.17

0

5

10

15

20

25

30

35

40

45

0

2

4

6

8

10

12

% Hours*

Delegable AHA Hours* - Nillumbik Health

AHA HoursIdentified

IdentifiedAHA EFT as %of AHP EFT

23


12. Key issues and solutions

Nurse Case Manager Roles The project team encountered challenges associated with the case management role. The incumbents in some case management positions are clinicians with a nursing background (NCM). This poses challenges for future strategic planning, as there is a lack of clarity regarding the delegation of tasks to AHAs by professionals (AHPs and nurses) who are in the emerging discipline of Case Management and Care Coordination. In order to fully inform the project, a variation was endorsed by the Steering committee to include Nurse Case Managers (NCMs) in all aspects of data collection and strategic planning. Data was collected in a concurrent component of the project, allowing comparison with a different workforce composition. Governance frameworks and supervision and delegation pathways between NCMs and AHAs were discussed with program managers, and are included within the strategic plan. Data Accuracy Concerns were raised by AHPs and case managers about the threat of AHP job losses as a result of increasing the AHA workforce. This was addressed throughout the project with reiteration of project intent. Staff satisfaction with this intent had the potential to affect the quality and accuracy of data. Whilst response rates were consistently high for all data collection elements, the responses require clinicians to be willing to participate fully and accurately. Workforce and team changes should contain a plan to address perceived risks and staff concerns. During the analysis of the quantitative data, a number of issues were noted with the Microsoft Access Database. This resulted in amendments to the database, conducted centrally. Despite data cleansing, there remains potential for inaccuracy in the data held within the database, risking the misdirection of the strategic plan. However, this was mitigated by the fact that strategic planning was also guided by qualitative data results. Supervision and Delegation Knowledge and understanding of the Supervision and Delegation Framework was inconsistent across the hub. During the initial phases of the project, there were opportunities for DoH-funded staff training in the use of the framework. However, these opportunities were not maximised within the hub, meaning awareness and understanding of the framework remains generally low. This poses risks to the quality of the data collected during the quantification survey. Training and understanding of the framework is crucial for safe and effective AHA support; hence a sustainable approach to workforce training in the framework has been included in the strategic plan.

13. Strategic workforce goals and outcomes The workforce goals and outcomes have been informed by data ranging from qualitative content, gathered through focus groups and stakeholder consultation, and quantitative data gathered from baseline and quantification. The first three goals are primarily informed by qualitative data, whilst addressing workforce capacity builds upon these, teamed with other EFT and funding measures. Achieving sustainability and consistency, and maximising skill development opportunities within the AHA workforce are key areas of focus for all the programs in the Hub. In order to achieve this, a number of key directions have been identified, including continuation of a partnership group to address overarching aspects for the workforce through: Sustainable and collaborative workforce

• Sustainable AHA Supervision and Delegation Framework training • Shared calendar of Professional Development for AHAs

Clinical Governance

• Consistent AHA Position descriptions • Supervision and Performance, Review and Development schedules • AHP delegation training

24


• Case management referral / delegation pathway AHA Workforce skills and training

• Registered Training Organisations training requirements for AHA positions • Core competencies for AHAs

Addressing these key opportunities teamed with additional funding or EFT redistribution will form the basis of workforce capacity building in specific programs. Outcomes from the strategic plan are expected to be:

• Agreed governance and supervision structure • Position descriptions, with associated task lists • Core competency documents • Hub AHA training opportunities (both internal and external) • Sustainable Supervision and Delegation training • Increasing the work force capacity using a number of methods including; task reallocation and staffing

redistribution.

14. Strategic plan for integrating the AHA workforce The strategic plan encompasses all participating organisations within the NE Hub. Continuation of an equivalent working group will form the platform from which Goals 1,2 & 3 will be addressed. The partnership work will build upon resources already developed in the AHA workforce area. Due to the size and breadth of the goals, successful achievement has been identified as contingent on a dedicated project role to oversee. Objective 1.1 has been addressed with NEPCP Governance Group endorsement of 12 month 0.2EFT project role. It is anticipated that the project role will continue to have leadership, support and supervision from the NEPCP. Participating organisations have acknowledged and consented to EFT (in-kind) to complete the requirements of the goals. Strategic planning will also identify opportunities for Hub-wide AHA training, as well as building relationships with key stakeholders such as local Registered Training Organisations.

15. AHA Strategic Workforce Plan See following pages.

15. AHA Strategic Workforce Plan

GOAL 1: WORKFORCE DEVELOPMENT

Establish a sustainable and collaborative AHA workforce strategy for the NE Hub by December 2015

Objectives Action Plan Output or outcome measures

Responsible position or area Key partners

Resources required

Timeframe (due date)

1.1 Establish a project role to facilitate progression of Stage 3 strategic plan by June 2015

Identify funding sources for potential role (DHHS – Commonwealth /State or PCP)

Funding options identified

Responsible: AHA Project Manager Partners: NE Hub Funding April 2015

Complete relevant proposal and submit

Submitted funding proposal

Responsible: AHA Project Manager/ AHA Workforce Strategic Group chair (see Objective 1.2)

Funding template June 2015

1.2 Establish a partnership group with representatives from program areas to address Stage 3 priorities (AHA Workforce Strategic Group) by June 2015

Complete proposal for approval at NEPCP Governance group

Completed and approved proposal

Responsible: AHA Project manager Partners: NE Hub

Outcome 1.1 Proposal template

March 2015

Establish TOR and group membership.

Schedule/locations of meetings for 12 months

TOR Template Outlook invites

June 2015

1.3 Establish a sustainable model to support competency of clinical staff in the AHA Supervision and Delegation Framework by December 2015

Identify appropriate champions from each program area Champions identified

Responsible: Project manager, program area managers Partners: Austin Health, Darebin Community Health, Nillumbik Health

Training package April 2015

Establish training opportunities for champions

Champions completed training

Responsible: Project manager, AHA Workforce Strategic Group Partners: NEPCP, project manager

Training package, time in kind from champions

June 2015

Establish competencies of champions to ensure sustainability of training

Champions competent to implement training.

Responsible: Project manager Partners: NE Hub

Competency package

December 2015

1.4 Collaborate and identify shared training opportunity schedule for NE Hub AHA’s by December 2015.

Identify current organisational training opportunities for AHA’s within NE Hub

Data from program managers re: opportunities

Responsible: AHA Workforce Strategic Group chair Partners: NE Hub

AHA survey, AHP survey

September 2015

Identify gaps in training for AHA’s Data from identified gaps from AHA/AHP

Training gap analysis survey – AHA/AHP

September 2015

Identify RTO training/ external training opportunities for AHA’s

List of subjects/training relevant to different teams.

RTO subjects, RTO gap analysis report on AHA discipline areas

October 2015

Create schedule of shared training opportunities across NE Hub

Calendar of training Data from previous actions

December 2015


26

GOAL 2: CLINICAL GOVERNANCE

Establish consistent clinical and operational governance structure for AHA workforce in NE Hub by June 2016



Resources required


2.1 Create agreed supervision and performance review schedules for AHAs in all programs by December 2015

Benchmark with other organisations

Evidence of other organisations’ supervision structures Responsible: AHA Workforce Strategic

Group chair

Benchmarking with other organisations

September 2015

Identify needs of program positions

Written governance structure

Organisational template

December 2015

2.2 All relevant AHP’s to be competent in supervising and delegating appropriate AHA tasks by June 2016

Program champions to have completed relevant competency training.

All programs champions competent in S&D training. Responsible: AHA Workforce Strategic

Group chair Partners: NE Hub, Wodonga TAFE

Training structure June 2015

AHPs (in teams with AHAs) to participate in training conducted by Wodonga TAFE or program champions

All AHP’s (in relevant teams) have participated in training.

Training schedule June 2016

2.3 All program areas with generic case management roles to have appropriate supervision and delegation pathways in place by June 2016

All tasks appropriate for delegation by case managers (generic) identified for program areas.

Task list of appropriate delegable tasks

Responsible: AHA Workforce Strategic Group chair Partners: NEAMHS, ACCP, CLink

Quantification task list

September 2015

Case managers (generic) to participate in relevant AHA supervision and delegation training.

Case managers aware of supervision and delegation protocols

Responsible: AHA Workforce Strategic Group chair Partners: AHA Workforce Strategic Group

Training opportunities

June 2016


27

GOAL 3: AHA SKILLS AND TRAINING Ensure 100% of the AHA workforce is appropriately skilled, competent and accountable in their provision of

patient care by June 2016



Resources required


3.1 Identify consistent components of an AHA position description (PD) between all programs by December 2015

Identify existing PDs, including those generated from Stage Two.

PDs from each organisation and Stage Two of AHA Project Responsible: AHA Workforce Strategic

Group chair Partners: AHA Project Stage Two Working Group

Benchmarking with other organisations

July 2015

Benchmark needs of each program position

Evidence of generic requirements of roles As above

September 2015

Develop PDs for use across program areas Ratified PDs Organisational PD

templates December 2015

3.2 Identify and match RTO subject opportunities relevant to PDs for AHA roles within the NE Hub by December 2015

Identify and analyse current AHA roles and PDs

Details of current AHA roles and PDs

Responsible: AHA Workforce Strategic Group chair Partners: NE Hub

Delegable tasks from quantification surveys, RTO subjects list

September 2015

Identify RTO training opportunities for AHAs

Details of RTO opportunities and correlations with needs of current roles

October 2015

Compile a list of recommended training for each AHA role

List of training suggestions for each role

December 2015

3.3 Develop and implement core competencies guidelines and practice for all AHA roles by June 2016

Compile existing core competency documents for AHAs

Individual programs to provide any existing core competency frameworks.

Responsible: AHA Workforce Strategic Group chair Partners: NE Hub, Program Managers

Benchmarking with other services

June 2015

Compile list of competency expectations for each role

Agreed expectations /tasks for AHA roles

Delegable tasks from quantification surveys

December 2015

Create core competency document

Core competency documents relevant for program areas

Example core competency documents

June 2016


28

GOAL 4a: WORKFORCE CAPACITY – AUSTIN HEALTH

Increase the capacity of the current Austin Health workforce using EFT redistribution and shared AHA roles by June 2016



Resources required


4a.1 Implement an AHA role within the Pain management team, utilising EFT redistribution, for a 12 month period to June 2016

Identify role/ skill expectations

Ratified core competency document Ratified delegation pathway.

Responsible: Sally Russell, HIP EFT May 2015

All relevant AHP’s to participate in relevant Supervision & Delegation training

All team members aware of S&D Framework and relevant delegable tasks

Responsible: HIP Partners: AHA Strategic Workforce Group

EFT June 2016

Evaluate the effectiveness of EFT redistribution

Measure the baseline AHA/AHP EFT + waitlist and compare

Responsible: HIP

PD Baseline AHA/AHP EFT Wait list No. of clients

June 2016

4a.2 Investigate potential for an interdisciplinary AHA role within the HIP Services program by June 2016

Explore options for EFT or task redistribution Options identified Responsible: HIP EFT

December 2015

Establish tasks and competencies, including inclusion of SW

Ratified core competency document

Responsible: HIP Partners: AHA Strategic Workforce Group

Quantification list June 2016

Evaluate effectiveness of role Evaluation report Responsible: HIP

Quantification survey review

June 2016

4a.3 Implement a shared multi disciplinary/ case management AHA role across TCP & ACAS.

Identify scope of potential role PD and core competencies

Responsible: Juliet Thorn, Michelle Long

Quantification list, PD, governance structure

Ongoing

Submit proposal for Workforce Innovation Grant Budget (or equivalent) bid in 2015-2016

Completed proposal Responsible: Project manager Partners: AHA Strategic Workforce Group

Funding bid template

Ongoing


29

GOAL 4a: WORKFORCE CAPACITY – AUSTIN HEALTH (cont)

Increase the capacity of the current Austin Health workforce using EFT redistribution and shared AHA roles by June 2016 (cont)



Resources required


4a.4 Explore the use of a support workforce in Mental Health programs and identify the most appropriate support workforce

Needs analysis with skill comparison of alternative support workforces

Decision re: ideal support workforce

Responsible: Sharon Sherwood, Marina Nasso Partners: AHA Strategic Workforce Group

Supplementary information regarding support workforce opportunities

Ongoing

Appropriate training for AHP/CM workforce to introduce support workforce

Pending outcome of above action

Responsible: Sharon Sherwood, Marina Nasso

Ongoing

Identification of training/ skill requirements of support role.

Pending outcome of above action

Responsible: Sharon Sherwood, Marina Nasso

Ongoing


30

GOAL 4b: WORKFORCE CAPACITY – DAREBIN COMMUNITY HEALTH

To increase capacity of the current Darebin Community Health workforce using task redistribution and skills training by September 2016

Objectives Action Plan Output or outcome measures Responsible position or

area Key partners

Resources required Timeframe (due date)

4b.1 To increase the confidence of all AHPs in delegating appropriately to AHAs by September 2016

All disciplines represented in training in the Supervision and Delegation of AHAs

All disciplines represented and participate in training

Responsible: Carolyn Jones Partners: NE Hub

Supervision and Delegation Training

June 2015

Establish required skills and competencies to support all staff

Ratified PD and core competencies list EFT

December 2015

Provide opportunities for trial usage of an AHA with the counselling and dietetics discipline

Trial completed Time in kind for AHAs released from other work

June 2016

Evaluate: • Level of confidence of all staff in

delegating to AHAs. • Satisfaction of AHAs and AHPs

Reported confidence of staff, reported satisfaction of AHAs and AHPs

Confidence and satisfaction evaluation

September 2016

4b.2 To increase the AHA workforce capacity EFT to enable adequate time to perform Nutrition & Dietetics assistant tasks by June 2016

Identify current AHA tasks that could be delegated to admin/volunteer Increased availability of AHA’s

Responsible: Carolyn Jones Partners: NE Hub

Quantification survey data

June 2015

Source funding opportunities for AHA within Nutrition and Dietetics Funding avenues identified Unmet demand

identification December 2015

Establish required skills and competencies to support Dietitians

Ratified PD and core competencies list EFT

December 2015

Identify and implement appropriate training opportunities for AHA’s to support Nutrition & Dietetics treatment and equipment component

Admin/volunteers performing appropriate tasks. Core competency for required tasks. AHA’s performing delegated tasks

Quantification survey December 2015

Implement AHA role in accordance with funding guidelines Trial of AHA in Nutrition and Dietetics Funding for AHA

EFT March 2016

Evaluate effectiveness of role Compare baseline wait list and no. of attendances pre and post Staff satisfaction

Baseline wait list, Attendance no., Satisfaction survey

June 2016

4b.3 Increase the generalizability and satisfaction of AHA staff by December 2015

Scope potential for rotating AHA roles – identify core common skills required Ratified PDs and core competencies Responsible: Carolyn Jones

Partners: Anna Crompton EFT December 2015

Shared training opportunities within the service ie. PAG Respective training schedules shared

Responsible: Carolyn Jones, Faye Reynolds Partners: AHA Strategic Workforce Group

Training calendars December 2015


31

GOAL 4c: WORKFORCE CAPACITY – NILLUMBIK HEALTH To increase capacity of the current Nillumbik Health workforce using task redistribution and additional

funding by September 2016

Objectives Action Plan Output or outcome measures Responsible position or area Key partners Resources required Timeframe

(due date) 4c.1 To increase the AHA workforce capacity by 0.2 EFT to enable adequate time to perform podiatry assistant tasks by September 2016.

Identify current AHA tasks that could be delegated to admin/volunteer

Increased availability of AHAs

Responsible: John Moran Partners: NE Hub

Quantification survey data June 2015

Identify opportunities for AHA EFT increase (growth funding)

Increased funding for AHAs Funding opportunities September 2015

Identify and implement appropriate training opportunities for AHA’s to support treatment and equipment component

Sterilisation training for AHAs (core competency)

Basic foot care skills (core competency)

• Quantification survey • Core competencies, • Training opportunities, • Time for staff to

undertake training, delegating, supervision

June 2016

Delegate sterilising and routine care

Admin/volunteers and AHAs performing appropriate tasks.

Evaluation of space and room requirements

June 2016

Evaluate effectiveness of podiatry support role

Compare baseline wait list and no. of attendances pre and post Staff satisfaction

Baseline wait list, Attendance no., Satisfaction survey

September 2016

4c.2 To increase the AHA workforce capacity by 0.1 EFT to enable adequate time to perform Nutrition & Dietetics AHA tasks by June 2016

Identify current AHA tasks that could be delegated to admin/volunteer

Increased availability of AHA’s

Responsible: John Moran Partners: NE Hub

Quantification survey data June 2015

Identify opportunities for AHA EFT increase (growth funding)

Increased funding for AHAs Funding opportunities September 2015

Identify and implement appropriate training for AHA’s in Nutrition & Dietetics treatment and equipment

Admin/volunteers performing appropriate tasks. Core competency for required tasks. AHA’s performing delegated tasks

Quantification survey December 2015

Evaluate effectiveness of role Compare baseline wait list and no. of attendances pre and post Staff satisfaction

Baseline wait list Attendance no. Satisfaction survey

June 2016

4c.3 Scope for interdisciplinary support role (progressive neurological and mental health)

Identify scope of potential role PD and core competencies Responsible: John Moran, Kate Barwick

Unmet demand Ongoing

Submit proposal for Workforce Innovation Grant Budget (or equivalent) bid in 2015-2016

Completed proposal Responsible: Project manager, John Moran

Funding bid template Ongoing

32


16. Conclusion

Appropriate utilisation of an Allied Health Assistant workforce is a multifactorial issue. From the conversations and consultation during this project, the following elements were highlighted as being necessary:

• Appropriate training of AHAs, including ongoing competency and skill development • Well-developed and consistent recruitment processes • Adequate supervision of AHAs, requiring training of AHPs • Delegation pathways that are clear and supported by clinical governance frameworks • Workplace culture that nurtures a positive attitude towards role development.

This project has developed a strategic plan to support the growth of these elements, not only within the participating programs, but also within all applicable member organisations of the NEPCP. Further goals have focused on the development of strengths and potential for change already identified within the respective programs. Future considerations Observation of past projects has revealed limited progress in AHA workforce development beyond the life of the respective projects. It is believed that the proposed local continuation of AHA workforce development, led by the NEPCP project role, will help to further embed the strategic plan within the workplaces. In addition, this model will provide an opportunity to continue partnership work that has already commenced within the PCP, with scope for additional organisations to participate. It also capitalises on the fact that the workforce is already informed and engaged in this project. There is ongoing work in this arena occurring across Victoria, within a range of health-care settings. Flagship projects in the areas of competency development for AHAs and AHPs have been, and are being, undertaken at Alfred-Monash Health. The NEPCP Project role will have the added advantage of working in a timely manner in this environment, and be able to incorporate this work into strategic goals.

17. References Department of Health. (2014). Allied Health Assistant Implementation Program - Stage One. Retrieved January

03, 2015, from Department of Health - Victoria's Health Workforce: http://www.health.vic.gov.au/workforce/reform/implementation-program

North East Primary Care Partnership. (2013). North East Primary Care Partnership: 2013-2017 Strategic plan.

Retrieved May 2014, from North East Primary Care Partnership: www.nepcp.org.au

18. Appendices 1. Quantification Surveys: Case Management and Clinicians 2. List of Resources

33


Appendix 1

Quantification Surveys: Case Management and Clinicians

34

ALLIED HEALTH ASSISTANT PROJECT SURVEY: Case Managers

Week Beginning (Date) Site/s Program/s Team/s Hours worked this week

Discipline Grade

• At the end of each day, please record how many minutes each day you spent completing tasks which could have been completed by an AHA.

• Record only one value per main category (ie one value per box).

• If there is a delegable task you have performed that is not listed, please include in ‘Other’ and specify/describe the activity.

• Please also ensure you complete the first item ‘number of hours worked this day’.

• Please place a tick in the boxes next to the tasks you have included in your time.

Mon Tues Wed Thurs Fri

Number of hours worked this day 7.6 0 3.8 0 7.6 ASSESSMENT/SCREENING Waiting list management, prioritisation and allocation Screen prior to referral (Dietetics) Screening - physical health, Basic 32, Drug & alcohol, home visit risk Regular screening R/V of services provided to case-managed clients

30 20

TREATMENT Assist AHP in session Group work - outside of session (planning, set up, clean up, follow up) Group work - during session (in respite and in homes, meal prep group) Administer prescribed therapy in clinic (ADL practice, organisation strategies) Administer therapy in home environment (HEP, use of gait aids, ADL retraining, UL ranging, relaxation) Administer therapy in the community (public transport training, community access, purchasing approp footwear,

Centre Link, Myki, shopping, social exposure) Mealtime assistance at Twin Parks (intake, weight) Education - nutrition, life skills Assist clients to transition to community groups Organisational behaviour assistance (multiple appointments, employment liaison) Transportation to GP, appointment, court and feedback Accompanying spouse/family member to inspect Aged Care facilities

30 20

CLINICAL REPORTING Progress notes Gather information for referrals - (internal/external agencies) - under the guidance of AHP (VCAT, SCoTT, DSP,

PRDDTF) Follow up referrals - (internal/external agencies) - under the guidance of AHP, Office of Housing, employment Liaison with internal/external agencies - Office of housing, employment agency) Photos of home modifications and compare with specifications Accompany client to health appointments and feed back to case manager (Care Packages) Provide feedback on patient progress Participate in clinical reviews/case conferences Welfare Checks Attend family meetings/ case conferences.

20 10

SUPERVISION Supervision of medication from a Webster pack RESEARCH/ QUALITY Data collection - finding and collecting data Service evaluations

EQUIPMENT AND ENVIRONMENT Equipment - delivery/prescription under guidance of AHP, education/ demonstration/ trialling, sourcing quotes,

researching new equipment Complete necessary equipment forms Maintain an equipment register Create, monitor and maintain resources for use in sessions Deliver and/or collect scripts from pharmacy Purchase and set up key and medication lock boxes, personal alarm

30 10 30

ADMINISTRATION Ordering stock (continence, nutrition, equipment, stationery) Finance and invoicing Follow up non-attendance Reminders Collate file folders (TCP) Updating client and episode information Admin assistance - co-ordinate, time keeping, minutes, photocopying, constructing forms) Orientation for new staff re: environment

45 20

OTHER TASKS NOT LISTED (please specify) Presentation to Community Group

30

TOTAL 155 60 110

PLEASE TURN PAGE OVER TO COMPLETE SURVEY

Place the completed survey in the envelope provided to your program area and collect your reward.

Thank you for your participation.

35

ALLIED HEALTH ASSISTANT PROJECT SURVEY: Case Managers


Number of hours worked this day

ASSESSMENT/SCREENING Waiting list management, prioritisation and allocation (excluding CLink) Screen prior to referral (Dietetics) (excluding CLink) Screening - physical health, Basic 32, Drug & alcohol, home visit risk Regular screening R/V of services provided to case-managed clients

TREATMENT Assist AHP in session Group work - outside of session (planning, set up, clean up, follow up) Group work - during session (in respite and in homes, meal prep group) Administer prescribed therapy in clinic (ADL practice, organisation strategies) Administer therapy in home environment (HEP, use of gait aids, ADL retraining, UL

ranging, relaxation) Administer therapy in the community (public transport training, community access,

purchasing approp footwear, Centre Link, Myki, shopping, social exposure) Mealtime assistance at Twin Parks (intake, weight) (TCP only) Education - nutrition, life skills Assist clients to transition to community groups Organisational behaviour assistance (multiple appointments, employment liaison) Transportation to GP, appointment, court and feedback Accompanying spouse/family member to inspect Aged Care facilities

CLINICAL REPORTING Progress notes Gather information for referrals - (internal/external agencies) - under the guidance

of AHP (VCAT, SCoTT, DSP, PRDDTF) Follow up referrals - (internal/external agencies) - under the guidance of AHP, Office

of Housing, employment Liaison with internal/external agencies - Office of housing, employment agency) Photos of home modifications and compare with specifications Accompany client to health appointments and feed back to case manager (Care

Packages) Provide feedback on patient progress Participate in clinical reviews/case conferences Welfare Checks Attend family meetings/ case conferences.

SUPERVISION Supervision of medication from a Webster pack

RESEARCH/ QUALITY Data collection - finding and collecting data Service evaluations

EQUIPMENT AND ENVIRONMENT Equipment - delivery/prescription under guidance of AHP, education/ demonstration/

trialling, sourcing quotes, researching new equipment Complete necessary equipment forms Maintain an equipment register Create, monitor and maintain resources for use in sessions Deliver and/or collect scripts from pharmacy Purchase and set up key and medication lock boxes, personal alarm

ADMINISTRATION Ordering stock (continence, nutrition, equipment, stationery) Finance and invoicing Follow up non-attendance Reminders Collate file folders (TCP) Updating client and episode information Admin assistance - co-ordinate, time keeping, minutes, photocopying, constructing

forms) Orientation for new staff re: environment

OTHER TASKS NOT LISTED (please specify)

TOTAL

Notes/Comments:

36

ALLIED HEALTH ASSISTANT PROJECT SURVEY: Clinicians Week Beginning (Date) Site/s Program/s Team/s Hours worked this week: Discipline

Grade

• At the end of each day, please record how many minutes each day you spent completing tasks which could have been completed by an AHA.

• Record only one value per main category (ie one value per box).

• If there is a delegable task you have performed that is not listed, please include in ‘Other’ and specify/describe the activity.

• Please also ensure you complete the first item ‘number of hours worked this day’.

• Please place a tick in the boxes next to the tasks you have included in your time.


Number of hours worked this day 7.6 0 3.8 0 7.6

ASSESSMENT/SCREENING Screening – (group, individual, PAV, Home visit risk, malnutrition, food security, growth monitoring, 3/12 post discharge) Waiting list management, prioritisation and allocation

30 20

TREATMENT Assisting AHP in session Assist with nail surgery/ nail care Accompanying clinician on kinder visits Group work - outside of session (planning, set up, clean up, follow up) Group work - during session (Joint, Hydrotherapy/Water Exercise, Chronic Fatigue group, Meet Your Feet, Basic Foot Care,

Balance, Hip & Knee, PAG, Gentle Exercise, Language, Steps, BMC) Administer prescribed therapy in clinic (ADL practice, HEP, practice use of gait aid, scooter training, UL ranging,

conversation practice, FES, basic foot care, relaxation, articulation therapy, fine motor activities, 10m walk test) Administer therapy in home environment (HEP, use of gait aids, DADL, PADL, UL ranging) Administer therapy in the community (public transport training, interdisciplinary) Wheelchair skills/ scooter skills practice Education/presentations - to patients/ support workers (basic foot care, equipment use) Assist clients to transition to community groups Outdoor mobility

30 20

CLINICAL REPORTING Progress notes Gather information for referrals - (internal/external agencies) - under the guidance of AHP Follow up referrals - (internal/external agencies) - under the guidance of AHP (council, SWEP) Gathering extra information about clients and feeding back to clinicians regarding status Photos of home modifications and compare with specifications Feedback from patient/family after follow up Attend family meetings/ case conferences.

30

DISCHARGE PLANNING Prepare clients for discharge - phone calls

20 10

SUPERVISION Student co-ordination

RESEARCH AND QUALITY Data collection - finding and collecting data Service evaluations Assist at community groups (AGM and Open Day, help run activities, distribute information)

EQUIPMENT AND ENVIRONMENT: Equipment - delivery/prescription under guidance of AHP, education/ demonstration/ trialling, sourcing quotes, researching

new equipment Complete necessary equipment forms Maintain an equipment register Create, monitor and maintain resources for use in sessions Assist with sterilising, maintenance and ordering Clean work area/equipment between patients Repair orthotics (apply padding/cushioning as prescribed)

30 10 30

ADMINISTRATION Ordering stock (continence, nutrition, equipment, stationary) Finance and invoicing Follow up non-attendance/reminders Organise/ send out wait list/discharge packs Updating client and episode information Admin assistance (co-ordinate, time keeping, minutes, photocopying, constructing forms, mail) Orientation for new staff re: environment Statistics (for everyone) OH&S/infection control audits Room bookings Liaising with volunteers Portering

45 20

OTHER (please specify) Presentation to Community Group

30

TOTAL 155 60 110

PLEASE TURN PAGE OVER TO COMPLETE SURVEY Place the completed survey in the envelope provided to your program area and collect your reward.

Thank you for your participation.

37

ALLIED HEALTH ASSISTANT PROJECT SURVEY: Clinicians


Number of hours worked this day

ASSESSMENT/SCREENING Screening – (group, individual, PAV, Home visit risk, malnutrition, food security, growth

monitoring, 3/12 post discharge) – including follow-up screening Waiting list management, prioritisation and allocation (excluding HIP)

TREATMENT Assisting AHP in session Assist with nail surgery/ nail care Accompanying clinician on kinder visits Group work - outside of session (planning, set up, clean up, follow up) Group work - during session (Joint, Hydrotherapy/Water Exercise, Chronic Fatigue group,

Meet Your Feet, Basic Foot Care, Balance, Hip & Knee, PAG, Gentle Exercise, Communication, Steps, BMC)

Administer therapy in clinic (ADL practice, HEP, practice use of gait aid, scooter training, UL ranging, conversation practice, FES, basic foot care, relaxation, articulation/language therapy, fine motor activities, 10m walk test, telephone practise, computer use )

Administer therapy in home environment (HEP, use of gait aids, DADL, PADL, UL ranging) Administer therapy in the community (public transport training, interdisciplinary) Wheelchair skills/ scooter skills practice Education/presentations - to patients/ support workers (basic foot care, equipment use) Assist clients to transition to community groups Outdoor mobility Review / follow-up on intervention already in place (equipment, treatment programs)

CLINICAL REPORTING Progress notes Gather information for referrals - (internal/external agencies) - under the guidance of AHP Follow up referrals - (internal/external agencies) - under the guidance of AHP (council, SWEP) Gathering extra information about clients and feeding back to clinicians regarding status Photos of home modifications and compare with specifications Feedback from patient/family after follow up Attend family meetings/ case conferences.

DISCHARGE PLANNING Prepare clients for discharge - phone calls

SUPERVISION: Student co-ordination

RESEARCH AND QUALITY Data collection - finding and collecting data Service evaluations Assist at community groups (AGM and Open Day, help run activities, distribute information)

EQUIPMENT AND ENVIRONMENT Equipment - delivery/prescription under guidance of AHP, education/ demonstration/ trialling,

sourcing quotes, researching new equipment Complete necessary equipment forms Maintain an equipment register Create, monitor and maintain resources for use in sessions (including communication

aids/systems) Assist with sterilising, maintenance and ordering Clean work area/equipment between patients Repair orthotics (apply padding/cushioning as prescribed)

ADMINISTRATION Ordering stock (continence, nutrition, equipment, stationary) Finance and invoicing Follow up non-attendance/reminders Organise/ send out wait list/discharge packs Updating client and episode information Admin assistance (co-ordinate, time keeping, minutes, photocopying, constructing forms, mail) Orientation for new staff and students re: environment Statistics (for everyone) OH&S/infection control audits Room bookings Liaising with volunteers Portering

OTHER TASKS NOT LISTED (please specify)

TOTAL

Notes/Comments:

38


Appendix 2

List of Resources

• Supervision and Delegation Framework for Allied Health Assistants


• Allied Health Assistant roles – Case Studies

http://docs.health.vic.gov.au/docs/doc/5CE0FADD73116196CA257A90006F53D4/$FILE/Supervision%20and%20delegation%20framework%20for%20allied%20%20health%20assistants%20–%20Case%20studies.pdf

• New roles in community services and health scoping project – Report on consultation findings –

June 2014 http://www.cshisc.com.au/media/278247/CS_HISC_NEW_ROLES_IN_COMMUNITY_SERVICES_AND_HEALTH_SCOPING_PROJECT_Report.pdf

• Allied Health Credentialling, Competency and Capability Framework

http://docs.health.vic.gov.au/docs/doc/AEB3DCC013FFDBCECA257D5E0013F252/$FILE/Allied%20health%20%E2%80%93%20credentialling%20competency%20and%20capability%20framework%20-%20Overview.pdf

• Guidelines to scope and introduce new Allied Health Assistant roles

http://docs.health.vic.gov.au/docs/doc/D9B86608A7586EA1CA2579F1001BDCEB/$FILE/Guidelines_14.08.12.pdf

• O'Malia, A. Hills, A.P , and Wagner, S. (2014) Repositioning Social Work in the Modern Workforce: The

Development of a Social Work Assistant Role. Australian Social Work, 67(4), 593-603






http://www.cshisc.com.au/media/278247/CS_HISC_NEW_ROLES_IN_COMMUNITY_SERVICES_AND_HEALTH_SCOPING_PROJECT_Report.pdf

http://www.cshisc.com.au/media/278247/CS_HISC_NEW_ROLES_IN_COMMUNITY_SERVICES_AND_HEALTH_SCOPING_PROJECT_Report.pdf






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