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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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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.
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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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
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Assessment Treatment ClinicalReporting
Researchand Quality
Equipmentand
Environment
Admin
Hours*
Pain Clinic - Delegable Hours* by Practice Category
Physiotherapy
Psychology
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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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 inter- disciplinary 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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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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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ACAS and TCP delegable time by practice category
Administration
Equipment and Environment
Research and Quality
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Assessment
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Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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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140
160
EFT* Hours*
Mental Health Delegable Hours* by Practice Category
21
Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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
Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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
Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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
Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
• 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
15. AHA Strategic Workforce Plan
26
GOAL 2: CLINICAL GOVERNANCE
Establish consistent clinical and operational governance structure for AHA workforce in NE Hub by June 2016
Objectives Action Plan Output or outcome measures
Responsible position or area Key partners
Resources required
Timeframe (due date)
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
15. AHA Strategic Workforce Plan
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
Objectives Action Plan Output or outcome measures
Responsible position or area Key partners
Resources required
Timeframe (due date)
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
15. AHA Strategic Workforce Plan
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
Objectives Action Plan Output or outcome measures
Responsible position or area Key partners
Resources required
Timeframe (due date)
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
15. AHA Strategic Workforce Plan
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)
Objectives Action Plan Output or outcome measures
Responsible position or area Key partners
Resources required
Timeframe (due date)
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
15. AHA Strategic Workforce Plan
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
15. AHA Strategic Workforce Plan
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
Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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
Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
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
Mon Tues Wed Thurs Fri
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.
Mon Tues Wed Thurs Fri
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
Mon Tues Wed Thurs Fri
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
Allied Health Assistant Implementation Program Stage Three – Metropolitan Community & Ambulatory Services
Appendix 2
List of Resources
• Supervision and Delegation Framework for Allied Health Assistants
http://docs.health.vic.gov.au/docs/doc/87B365A392B0332CCA25799E007F8ACE/$FILE/framework-for-web-060612.pdf
• 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
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