Exploring utilisation of the allied health assistant workforce in the Victorian health, aged care and disability sectors

Translating acceptability to sustained delivery: Clinician and manager perspectives on implementing modified constraint-induced movement therapy in an early-supported discharge rehabilitation service

BACKGROUND

Modified constraint-induced movement therapy (mCIMT) improves upper limb (UL) function after stroke. Despite up to one-third of stroke survivors being eligible, clinical uptake remains poor. To address this, a multi-modal behaviour change intervention was implemented across a large seven-site early-supported discharge (ESD) rehabilitation service. This study investigated the acceptability of mCIMT implementation within this ESD service and identified adaptations required for sustained delivery.

METHODS

This qualitative study was nested within a mixed-methods process evaluation of mCIMT implementation. Four focus groups (n = 24) comprising therapists (two groups), therapy assistants (one group), and allied health managers (one group) were conducted. Data were analysed using reflexive thematic analysis and mapped to the Theoretical Domains Framework (TDF).

CONSUMER AND COMMUNITY INVOLVEMENT

Consumers were not directly involved in this study; however, lived experience research partners have helped shape the larger mixed-methods implementation study.

FINDINGS

Four themes were generated and mapped to the TDF. Factors related to acceptability included interdisciplinary practice in sharing workloads (belief about capabilities), practice opportunities across a range of UL presentations (skills), clinician attitudes influencing patient engagement (optimism), time constraints (belief about consequences), and cognitive overload from multiple systems and processes (memory, attention, and decision-making processes). Factors facilitating sustained delivery included improving stroke survivor education (knowledge), sharing success stories across teams (reinforcement), manager facilitation (social/professional role and identity), and the perception that the ESD setting was optimal for mCIMT delivery (social influences).

CONCLUSION

mCIMT was acceptable in the ESD service, with clinicians feeling a responsibility to provide it. Key adaptations for sustained delivery included ongoing training, resource adaptation, and enhanced patient and carer engagement. Successful implementation and sustained delivery of mCIMT in the ESD service could enhance UL function and reduce the burden of care for potentially hundreds of stroke survivors and their carers.

PLAIN LANGUAGE SUMMARY

Modified constraint-induced movement therapy (mCIMT) helps improve arm movement after a stroke. However, many stroke survivors do not get this therapy. To fix this, we started a program in a large home-based rehabilitation service. This study looked at how well mCIMT could fit into this service. We also wanted to know what changes were needed to make sure it was regularly provided. We held four group discussions with therapists, therapy assistants, and health managers. A total of 24 people took part. From these discussions, we found several important points. Therapists needed to work together as a team. They also needed to practice mCIMT to get better at delivering it. Therapists having a positive attitude would encourage more stroke survivors to take part. For long-term success, stroke survivors need better education about mCIMT. Managers need to encourage therapists to provide mCIMT. The rehabilitation service should also share their success stories about this therapy to encourage therapists to deliver it and stroke survivors to ask for it. Therapists enjoyed delivering mCIMT in the rehabilitation service. It worked better than other therapies to improve a stroke survivor's arm function. Because of this, they also felt it was their duty to offer mCIMT. Having ongoing training and better resources would help keep mCIMT going. If mCIMT can be provided regularly in this service, it could lead to better arm function and less care needed for many stroke survivors and their carers.

Use of digital food records in clinical settings: lessons in translation from a randomised controlled trial

BACKGROUND

Digital food records offer efficiencies in collecting and assessing dietary information remotely; however, research into factors impacting their translation into clinical settings is limited.

METHODS

The study examined factors that may impact the integration of digital food records into clinical dietetic practice by assessing (1) the source and rate of data errors received, (2) the impact of dietitian-adjusted data on dietary variables and (3) the acceptance of use in a complex chronic condition cohort. Adults from specialist clinics enroled in a randomised controlled feasibility trial participated. Participants recorded their dietary intake using a mobile food diary application (Research Food diary, Xyris Software Pty Ltd.); it was analysed via electronic nutrition analysis software (FoodWorks, Xyris Software Pty Ltd.). Records were verified and corrected by a dietitian. Dietary variables assessed before (participant-unadjusted data) and after (dietitian-adjusted data) were compared by the Wilcoxon signed-rank test, Bland-Altman and Passing-Bablok analysis. Surveys and Interviews assessed participants'; acceptance of the mobile application's usability.

RESULTS

Errors appeared in 93% of records. Dietitian-adjusted median data were higher for most variables compared to participant-unadjusted median data (p < 0.05, median changes between 0.0% and 64.7%) of 59 participant records (median age 51 years, interquartile range 38-58). There was poor agreement between participant-unadjusted and dietitian-adjusted data for some dietary variables. Sixty-four percent surveyed (n = 32/50) found the app easy to use, whereas 29 interviews provided insights into facilitators and challenges of use.

CONCLUSIONS

Significant barriers to integrating digital food records into clinical settings exist requiring dietitian adjustment to correct errors which has major implications for estimates of diet quality and intake.

Boosting hospital falls prevention using health assistant staff alongside usual care

OBJECTIVES

Patient education is crucial for preventing hospital falls, yet workforce constraints can hinder targeted delivery. Utilising supervised healthcare assistants can enhance standard care. This study sought to understand factors that impact the feasibility of supplementing usual care with patient falls education delivered by supervised allied health assistants.

METHODS

In a qualitative study nested within a randomised controlled trial, focus groups and interviews were conducted with twelve health assistants, seven allied health professionals and two managers from the participating hospital. This elicited insights on barriers and facilitators to implementing workforce redesign to deliver tailored patient falls education. An inductive approach was used to thematically analyse the data.

RESULTS

Three key themes emerged: (i) it was feasible for health assistants to deliver hospital patient education; (ii) patients engaged with hospital falls prevention education delivered by assistants; (iii) hospital workforce redesign can be successfully implemented provided there is system-wide buy-in.

CONCLUSIONS

Health assistants can be trained to successfully deliver hospital falls prevention education provided they have adequate supervision, training, and resources.

PRACTICE IMPLICATIONS

Sustained implementation requires dedicated staffing hours for service delivery and staff education.

Building the private practice workforce in the Northern Territory: Barriers and facilitators for implementation of the allied health assistant role

OBJECTIVE

To identify barriers and facilitators contributing to the successful implementation of the allied health assistant role in private disability practice to better meet population needs.

DESIGN

A qualitative case study.

SETTING

This study was completed with staff working in private disability practices in a regional context in the Northern Territory.

PARTICIPANTS

Eight participants were interviewed, including three allied health assistants, three allied health professionals, and two managers with allied health backgrounds.

RESULTS

More barriers were reported than facilitators, with four key themes identified. Financial risk was a barrier when employing allied health assistants. This risk was mediated by providing part-time employment or having allied health assistants in dual roles. Reduced confidence from allied health professionals and assistants to complete delegation work was the second barrier. A facilitator was increasing allied health assistants' task variation, which participants reported increased retention. Finally, a positive working relationship between allied health professionals and assistants facilitates delegation.

CONCLUSION

This research offers private disability providers insight into the realities of employing an allied health assistant. It also suggests that formal training programs for both allied health assistants and professionals require increased focus on delegation in the private disability sector. On a government level, a review of the NDIS price guide for allied health assistant rates is needed if private providers are to better meet the requirements for NDIS participants in regional areas.

"Where's my baby?" A feminist phenomenological study of women experiencing preventable separation from their baby at caesarean birth

PROBLEM

Separating women and babies immediately after birth contributes to poor birth experience and reduced satisfaction.

BACKGROUND

A negative birth experience can impact a woman's transition to motherhood and emotional well-being beyond the newborn period. Separating women from their baby at birth is known to reduce birth satisfaction and is more likely to happen at caesarean section births.

QUESTION

What is the experience of women who are separated from their baby after caesarean section birth without medical necessity?

METHODS

Unstructured, in-depth phenomenological interviews were conducted with fifteen women who had been separated from their well-baby at caesarean section birth. Data was analysed using a Modified van Kaam approach. A novel feminist phenomenological framework with two birthing theories was used to explore the experience of the participants.

FINDINGS

Four major themes emerged - Disconnection, Emotional Turmoil, Influence, and Insight. These demonstrated significant trauma that both the separation and perinatal care created.

DISCUSSION

The participants recognised their vulnerability and the lack of power and control they had over themselves and their baby, which was seemingly not acknowledged. Provider and hospital needs were valued above those of the women.

CONCLUSION

Woman-centred care was not evident in the treatment of these women despite the attendance of a midwife at each birth. This research challenges midwives and other health care providers to support and advocate for those birthing by caesarean section to return power and control and support them to remain in close physical contact with their baby immediately after birth.

Agreeing priority categories and items for inclusion in a future best practice delegation framework for musculoskeletal outpatient physiotherapy services: A consensus groups study

PURPOSE

Delegation of clinical tasks from physiotherapists to physiotherapy support workers varies considerably in musculoskeletal outpatient physiotherapy services leading to variation in patient care. This study aimed to develop consensus amongst physiotherapists, support workers and managers about what components should be included in a future framework to guide effective and safe delegation of clinical tasks to physiotherapy support workers in United Kingdom's National Health Service musculoskeletal outpatient physiotherapy services.

METHODS

A consensus study was carried out, using Nominal Group Technique. Seven physiotherapists, ten physiotherapy support workers and ten physiotherapy operational/clinical leads from 13 musculoskeletal physiotherapy services within United Kingdom's National Health Service were recruited through the Chartered Society of Physiotherapy's professional networks and social media. Three separate, role-specific consensus groups were convened, involving participants generating, discussing and rating on a Likert scale, components for inclusion in a future delegation framework.

RESULTS

32 out of 38 generated items reached consensus of ≥70%, i.e. a mean of ≥4.9 on a 7-point Likert scale, across the three groups. Items were grouped under five main categories: 1) training/Continuous Professional Development for physiotherapists and support workers; 2) need for a clear delegation process; 3) competencies 4) defining the role of support workers and 5) safety net.

CONCLUSION

Key stakeholder groups were able to reach consensus on five priority areas which will be developed into a best practice framework to standardise delegation and guide physiotherapists when delegating clinical tasks to support workers.

The evaluation of health, disability and aged care-sector engagement with resources designed to support optimisation of the allied health assistant workforce: a qualitative study

BACKGROUND

Allied health assistants (AHAs) support allied health professionals (AHPs) to meet workforce demands in modern healthcare systems. In an Australian context historically, AHAs have been sub-optimally utilised. Prior research has identified that AHAs and AHPs working in health, disability and aged care sectors, and the Vocational Education and Training (VET) industry, may benefit from access to resources to support the optimisation of the AHA workforce. As a part of a Victorian department of health funded project, several resources were developed in line with workforce recommendations for use in each of the above sectors. Recommendations and resources covered the broad areas of pre-employment training, workforce planning and governance, consumer-centred therapy and supports, recruitment and induction and workplace training and development. This study aimed to evaluate the engagement with these newly designed resources to support optimisation of AHAs in the Victorian context.

METHODS

Semi-structured interviews were conducted to evaluate engagement with resources, from the perspective of AHAs, AHPs and allied health leaders (AHLs) in the health, aged care or disability sectors, and educators and managers of allied health assistance training. Thematic analysis was conducted using team-based framework analysis.

RESULTS

Thematic framework analysis of the interview data identified four themes; Why participants accessed the resources; How participants engaged with the resources; What (if any) changes in practice occurred as a result of engaging with the resources in a participant's local context, How did participants envision the resources being utilised for AHA workforce optimisation in the future. Responses were mapped to the AHA workforce career pathway at the career preparation, career development and career trajectory tiers.

CONCLUSIONS

Appetite for AHA workforce development and optimal utilisation is evident across Victoria, Australia. Readily accessible resources that inform AHA role and scope of practice, delegation practice, or improve the ability for an AHA to state their own development needs, were identified as useful by participants. The potential for these resources to assist in the optimal utilisation and development of AHA workforces across the career continuum differs according to the role, sector and geographical location of the resource user. Further study is needed to investigate the transferability of these resources to national and global contexts.

The Deployment and Utilization of the Allied Health Professions Support Workforce: A Scoping Review

The demand for healthcare services internationally continues to increase, exacerbated by patient backlogs resulting from the COVID-19 pandemic and the difficulties in recruiting and retaining healthcare staff. These difficulties have led to increased interest in workforce redesign, and the upskilling of existing staff in all areas of healthcare, including within the Allied Health Professions (AHP). Clinical support staff are a key component of workforce redesign, yet little has been documented on the utilization of this workforce across the wide range of professions that collectively form the AHP workforce. Existing research is also unclear due to the variety of titles used to describe them (eg, allied health assistants, therapy assistants, etc). This study aimed to review how Support Workers and Assistant Practitioners (SWAPs) are utilized within the AHP professions. Electronic databases (MEDLINE, CINAHL complete, Scopus, and Google Scholar) were searched to find English Language primary research articles that explored the deployment of clinical support staff within Allied Health. Following the scoping review methodology, data from each study were analyzed in terms of design, key findings, and implications. A quality assessment was also completed. Thirty-nine articles met the eligibility criteria. Studies were undertaken in Australia, UK, and USA, and covered a range of AHPs and methodological approaches. Most articles employed qualitative methods, with highly variable research quality identified. Key findings were that cost-effectiveness of this workforce has not been formally evaluated in any setting or AHP discipline, and that support workers are a largely underutilized staff group potentially due to inconsistencies in their deployment and scope of practice, and the lack of a clear career pathway. Rigorous, quantitative, and mixed methods research into the deployment and impact of this staff group is needed in order to gain a clearer understanding of how they are optimally utilized across the different AHP disciplines.

Reforming allied health service provision in residential aged care to improve the rehabilitation reach: a feasibility study

Objective My Therapy is an allied health guided, co-designed rehabilitation self-management program for residents of aged care facilities. This study aimed to determine the feasibility of implementing My Therapy in a residential aged care setting. Methods This observational study was conducted on a 30-bed wing, within a 90-bed metropolitan residential aged care facility, attached to a public health service, in Victoria, Australia. Staff and resident data were collected prospectively over 6 weeks (staff focus groups, patient surveys, and audits) to evaluate the feasibility domains of acceptability , reach and demand , practicality , integration , limited efficacy testing and adaptations . Results Twenty-six residents and five allied health staff (physiotherapy and occupational therapy) participated. My Therapy was acceptable to residents (survey) and staff (focus groups). Via initial My Therapy discussions between the resident and the therapists, to determine goals and resident preferences, My Therapy reached 26 residents (n  = 26/26, 100% program reach ), with 15 residents subsequently receiving a rehabilitation program (n  = 15/26, 58% program demand ). The remaining 11 residents did not participate due to resident preference or safety issues (n  = 11/26, 42%). Collecting physical function outcome measures for limited efficacy testing was practical , and the cost of My Therapy was AUD$6 per resident per day, suggesting financial integration may be possible. Several adaptations were required, due to limited allied health staff, complex resident goal setting and program co-design. Conclusion My Therapy has the potential to improve the rehabilitation reach of allied health services in residential aged care. While introducing this low-cost intervention is feasible, adaptations were required for successful implementation.

Professional care workforce: a rapid review of evidence supporting methods of recruitment, retention, safety, and education

BACKGROUND

Across the care economy there are major shortages in the health and care workforce, as well as high rates of attrition and ill-defined career pathways. The aim of this study was to evaluate current evidence regarding methods to improve care worker recruitment, retention, safety, and education, for the professional care workforce.

METHODS

A rapid review of comparative interventions designed to recruit, retain, educate and care for the professional workforce in the following sectors: disability, aged care, health, mental health, family and youth services, and early childhood education and care was conducted. Embase and MEDLINE databases were searched, and studies published between January 2015 and November 2022 were included. We used the Quality Assessment tool for Quantitative Studies and the PEDro tools to evaluate study quality.

RESULTS

5594 articles were initially screened and after applying the inclusion and exclusion criteria, 30 studies were included in the rapid review. Studies most frequently reported on the professional nursing, medical and allied health workforces. Some studies focused on the single domain of care worker education (n = 11) while most focused on multiple domains that combined education with recruitment strategies, retention strategies or a focus on worker safety. Study quality was comparatively low with a median PEDro score of 5/10, and 77% received a weak rating on the Quality Assessment tool for Quantitative Studies. Four new workforce strategies emerged; early career rural recruitment supports rural retention; workload management is essential for workforce well-being; learning must be contextually relevant; and there is a need to differentiate recruitment, retention, and education strategies for different professional health and care workforce categories as needs vary.

CONCLUSIONS

Given the critical importance of recruiting and retaining a strong health and care workforce, there is an immediate need to develop a cohesive strategy to address workforce shortfalls. This paper presents initial evidence on different interventions to address this need, and to inform care workforce recruitment and retention. Rapid Review registration PROSPERO 2022 CRD42022371721 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022371721.

Factors Impacting Retention of Aged Care Workers: A Systematic Review

Retention of care support workers in residential aged care facilities and home-based, domiciliary aged care is a global challenge, with rapid turnover, low job satisfaction, and poorly defined career pathways. A mixed-methods systematic review of the workforce literature was conducted to understand the factors that attract and retain care staff across the aged care workforce. The search yielded 49 studies. Three studies tested education and training interventions with the aim of boosting workforce retention and the remaining 46 studies explored opinions and experiences of care workers in 20 quantitative, four mixed-methods and 22 qualitative studies. A range of factors impacted retention of aged care staff. Two broad themes emerged from the analysis: individual and organisational factors facilitating retention. Individual factors related to personal satisfaction with the role, positive relationships with other staff, families, and residents, and a cooperative workplace culture. Organisational factors included opportunities for on-the-job training and career development, appropriate wages, policies to prevent workplace injuries, and job stability. Understaffing was often cited as a factor associated with turnover, together with heavy workloads, stress, and low job satisfaction. With global concerns about the safety and quality of aged care services, this study presents the data associated with best practice for retaining aged care workers.

An ethnographic study exploring person-centred nutrition care in rehabilitation units

PURPOSE

Person-centred care (PCC) is an essential component of high-quality healthcare across professions and care settings. While research is emerging in subacute nutrition services more broadly, there is limited literature exploring the person-centredness of nutrition care in rehabilitation. This study aimed to explore person-centred nutrition care (PCNC) in rehabilitation units, as described and actioned by patients, support persons and staff. Key factors influencing PCNC were also explored.

MATERIALS AND METHODS

An ethnographic study was undertaken across three rehabilitation units. Fifty-eight hours of field work were completed with 165 unique participants to explore PCNC. Field work consisted of observations and interviews with patients, support persons and staff. Data were analysed through the approach of reflexive thematic analysis, informed by PCC theory.

RESULTS

Themes generated were: (1) tensions between patient and staff goals; (2) disconnected moments of PCNC; (3) the necessity of interprofessional communication for PCNC; and (4) the opportunity for PCNC to enable the achievement of rehabilitation goals.

CONCLUSIONS

PCNC was deemed important to different stakeholders but was at times hindered by a focus on profession-specific objectives. Opportunities exist to enhance interprofessional practice to support PCNC in rehabilitation. Future research should consider the system-level factors influencing PCNC in rehabilitation settings.

Delegation of workload from musculoskeletal physiotherapists to physiotherapy assistants/support workers: A UK online survey

PURPOSE

There are approximately 9000 physiotherapy assistants/support workers in the UK. Many of them work in NHS physiotherapy outpatient services treating patients with musculoskeletal conditions, but their role(s) are relatively undefined and as such there is considerable variation in the duties and tasks they undertake. This study aimed to explore current practice of UK musculoskeletal physiotherapists in relation to delegation to physiotherapy assistants/support workers.

METHODS

An online cross-sectional descriptive survey was designed and collected data on delegation practice and training in delegation. The survey was piloted with 10 physiotherapists. The final questionnaire was distributed via the interactive Chartered Society of Physiotherapy's website and the authors' professional networks via Twitter. Responses were collected over a five-week-period from October to November 2020.

RESULTS

Of 302 survey responses, 232 were analysed (46 incomplete, 24 ineligible). The majority of respondents (66.3%, 154/232) had worked as physiotherapists for over 10 years. Most respondents indicated they had neither formal training (84%, 195/232) nor informal training (60.3%, 140/232) regarding how to delegate tasks. The clinical tasks most commonly delegated by physiotherapists were supervision of exercises (81.0%, 188/232) and walking aid provision (78.5%, 182/232) whereas the least delegated clinical task was the application of electrotherapy (19.8%, 46/232).

CONCLUSION

These survey results provide evidence for the need to improve training in delegation for both physiotherapists and physiotherapy assistants, and to ensure clearer delegation processes to facilitate good delegation practice in the musculoskeletal setting.

Allied health assistants' perspectives of their role in healthcare settings: A qualitative study

Allied health assistants (AHAs) are important members of the health workforce and key to meeting population health needs. Previous studies exploring the role and utility of AHAs from multiple stakeholder perspectives suggest AHAs remain poorly utilised in many healthcare settings. This qualitative study explores the experiences and perspectives of AHAs working in healthcare settings to determine the contextual factors influencing their role, and mechanisms to maximise their utility. We conducted semi-structured interviews using purposive sampling with 21 AHAs, from one regional and three metropolitan health services in Australia, between February and July 2021. We used a team-based framework approach to analyse the data. Four major themes were identified: 1) AHAs' interpersonal relationships, 2), clarity and recognition of AHA roles and role boundaries, 3) AHAs accessing education and professional development, and 4) the professional identity of the AHA workforce. Underpinning each of these themes were relationships between AHAs and other healthcare professionals, their patients, health services, and the wider AHA workforce. This study may inform initiatives to optimise the utility of AHAs and increase their role in, and impact on, patient care. Such initiatives include the development and implementation of guidelines and competencies to enhance the clarity of AHAs' scope of practice, the establishment of standardised educational pathways for AHAs, and increased engagement with the AHA workforce to make decisions about their scope of practice. These initiatives may precede strategies to advance the AHA career structure.

Delegation of patient related tasks to allied health assistants: a time motion study

Background

Allied health assistants (AHAs) are support staff who complete patient and non-patient related tasks under the delegation of an allied health professional. Delegating patient related tasks to AHAs can benefit patients and allied health professionals. However, it is unclear whether the AHA workforce is utilised optimally in the provision of patient care. The purpose of this study was to determine the proportion of time AHAs spend on patient related tasks during their working day and any differences across level of AHA experience, clinical setting, and profession delegating the task.

Methods

A time motion study was conducted using a self-report, task predominance work sampling method. AHAs were recruited from four publicly-funded health organisations in Victoria, Australia. AHAs worked with dietitians, occupational therapists, physiotherapists, podiatrists, social workers, speech pathologists, psychologists, and exercise physiologists. The primary outcome was quantity of time spent by AHAs on individual task-categories. Tasks were grouped into two main categories: patient or non-patient related activities. Data were collected from July 2020 to May 2021 using an activity capture proforma specifically designed for this study. Logistic mixed-models were used to investigate the extent to which level of experience, setting, and delegating profession were associated with time spent on patient related tasks.

Results

Data from 51 AHAs showed that AHAs spent more time on patient related tasks (293 min/day, 64%) than non-patient related tasks (167 min/day, 36%). Time spent in community settings had lower odds of being delegated to patient related tasks than time in the acute hospital setting (OR 0.44, 95%CI 0.28 to 0.69, P < 0.001). Time delegated by exercise physiologists and dietitians was more likely to involve patient related tasks than time delegated by physiotherapists (exercise physiology: OR 3.77, 95% 1.90 to 7.70, P < 0.001; dietetics: OR 2.60, 95%CI 1.40 to 1.90, P = 0.003). Time delegated by other professions (e.g. podiatry, psychology) had lower odds of involving patient related tasks than physiotherapy (OR 0.37, 95%CI 0.16 to 0.85, P = 0.02).

Conclusion

AHAs may be underutilised in community settings, and by podiatrists and psychologists. These areas may be targeted to understand appropriateness of task delegation to optimise AHAs’ role in providing patient care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-08642-7.