Pathways to success: The role of mentors in developing emerging researchers in Allied Health

Professor Michal Schneider

Director of Research and Deputy Head of Department and newly appointed Allied Health Research and Translation Program Director for the Department of Health and Human Services, Victoria.

Abstract:

Evidence-based practice (EPB) is the foundation of modern, high-quality health care. Although EPB is embedded in all medical and allied health curricula today, implementing EPB and research into day-to-day clinical practice remains a challenge across most allied health disciplines. Poor research cultures, lack of appropriately qualified staff, poor professional career pathways for research active staff and lack of resources and dedicated research time are just a few of the hurdles that have been identified in the literature. Active changes to assist the implementation of EPB and research are required on several organisational levels, however, the role of mentors has been acknowledged as pivotal for success. Using the Allied Health Research Framework, recently established by the Department of Health and Human Services (Victoria) as an example, this presentation will explore the role of mentor-mentee relationships in creating successful and sustainable research pathways in the delivery of evidence-based allied health care.

Biography:

Professor Michal Schneider works at the Department of Medical Imaging and Radiation Sciences in the Faculty of Medicine, Nursing and Health Sciences at Monash University. She is the Director of Research and Deputy Head of Department and newly appointed Allied Health Research and Translation Program Director for the Department of Health and Human Services, Victoria.

What are the outcomes of Allied Health leadership?: A thematic analysis of executive level Allied Health Professionals’ narratives

Ms Janice Mckeever1

1Monash Health , Clayton , Australia

Abstract:

Aim:
To investigate the outcomes of effective Allied Health Leadership though the narratives of executive level Allied Health leaders.

Method:
A qualitative thematic analysis approach was taken.  Semi-structured interviews were conducted with nine Allied Health Professional (AHP) leaders. Interviews were audio-recorded and transcribed. Data were thematically analysed and sorted into codes & themes. Six themes and six subthemes were identified. Member checking & completion of a reflective diary were used to ensure trustworthiness & rigor. Secondary sources from government reports, human resource, finance & quality departments were used to assist with triangulation of qualitative results.

Results:
AHP leaders described a number of positive outcomes covering all three domains of client, organisational & employee outcomes  e.g. service redesign, improved governance, funding increases  & mentoring. Barriers and enablers were identified that influenced leadership performance including personal, interpersonal and organisational factors. The unique skills of executive level AHP were viewed as ideally suited to leadership in complex healthcare systems. Suggestions are made for how to utilise these skills to improve outcomes for the entire health service not just the AHP workforce. These will be reported in detail.

Significance of the findings to allied health:
With low representation of AHP in senior leadership positions and the dearth of research on the ‘value add’ of AHP leaders, the thematic results from the interviews are a rich data source documenting the outcomes of AHP leaders. Notwithstanding the barriers to leadership performance, there are strategies that emerging and established AHP leaders can avail of to advocate for & promote their unique skillset as well as meet the operational needs of their organisation.

Implementing a podiatry prescribing mentoring program in a public health service: a cost-description study

Ms Anna Couch1, Dr Alicia James1, Jon Foo2, Associate Professor Stephen Maloney2, Dr Cylie Williams1

1Peninsula Health, Frankston, Australia, 2Monash University, Frankston, Australia

Abstract:

Aim:
To identify the costs associated with developing and implementing a podiatry prescribing mentoring program; and to compare the cost of this program against potential healthcare savings made.

Method:
This was a cost-description analysis, involving the calculation of costs associated with the development and implementation of a mentoring program to train podiatrists to become endorsed prescribers. Costs were calculated using the Ingredients Method and examined from the perspective of a public health service provider, and the individual learner podiatrist. Breakeven analysis compared the cost of training a podiatry prescriber for endorsement against the potential benefit (savings) made by averting complications of an infected foot ulcer. A sensitivity analysis was conducted to allow for uncertainty in the results of an economic evaluation.

Results:
*Total start-up cost for the podiatry prescriber mentoring program was $13, 251. The total cost to train one learner podiatrist was $30, 087, dispersed between the hospital $17, 046 and the individual learner $13, 041. A podiatry prescriber must avert 0.40 major amputations arising from an infected foot ulcer through prescribing to recuperate the cost of training in the setting studied.

Significance of the findings to allied health:
The economic benefits (savings) created by an endorsed prescribing podiatrist over their career in a public health service are likely to outweigh the costs to train a podiatrist to attain endorsement.

*Health economics analysis is currently being considered to reflect the updated ESM requirements

Biography:

Anna Couch graduated from La Trobe University in 2014 with a Bachelor of Health Sciences/ Masters of Podiatric practice. She completed her graduated year at the Royal Melbourne Hospital working as a member of the Diabetic Foot Unit. Anna now works as a podiatrist at Peninsula Health and Kingston Foot Clinic. Anna has worked on multiple projects across her different employment settings. Key successes include integrating prescribing rights into the podiatry department at Peninsula Health and working as the research assistant for the PAIGE: Podiatrists in Australia Investigating Graduate Employment project. Anna has recently enrolled in a Masters of Philosophy at Monash University.

A rapid review strategy to identify allied health research assets in a start-up context

Dr Olivia King1,2, Dr Rosalie Boyce1

1Barwon Health And South West HealthCare, Ocean Grove, Australia

Monash Centre for Scholarship in Health Education, Victoria, Australia

Abstract:

Recent state-wide investment resulted in new allied health research capacity building (RCB) and translation roles in Victoria. The aim is to present the start-up strategy adopted to accelerate RCB through:

-Analysing baseline research activity and service evaluation projects using existing secondary data resources from 2016-18,

-Identifying patterns of engagement and mapping activity to the Allied Health Research Continuum

-Assessing research literacy and potential to convert research-active allied health professionals (AHPs) to higher levels of engagement, achievement and impact.

Method:
Research assets were identified via a review of secondary data sourced from publicly available documents: BSW and Grampians Allied Health Conference (2016, 2018) and the Victorian Allied Health Research Conference (2017) programs.

Programs were searched for evidence of research and evaluation studies selected for oral presentations, posters and workshops/symposia. This enabled identification of a cohort of research active AHPs in the BSW region. Content analysis will be undertaken to identify patterns in the research undertaken.

Results:
Patterns in the type and clinical focus of research will be identified. Interesting insights into the types of AHPs more frequently undertaking and presenting research may be revealed. Some projects will be identified as having potential to result in peer-reviewed publication; others may have potential to progress to research projects. Candidates for higher degree research may also be identified.

Significance:
This novel approach to establishing the strengths, capacity, and patterns in research and evaluation work will contribute to a regional research strategy; facilitate community engagement and development, and provide a mechanism to develop individual researchers.

Biography:

Olivia is a qualified podiatrist and credentialled diabetes educator. She completed her PhD (Health) which explored the role boundaries and differences in the scopes of practice of diabetes educators of allied health and nursing background, in 2018. She has recently been appointed (with Dr Rosalie Boyce) as Regional Allied Health Research and Translation Lead for the Barwon South West region. She also has an adjunct appointment at Monash University as a Postdoctoral Research Fellow. Her research interests include studies of the allied health professions, sociology of the professions and health education.

Allied Health Flow and Interdisciplinary Referral Management (AHFIRM) Program

Mrs Angela Mucic1

1Western Health, St Albans, Australia

Abstract:

Aim:
The primary aim of this project was to determine if enhanced allied health (AH) leadership at ward level improves referral effectiveness. The secondary aim was to determine if AHFIRM improves ward staff members perception of multidisciplinary team work.

Method:
AHFIRM positions were advertised to Grade 2 and 3 AH staff members internally. There was no new EFT. The position description was based on the following three pillars:

  • Access and flow, through proactive AH referral management;
  • Interdisciplinary communication, through a single point of contact
  • Allied health leadership presence at ward level, through influence and advocacy.

The successful applicants were trained in referral reasons and prioritisation criteria for each AH discipline and interdisciplinary leadership.

Results:
A pre implementation referral audit found that 43% of referrals to inpatient AH were inadequately completed and did not allow prioritisation. A follow up audit will be completed in March 2019. Preliminary results have shown a improvement in the quality of referrals into General Medicine.

A pre implementation survey was completed looking at multidisciplinary team-work and leadership at ward level. The survey found that 37% of respondents were not sure which AH ward staff member could act in a leadership capacity. A follow up survey will be completed in March 2019.

Significance of the findings to allied health:
AH leadership in inpatient referral management may improve access and flow. This study looks at a sustainable model for delivery of shared ward based leadership, without additional funding.

Biography:

Angela is the Allied Health Education Lead for Workforce at Western Health.  Angela’s interest is in developing structures and processes that nurture the building of leadership capacity among allied health clinical and the ground level.

Angela trained as a physiotherapist graduating from Latrobe University in 2002 with First Class Honours. She completed a Masters of Business Administration with a double major in health service management and knowledge management.

More than just a Buddy: Implementation of a peer-support program in a private community neurorehabilitation setting

Miss Pip Willson1, Mrs Susan Petrie1, Mrs Kate Phillips1

1Independent Rehabilitation Services, Ashburton, Australia

Abstract:

Aim:
The Buddy Program is an opt-in peer-support program offering support to new staff joining the service. New staff are matched with a clinician from a different discipline, who is a resource for informal queries and support. New staff can access 12 hours of paid Buddy support annually. Our aim was to evaluate the effectiveness of the pilot Buddy Program.

Method:
Staff who had received Buddy support within the previous 12 months were invited to participate in a focus group. Informed consent was gained. 8 participants were recruited, Speech Pathologist (N=1), Physiotherapists (N=2) and Occupational Therapists (N=5). An interview guide of 8 open questions was developed. The focus group was facilitated by an independent clinician. It was recorded, transcribed and thematic analysis was completed.

Results:
Three main themes were revealed. The Buddy Program: 1. Compliments clinical supervision, due to informal support from another discipline. 2. Is flexible to clinicians needs, as staff controlled where and when they met, discussion content, how long they accessed support for. 3. Supports clinicians wellbeing in the workplace, as staff were accountable to implementing self-care strategies.

Significance of the findings to Allied Health:
Peer-support programs can be successfully implemented in private community rehabilitation settings. They help clinicians develop healthy and sustainable work practices and reduce the risk of staff burnout. These benefits extend to clients who receive care continuity and quality interventions because their clinicians are prioritising self-care.

Biography:

Pip Willson is a Senior Occupational Therapist and Deputy Occupational Therapy Team Leader at Independent Rehabilitation Services. Independent Rehabilitation Services provides multi-disciplinary community-based rehabilitation to clients with neurological conditions.

Interprofessional collaboration at mealtimes in hospital: The need for cultural change

Mrs Ella Ottrey1,2,  A/Prof Judi Porter1,2, Dr Catherine E. Huggins1, A/Prof Claire Palermo1

1Monash University, Notting Hill, Australia, 2Eastern Health, Box Hill, Australia

Abstract:

Aim:
Examination of interprofessional collaboration at mealtimes is needed to build a culture where staff work together to prioritise nutrition care. This study explored the relationships, roles and responsibilities of hospital staff involved at mealtimes and the impact on meal provision.

Methods:
This ethnographic study was conducted on two hospital wards in Melbourne. Sixty-seven hours of observation (112 pages of typed fieldnotes) and 75 interviews with 61 staff, volunteers and visitors were used to identify patterns in attitudes and intentions, behaviours and interactions at mealtimes. Data were analysed inductively and thematically, supported by memo writing and reflective journaling.

Results:
Three key themes emerged to describe mealtime culture and reflect the interrelationships of staff involved in the delivery of nutrition care: (1) defining mealtime roles and maintaining boundaries; (2) balancing the need for teamwork and having time and space; and (3) effective communication supports role completion and problem solving. Staff working relationships were degraded by a lack of appreciation of workflow barriers and enablers, and conflict between wanting teamwork and segregation at mealtimes.

Significance of the findings to allied health:
The findings suggest that a culture of interprofessional collaboration is yet to be achieved at mealtimes in hospital. Staff awareness of their and others’ mealtime roles and responsibilities is central to supporting a coordinated approach. Healthcare organisations should reinforce the overall vision for quality patient care and shared goals to improve nutrition care.

Biography:

Ella Ottrey is a clinical dietitian with 10 years of experience across a number of Victorian healthcare services. She is currently undertaking her PhD at Monash University exploring mealtimes in subacute care.

The organisational benefits of a strong research culture in a health service

Dr Katherine Harding1, Prof Nicholas Taylor1,2, Ms Lauren Lynch1, Dr Judi Porter1,3, Ms Anita Wilton1

1Eastern Health, Box Hill, Australia, 2La Trobe University, Bundoora, Australia, 3Monash University, Clayton, Australia

Aim: A ‘research culture’ within health services is one in which evidence is valued, clinicians are encouraged to participate in research activities, research training opportunities are available, achievements are recognised and there is investment in research activity. Investment in these areas has been shown to increase academic outputs.  This systematic review of the literature aimed to determine whether there a strong research culture is also associated with improved organisational performance outcomes.

Methods: Key health databases were searched, combining the key concepts of “organisational performance” and “research culture”.  Inclusion criteria applied, and study quality appraised. Data were extracted from selected studies and the results were synthesised descriptively.

Results: Eight studies met inclusion criteria. Five compared health services with high versus low research activity, and three evaluated specific interventions focused on the health workforce. All reported a positive association between research activity and organisational performance.  Benefits included lower mortality rates, higher levels of patient satisfaction, reduced  turnover and satisfaction of staff and improved efficiency.

Significance for Allied Health: In recent years there has been significant investment in initiatives within health services to facilitate a culture of research in Allied Health.  This review supports the existence of associations between a strong research culture and benefits to patients, staff and the organisation. However the magnitude of this effect and mechanisms underlying the association remain unclear.  More evidence is needed to determine the return on investment in activities that contribute to a research culture, and the nature of interventions that best achieve this aim.

The role of allied health leadership in the implementation of an electronic medical record

Ms Jane Carlin1, Mr Adam  Stormont1, Ms Naomi Dobroff1, Dr Suong Le1

1Monash Health, Clayton, Australia

Aim

Electronic Medical Records (EMRs) represent a core strategy for future healthcare delivery. This multidisciplinary study evaluated baseline clinician perception, knowledge and expectation of an EMR on clinical workflow, patient care and research productivity.

Method

A mixed method two phase study was conducted at Monash Health, VIC from March to August 2016.  This consisted of an 18 item, literature derived questionnaire evaluating demographics, satisfaction, clinical workflow, clinical efficiency and qualitative feedback.  This was followed by a time motion study measuring direct clinical time and barriers to clinical workflow.

Results

809 clinicians participated in the survey (89 physiotherapy, 61 pharmacy, 213 medical, 456 nursing and midwifery) across 4 Monash Health hospitals. 64.7% of respondents reported low satisfaction with current workflow on a 5 point Likert Scale.

Domains reported as likely to benefit from an EMR included: improved patient quality of care, reduced medication error and increased research efficiency. Respondents aged over 50 were more sceptical regarding the potential benefits of an EMR (p-value <0.001). The time motion study verified the clinical workflow barriers identified in the survey.

Core challenges identified were: hardware access; handwritten documentation ambivalence; impact on patient rapport; lack of visible leadership; user experience; and staff communication.

Significance of the findings to Allied Health:

This is the first study to characterise the baseline perception, knowledge and expectation of a multidisciplinary workforce towards an EMR. The EMR is a catalyst for clinical workflow reform but Allied Health leadership is essential if we are to realise its true potential to improve patient safety, quality of care and clinical research output.

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