Workforce futures: towards research-informed reform

Mr Dean Raven1

Department of Health and Human Services

Health and human services in Victoria are going through an unprecedented period of transformation. Reforms such as the 10 Year Mental Health Plan, Health 2040: Advancing Health, Access and Care, Roadmap for Reform: Strong Families, Safe Children, Ending Family Violence: Victoria’s Plan for Change, and rollout of the National Disability Insurance Scheme provide opportunities for research, innovation and the embedding of evidence into learning systems and practice. This presentation will discuss how these reforms are structured and integrated, and the implications and opportunities for researchers and academics.

Allied health inpatient staffing profiles in Victorian hospitals

Ms Lyndell Keating1, Mr James Sayer1

1Healthcare Management Consultant, , Australia

Aim:

To provide information resources regarding Allied Health inpatient staffing profiles, such as the average Equivalent Full Time (EFT) per bed by profession and clinical grouping.

Method:

Victorian public hospitals with multi-day inpatients were invited to participate in macro benchmarking. Consenting hospitals completed a survey regarding the inpatient EFT per classification for each of the Allied Health therapy professions. Of 132 eligible hospitals, 55 hospitals completed the survey (22 acute only, 13 sub-acute only, 20 both acute & sub-acute beds).

Hospitals that rated activity statistics as “good” or “very good” were invited to submit Individual Patient Attributable (IPA) hours mapped to agreed clinical groupings, from which estimated EFT was derived using an established ratio. Statistics data was submitted by 16 hospitals.

Results:

Reports were provided to Allied Health leaders regarding the average EFT per 10 beds for acute and sub-acute, categorised by hospital size and acuity. The reports also outlined the percentage of hospitals with each profession, and the proportion of grades and assistants for each profession.

Further reports included the average estimated EFT per bed by profession and clinical grouping, and additional comparative information such as length of stay and percentage of patients seen.

Significance of the Findings to Allied Health:

Allied Health leaders are required to deliver effective and efficient allied health services within fiscal constraints. The staffing analysis resources have been utilised by managers to assist with decision making regarding workforce profiles, and to modify staffing levels as a result of service change, growth, and other drivers.

Improving access for foot and ankle patients on an orthopaedic waiting list

Mrs Charlotte Cooke1, Ms Julia Firth1

1Western Health, Footscray, VIC, Australia

 

Aim
This study aimed to determine the efficacy of integrating an Advanced Practice Orthopaedic Podiatry (APOP) clinic to the Orthopaedic Outpatient’s service. Pilot funding was received from DHHS.
Method
The APOP screened referrals received by the Orthopaedic Outpatient department to determine whether they required advanced practice podiatric management or surgical opinion. A clinical governance tool was developed alongside a competency package. Data collection completed October 2015– January 2016. Patients > 18 years of age were eligible. Patient centred outcomes were analysed, patient satisfaction survey, waiting list and referral analysis.
Results
Patient referrals to Orthopaedic clinic between 2013 -2015 were assessed. N = 103, 70% were managed effectively and did not require an orthopaedic opinion for their presenting musculoskeletal pathology. Most commonly assessed condition was Hallux Valgus (51%) followed by 33% with a hind foot pathology. 66% of patients were discharged completely to community providers. Overall satisfaction with APOP visit – 94% strongly agree 6% agree.
Significance of the findings to Allied Health Practice
The aim of this inter-professional model of patient care is to provide seamless movement of patients from one service to another. Shifting resources into prevention and self-management; providing patients with real choices about their treatment options, empowering them to make informed decisions about their health care. Whilst providing them with support, education and tools to improve their understanding of their journey through the health care system.

Implementation of an advanced scope of practice physiotherapist in neurosciences clinics improves patient access to community services

Ms Jan Quiney1, Ms Lucinda  Marr1, Ms Samantha  Plumb1, Mr Scott Edwards1

1Royal Melbourne Hospital, Parkville, Australia

 

AIM: To investigate if the implementation of an advanced practice physiotherapist (APP) within three neurosciences outpatient specialist clinics improves patient care by addressing unmet physical need and satisfaction.

METHOD: Prospective implementation study. APP roles were implemented in three Neurosciences specialist outpatient clinics (Stroke, Neuro Oncology and Neuromuscular). An APP worked alongside the usual specialist medical staff. Quality of care data included number of patients seen; interventions performed (including referrals to community services); and patient and medical staff satisfaction.

RESULTS: Over 4 months, 126 patients were seen by the APP across the 3 clinics (equivalent to 378 per annum). Main interventions included: patient education/advice (73-100%); exercise prescription (50-92%); linking to community services (8-56%) referral to community physiotherapy (27-56%); referral to other community Allied Health discipline (8-33%). All clinic medical staff (100%) believed the APP addressed the physical needs of their patients (rated 10/10) and were supportive for an ongoing role. Patient satisfaction was high, with 100% of respondents (n=9) reporting that the APP assessment benefited them, and addressed all identified problems (44%). Over 69 hours of medical consultant time was freed up by APP over the four months.

SIGNIFICANCE OF THE FINDINGS TO ALLIED HEALTH: The APP in specialist neurosciences clinics improved the quality of care provided through timely physiotherapy interventions and increasing linkages with community based services.  The role enables optimal use of the physiotherapy workforce to free up consultant time and provides an enriching career path for hospital physiotherapists into more senior clinical roles. Further investigations are needed to determine the efficacy on patient outcomes and health economic benefits.

A co-located physiotherapist and sonographer led hip dysplasia clinic can improve family satisfaction, staff satisfaction, and reduce burden of care in infants with developmental dysplasia of the hips

Mr David Harding1, Ms Glenda McLean1,2, Ms Janet Hough1

1Monash Children’s Hospital, Monash Health, Clayton, Australia

2Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Monash University, Melbourne, Australia

 

Aims

  1. To improve family satisfaction
  2. To improve staff job satisfaction
  3. To reduce the burden of care by reducing the number of hospital visits required by families with children who are braced for developmental dysplasia of the hips
  4. To evaluate the the professional interaction between staff in the co-located clinic and to determine how it may enable them to perform their roles better

 

Methods

  1. Family satisfaction surveys were completed by families in this service and our conventional service
  2. Staff satisfaction surveys were completed prior to the service commencing and after six months of the service operating
  3. The number of appointments required by famlies during the treatment phase was counted and compared to the number of appointments required by famlies being treated in our conventional service
  4. Professional interaction was recorded by physiotherapists and sonographers for the first 100 patients treated in this clinic

 

Results

  1. Families were overwhelming positive and supportive of the new service. Families were happy with the usual service. There was a significant improvement in waiting times, and families appreciated the ability to attend on one occasion for the hip ultrasound and clinical assessment in the new service.
  2. Improved staff satisfaction
  3. Reduced burden of care with average of 2 less appointments required in the new service
  4. Positive professional interaction enable staff to perform their roles more effectively

 

Significance of findings to Allied Health

There were significant benefits for families in reducing burden of care.

The professional interaction between staff working closely is beneficial to both professions

This model can be replicated to suit health service needs

Defining the role of an allied health assistant in hand therapy

Miss Laura Isherwood1

1Barwon Health, Geelong, Australia

 

Aim:

To clearly define the role of an Allied Health Assistant (AHA) within the Hand Therapy Department at Barwon Health.

 

Method:

A qualitative survey was conducted among AHA’s and Hand Therapists, to determine how staff felt the role of the AHA within the Department was currently defined, the efficiency of the role and communication methods, and the current system for the recording of completed tasks. The results were then collated and analysed, and used to create a prioritized list of tasks with a description of each. Once reviewed and approved, an orientation was provided to AHA’s, and the Task List was used during each shift.

 

Results:

The initial survey completed showed that although AHA presence in Hand Therapy was valuable, their role was not clearly defined. As a result, many tasks were not completed. Staff also reported that there was no clear method for communication or handover between AHA’s and therapists, which was impacting the service. These results were therefore used to help to develop the Task List.

The refined AHA Program within Hand Therapy is currently being trialled. Preliminary feedback from staff has been that channels of communication for handover are clearer, and that there is a greater understanding of the scope of the AHA role, which is contributing to greater job satisfaction and therefore a more efficient AHA program.

 

Significance for Allied Health:

This project will define the role of the AHA within Hand Therapy, and assist with the future direction of the AHA role in Hand Therapy.

Profiling the general medicine physiotherapy service delivery models across major acute metropolitan hospitals within Australia

Ms Hannah Davies1, Ms Catherine  Granger1

1The Royal Melbourne Hospital, Macleod, Victoria, Australia

 

Aim:

Physiotherapy is vital in the management of General Medical patients; however it is often felt physiotherapy services are understaffed resulting in busy caseloads, potential for inadequate delivery of physiotherapy, staff fatigue and burn out. This study aimed to investigate 1) physiotherapy service delivery for General Medical patients in Australian hospitals and 2) staff satisfaction in this area.

 

Method:

Australian metropolitan hospitals with a General Medical Unit were eligible. Physiotherapy managers were approached and those interested completed a 40-item online survey.

 

Results:

45/54 hospitals were able to be contacted and 32 responded (71% response rate). The mean (SD) number of funded beds allocated to General Medical patients was 90±53.7, however respondents reported numbers frequently flexed up despite nil additional physiotherapy funding. Physiotherapy staffing was perceived to be ‘inadequate’ or ‘very inadequate’ by 38% of responders. 69% reported they did not have a recommended clinical care ratio for staff and only 34% had a weekend General Medical Physiotherapy Service. Skills most frequently performed were gait assessment/retraining, discharge planning and respiratory assessment, with only 15% providing group therapy. 80% of respondents reported being ‘satisfied’ or ‘very satisfied’ with their job, despite 62% reporting they receive negative feedback with regard to their staffing levels and capacity to service patients.

 

Significance:

This project has established the profile of Physiotherapy service delivery models across major metropolitan hospitals within Australia. Physiotherapists in this area experience job satisfaction despite evidence of challenges including inadequate staffing and equipment. Further work needs to be completed to determine the optimal service delivery model.

Profiling the general medicine physiotherapy service delivery models across major acute metropolitan hospitals within Australia

Ms Hannah Davies1, Ms Catherine  Granger1

1The Royal Melbourne Hospital, Parkville, Melbourne , Australia

 

Aim:

Physiotherapy is vital in the management of General Medical patients; however it is often felt physiotherapy services are understaffed resulting in busy caseloads, potential for inadequate delivery of physiotherapy, staff fatigue and burn out. This study aimed to investigate 1) physiotherapy service delivery for General Medical patients in Australian hospitals and 2) staff satisfaction in this area.

 

Method:

Australian metropolitan hospitals with a General Medical Unit were eligible. Physiotherapy managers were approached and those interested completed a 40-item online survey.

 

Results:

45/54 hospitals were able to be contacted and 32 responded (71% response rate). The mean (SD) number of funded beds allocated to General Medical patients was 90±53.7, however respondents reported numbers frequently flexed up despite nil additional physiotherapy funding. Physiotherapy staffing was perceived to be ‘inadequate’ or ‘very inadequate’ by 38% of responders. 69% reported they did not have a recommended clinical care ratio for staff and only 34% had a weekend General Medical Physiotherapy Service. Skills most frequently performed were gait assessment/retraining, discharge planning and respiratory assessment, with only 15% providing group therapy. 80% of respondents reported being ‘satisfied’ or ‘very satisfied’ with their job, despite 62% reporting they receive negative feedback with regard to their staffing levels and capacity to service patients.

 

Significance:

This project has established the profile of Physiotherapy service delivery models across major metropolitan hospitals within Australia. Physiotherapists in this area experience job satisfaction despite evidence of challenges including inadequate staffing and equipment. Further work needs to be completed to determine the optimal service delivery model.

Leading the way for advanced practice in occupational therapy: Implications of a scoping review and workshop

Ms Annette Leong2, Ms Susan Giles1, Ms Jude  Boyd2, Ms  Alison Lunt3, Associate Professor Ted Brown5, Ms  Lisa Vale6, Ms Kim Mestroni8, Ms Janice  McKeever4, Ms Claire Lynch7

1Western Health, Footscray, Australia,

2Eastern Health, Box Hill, Australia,

3Peninsula Health, Frankston, Australia,

4Monash Health, Clayton, Australia,

5Monash University, Frankston, Australia,

6Splash Occupational Therapy, Werribee, Australia,

7St Vincent’s Private Hospital, Fitzroy, Australia,

8Occupational Therapy Australia, Fitzroy, Australia

 

Background: With lack of clarity regarding potential occupational therapy advanced practice roles (OTAPRs), other than in recognised specialty practice areas such as Hand Therapy, it is imperative for the occupational therapy profession to identify, define and operationalise suitable functions and responsibilities so that it is positioned to effectively respond to strategic opportunities as they arise. The development of a flexible, cost effective, responsive allied heath workforce is a priority for many funders of health care services.  There is evidence that advanced practice roles (such as OTAPRs) have the potential to improve service efficiency, effectiveness, patient satisfaction and outcomes, costs reduction, hospital admission rates and provide expanded career pathways for clinicians.

 

Aim: To identify and review issues related to OTAPRs including competency/credentialing frameworks, trends in the empirical literature, and the measurement of advance practice role efficacy.

 

Method: A workshop was held with expert clinicians from eight key occupational therapy practice areas. Participants identified potential OTAPRs relevant to their practice areas. Each group generated a specific work plan. A scoping review of the related empirical literature was also completed.

 

Results: Several OTAPRs were identified, with specific competencies and credentialing processes developed. These have been endorsed by the OTA Victorian Divisional Council, and will facilitate spread and sustainability of robust effective professional roles.

 

Significance of the findings to allied health: This process can be used to identify appropriate advanced practice roles, across allied health disciplines, and multi-disciplinary teams. OTAPRs will be described and findings from the scoping review will be presented.

Advanced musculoskeletal physiotherapy and telehealth – improving access for patients following joint arthroplasty

Ms Stephanie Carroll1, Ms  Carolyn  Page1, Ms Belinda Cary1, Mr Colin Laurie1

1St Vincent’s Hospital, Victoria, Fitzroy, Australia

 

Aim:To scope, develop and implement a Telehealth service within the established orthopaedic post arthroplasty review (PAR) clinic, that  improves clinic efficiency and increases access to care.

Method: Phase 1: Scoping  – A literature review and benchmarking of Telehealth services in Victoria and survey of 100 patients attending the Elective Surgery Access Service (ESAS) to ascertain interest in utilising Telehealth and potential barriers. Patient eligibility criteria developed based on literature, consumer engagement and orthopaedic surgeon consultation.  Phase 2: Pilot  – Broad stakeholder engagement, telehealth clinic processes developed, technology interface established (Blue Jeans), online access to radiology secured for external sites, telehealth trialled on a small cohort of patients and processes modified following patient feedback. Phase 3: Integration  – Operational guidelines developed, patients triaged and invited to use Telehealth, evaluation of service, training of other Advanced Musculoskeletal Physiotherapists (AMPs) and orthopaedic surgeons to ensure sustainability of service and webinar education delivered to 10 public healthcare organisations across Victoria to share learnings.

Results: This patient focused service demonstrated high patient satisfaction and cost savings to individual patients and the organisation.  Telehealth also demonstrated improvements in clinic efficiency with quicker consultation times and fewer ‘Did Not Attends’ (DNAs). Telehealth was shown to be a safe and innovative service delivery model that can improve system capacity and offer patients greater choice in their care delivery.

Significance of the findings to allied health: Telehealth has wide applicability for Allied Health as an innovative model of service delivery that can increase access for patients and result in cost savings for patients and health services.