A four-year, systems-wide intervention promoting interprofessional collaboration

Background: A four-year action research study was conducted across the Australian Capital Territory health system to strengthen interprofessional collaboration (IPC) through multiple intervention activities. Methods: We developed 272 substantial IPC intervention activities involving 2,407 face-to-face encounters with health system personnel. Staff attitudes toward IPC were surveyed yearly using Heinemann et al’s Attitudes toward Health Care Teams and Parsell and Bligh’s Readiness for Interprofessional Learning scales (RIPLS). At study’s end staff assessed whether project goals were achieved. Results: Of the improvement projects, 76 exhibited progress, and 57 made considerable gains in IPC. Educational workshops and feedback sessions were well received and stimulated interprofessional activities. Over time staff scores on Heinemann’s Quality of Interprofessional Care subscale did not change significantly and scores on the Doctor Centrality subscale increased, contrary to predictions. Scores on the RIPLS subscales of Teamwork & Collaboration and Professional Identity did not alter. On average for the assessment items 33% of staff agreed that goals had been achieved, 10% disagreed, and 57% checked ‘neutral’. There was most agreement that the study had resulted in increased sharing of knowledge between professions and improved quality of patient care, and least agreement that between-professional rivalries had lessened and communication and trust between professions improved. Conclusions: Our longitudinal interventional study of IPC involving multiple activities supporting increased IPC achieved many project-specific goals, but improvements in attitudes over time were not demonstrated and neutral assessments predominated, highlighting the difficulties faced by studies targeting change at the systems level and over extended periods

Thriving in the cash strapped organisation

Allied health professionals make valuable contributions to the health of their clients and communities as expert clinicians in their field of expertise. Work priorities are often dominated by managing large caseloads and meeting complex client needs. Less well appreciated is the need for a range of non-clinical skills that both support and amplify the health professional's clinical outcomes. Competence in management, leadership and especially finance, come to the fore in environments where resources are declining, unstable or where political and organisational politics are rife over the allocation process. Resource allocation processes are inherently competitive and the relative prosperity of the allied health professions, in terms of their ability to acquire resources, depends on being able to obtain and manage money creatively. In this chapter, the focus is on the art of acquiring resources, particularly in the cash strapped publicly funded health care sector. The rationale is that firstly, although allied health professionals work across many settings, the publicly funded health sector in many western industrialised countries is the majority employer. Secondly, compared to the private sector, the publicly funded health sector is often more constrained by the methods and techniques that can be used in obtaining money. Bureaucratic controls and public accountability standards typically act as limiting factors on public sector management and financial behaviour.(1, 2) The espoused priorities for health professionals in the public sector are usually expressed as a demand to concentrate on the ‘core business’ of meeting client demand, not on generating innovative revenue streams. Despite these espoused priorities health professionals need to exercise strategic thinking about how to acquire additional funding within the constraints of public sector practice. Where resource environments are unstable, service providers also need to use the same strategic thinking to ensure they maximise the available resources and opportunities. This is especially the case for the allied health professions. Marginalised or 'cinderella' services in the health system are often targeted for deeper cuts, so service leaders need to be especially skilled in the finance and leadership area

The organisation of allied health professionals in Australian general hospitals

This research is a case study in the sociology of professions. It reports on the Australian allied health professions, a group that has rarely been the subject of sustained research. The central purpose of the research is to examine the impact of local workplace organisation in Australian general hospitals in the public sector on the position of the allied health professions and their autonomy. Further, the research seeks to unbundle the competing claims about the utility of alternative organisational approaches and to examine how the allied health professions negotiate inter-professional relationships as a consequence of particular organisational approaches. The research draws on Eliot Freidson's professional dominance theory (medical dominance theory) as the underpinning theoretical framework. Medical dominance theory portrays the allied health professions as inevitably subject to medical dominance and subordination, a proposition which is critically appraised through a contemporary analysis of local workplace arrangements. To address these issues three models of allied health profession organisation were identified; the classical medical model, division of allied health model and the unit dispersement model. The research method involved a comparative case study approach and included fifty-three interviews, document analysis, observation strategies and key informants over a two year period. Data collection was guided by seventeen themes of inquiry which were identified from a multiple methods approach as likely to be important in a comparative analysis of the organisation of the allied health professions