Do you work with allied health assistants (AHAs) in your health, disability or aged care organisation? Are they employed as effectively as they could be?
Guest contributors Lucy Whelan, Jessica Huglin and Sharon McLean describe four, assistant-identified ways to improve the way you work with AHAs.
This research involved consultation with education providers, consumers, allied health assistants, allied health professionals and allied health leaders and was funded by the Victorian Department of Health. The project developed several valuable resources to support the implementation of and effective working with allied health assistants including position descriptions, interview guides, delegation tools and progress measurement tools. The draft resources are available for download here.
It is well documented that AHAs contribute immense value as a workforce in both the attributes they bring to the workplace and in supporting allied health professionals with growing and complex workloads through delegated activities.
Our research identifies four key factors that can improve the way we work with AHAs in the workplace. These include individual AHA factors, system factors, workplace factors and training factors.
Positive progress in one or more of these areas enables assistants to make a meaningful impact in your workplace and be a valuable support to the workforce, service, waitlist or quality challenges you may be facing. All of these factors are vitally important to the AHAs we spoke with.
Conversely, poor implementation of these four factors can result in underuse of AHAs, poor recognition of their contribution, and ultimately reduce the likelihood of their effective employment in your workplace.
1. Individual AHA factors
The personal attributes and skills of an AHA before entering and once in the AHA workforce can play a pivotal role in whether the individual is suited to and will thrive in an AHA role.
This assistant summarised why this is so important to them and the workplace:
“I’ve had to prove my competency, capability, reliability etc. The teams had not had … great experiences with AHAs in the past, so I had to change their mindset. I had to gain their trust and show them I’ve got the skills and knowledge to assist them. I was working below my capabilities but now I’m working at my full potential which is good. I’ve shown the teams that I’m more than capable.” [Focus Group: AHA – metro]
Assistants described the core skills and attributes associated with greater engagement and utilisation of their roles as:
- an awareness of scope of practice
- the ability to recognise and report clinical risk
- the confidence to speak up around capabilities and training needs
- the ability to learn and develop new skills and to drive this learning
- the ability to manage competing demands
You could consider including behavioural interview questions in your recruitment processes to seek out individual attributes that will best fit with your workplace environment and the assistant role.
2. System factors
System factors are the external influences on training and influences that were external to the workplace such as training funding models, industrial agreements, geographical locations of services and emerging health issues.
The Free TAFE (vocational training) initiative has increased the variability of students applying for the Certificate AHA courses:
“the screening of who is actually going to be able to manage that is increasingly difficult with some of the students who are applying through the free course” [Registered Training Organisation Focus Group Participant]
Our research participants said that barriers to effective working include inconsistent assistant funding models, different industrial agreements to allied health professionals, demands of growing programs like the NDIS and varying levels of endorsement for the existing pre-employment qualifications and the assistant workforce from professional associations.
One assistant summarised what this meant for them and the workplace:
“ … the Certificate IV Allied Health Assistance … [would benefit from] … different subjects like healthcare, NDIS and a few other things to help shape it so allied health assistants that are restarting or getting into the course are able to learn … and develop their role.” [Focus Group: AHA – metro]
We found that the following system factors were associated with better engagement and use of AHAs:
- A pre-training review of the attributes that suit a people facing career such as an AHA
- Strong industry engagement in reviewing pre-employment training at a national Skills Services Organisation (SSO) level
- Collaborative industry engagement in annual reviews of local Registered Training Organisation course content
- Advocating with peak bodies to promote the value of the assistant role and the need for endorsement and education
- Clear profiling of the value of the AHA role in differing contexts e.g. COVID surge, regional thin markets, cadetships, aged care access to allied health input etc
- Industry engagement with industrial agreement reviews in order to advocate for the value of this workforce
A range of innovative service models, such as cadetships, COVID-19 related service redesign and new opportunities in disability and aged care settings can improve the use of AHAs in your workplace. Participants said that the benefits of AHAs are well established and the role now needs to be formalised within existing systems. However the need for clear business models in billable markets where AHAs have not traditionally been employed needs further thought.
A range of existing frameworks (for example the Victorian Department of Health Supervision and Delegation Framework for Allied Health Assistants in Disability) can help to advocate for enhancing AHA roles in your workplace. Furthermore, each state and territory and each sector (health, aged care and disability) employ AHAs under different industrial awards which may be useful to review before becoming involved in industry advocacy.
3. Workplace factors
Workplace factors are the workforce models, governance, supervision and delegation structures, formal credentialing and AHA representation.
Assistants in our research said that poor or disorganised planning around where they are employed, lack of governance and oversight of their skills and scope of practice and poor supervisory relationships with allied health professionals can result in a misuse of AHAs and feelings of lesser value.
Importantly, assistants said that workplace culture can impact how they are viewed within a team and whether they are supported to learn and develop. A workplace culture that is not inclusive or respectful can undermine relationships between AHAs and allied health professionals, leading to poor engagement and utilisation as expressed by this assistant:
“It’s like a cohesive work environment where everybody’s work is considered to be equally important matters because then, you will help them and they will help you … – and it just works better as a team. It’s quite hard sometimes to assert yourself … and say, “Well, what I do for this patient is just as important as what you do,” and so … the AHA role needs to be recognised as part of that whole team.” [Focus Group: AHA – metro]
The following workplace factors need to be in place to ensure good levels of engagement and utilisation of AHAs:
- strong planning
- inclusive and respectful workplace culture
- robust governance inclusive of effective orientation, workplace training, credentialing, supervision structures, clear scope of practice, delegation process and training
- visible and established AHA leadership
Existing resources like the Calderdale framework or the Victorian Assistant Workforce Model (VAWM) can be used to support workforce planning. AHAs suggested that they can be better included in workforce planning by contributing to the orientation of new staff and being involved in relevant committees or working parties. Finally, a workplace role to professionally oversee and advocate for assistants may positively influence the development of the assistant workforce, and supervision and delegation practices.
4. Training factors
We identified a number of variations in training that can impact on the way that AHAs are understood in the workplace. These included differences in externally offered training such as the Certificate courses offered; AHA student placements; on-the-job workplace training; orientation and on-the-job competency-based training and professional development.
Assistants told us that variability across pre-employment training can negatively impact on skill development and how allied health professionals viewed (and had confidence in) their ability.
“…I think we find that job readiness is somewhat increased across the physiotherapy and occupational therapy sector but if you were looking at an AHA commencing a role in dietetics, speech pathology, podiatry, any of the smaller disciplines, that’s something that’s an issue”. [Focus Group: AHA – metro]
“There’s probably not enough placement time on the certificate to fit in enough experience, and also if you work in a small discipline these days the certificate course is only geared towards physio and OT. “ [Focus Group: AHA – metro]
The inconsistency makes on-boarding and identifying a baseline of skills difficult for the delegating allied health professionals:
“The course can be quite broad, so it’s hard sometimes to understand what I guess a new AHA’s technical skills are going to be. And we are quite reliant on I guess training them up on the job with the key tasks that they need to be confident doing.” [Focus Group: Allied Health Professional – regional]
The following training factors need to be in place to ensure good levels of engagement and utilisation of AHAs:
- Supporting local Registered Training Organisations (RTOs) to deliver consistently high quality graduates of AHA training
- Once in the workplace training for both the allied health professional and AHA on delegation and supervision, role scope and competency-based training and assessment for identified learning needs
- Taking a key part in industry consultation held by local RTOs to ensure graduates meet the needs of your workplace and local community and partnering to deliver high quality clinical placements as part of a recruitment pathway
- Offering in house training on supervision and delegation or making existing external resources like the Wodonga TAFE e-learning modules available
- Ongoing identification of learning needs and provision of on-the-job competency training has been effective in profiling an individual AHA’s skills and capabilities in many settings
The ongoing challenge to meet the growing needs of consumers across health, aged care and disability is something all sectors continue to face. Considered planning and preparation for assistants will ensure they are valued and optimally utilised within your workplace. Working to improve one or more of the factors described above will enable you to meet your workforce challenges and support the development of a key workforce of the future.
A full suite of draft practical tools to help you effectively implement your allied health assistant workforce are available for download here.
We have other resources to help you to work with AHAs, including ways to optimise your allied health assistance workforce in your workplace and create the appropriate systems and structures to enhance allied health implementation in your workplace. We also have a suite of practical tools to guide effective allied health employment in your workplace.
If you are using innovative ways to improve the way you work with AHAs and enhance your allied health workforce capacity, we want to know! Drop us a line …