The impact of the work conditions of allied health professionals on satisfaction, commitment and psychological distress

BACKGROUND: Allied health professionals are integral to the effective delivery of hospital-based health care, yet little is known about the working conditions associated with the attitudinal and health outcomes of these employees.

PURPOSE: The purpose of this study was to investigate the extent to which the demand-control-support model, in combination with organizational justice variables, predicts the employee-level outcomes of allied health professionals.

METHODOLOGY/APPROACH: Allied health professionals from an Australian health care organization were surveyed, with 113 (52.6%) participating. The survey included measures of job demands, job control, social support, organizational justice, satisfaction, commitment and psychological distress.

FINDINGS: Multiple regression analyses reveal that the additive demand-control-support model predicts the outcome variables of job satisfaction, organizational commitment and psychological distress, whereas the organizational justice variables predicted organizational commitment and psychological distress. Further, both work and nonwork sources of support, in addition to specific justice dimensions, were closely associated with employee-level outcomes.

PRACTICAL IMPLICATIONS: When coupled with previous research involving social support and organizational justice, the findings from this study suggest that initiatives aimed at strengthening supervisor and nonwork support, while enhancing perceptions of organizational fairness, may offer useful avenues for increasing the levels of satisfaction, commitment and well-being experienced by allied health professionals.

Why did they leave and what can they tell us? Allied health professionals leaving rural settings

The aim of this paper is to explore the lack of retention of allied health professionals in rural areas in Victoria, Australia. A structured telephone interview was used to elicit responses from 32 allied health professionals from south-west, central-west and north-east Victoria about their working experiences and reasons for resignation. The data revealed that work experiences in rural areas can be summarised within three domains: organisational, professional and personal/community. Under the organisational domain the participants were mainly focussed on the way in which their work arrangements require them to be both more generalist in their approach to day-to-day work, and more expansive in shouldering management style functions in the workplace. Under the professional domain there were three major issues; clinical, career and education/training. The personal/community domain focussed on issues to do with their affinity for their workplace as well as their location in a rural place. The attempts by government to address some of the leading factors for retention of allied health professionals are perhaps too narrowly focussed on the public sector and could encompass a wider approach.

What is known about the topic? Although recruitment and retention of allied health professionals in rural areas is widely discussed, the professionals have not been interviewed about their experiences once they have left rural employment.

What does this paper add? This paper provides detailed insights into the reasons why allied health professionals leave their positions in rural areas and the positive and negative aspects of living and working in a rural area. The results of this study contribute to the development of better policy models for recruitment and retention of allied health professionals in rural areas.

What are the implications for practitioners? The factors that influence whether allied health professionals stay or leave rural areas is of concern for health policy makers at state and federal levels. This paper provides information for the extension and development of programs to attenuate rural leakage of professionals.

A study protocol of a randomised controlled trial incorporating a health economic analysis to investigate if additional allied health services for rehabilitation reduce length of stay without compromising patient outcomes

Background
Reducing patient length of stay is a high priority for health service providers. Preliminary information suggests additional Saturday rehabilitation services could reduce the time a patient stays in hospital by three days. This large trial will examine if providing additional physiotherapy and occupational therapy services on a Saturday reduces health care costs, and improves the health of hospital inpatients receiving rehabilitation compared to the usual Monday to Friday service. We will also investigate the cost effectiveness and patient outcomes of such a service.
Methods/Design A randomised controlled trial will evaluate the effect of providing additional physiotherapy and occupational therapy for rehabilitation. Seven hundred and twelve patients receiving inpatient rehabilitation at two metropolitan sites will be randomly allocated to the intervention group or control group. The control group will receive usual care physiotherapy and occupational therapy from Monday to Friday while the intervention group will receive the same amount of rehabilitation as the control group Monday to Friday plus a full physiotherapy and occupational therapy service on Saturday. The primary outcomes will be patient length of stay, quality of life (EuroQol questionnaire), the Functional Independence Measure (FIM), and health utilization and cost data. Secondary outcomes will assess clinical outcomes relevant to the goals of therapy: the 10 metre walk test, the timed up and go test, the Personal Care Participation Assessment and Resource Tool (PC PART), and the modified motor assessment scale. Blinded assessors will assess outcomes at admission and discharge, and follow up data on quality of life, function and health care costs will be collected at 6 and 12 months after discharge. Between group differences will be analysed with analysis of covariance using baseline measures as the covariate. A health economic analysis will be carried out alongside the randomised controlled trial.
Discussion This paper outlines the study protocol for the first fully powered randomised controlled trial incorporating a health economic analysis to establish if additional Saturday allied health services for rehabilitation inpatients reduces length of stay without compromising discharge outcomes. If successful, this trial will have substantial health benefits for the patients and for organizations delivering rehabilitation services.

Evaluation of a filmed clinical scenario as a teaching resource for an introductory pharmacology unit for undergraduate health students: A pilot study.

BACKGROUND: Simulation is frequently being used as a learning and teaching resource for both undergraduate and postgraduate students, however reporting of the effectiveness of simulation particularly within the pharmacology context is scant. OBJECTIVES: The aim of this pilot study was to evaluate a filmed simulated pharmacological clinical scenario as a teaching resource in an undergraduate pharmacological unit. DESIGN: Pilot cross-sectional quantitative survey. SETTING: An Australian university. PARTICIPANTS: 32 undergraduate students completing a healthcare degree including nursing, midwifery, clinical science, health science, naturopathy, and osteopathy. METHODS: As a part of an undergraduate online pharmacology unit, students were required to watch a filmed simulated pharmacological clinical scenario. To evaluate student learning, a measurement instrument developed from Bloom's cognitive domains (knowledge, comprehension, application, analysis, synthesis and evaluation) was employed to assess pharmacological knowledge conceptualisation and knowledge application within the following fields: medication errors; medication adverse effects; medication interactions; and, general pharmacology. RESULTS: The majority of participants were enrolled in an undergraduate nursing or midwifery programme (72%). Results demonstrated that the majority of nursing and midwifery students (56.52%) found the teaching resource complementary or more useful compared to a lecture although less so compared to a tutorial. Students' self-assessment of learning according to Bloom's cognitive domains indicated that the filmed scenario was a valuable learning tool. Analysis of variance indicated that health science students reported higher levels of learning compared to midwifery and nursing. CONCLUSION: Students' self-report of the learning benefits of a filmed simulated clinical scenario as a teaching resource suggest enhanced critical thinking skills and knowledge conceptualisation regarding pharmacology, in addition to being useful and complementary to other teaching and learning methods.

Perceptions of fairness in the psychological contracts of allied health professionals

Purpose-The purpose of this paper is to investigate the relationships between components of the psychological contract, organisational justice, and negative affectivity (NA), with key employee outcomes (i.e. organisational commitment, job satisfaction, depression, and psychological distress) among allied health professionals. Design/methodology/approach-In total, 134 (response rate of 46 per cent) Australian allied health professional completed a questionnaire. Findings-Multiple regressions revealed that higher NA was associated with lower organisational commitment, lower job satisfaction, and higher levels of depression. The psychological contract variable, breach, was associated with depression. Informational justice was associated with organisational commitment. Distributive justice was associated with job satisfaction. Research limitations/implications-This research is limited by its cross-sectional design and that the data were self-reported. The results obtained suggest the potential utility of collecting longitudinal data to replicate and extend the results. Practical implications-While NA may be beyond management control, it may be ameliorated by attention to improving communication of management decisions and by sensitivity to the elements implicit in psychological contracts. The negative consequences of contract breach may be offset by informational and distributive justice. Originality/value-This study is one of the first to examine multiple measures of the psychological contract in addition to organisational justice and NA. Further, this study adds to the literature for allied health professionals, where little is known about factors contributing to their turnover.

Building allied health workforce capacity: a strategic approach to workforce innovation

Objective The aim of the present study was to identify areas where allied health assistants (AHAs) are not working to their full scope of practice in order to improve the effectiveness of the allied health workforce.

Methods Qualitative data collected via focus groups identified suitable AHA tasks and a quantitative survey with allied health professionals (AHPs) measured the magnitude of work the current AHP workforce spends undertaking these tasks.

Results Quantification survey results indicate that Victoria’s AHP workforce spends up to 17% of time undertaking tasks that could be delegated to an AHA who has relevant training and adequate supervision. Over half this time is spent on clinical tasks.

Conclusions The skills of AHAs are not being optimally utilised. Significant opportunity exists to reform the current allied health workforce. Such reform should result in increased capacity of the workforce to meet future demands.

What is known about the topic? Increasing skill shortages across Australia’s health workforce necessitates that the capabilities of all healthcare team members should be used optimally. AHA roles are an important and growing response to current health workforce needs. Increasing workforce capacity will ensure the right health workers are matched to the right task by skill, experience and expertise.

What does this paper add? This paper presents a model that assists services to identify tasks suitable for delegation to an AHA by an AHP. The model is unique because it describes a process that quantifies the need for AHAs and it has been successfully implemented in rural, regional and metropolitan health services in Victoria.

What are the implications for practitioners? Working collaboratively, with executive support, will lead to a sustainable and integrated approach to support workforce capacity building. Altering the skill mix of healthcare teams through increasing the role of AHAs has benefits for AHPs, patients and the healthcare system.

Reflective positioning : the impact of conversations in the social and cultural environment of midwifery practice settings on professional learning for students

Literature reviews on the topic of reflection and reflective practice encompassed midwifery, nursing, medicine, allied health, education and professional education. This investigation also included socio-psychological theories by leading authors such as Benner (nursing), Schön (professional education) and positioning theory by Harré and others. Positioning is a psycho-sociological ontology in which individuals metaphorically position themselves within three entities: people, institutions, and societies, where conversations are constructed and make an impact upon the social world. The social and cultural structures and interactions developed in Archer’s morphogenesis were examined in terms of the impact of possible encounters and the transformational effects of learning experiences in practice settings. These bodies of work provided the theoretical framework for the author’s research of students’ experiences in midwifery education for postgraduate students from which selected excerpts with three participating students and their supervising midwives are presented. These excerpts are related to reflective practices and the professional conversations conducted between students and midwives. It was found that reflective positioning applied in midwifery education by students can serve as an analytical tool in explaining social and cultural elements of clinical placements to influence and transform their learning. The potency of conversations that occur in everyday moment-to-moment interactions do contribute to students’ induction in professional midwifery practice and their identity formation as a midwife.