Are Assistants a Solution to our Workforce
Shortages?
HWA workshop and panel discussion report
James Buchan and Karen Cook
Background
• There is significant evidence that
assistants are a key part of the workforce.
• Some areas are using them more
extensively and effectively than others.
• HWA is currently doing some work on
assistant and support roles.
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Session aims
• Share current initiatives and perspectives
on assistants and the support workforce.
• Draw out key issues, identify areas of
commonality, outline areas of difference
and cover what’s next for this workforce.
• Act as a consultation input for HWA’s work
on Assistants and Support roles.
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Our expert panel
• Ms Deborah Law - Policy and Strategy Manager, HWA .
• Ms Ann- Maree Keenan - Executive Director, Ambulatory and
Nursing Services, Austin Health, Victoria
• Dr Saravana Kumar - Deputy Director, International Centre for Allied
Health Evidence, University of South Australia
• Mr Andrew Larpent - CEO, Southern Cross Care
• Mr Rod Cooke - CEO, Community Services and Health Industry
Skills Council
• Ms Lee Thomas - Federal Secretary, Australian Nursing and
Midwifery Federation
• Ms Tanya Lehmann - Principal Consultant Allied Health, Country
Health SA Local Health Network
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Deborah Law, HWA
• Setting the scene; outlining HWA related work
on assistants/other work
• Always a core part of the broader health/care
workforce..
• But only one facet in pursuit of availability/
sustainability/ affordability
• Multiplicity of roles, titles, uses,
training…deflected from national
attention/debate from most productive models
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Deborah Law HWA
• Four main aspects:
1.Roles they undertake
2.Contributions they make
3.The way they work (substitution/ supplementation/
workforce of choice) to enable everyone to work to
full scope
4.Not an “unqualified” workforce (partic.aged care)
• = Active management of perceived and real barriers
• National guidance/ local governance
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Ann Maree Keenan, Austin
• 900 bed tertiary hospital, 8000 staff
• Recognised need to use workforce to best
capacity
• 2008-9 feasibilty study- asked nurses what
would make work easier/ more rewarding
• Assistant introduced- Complementary role
• Outcomes-incl. +staff satisfaction; pathway to
other health careers
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Ann Maree Keenan
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Governance at organisational level
Leadership from nursing team
Communication
Education- grow your own- clear selection
process
• Role clarity- delegation, supervision
• Nurses satisfaction- basic care now being
attended to/ not managed previously
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Saravana Kumar
• Allied Health Assistants
• Increasingly recognised as an important piece of
the puzzle, but not always well integrated
• Benefits: +patient satisfaction;+ access; AHPs
working to full scope
• Barriers; poor clarity about delegation +
supervision; role delineation ;turf protection
• ..little evidence of cost effectiveness, or how
AHP’s can be used when released
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Saravana Kumar
• Why, despite the evidence are there
ongoing challenges in integration of
roles?:
• Change management issues
• AHA roles, work settings, delegation and
supervision, skills of AHP in delegation
and supervision; role divisions
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Andrew Larpent
• ?? Use of title of “assistants”?
• Need right type of worker for care requirementsmatching
• Silos between health/ aged care
• Some existing health professionals felt threatened by the
HWA , ACWR project
• Focused on the caring profession as the key deliverer,
not med/tech
• Referred to UK NHS Francis report
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Andrew Larpent
• New models of care/ new roles- e.g PCA
in community dementia care
• New worker- STELLA- Specially Trained
End of Life Living Assistant
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Rod Cooke
• Large component of an even larger
workforce, where 69% are informal carers
• Also questioned use of title “assistant”
• Different roles and titles
• Lack of other workers in some care
environments to provide supervision
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Rod Cooke
• Demographic, funding and policy drivers to
increased use of assistants
• E.g +125,000 needed in disability care in
next few years
• Need for increased training and
development capacity
• ..a “partial answer” to shortages
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Lee Thomas
• Current growing and essential part of the
nursing family
• Lack of national consistency [e.g compared to
plumbers, electricians]
• Changing nature of hospital based care- i.e.
Increased acuity- yet no nationally mandated
quals for AINs in acute care
• Huge variations in qualifications, titles, education
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Lee Thomas
• Apply a single title to the role
• National regulation “the best way”- incl
prof practice framework and defined scope
of practice
• Emphasis on minimum level of knowledge;
protection of the public
• “Everyone is responsible”
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Tanya Lehmann
• Focus on rural/remote- health disparities; geog.
distribution issues
• Small dispersed population; lower frequency of
need; smaller quantity of service- different
workforce models required
• (Local) assistants are needed in remote
communities- more generalists
• Issues of training, supervision and governance;
telehealth
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Tanya Lehmann
• Assistants as a solution:
• Small numbers= “little change can make a big
difference”; +job satis, patient satis, productivity
• Remote supervision can work; need to have role clarity;
distinguish between delegated and assigned tasks;
• Need to variation- one size does not fit all=cant overstandardise/ nationalise
• Risk management not regulation
• Focus for safety, quality
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The questions
• What might need to be done in order to
better utilise assistant and support roles in
the workforce?
• What risks would
need to be managed?
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The themes
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Safety and quality
The contribution that assistants can make
Career development
Organisational readiness
Industry and regulatory
considerations
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The results – Safety and Quality
• Appropriate competency based training
• Clearly defined roles and scope of practice,
including supervision, so the roles and
parameters are understood
• Clear rationale for implementing the role
• Focusing on growing your own and making sure
it is context specific for the community
• Need for regulation
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The results – The Contribution that Assistants
can make
• Increased understanding of the role in health care teams
and the community
• Establishing a national framework which matches the
role against the education
• Articulation of a clear career pathway with early
exposure to assistant roles as a career option at school
• Need to establish the evidence for safe integration and
establishing the benchmark for the ratio between skilled
and unskilled workers
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The results – Career Development
• Training and education needs to be based on agreed core
competencies which can be built on for different career paths
• Existing workforce is able to supervise and mentor assistants
effectively
• Importance of describing the scope of the assistant and the mapping
of core competencies, leading to specialisation of some kind, (eg
speech, OT, dental) or across professions and service delivery
areas
• Professionals need to be trained to supervise and delegate
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The results – Organisational Readiness
• Reform process has to be done together ie
workforce, clinical and education reform
• Focus of a good delegation supervision
framework rather than rigid scope of practice
• Upfront identification of patient need
• Broad communication about the changes
needed /management
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The results – Industrial and regulatory
considerations
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Clarity between industries – one size may not fit all
Generalist not specialist
National minimum training competency standards
Clear framework for risk management (indemnity etc)
Funding for upskilling
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(Some) Identified Risks and Barriers
• How to evaluate the costs and
effectiveness of the role?
• Acceptance/ resistance from established
professionals/ supportive work
environment?
• Public awareness / support
• Cost saving as major perceived driver
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(Some) Identified Risks and Barriers
• Achieving serious buy in and engagement
by management
• Government appetite for change?
• Overregulation-management
response?/assistant, potential assistant
response?
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In summary..
• Assistants are a key component in the
overall solution
• National guidance/local governance
• Active management of real and perceived
barriers
• Regulation issue remains unresolved
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In summary
• Assistants are a key component in the
overall solution
• On oredr to be most eferive, there needs
to be a level of national standardisation
combined with local combined with l
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