Initiative 6 Allied Health Project 6.1 Allied Health

65 Pages·2004·0.21 MB·English

Initiative 6 Allied Health

Project 6.1 Allied Health Infrastructure

December 2004
Allied Health Infrastructure
Table of Contents

Section 1
Organizational Structure, Regional Director Role Definition, Authority, and Accountability

Executive Summary..............................................................................................iii
I. Introduction....................................................................................................1
II. Impetus for Change.......................................................................................1
III. Description of Proposed Regional Model...................................................4
IV. Recommendations........................................................................................7
V. Financial Implications.................................................................................10
VI. Benefits........................................................................................................11
VII. Implications of Maintaining the Status Quo..............................................13
VIII. Performance Measurements......................................................................14
IX. Description of Project Process..................................................................14
Goal
Guiding Principles
Objectives
Vision Statement for the Allied Health Infrastructure Project
Methodology
References

Section 2
Recruitment and Retention

I. Introduction..................................................................................................19
II. Project Overview.........................................................................................19
III. Overview of Allied Health Recruitment and Retention – Ongoing WRHA
Initiatives......................................................................................................19
IV. Review of Relevant Literature....................................................................22
V. Recruitment and Retention - Standards and Goals.................................23
VI. Methodology................................................................................................23
VII. Recommendations for Recruitment and Retention..................................24
VIII. Summary......................................................................................................26
IX. Plan for Implementation..............................................................................26
X. Funding Requirements to Support an Education Funding Plan.............26
XI. Evaluation....................................................................................................26
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Section 3
Allied Health Infrastructure Sub Tasks
I. Overview..............................................................................................28
a. Professional Support and Education Strategies
b. Adjusted Staffing Levels
c. Relief Pools
Section 4
Conclusion...................................................................................................................32
Next Steps....................................................................................................................32

Appendices
Appendix 1 Communication Plan.......................................................................A33
Appendix 2 References.......................................................................................A37
Appendix 3 Responsibilities Matrices................................................................A39
Appendix 4 Regional Director Allied Health – Discipline Specific Position
Description.......................................................................................A55
Appendix 5 ABC 6.1 Allied Health Infrastructure Team Members...................A60

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Section 1
Organizational Structure, Regional Director Role Definition,
Authority, and Accountability

Executive Summary

The Deloitte and Touché (D&T) Report July 2002 identified consistent themes related to
the role and support for Allied Health professionals across acute facilities. The key
phrases used were: fragmentation, decentralization, increase in meeting time,
inconsistencies in adoption of program management structure, unclear and ineffective
communication channels, lack of support in management/administration, insufficient
support for professional practice, significant competition between facilities, limited
access to services, perception of low corporate and regional priority, and lack of
effective/consistent workload measurement tools.1 Although these comments were
made in the acute care context, the Allied Health Regional Directors have been tasked
with addressing these factors for their respective disciplines across the full care
continuum.

The Achieving Benchmarks through Collaboration (ABC) Allied Health Infrastructure
Team developed a reorganization plan that addresses the issues identified by D&T and
is consistent with the Winnipeg Regional Health Authority (WRHA) Board strategic plan
and vision.2 The plan sets direction for the WRHA that is innovative, progressive,
supportive of Clinical and Community Programs, and assures the delivery of the most
effective care in the most appropriate environment.

By clearly defining roles, responsibilities and accountabilities, and by aligning resources
with each discipline, the Allied Health Regional Directors will be in a better position to
ensure effective and efficient utilization of Allied Health resources, optimize service
delivery in the community, and ultimately improve continuity in the provision of services
across the continuum.3

This report contains specific recommendations regarding Allied Health infrastructure
that define a model in which the Regional Directors assume responsibility for delivery of
their disciplines’ services throughout the Region. It is predicated upon an approach to
planning and implementing service delivery that includes collaboration and consultation
with sites, program teams, and community area directors, to improve productivity,
patient/client/resident flow, and patient/client/resident outcomes.

Specific recommendations include:
1. Accept and implement the proposed model across all sites for all disciplines
involved in the project.
2. Accept and implement the proposed Allied Health Regional Director position
description.
3. Assign accountability to the Allied Health Regional Directors for the overall
services provided by their disciplines at each site similar to the Clinical Program
Management structure.
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4. Develop strong partnerships and agreements with stakeholders to ensure a
collaborative approach.
5. Eliminate the designation Professional Leader and replace these positions with
discipline-specific Managers.
6. Ensure Site Managers are accountable to the site/community area
management team for day-to-day operations and to the Allied Health Regional
Director for discipline specific issues.
7. Provide Site Managers with responsibility for managing staff and supplies within
a discipline-specific budget, consistent with MIS guidelines, consolidated into a
single regional report monitored by the applicable Allied Health Regional
Director. This will facilitate the appropriate alignment and distribution of
resources.
8. Adopt a decision making model that will enable decisions that are binding on,
and supported by, all members of the health care team.
9. Implement Allied Health initiatives regionally once approved by WRHA senior
management.
10. Develop a model to ensure Allied Health representation at site senior
management.
11. Ensure Allied Health Regional Directors participate with Site Management in
the performance evaluation of Site Managers.
12. Redefine job classifications/descriptions in collaboration with WRHA Human
Resources.

The implementation of the proposed organizational structure will result in a
strengthened regionalized approach enabling the Allied Health disciplines to manage
their staff resources as a collective whole, in collaboration with programs, sites, and
community areas, to ensure seamless delivery of Allied Health services across the full
care continuum.

The implementation of these recommendations will improve clinical outcomes and
quality of life for patients/clients/residents, provide a high quality of work life for staff,
and ensure effective and efficient utilization of human and material resources.
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Allied Health Infrastructure

I. Introduction

This section will focus on the initial phase of ABC Project 6.1 dealing with
Allied Health Organizational Structure including the role of the Allied Health
Regional Director and the resources required to support a regionalized
approach to Allied Health service delivery across the continuum of care.

The disciplines included in this project are Occupational Therapy,
Physiotherapy, Respiratory Therapy, Clinical Nutrition, Social Work,
Audiology, and Speech-Language Pathology.

II. Impetus for Change

The ABC 6.1 Project Team was tasked with creating and implementing a
supportive infrastructure for Allied Health that describes the manner in which
authority, accountability, and information are distributed:
• To improve the efficiency and effectiveness of the delivery of health care
across all sites in the WRHA
• To provide clarity and consistency around Allied Health structures in the
region
• To increase the role of Allied Health in the care continuum.

Drivers for this change initiative include: the WRHA Strategic Plan, the
Deloitte and Touché (D&T) External Review, the Allied Health Worklife
Survey, and the ABC Project 8.2 Regional Program Structure and
Accountability: Conceptual Design Phase Report.

WRHA Strategic Plan

The recommendations for Allied Health organization outlined in this report
provide the framework for moving forward with a structure that enables
change consistent with the WRHA Board of Directors Strategic Plan and its
Mission, Vision, Values, and Principles.

The WRHA Strategic Plan describes the WRHA mission as:
- To deliver and administer health services in the Winnipeg region and to
promote and protect health.
- To improve health and well being by leading Winnipeg’s health
services and building partnerships with the community.

Specific goals, measurements, and strategies are defined within the strategic
plan that support the five key components of the Board’s Vision: prevention
and promotion, treatment and support, working with our community, working
with our staff, and accountability.

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Allied Health has a unique opportunity to support the Vision provided
appropriate structures are in place to enable the disciplines’ active and
meaningful participation. For example:

- Providing better access to primary health care services in the
community as an alternative to hospital-based services through the
provision of a wide network of services and delivery of the right care, in
the right place, at the right time, by the right provider, to meet people’s
needs.
- Addressing accountability through centralized Allied Health budgets
that increase adherence to national MIS guidelines (which include
functional centers and accounting structures specific to Allied Health)
that will enable the ability to collect and analyze information to assess
impacts and cost effectiveness of services.

Deloitte and Touché External Review

The External Review conducted by Deloitte and Touché identified a variety of
issues that were negatively impacting the Allied Health professionals of
Audiology, Occupational Therapy, Physiotherapy, Respiratory Therapy,
Clinical Nutrition, Social Work, and Speech-Language Pathology.

The External Review observed that in general the Allied Health staff had been
decentralized into clinical program structures at each of the facilities and that
most facilities had reduced their administrative structure supporting the
disciplines, replacing that role with a combination of part-time professional
practice leaders and multidisciplinary professional advisory committees. The
variability and inconsistency in organizational structures across sites and
disciplines is not sustainable or acceptable in an evolving health system and
is inconsistent with the WRHA values and principles, specifically shared
leadership and accountability, continuous improvement and willingness to
change, and high quality of work life. Therefore, a primary directive for this
project has been to define an organizational structure for Allied Health that
will address these issues, including the elimination of the designation of
professional leader and the appointment of managers with clearly defined
roles and responsibilities.

Further issues identified by the External Review driving the need for change
in the organization of Allied Health include:

Management Structure
• Fragmentation of staff into programs has resulted in disconnection from
peers within the professions and from the other Allied Health disciplines.
• Decentralization of staff from core departments/services limits ability to
recruit and retain staff and provide relief coverage for vacations, sick time,
weekend coverage, etc.
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• Meeting time is substantially increased through multiple reporting
structures.
• Inconsistencies in adoption of the program structure between some
facilities and for some disciplines.
• Communication channels are unclear and not effective.
• Need to provide clear direction for the role and authority of the regional
directors in comparison to the roles and authority of the sites and program
teams.
• Need for ongoing leadership and professional development.

Professional Voice/Support
• Clinical planning does not sufficiently involve Allied Health professionals.
• Lack of support (management and administrative) for professionals within
disciplines.
• Insufficient support for professional practice and educational needs of the
disciplines at the site/program level.
• Not all Allied Health professionals are working within their full scope of
practice.
• Allied Health has limited professional voice/support in the region.
• Need to establish regional strategies and approaches in the areas of
recruitment and retention of Allied Health professionals.

Systemic Issues
• Need to reduce the barriers between regional programs and site-based
programs to improve communication and reduce unhealthy competition.
• Limited access to hospital-based outpatient/day services and community-
based services.
• Allied Health is perceived to be a low corporate and regional priority.
• Lack of effective/consistent workload measurement for Allied Health
disciplines.

Other Issues
• Inconsistent distribution of Allied Health staff across all sites and
programs.
• No consistent methodology for allocating Allied Health Resources.
• Accurate MIS reporting should occur at all sites, with Allied Health
resources being centralized back to core department functional centres
rather than distributed within individual patient care cost centers.
• Work performed for outside agencies/organizations should be reflected in
revenues attributed to Allied Health functional centers.
• Select disciplines in Allied Health have substantially lower staffing than
peers with impact on the Allied Health range of service and scope of
practice, particularly respiratory therapy, social work, and clinical nutrition.

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WRHA Allied Health Worklife Survey

The Allied Health Worklife Survey identified a number of issues affecting work
life satisfaction for Allied Health including:
o Workforce shortages
o Heavy workload
o Lack of continuing education opportunities
o Lack of career laddering opportunities
o Inadequacy of workplaces
o Compensation issues

Surprisingly, even in those sites and disciplines where more centralized
structures had been maintained, strong dissatisfaction with program
management was expressed (especially Respiratory Therapy and
Physiotherapy), mainly related to the inability to address cross-program
issues such as continuity of care.

ABC Project 8.2
Regional Program Structure and Accountability: Conceptual Design
Phase Report and Presentation

The team reviewed ABC Project 8.2’s report to ensure our recommendations
were consistent with and supportive of the concepts identified by this project,
such as accountability (authority, responsibility, performance management),
integration of services, and team decision-making.

Consistent with the report recommendations, the term “Clinical Support
Program”, defined as “programs consisting of health care providers that
offer clinical services to programs”, has been adopted by each of the
Allied Health disciplines in this project. This is consistent with Laboratory
Medicine, Diagnostic Imaging, and Pharmacy programs. Alternatively the
term Clinical Support Service could be used.

III. Description of Proposed Regional Model

Consistent with the regional strategic plan, the WRHA Allied Health Regional
Directors for Occupational Therapy, Physiotherapy, Respiratory Therapy,
Clinical Nutrition, Social Work, and Communication Disorders (Audiology and
Speech-Language Pathology) were tasked with the responsibility of ensuring
the provision of their disciplines’ services across the full continuum of care
with the aim of improving service delivery and enhancing continuity of care.
The concept of exploring alternative settings of care, including moving care
into community areas, where appropriate, versus the traditional hospital
setting is inherent in the Regional Directors’ role definitions.

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The ABC Project Team developed a position description and matrices
that clearly define the roles, responsibilities, and accountabilities of the Allied
Health disciplines. (Appendix 3 – Responsibilities Matrices; Appendix 4 –
Regional Director Allied Health – Discipline Specific Position Description)

In order for the Allied Heath Regional Directors to be truly accountable for
restructuring their disciplines’ service delivery across the continuum, they
require the information and authority to influence the management of the
discipline’s resources as a whole, recognizing the need for collaboration
with all stakeholders while doing so.

The implementation of the proposed organizational structure will enable the
Allied Health disciplines at the Site level to manage their staff resources as a
whole, thus decreasing resource fragmentation, especially in smaller Sites,
and improving local resource utilization. Provision of Site financial reports to
the Regional Directors will provide the necessary information to enable
discussions with stakeholders regarding consistent resource allocation and
implementation of regional service initiatives to enhance delivery of care in
the most appropriate setting across the continuum.

It is recognized that project recommendations defining responsibility for
resource allocation may be inferred as a return to the former traditional
departmental structures separate from the program management model.
However, the Allied Health disciplines are committed to maintaining the
positive aspects of program management while acknowledging the need to
restructure the disciplines in order to meet the goals and objectives of the
Region’s strategic plan. Strong partnerships and agreements will be
developed with sites, clinical programs, and community areas to ensure
all parties are working collaboratively to meet mutual goals. The relationships
are well defined in Appendix 3 – Responsibilities Matrices.

By aligning staff with central departments/services, the proposed structure
reduces staff fragmentation and facilitates adequate staff coverage to
meet the needs of the clients, patients, residents, clinical programs, and the
region overall. The ability to recruit and retain staff and provide relief
coverage for vacations, sick time, etc. as well as weekend coverage has
been compromised within the current model; the proposed structure will
maximize efficient use of limited resources.

The proposal eliminates the professional leader designation and replaces
this role with Site Managers with a dual reporting relationship to the Site and
their Allied Health Regional Director. Where workload and complexity is
sufficient, single Site Managers are recommended (and already exist in some
disciplines at some sites). The plan will ensure that job responsibilities for
site management staff will be consistent across the region in regards to levels
of responsibility and accountability.
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