Author: Ali Dymmott
Dymmott, Ali, 2023 The allied health rural generalist pathway: A workforce initiative, Flinders University, College of Nursing and Health Sciences
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Rural and remote allied health professionals work across a broad scope of practice with high levels of clinical complexity and workload demands and, in an environment where professional support is limited. The allied health rural generalist pathway (AHRGP) is a workforce strategy that enables early career allied health professionals to develop generalist and service development skills and knowledge for practice. The pathway includes work integrated learning activities, dedicated study time and supervision and is available for rural or remote allied health professionals with up to 3 years’ experience (level 1 program) or more than 2 years’ experience (level 2 program). This research investigated the experiences and impact of the AHRGP as it was introduced in South Australia. The research sought to explore the experiences and perceptions of the rural generalist trainees, their supervisors, managers, clinical leads, and consumers. It also aimed to measure the impacts of the pathway on individuals, organisations, and consumers.
This research generated new knowledge in rural and remote allied health workforce and training. Personal and organisational contextual factors for rural and remote practice were synthesised for allied health professionals and doctors for the first time outlining relevant workforce recommendations for both groups. The experiences and perceptions of trainees undertaking the AHRPG as well as their supervisors, managers, clinical leads and consumer representatives were described across four distinct phases (pre, mid, end and six months post pathway). A range of factors for success of the pathway were outlined including organisational and personal elements. The costs and consequences of AHRGP were also measured and an innovative approach to economic evaluation was developed.
A pragmatic mixed methods approach underpinned the research with concurrent convergent analysis. This ensured a comprehensive analysis of the experiences and impact of the AHRGP for regional Local Health Networks across South Australia. Semi structured interviews were used to collect rich qualitative data across three research phases. Quantitative methods included the descriptive analysis of survey and workforce data and a cost consequence analysis.
Between 2019 and 2022, 15 trainees participated in the AHRGP in South Australia, seven completed the pathway, one deferred and seven discontinued. Of the 10 level 1 trainees, three completed and all five of the level 2 trainees either completed or planned to complete. Despite the high turnover of level 1 trainees, their length of stay in rural South Australia was 82% longer than the rest of the allied health population working at the equivalent pay level. During the follow up period, no level 2 trainees left, however 17.6% of allied health professionals at the equivalent pay level left across the regional LHNs. While a range of factors contribute to retention, these results indicate the AHRGP had a positive impact on workforce outcomes.
The AHRGP was cost effective considering the relatively small costs and the wide-ranging benefits. Benefits included reduced turnover, positive impacts on trainees’ intention to continue working rurally, increasing confidence and competence and participation in service development activities. Costs included tuition, study time and the project manager salary. Time for supervision and management support were found to be within organisational expectations and were not an additional cost.
Results of this research indicated the experience of early career allied health professionals working in rural and remote areas is both rewarding and challenging and a range of workforce strategies are required to meet individuals needs and encourage them to continue to stay. Organisations and consumers benefit from the AHRGP through the development of more skilled, knowledgeable, consistent, and passionate allied health professionals.
The experience of trainees participating in the AHRG was mixed. Benefits included developing rural generalist and project management skills and knowledge, participating in service development activities, feeling more confident and developing a passion for rural health. Challenges relating to finding time to study, maintaining motivation and the relevance of course content.
Over the four research phases, factors related to successful completion of the pathway were identified. Access to supervision and management support, the opportunity to work across a broad range of clinical areas and participation in service development activities were important.
It is recommended that education providers and employing organisations work together to develop training programs that effectively support the development of allied health rural generalist skills and knowledge. This study found that the AHRGP is an effective workforce strategy. However, to increase the effectiveness of the pathway, clearer career advancement opportunities and support structures are needed. More research is required to explore alternative workforce strategies and to continue to build the evidence base measuring the effectiveness and experience of allied health rural generalist training in different organisational contexts and jurisdictions.
Keywords: allied health, rural and remote, generalist, workforce, retention, mixed methods, pragmatism, cost consequence analysis
Subject: Health Sciences thesis
Thesis type: Doctor of Philosophy
Completed: 2023
School: College of Nursing and Health Sciences
Supervisor: Chris Brebner