00:03: This is a learning tool to understand the importance of governance structures on ways of working.
00:09: Australian health services have three patient care workforces; doctors, allied health professionals and nurses and midwives, together delivering great care for their patients.
00.19: The allied health workforce is known to be smart, good communicators and creative problem solvers who contribute across the whole system.
00:27: There are around 27 allied health professions and in Victoria we think about these professions in two groups.
00:34: Allied health therapy and allied health science.
00:38: Health services come in different sizes and have different governance structures, which means that the allied health workforce can be organised in many different ways.
00:47: This film will help you get the most out of your health service's existing organisational structure, as well as prepare you to influence in times of change.
00:55: So that you find satisfaction in your work, as you contribute to an efficient organisation and deliver great care for your patients.
01:02: Let’s start with some history.
01:04: In the 1960’s and 70’s, hospitals almost universally used the traditional medical model of organisational governance.
01:11: This model has departments that are led by professionals with a medical background and has a director of medical services and a director of nursing on the executive team.
01:21: Where did allied health live in this model?
01:23: Directors of medical services were supported by deputy medical directors who had allied health reporting to them.
01:32: In the 1980’s we saw the global rise of managerialism, thatcherism and the purchaser provider split.
01:39: From all of this governance models in Australia began to change.
01:43: New and hybrid models emerged.
01:45: At the same time, allied health therapy professions were moving towards a more collective allied health identity.
1:53: In all models, allied health professionals work across different clinical areas throughout the health service.
1:59: What changes in the different models are the governance and reporting structures.
02:03: In essence, there are two ways to think about governance structures from the allied health perspective.
02:09: In the first, the allied health workforce is managed by a single director of allied health who is usually a senior allied health practitioner.
02:16: We’ll call this the ‘collective’ model.
02:19: In the second, allied health practitioners are dispersed across the health service and managed by the director of their clinical services unit who is likely to have a medical or nursing background.
02:29: This is most like the traditional medical model. We’ll call this the ‘dispersed’ model.
02:36: You’ll see many hybrids of these models in our health services.
02:40: Allied health therapy professionals are more likely to be organised in the collective model, while allied health science professionals are more likely to be organised in the dispersed model.
02:50: To understand the different advantages of governance structures, there are three key questions we can ask:
02:56: Does the structure give allied health a voice at the decision-making table?
03:00: Does the structure allow the organisation to put the right people in the right place?
03:05: And finally, does the structure support allied health to find better solutions for patient care?
03:11: So how do the collective and dispersed models answer these questions? Let’s have a look.
03:16: The first question is, does the governance structure give allied health a voice at the decision-making table?
03:21: That’s where the allied health workforce can contribute to important decisions such as the budget, policy and strategic direction.
03:28: It also means that CEOs can talk directly to the allied health workforce to better understand and work with this important group.
03:36: In the collective model, the allied health workforce can easily communicate with executive through the director of allied health.
03:42: This also means that the health service can quickly make improvements across allied health leading to a better workforce, a better organisation, and better patient outcomes.
03:52: However, for the collective model to work at its best, the director of allied health needs to have a comprehensive understanding of all the professions to speak confidently on their behalf.
04:04: In the dispersed model, each clinical services unit works closely together, and they communicate well with each other.
04:11: However the allied health workforce may not have their voice heard at the executive level in the same way that their medical and nursing colleagues can, because their manager or executive is likely to have a medical or nursing background.
04:23: So for the dispersed model to work at its best, the director of each clinical services unit must foster good relationships with their allied health workforce and understand their broader practice.
04:34: The second question is, does the structure allow the organisation to put the right people in the right place?
04:40: This means the organisation has the flexibility to put the right resources where they’re needed, resulting in:
04:46: The best use of allied health skills, a budget working at its best, and patients getting excellent care.
04:53: In the collective model, the organisation has a strategic overview, and the ability to build an allied health workforce that is flexible and responsive to the organisation’s changing needs.
05:04: To work at its best, the collective model relies on the director of allied health having good relationships with the directors of the clinical services units.
05:13: The dispersed model naturally encourages clinical expertise.
05:17: However in the dispersed model, directors of clinical services units may be less aware of the professional needs of the allied health workforce, and this model isn’t as responsive to the organisation’s changing needs.
05:31: The third question asks, does the structure support allied health to find better solutions for patient care?
05:37: This is where allied health can develop knowledge that leads to better models of care and better patient outcomes.
05:43: In the collective model, the allied health workforce can easily share and build knowledge, and skills, through practice and research, both within allied health professions as well as across professions.
05:54: And, in the collective model, when allied health develops innovative models of care, the improvements for patients can be quickly implemented across the whole organisation.
06:04: We know that the dispersed model effectively facilitates individual clinical expertise, but this also means that the dispersed model must work harder at developing and sharing the knowledge and skills across the allied health workforce for the benefit of patient care.
06:22: The governance structure of every health service can evolve many times over the years.
06:29: That change is your opportunity.
06:31: You can influence and shape the conversation, as well as the decisions, when you can:
06:36: Understand which governance structure is best for your workforce, your organisation, and your patients.
06:41: Then discuss the best structure with your peers and then put forward suggestions to your senior management.
06:52: Your medical and nursing colleagues can often confidently answer these questions for their professions.
06:57: This is an opportunity for you, as an allied health professional, to get the most out of your current governance structure and contribute in times of change.
07:05: So take a moment to reflect.
07:07: Consider again these three key questions about your organisation’s governance structure:
07:12: Does it give allied health a voice at the decision-making table?
07:15: Does it allow the organisation to put the right people in the right place?
07:19: And finally, does it support allied health to find better solutions for patient care?
07:24: By answering these questions, we can help create more effective leadership for all allied health professionals and build a better health system for all Victorians.
