About the Guidelines
The Allied Health Education and Training Governance Guidelines supports the establishment, access and management of local systems of governance for allied health education and training within Local Health Districts and Specialty Networks in NSW.
The Guidelines are made up of five key elements:
- Patient driven
- Clinician focussed
- Organisational factors
Governance is a core function in health system frameworks and critical to improving health outcomes (Barbazza & Tello, 2014; Fryatt et al, 2017). Education and training is a critical component of the overall system of clinical and corporate governance of health care organisations (Braithwaite & Travaglia, 2008). The Allied Health Education and Training Governance Guidelines (“The Guidelines”) will support health services to develop systems of governance to grow allied health capabilities in the delivery of person-centred care and promote a culture of lifelong learning.
Health service organisations have a responsibility to the community to ensure there is continuous improvement and services are safe, effective and human centred. This is achieved through good governance. Governance has been described by the NSQHS as a “… set of relationships and responsibilities established by a health service organisation between its department of health (for the public sector), governing body, executive, workforce, patients and consumers, and other stakeholders to deliver safe and high-quality health care. It ensures that the community and health service organisations can be confident that systems are in place to deliver safe and high-quality health care, and continuously improve services” (NSQHS).
Patient and clinical service needs and benefits are an overarching principle of workforce education and training.
Learning and development planning, responsibility and evaluation is essential to embedding new skills and knowledge into practice.
Effective leadership encourages and facilitates education & training opportunities to build capability and empower allied health
Health services have organisational structures that value and promote education and training embedded as core business
Facilitating access to education and training is supported by allocation of human and financial resources
Governance in education and training is critical to meeting patient needs
Governance in education and training has a critical role in embedding professional development into organisational systems. A focus on education and training helps achieve and develop the right mix of skills and capabilities in health professionals to deliver safe, appropriate care, and respond to changing and evolving needs of patients and the community. This aligns with the health strategic objective of the right people with the right skills in the right place. By ensuring that allied health professionals are supported to engage in lifelong learning and continuing professional development, health care organisations can be increasingly confident that they are employing a workforce capable of delivering human-centred care and contributing towards enhancing care outcomes.
Allied health deliver interprofessional human-centred care
Allied health professionals deliver specialised, coordinated care, making a difference across the patient journey in the health care system. Patient care is enhanced when delivered by a team of health professionals. There are 23 allied health professions employed by NSW Health (see Table 2) making up a workforce of over 13,000 highly skilled staff. These professionals deliver care that improves patient outcomes (e.g., stroke outcomes, quality of life), reduces readmission rates, reduces risks (e.g., falls, malnutrition, pneumonia), maximises safety (e.g., safe discharge home, social supports) and can be preventative (e.g., reduce the need for surgical intervention). Allied health staff work collaboratively with doctors, nurses and other staff within hospitals and community settings to meet population needs. They lead and/or support many and varied specialty clinics, such as eating disorders, diabetes, fracture, voice disorders, and high-risk foot disease making a difference to the delivery of holistic patient care. The customised care delivered by specialty clinics draws heavily from the skill and training of many allied health professionals including dietitians, physiotherapists, speech pathologists, occupational therapists and pharmacists. It is important that the professional development of allied health professionals is maintained, developed and promoted to provide best value, leading and advanced care.
In 2011, Health Education and Training Institute (HETI) allied health team in collaboration with the Allied Health Directors Network, commissioned a project to develop a best practice governance framework for allied health education, published as “Best Practice Governance Framework for Allied Health Education and Training (Governance Guide)”. The Governance Guide has been revised in 2021 with updated content based on current evidence. The document is now available as the renamed, interactive ‘Allied Health Education and Training Governance Guidelines’ on the HETI website.
The five guidelines
Allied health education and training is a multifaceted activity, which needs to be fully integrated into the workplace at organisational, departmental, and individual levels for it to result in high quality service delivery and patient care. These guidelines support individuals, managers and organisations to self-assess, evaluate and determine an action plan across the five key guidelines in the context of education and training.
Allied health play an important role to support, promote, prevent and maintain health care for people across communities, services and hospital settings. Education and training must align with population health needs, geography and service provision to provide high quality and safe human-centred care.
A human-centred approach to service provision, including health professional education and training, is supported by the Australian Charter of Healthcare Rights, the Australian Safety and Quality Framework for Health Care, and National Safety and Quality Health Service (NSQHS) Standards. International approaches to health workforce development also prioritise patient needs and benefits as an overarching principle of workforce education and training (Skills for Health, 2019; Broughton & Harris, 2019). Delivering education and training may focus on maintaining skills and/or building on existing skills in the workforce (to advance and/or develop extended scope of practice) to meet the needs of the population (New Zealand Institute of Economic Research, 2021).
Reflect diversity of the population
Allied health education and training should reflect the diversity of the population and foster a culture of inclusivity. Diversity includes all the differences that people bring including culture (e.g., cultural and linguistic diversity, Aboriginal and/or Torres Strait Islander peoples), demographic, socio-economic factors, experiences and values. Education and training is an enabler for embracing diversity and cultural inclusivity. Consumer engagement should therefore form part of education and training approaches. It is essential in health care that Aboriginal cultural awareness, safety and responsiveness education and training is undertaken for the development of the necessary knowledge, skills and attitudes that will enable the delivery of culturally safe and responsive care (National Rural Health Commissioner Report, 2020). Building cultural awareness and safety are identified as key strategies for reducing inequalities in healthcare access and improving the quality and effectiveness of care for Aboriginal people and is articulated in the NSQHS Standards - User Guide for Aboriginal and Torres Strait Islander Health. (NSQHS).
Health systems and population needs are in a continual state of change. To keep up with these changes, allied health professionals must engage in lifelong learning and draw from practice-based experience and current evidence.
Focusing on clinician learning, teaching and Continuing Professional Development (CPD) supports health care professionals to maintain, improve and broaden their knowledge, expertise and capability. This requires an active approach to enable access to education and training and to support evaluation and implementation of new knowledge and skills. Lifelong learning is considered a shared responsibility between individuals, managers and organisations.
Professional development mandated
Ongoing professional development for clinicians may also be mandated by professional organisations or required by codes of conduct or codes of ethics. Allied health professions are either registered or self-regulated (Table 3). Registered professionals must comply with CPD requirements from the Australian Health Practitioner Regulation Agency (AHPRA) and fall under Health Practitioner Regulation National Law. The National Law requires allied health boards to develop and maintain registration standards about the CPD requirements for registered health practitioners. Self-regulated health professions are unregistered and their practice must comply with the Public Health Act 2010 and the Public Health Regulation 2012. Minimum CPD requirements are mandated for registered professions by each professional board. Guidelines for self-regulated professions are provided through their professional associations to support and promote rigorous participation in CPD.
Professional development opportunities
CPD covers a range of professional development activities including formal learning opportunities such as courses offered by universities or other education and training organisations, eLearning, conferences and workshops; workplace or on-the-job learning such as mentoring, case-based learning, simulations and observation; and informal learning such as communities of practice and online discussion boards. Participation in education and training activities and networking with colleagues enables staff to maintain currency in their knowledge and clinical skills, build confidence and keep pace with the current standards and evidenced based practice. The importance of CPD should not be underestimated – it is a career-long obligation for practising professionals.
Allied health leading and advocating for education and training in health organisations contributes to high quality learning and development. Furthermore, aligning operational and strategic leadership with education and training are considered system enablers. Managers at all levels have a vital role in enabling allied health professionals to access professional development.
Allied health advocacy
Allied health educator positions play a key role in education and training leadership. There have been calls for education and training to be more expertly planned, needs assessed, formal and informal education and training overseen and for educational leaders to have a stronger voice on organisational committees (Golder et al, 2016; Lloyd et al, 2014). Allied health representation on education committees within organisations is recommended. A review of the contribution of allied health to decision making found that allied health was under-represented on decision making bodies within Australian public health systems, relative to other disciplines and that “Allied health needs a stronger focus on leaders, leadership and leading” (Boyce et al, 2016, p. 9). Allied Health Directors in NSW highlighted the importance of system leadership to workforce development and service innovation, including education and training, in Principle 7 of its Consensus Statement – Governance (NSW Health, 2013).
Academic leadership and collaboration
Academic leadership in health education and training is also important for fostering a research culture within health organisations to advance knowledge of best practice and to promote translation of research into practice. Academic leaders “teach, question, investigate, research, innovate and build cultures of evidence-based practice to accelerate improvements in clinical care. Working in multidisciplinary and inter-professional teams, research leaders apply research skills and analytical thinking to understand clinical problems, develop evidence-based solutions and implement change” (Westwood et al, 2013). In the UK, clinical academic pathways for nurses, midwives and allied health professionals have been developing since 2005 and frameworks exist for providing support to early, mid and late clinical academic research career pathways (NHS, 2011). There are some Australian examples where health services have taken a leadership role. For example, in NSW, the Western Sydney LHD Allied Health Research Unit aims to support a culture of research and increase the capacity of allied health professionals to undertake research (WSLHD, 2019); while in Victoria, the Allied Health Clinical Research Office works in partnership with La Trobe University to strengthen the evidence base of allied health practice through undertaking, mentoring and facilitating clinical research projects, and promoting a research culture within allied health at Eastern Health (Eastern Health, 2019).
Interprofessional education and collaboration in education and practice improve health outcomes (WHO, 2010). Integrated and quality care is enhanced by interprofessional practice and enables a more responsive workforce to meet population health care needs (CAIPE, 2017; 2021). Leadership is essential to develop and coordinate training for interprofessional education opportunities to occur. Leadership is also required to ensure there are integrated health and education policies to promote effective interprofessional education and collaborative practice. Interprofessional education occurs during pre- and post-qualifying education in a variety of clinical settings and has been associated with many benefits such as teamwork, reduced service duplication, patient-centred care, elevated levels of workforce satisfaction and wellbeing (WHO, 2010).
Health systems must support allied health professionals to engage in lifelong learning by embedding education and training as core business CPD may encompass or focus on clinical, cultural, leadership, education or research needs. This impacts all learners across their career and/or roles such as students, new graduates transitioning into practice, early career, experienced clinicians, managers, researchers and those who deliver allied health education training (teachers and coordinators). Processes, monitoring and reporting systems to support education and training are required.
Accountabilities should be outlined, documented and communicated at each level of the organisation. This may include relevant policies and procedures, targets, Key Performance Indicators (KPIs) and approaches to recording and managing education and training data. For example, AHPRA recommends that Australian health professionals complete 20-40 hours of continuing professional development, per year (AHPRA, 2015). It is critical that structures are in place to support staff to achieve and measure how much time is spent in professional development, mandatory education and training, clinical supervision (appropriate to their qualifications and level of experience), and for the development and maintenance of advanced and/or extended scope of practice. This may include ensuring learning and development plans are in place and monitored, protected or allocated CPD time is available, and that relevant leave and backfill arrangements are explored.
Clinical supervision has an integral role in learning and is considered a vital part of modern, effective health care systems (Milne 2007). Supervision should be available to and is recommended for all allied health professionals. It supports continuing professional development and facilitates safe and high-quality patient care (Fitzpatrick et. al., 2012; Snowden et. al. 2020). The NSW Health Clinical Supervision Framework (2015) provides overarching guidance to health care services and the HETI Superguide: a handbook for supervising allied health (2012) supports the implementation of supervision for supervisees and clinical supervisors in addition to modules developed and located on the NSW Health Learning Management System known as ‘My Health Learning’.
Allied health encompasses a broad range of disciplines with differing clinical skills, qualification and registration requirements. Some registration boards require accredited skills and formal maintenance of supervisory skills e.g., psychology. All supervision should comply with any national and state mandatory requirements for registration. There are specific skills and attributes are required to provide high quality supervision (HETI, 2012). Allied health professionals require training in supervision to facilitate a constructive supervisory relationship. There is also a need to develop supervision skills and training for allied health professionals that supervise allied health assistants. Organisations can support supervision by providing and promoting formal training for both supervisees and supervisors to develop skills in supervision and build capability.
Organisational clinical supervision policies and guidelines have an integral role in the governance and quality of allied health supervision. Clear guidelines on the manner of clinical supervision (e.g., duration, frequency, roles) can assist to ensure that supervision occurs regularly and promotes a positive culture of supervision. Key performance indicators should be used to measure supervision activity, be monitored and reviewed. Snowden et al (2020) described that Allied health professionals reported that clinical supervision was most effective when it supported and facilitated their professional development.
Clinical supervision should be inclusive and adopt an integrated approach for allied health staff from diverse cultural backgrounds including those staff who identify as Aboriginal and/or Torres Strait Islander peoples (SESLHD, Supervision guideline, 2017). In addition to clinical supervision, professional development and ongoing learning can be supported by mentoring and coaching. Mentoring is a valuable tool to promote cultural reflection and nurture cultural strengths e.g., cross-cultural or Aboriginal cultural mentoring. Aboriginal cultural mentoring can play a key role in supporting and guiding Aboriginal allied health trainees, cadets, graduates, technicians, professionals and assistants in NSW Health.
Partnerships with education providers can support education and training for organisations. These can be informal collaborative opportunities or formal arrangements such as conjoint appointments, agreements or Memorandum of Understanding (MOUs) between health care and education providers. Formal agreements or MOUs may lead to joint research initiatives, open opportunities for CPD or staff training in research and other skills. Service agreements are also required for the provision of student placements in health care services.
Structures around key organisational information can support education and training such as data management systems, quality and safety improvement programs. Existing information technology programs and databases can capture patient trends, patient care, outcomes and critical incidents. This data can be used to inform education and training needs and promote quality and safety within the organisation. Valuable information generated from Patient Reported Outcome Measures (PROMs) and Patient Reported Experience Measures (PREMs) can also be used to inform education and training needs.
Alignment with priorities and directions
Organisations can further support allied health by aligning education and training with local priorities and strategic directions, state-wide plans/strategies and where appropriate national approaches. It is essential that value-based health care underpins education and training. Planning and implementing strategies around education and training also require monitoring, evaluation and reporting. The importance of monitoring and evaluating the quality and impact of education and training cannot be underestimated. Allied health professionals are motivated to implement new knowledge and skills and make a difference to our patients and the workplace, and this should be measured and evaluated. There is much literature on measuring training effectiveness, and this includes satisfaction, learning, application, impact and may also include return on investment.
Allied health professionals need access to high-quality, flexible and cost-effective education to continuously respond to the changes of an evolving healthcare system. Education and training should be appropriately supported, funded and given time by organisations in order to promote learning, career development and prevent professional attrition (Haywood et al, 2012). Allied health professionals will require allocated time away from clinical duties to spend on education and training.
Garling (2008) recommended funding support of allied health professionals to attend external education and training courses relevant to their specialty. Systems to allocate funds and/or support access to education and training need to be in place to support this recommendation. Attendance at external courses and conferences can also be enriched by valuing and seeking out experiences that occur within the workplace (Lloyd et al, 2014).
Workplace-based learning activities offer an economical approach to education and training. Lloyd et al (2014) highlighted in their study that this approach provides a greater return on investment as greater numbers of clinicians can access the training with fewer funds. Workplace learning activities can cut across geographical boundaries by bringing the learning to the workplace, whether rural or metropolitan enabling more equitable access to education and training. With teams/groups learning together, there is greater potential for the translation of new knowledge into change of practice, compared with individuals accessing external training and attempting to drive change of practice on their own. This also supports the application of effective adult learning principles.
Allied health educator roles
Allied health educator roles are an integral resource for staff and their organisations. Allied health educators coordinate and facilitate ongoing education, training and clinical support. These roles may be discipline specific (e.g. pharmacy specific, radiation therapy specific) or support all allied health professionals on site, across multiple sites, services or across a health care district or network. Allied health expertise applied to design, and delivery of education programs results in greater access to high quality education and training opportunities. Establishing and advocating for allied health professional educator roles is an important way that organisations can support education and training amongst the allied health workforce.
Rural and remote access
Access to education and training for rural and remote allied health professionals requires prioritisation and an explicit approach. Allied health staff based in rural and remote areas deliver care across geographically dispersed locations, culturally diverse populations, often with limited resources which requires an extensive skills base to meet these challenges. Education and training plays a significant role in the development of the rural generalist skill set. The need for training and CPD can be greater in rural and remote areas where clinicians may need to treat patients that have not been part of their practice experience in an environment where there are limited support structures (Berndt et al, 2017). Professional development opportunities, education, training, supervision, and opportunity for career progression have also been reported in the literature as factors affecting health worker motivation, recruitment and retention in rural areas (WHO, 2010; Henderson & Tulloch, 2008).
A range of education and training programs should be available, sufficiently flexible and varied, yet matched to need for allied health professionals. Technology can improve and support access to education and training. The technological infrastructure requirements should be assessed and provided.