Measuring the quality of allied health services in Australia: is it a case of “the more we learn, the less we know?”

Journal of Healthcare Leadership Dovepress open access to scientific and medical research P e r specti v es Journal of Healthcare Leadership downloaded from https://www.dovepress.com/ by 213.32.48.132 on 12-Jul-2018 For personal use only. Open Access Full Text Article Measuring the quality of allied health services in Australia: is it a case of “the more we learn, the less we know?” This article was published in the following Dove Press journal: Journal of Healthcare Leadership 26 July 2012 Number of times this article has been viewed Karen Grimmer-Somers Steve Milanese Saravana Kumar International Centre for Allied Health Evidence (iCAHE), University of South Australia, North Terrace, Adelaide, Australia Introduction Correspondence: Karen GrimmerSomers University of South Australia, City East Campus, North Tce, Adelaide 5000, Australia Email karen.grimmer-somers@unisa. edu.au submit your manuscript | www.dovepress.com Dovepress http://dx.doi.org/10.2147/JHL.S33163 Powered by TCPDF (www.tcpdf.org) Background: Sensitive and reliable measurement of allied health (AH) service quality is in its infancy. This is largely related to the complexity of the AH discipline-mix, the services these disciplines provide, and the locations in which services are provided. AH is variably described, with up to 49 disciplines being listed in the literature. These disciplines often undertake a range of interlinked activities such as assessment and diagnosis, counseling, therapy and rehabilitation, manufacture, education, and service organization. AH disciplines work in a range of roles in a range of public and private sector organizations, and often consult with their patients/ clients a number of times for the management of one condition. They operate under a variety of funding models, and often within service delivery constraints. This evidence-informed analytical review outlines factors which should be considered by allied health leaders, reflecting clinicians, policy-makers, managers, and academics, in regards to making an informed choice of sensitive and reliable measures of AH service quality. Strong, visionary, and collaborative leadership is required to ensure that allied health activities and outcomes are measured and reported effectively and efficiently. Keywords: allied health (AH), sensitive, reliable measures, health service quality Measuring and monitoring aspects of the services provided by healthcare practitioners, either as individuals or as organizations, is the most common method for estimating the quality of care that is being provided.1 This requires the regular collection, analysis, and reporting of data items which sensitively, specifically, and reliably reflect the nature of the service being provided, its purpose, its customers, and outcomes. There is increasing pressure on allied health (AH) leaders in public and private sectors to demonstrate service quality. However objective data to underpin reporting of any quality element is often not available. There is no agreed approach to measuring or monitoring AH service quality. This is most likely because of the range and complexity of services offered by the disciplines listed under the AH umbrella.2 These disciplines have different purposes and ways of operating, different customers, stakeholders, outcomes, and quality measures. This paper presents an evidence-informed analytical review that raises issues which may assist AH leaders in considering the many issues relevant to measuring and monitoring AH service quality. Fifteen factors are considered within the context of the Australian healthcare system, relative to AH disciplines, organizations (operations) in which AH services are provided, and patients/customers of AH services. Figure 1 provides an overview of the factors discussed in this paper. This figure highlights that some factors Journal of Healthcare Leadership 2012:4 71–81 71 © 2012 Grimmer-Somers et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. Dovepress Journal of Healthcare Leadership downloaded from https://www.dovepress.com/ by 213.32.48.132 on 12-Jul-2018 For personal use only. Grimmer-Somers et al Service purpose Measures of AH service delivery Models of AH care Information provided by AH providers to support evaluation of quality AH discipline issues Measures of AH outcomes Evidence-based practice Risk factors for poor health and cost outcomes AH workforce Retention and recruitment of AH workforce IT support systems What is AH? Training Customer/patient issues Who are patients/customers? Why do patients/customers seek AH care? Who pays for care? Figure 1 Factors of allied health services in Australia. Abbreviations: AH, allied health; IT, information technology. are unique to one area, while others are shared. This figure also highlights the need for individual as well as collaborative leadership to address the multiple issues which impact the measurement of AH quality. What is AH? AH is an “umbrella” term broadly encompassing health disciplines other than medicine and nursing. Although many authors have attempted to define AH,3,4 there remains a lack of an internationally recognized definition. The most common approach is simply to list disciplines which are “in,” or “out.” List membership varies between institutions, organizations, and countries,2,5–9 with the most extensive list of AH disciplines (N = 49) provided in 2001 by Services for Australian Rural and Remote Allied Health.4 The lack of a 72 Powered by TCPDF (www.tcpdf.org) Organizational/ operational issues submit your manuscript | www.dovepress.com Dovepress definitive AH definition has supported seemingly ad hoc inclusions/exclusions to lists of AH disciplines operating in Australian healthcare environments. This has precluded a comprehensive understanding of AH quality service issues.10 Commonly listed AH services include audiology, dietetics and nutrition, occupational therapy, orthotics and prosthetics, physiotherapy, podiatry, psychology, radiography, and speech pathology. Social work and pharmacy may or may not be included. AH workforce In the most recent Australian health workforce statistics,11 there were 57,019 medical practitioners, 65,284 AH professionals (not including pharmacists or complementary medicine practitioners), and 202,735 registered nurses. This suggests that Journal of Healthcare Leadership 2012:4 Dovepress in 2010, AH disciplines in Australia contributed approximately 20% of the mainstream health workforce. Journal of Healthcare Leadership downloaded from https://www.dovepress.com/ by 213.32.48.132 on 12-Jul-2018 For personal use only. Who is a patient/customer? There are direct and indirect customers/stakeholders in AH services whose interests and inputs need to be considered when measuring service quality. Direct customers/stakeholders include (...truncated)