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The Value of Allied Health Activity in a District Health Board Setting in New Zealand

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Thesis(2.46 MB)

Date

2023

Authors

McNicholl, Seamus Gary

Supervisor

Reid, Duncan
Bright, Felicity

Item type

Thesis

Degree name

Doctor of Health Sciences

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Publisher

Auckland University of Technology

Abstract

Introduction: Workforce planning for allied health is complex and difficult. Measurement of allied health service activity is a key component of understanding service delivery and capacity. Activity data of allied health professionals’ work is currently being captured in New Zealand District Health Boards (DHB) to develop a methodology to determine allied health staffing requirements. The purpose of this research was to determine if DHBs in New Zealand are measuring the allied health workplace activities that matter to patients, allied health staff, and managers. The research focused on one specific DHB as an exemplar. There were two aims: first, to investigate what activities allied health staff undertook at the Bay of Plenty District Health Board (BOPDHB); and second, to explore what allied health workplace activities were the most important to patients, allied health staff, and managers at the BOPDHB. Methodology: A sequential mixed methods design, underpinned by pragmatism, was used to address both aims of the study. The initial quantitative phase collected allied health activity data from the BOPDHB. The data were analysed using a one-way ANOVA and post hoc analysis on six allied health disciplines’ clinical care ratios and descriptive statistics of clinical activities which aligned to New Zealand national data standards. The subsequent qualitative phase used semi-structured interviews with patient, allied health staff, and manager participants at the BOPDHB to determine what activities were most important to each stakeholder. The interview transcripts were analysed using conventional content analysis. Results: The quantitative analysis demonstrated that the BOPDHB used a broad approach to measure allied health workplace activities and showed different activity patterns across different disciplines. A large proportion of all clinical allied health workplace activity was indirect (43.5%); this was higher in the allied health assistant (51.7%), occupational therapy (53%), and social work (45.3%) disciplines. The qualitative analysis constructed three categories of important allied health workplace activities: building positive relationships; providing meaningful care; and backstage activities, such as non-clinical work and indirect patient activity. Allied health managers and staff had contrasting views on the importance of recording of activity statistics. Discussion: The current approach to measuring allied health activity provides high-level insights into the work done by allied health in New Zealand DHBs. While this may be important for workforce planning, benchmarking, and understanding staff resourcing requirements for allied health services, an unintended consequence of this high-level approach is that aspects of allied health care which matter most to patients and allied health staff, such as relational practice and meaningful patient outcomes, are not visible. The current focus on metrics that matter to the organisation may mean that allied health staff struggle to prioritise and legitimise aspects of care which matter to patients. This study has highlighted a significant proportion of work conducted by allied health staff is indirect and often unseen. The results from this research support the calls for a national approach to measuring the outcomes of allied health activity which matter to patients; this would ensure what matters to patients is not lost to organisational and economic priorities when planning allied health services.

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http://hdl.handle.net/10292/17071

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Doctoral Theses