Donna Markham OAM has two pieces of advice for AHPs considering a “life after allied health” career transition: trust yourself, and do it before you think you’re ready.
Donna is a key leader in allied health who held Chief Allied Health Officer (CAHO) positions at Monash Health and Safer Care Victoria, before making the move to entrepreneurship.
In our interview, we discuss the aspects of Donna’s clinical career that prepared her for allied health leadership and what that means to her: “it’s trying to break down the individual silos of each of the professions and influencing them to realise that we actually have greater impact if we work together.”
She shares her experiences as CAHO of Safer Care Victoria at the height of COVID, and some of the standout moments from that period, particularly in terms of strengthening relationships with the private sector.
Donna goes into detail about what ultimately made her decide to pivot from her allied health leadership role into entrepreneurship, how she managed uncertainty, and the transferrable skills that helped her along the way: “I think I was craving perhaps a little bit more freedom to really explore things my own way.”
How did your professional pathway evolve from clinical care to leadership?
I was working at Monash Health in OT roles on the wards, and I started to develop a bit of an interest in more of the interdisciplinary kind of roles. I found myself in a rehab liaison role working alongside geriatricians assessing for aged care or rehab needs, and then went into the emergency department where I was leading a team of care coordinators.
It was really when I started to step into those senior clinician roles that—without realising I was doing it—I was starting to network more broadly across the hospital and create strong relationships with people outside of OT and outside of allied health.
The opportunity to step up to a director of allied health role became available, and I spent a lot of time agonising over whether or not I should do something like that. I had to put a lot of my own anxiety and impostor syndrome aside, and decided to believe what other people believed about me and give it a go.
That’s when I had my first really big step up into a director-level role. It was an acting role, and I was deciding whether I would apply ongoing. Then my boss resigned, and I was asked to do her role! I was acting in that role for three months and I was like, ‘You’d be stupid not to apply, you’re already doing the job’. So I applied and was permanently appointed. That’s when I became the Chief Allied Health Officer at Monash Health.
A few years later, our CEO created a leadership development-type position, so I was doing that role. Then as I was returning from maternity leave after my second baby, I stepped into the Chief Allied Health Officer role with the Victorian Government, where I was up until two years ago when I stepped away and started my own business.
Is there an aspect of your clinical career that you’re most proud of?
I was really passionate about frequent presenters—those people who frequently came to the ED to have their care needs met who, we all recognised, didn’t necessarily need emergency department care, but there was a big gap in their care needs somewhere. Their needs weren’t being met, which is why they kept fronting up to ED, and so we established the Frequent Presenters Program: a multidisciplinary program that ended up getting rolled out across the three emergency departments at Monash to try and support these individuals through case conferences, individualised care plans, etc.
I think that’s a standout for me in terms of my clinical days, setting up and implementing that program and having that sustained in terms of how we better supported those people who didn’t really need to be in ED.
So what motivated you to step into the CAHO role with Safer Care Victoria?
I became much more interested in leadership—while I still cared very much about patient care and clinical care—and the desire to influence that at a system level rather than just at an individual level.
Safer Care Victoria is the quality and safety agency of the Victorian Government—an arm or a branch, if you like, of the Victorian Government, and so my role within that agency was professional governance of the allied health workforce in Victoria.
It’s debatable how many professions fit under the allied health umbrella, but the count at the time that I was responsible was about 26. There were other relationships that I was responsible for as well: spiritual care practitioners and other sorts of professions like that—which weren’t officially classified as allied health, but was still within my remit—as well as specific quality and safety issues that might arise, which fortunately is not that frequent in the allied health world.
It was also my role to consider allied health’s contribution to broader quality and safety matters as well, so should there have been a quality and safety issue, it would have been my role to investigate or lead reform in that space. And when there were quality and safety improvement opportunities or other matters, my role was to provide that allied health voice and lead change.
When COVID hit, my role pivoted to be very much around the COVID response, and what that meant for allied health.
What was it like leading a quality and safety agency during COVID?
During COVID [in my capacity as CAHO of Safer Care Victoria], we got a lot of really great feedback from the allied health sector about our communication. The leadership that I was able to show with the support of a very important team through that time meant that the stakeholders were well informed; we advocated to make sure that the restrictions were as reasonable as possible, trying to balance the public safety message with an ‘access to health care’ message.
Any private practitioners who are reading this will know that they were heavily impacted because of the restrictions, whereas public hospitals weren’t as much. So where we had been quite public health-focused—because that’s who the government funds—COVID pivoted us towards relationships with the private sector and the professional associations to be much more significant and much stronger.
We strengthened a lot of relationships across the sector—education, the unions, the peak bodies, and advocated as best we could to minimise the impact of the restrictions on allied health being able to provide really important care. That was definitely a highlight for me, even though it was incredibly challenging.
Another achievement from that role—which is a nice example of how transferable skills are—I was asked to be the executive lead for the Voluntary Assisted Dying review board in Victoria. (Victoria had the first legislation to establish VAD.) They had an independently appointed board, and I acted like a CEO equivalent or executive sponsor. It was a nice example of how transferable our allied health leadership skills are, because we’re good at relationships, we’re good at complex problem solving, we’re good at stakeholder engagement—we’re system thinkers.
Speaking of COVID, what are your thoughts on the innovations and adaptations by allied health during the height of the pandemic?
We shifted very rapidly to using more telehealth and that has stayed with us. That’s definitely been a really positive thing as a result of COVID in terms of how we can provide some of our services. It’s not appropriate for all, but we’re definitely able to provide more services via telehealth.
I’m sure there were lots of other innovations that occurred as well, in terms of hybrid service provision, and hybrid working arrangements. I do executive coaching now, and I’ve got coaching clients in other jurisdictions, such as Northern Territory and Queensland, and that probably wouldn’t have happened pre-COVID. It’s opened up a lot of other opportunities; I mean, I run my business from home now.
You received the Order of Australia Medal in 2022. Tell us about that!
That was very cool. It was and still is an incredible honour. It was an interesting time, because I’d left Safer Care Victoria at that point when I found out but the email address they had for me was still Safer Care Victoria, so I got a phone call from the Governor General’s office saying, ‘Just following up if you got our email’, and I’m like, ‘What email’s that?’ And they said, ‘Oh, well you’ve been nominated for a Medal of the Order of Australia’.
I hung up the phone and burst into tears. I was also quite emotional because we were in the process of exploring whether our youngest son is autistic and has ADHD. So it just felt like this collision of being recognised and nominated for these incredible accomplishments, and at the same time going through these incredibly challenging things at home—so much grief, sadness, loss and adjustment related to learning all about our son, and that’s a process in itself.
My nomination was for my contributions to healthcare administration. It was an incredible experience, and some beautiful recognition from the broader allied health community and health networks around that time.
I took my mum and dad and my partner, Daniel, along to the ceremony, and that was an amazing event. The Governor General was pinning on my medal, and she’s like, ‘You know, you must be pretty impressive, you’re a lot younger than many people here’.
So that was an incredible honour, and I’m really grateful for the people who took the time to put in reports and references and all that sort of stuff as well.
What does leadership in allied health mean to you?
Good question. I think it means influencing change. It means advocating for the profession. It means helping others understand what we do and recognise the value and the unique contribution that we bring to the communities that we serve. It means, to me, helping the professions come together and recognise our value in a shared identity.
For me, it’s trying to break down the individual silos of each of the professions and influencing them to realise that we actually have greater impact if we work together. That’s not to diminish the unique skills and contributions of each profession, but we are much stronger if we are a united and unified voice. What it meant to me in those [leadership] roles was actually trying to shift the dialogue and change the narrative about who allied health is, and how we contribute to the broader community.
And how do you feel about the Scope of Practice Review taking place at the moment?
I think there is so much that allied health can be doing to push the edges of our scope, but also to look at where the overlap of our practices lies across the professions.
If I were to think about some of the outcomes of the review, what would be amazing would be greater acceptance of the grey areas, where we have shared competency and shared skills, and that we embrace some of that inter-professional or transdisciplinary-type practice.
There is an opportunity to recognise what advanced or extended practice might be for the various professions, and that we have a mechanism for working towards the ability for each individual profession and professionals within that to work to the top of their chosen scope of practice.
Even just last week, I emceed a conference with the medical radiation practitioners, and there’s some turf war between radiologists and radiographers—I would love some of those arguments to be put to bed.
I know that’s probably a really big ask, but where allied health overlaps with what is currently the scope of practice of medical practitioners, it would be amazing if one of the outcomes of the review is that we actually were able to define what is really safe, because we have really strong governance around allied health—and, to support all of that at the back-end, the scope of practice of allied health assistants. It’s that continuum from our allied health assistants right through to those who might be in advanced or extended scope roles, and obviously some of that requires legislative change.
What made you decide to pivot away from allied health? Career transition presents enormous challenges with a lot of what-ifs and uncharted territory
After two years of COVID, I was fairly spent. I didn’t quite hit the wall, I think I pulled up stumps just before I completely hit burnout; I’d probably done enough personal work over the years and knew myself well enough to know it was time.
I was in a team where how I was trying to lead was quite different to how other members of the team were trying to lead, and so it felt like there was a lot of effort to turn up as my best self. I felt like I didn’t want to be in an environment where that was hard—and I say this with a lot of respect—but maybe that’s a little bit representative of government. There’s a lot of bureaucracy that you have to deal with, and I think I was craving perhaps a little bit more freedom from that to really explore things my own way.
I didn’t know that my son was autistic at the time, but there was a part of me that just knew as my children got older, I wanted to be more present. There was an inkling in me that just knew I needed to be a bit more available and around for them. When I stepped into that Chief Allied Health Officer role, I did have a sense that it might have been my last allied health leadership role, and I was curious as to how I could use my skills in different ways, still in leadership, but perhaps take it outside of allied health and influence.
I just had this really strong sense of, ‘I just want to give it a go my way’.
OK, let’s talk about your current business: Disequilibrium
Before I even left working, I was like, ‘I think I want to go out on my own and try something’, not knowing what I would do—but I had my business name already.
Back in 2014, I did the Williamson Community Leadership program with Leadership Victoria, and I remember at the beginning of that year, they did this big kind of squiggly line on the board and said, ‘This is the state of disequilibrium that you’re going to be in all year. One moment, you’ll feel like it’s all clear, and then the next moment…’ I remember this resonating so strongly for me—it’s always been the most challenging parts of my life and the most uncomfortable experiences where the greatest growth has occurred for me.
I’ve learned to embrace that ‘disequilibrium’ space, and I would love to work with other people to embrace that space and realise that that’s where the growth occurs. Then I spent some time thinking about what the by-line is, and so the by-line is the sweet spot where growth occurs, because it just resonated with my experience.
So I’m like, ‘Great, I’ve got a name now, what the hell am I going to offer?’ I was very interested in what I could do in the coaching or mentoring-type space. I signed up to do my level one coaching certification with the Institute of Executive Coaching and Leadership (IECL), and I completed my level one.
During that course, I had this kind of coming home moment of, ‘This is what I’m meant to be doing’. I’ve always loved the mentoring side of my leadership role, so to be able to offer that through a coaching relationship, and then understanding how it can benefit others was just this incredible moment of, ‘Yeah, this is what I want to do’.
I started to think of my business in buckets: one was a coaching bucket, one was a consulting bucket—which could be anything from facilitating a workshop to doing a small kind of project—and then my third bucket was my board work. That’s how I envisaged things, and as time has gone by, the coaching bucket has grown.
I do a lot of one-on-one coaching now, as well as team coaching, and my consultancy work is probably becoming a little bit more targeted at facilitation; some project work, but mainly facilitation of conferences or workshops or keynotes. It’s mostly been in the allied health space, which I love—I moved away from a dedicated allied health leadership role, but I still feel like I’m providing leadership in the allied health space, but just in a different way, in a way that brings me a lot of joy.
A large portion of my coaching clients right now are allied health leaders, or allied health business owners.
What are the biggest lessons you’ve learned in the last two years since pivoting to entrepreneurship?
The two years have been a very steep learning curve. I’ve learned how important my networks are—the strength of my relationships and networks is fundamental to my ability to succeed and be sustainable in business, as well as the importance of my reputation, because a lot of my work is based on referrals.
I’ve learned a lot about how best to manage interactions and engagements, and how to pitch for a piece of work. I’ve had to learn how to sell myself, and how to put a price on that, which isn’t something we get taught at uni; and then, learning how to say no to work that’s not quite right, and to trust that the right work will come.
And for other AHPs who are considering a “life after allied health” career transition… what advice would you have for them?
I think you’re always an allied health professional; our skills are so transferable.
Firstly, trust yourself and back yourself. Sometimes we tell ourselves, we need to go back and do further study, you don’t always need to—we have so many transferable skills that are really sought after.
The second bit of advice is do it before you think you’re ready, because I don’t think we’re ever really ready or all that comfortable, so apply for that job or step out on your own before you think you can. You’ve got to be a little bit sensible, you’ve got to make some decisions about what you can afford, and how you can support yourself.
It takes courage, because that first leap is hard, but know that the good stuff will come. And I think, as allied health professionals, you’ve always got a safety net. I don’t think people ever need it when they’ve made that kind of decision to branch out, but it is always there; we’re very employable.
Trust in your own abilities, do it before you think you can, have good people around you, and use your network and your mentors to support you. And if you’re having a lot of doubt, listen to them more than you listen to your own inner critic.
To learn more about Disequilibrium, connect with Donna Markham on LinkedIn | We host a number of career forums and communities of practice that facilitate discussion around career transition and entrepreneurship for allied health professionals. Please visit The Allied Health Academy to find out more.