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Supporting Health Care Professionals Working At Top Of Scope To Thrive (Not Just To Survive)

We are seeing a strategic realignment of the health workforces towards top of scope roles. According to this strategy, by leveraging the full extent of a practitioner’s skills and training, health systems can more efficiently meet patient needs, particularly where demand outstrips supply. Similarly, the focus on higher complexity cases (e.g. in acute care settings) aims to ensure that those with the most urgent needs receive timely and specialised care.

However, the move to facilitate top of scope work to meet current day challenges—potentially driven by rising demand for healthcare services in the face of health workforce shortages, lack of access to care in rural and remote communities, entrenched workforce practices post-COVID—does not occur in vacuum. Health professionals’ health, wellbeing and job satisfaction can be affected.

This article attempts to define the problem and provide some ‘success factors’ to empower governing boards, managers and health leaders to ensure the longevity of their workforces whenever making practical decisions resulting in health professionals working more consistently at the top of their scopes of practice.

The problem: impacts on job satisfaction and burnout rates among health care professionals working at top of scope

Job satisfaction in healthcare is multifaceted, influenced by factors such as work-life balance, autonomy, recognition, and a sense of purpose.

For many practitioners, the joy of healthcare lies in the diversity of cases and the ability to apply a broad spectrum of skills. The narrowing of scope to high-acuity cases, while potentially enriching from a professional challenge perspective, can also lead to a sense of monotony and confinement, diminish the sense of professional growth and satisfaction, and lead some to question their career longevity within the sector.

Burnout—characterised by emotional exhaustion, depersonalisation, and a diminished sense of personal accomplishment—has similarly devastating effects on the workforce, and among health care professionals is a well-documented phenomenon.

It’s also nothing new. As Helen Whait states in her guest postBurnout Is A Huge Problem In Allied Health. Here’s What Needs To Change, “I could’ve written this article a decade ago and it still would have been relevant today. That in itself is a problem. We’ve known about the issue of health care burnout and allied health burnout for a long time, and yet little has changed.” However, the intensification of work roles, coupled with the emotional and physical demands of dealing with more complex and acute cases, exacerbates the potential for burnout and short-term, long-term or permanent exit from the workforce.

Strategies for harnessing the power of workplace change

There is no on-size-fits-all approach; every workplace and every practitioner is different.

However, the research (and my own decades of conversations with practitioners), point to some key enablers of job satisfaction, health and wellbeing.

The key for health boards and management is to find the mix of arrangements required to maximise the desired outcomes of service redesign, while also creating the environment for health professionals working at top of scope to thrive, not just survive.

Here are some examples of strategies that should be in the mix.

Enhanced support systems: consider implementing robust support systems for those in high-stress roles, including access to mental health services, peer support groups, and stress management resources. Many professions during the COVID-19 pandemic found themselves working to top of scope, including paramedics, physiotherapists, respiratory therapists, and occupational therapists. The stress and burnout that came with working in such high-pressure roles helped to galvanise peer support services for health care professionals, some of which have continued to grow and flourish in the years following the pandemic. (This is true of many technologies and innovations taken advantage of during the pandemic).

Flexible work arrangements: offering flexible work arrangements can help professionals manage their workloads and enhance the quality of their time outside work, helping with workforce retention. Examples include: implementation of telehealth and support for remote work infrastructure; flexitime arrangements; part-time positions for top of scope professionals; and compressed workweeks.

Robust delegation frameworks and adequate resourcing of the delegated workforce: encourage health professionals working at top of scope to know when and how to delegate, and ensure that there are sufficient workers to delegate to. As roles and practitioners move towards top of scope activity, there will be a ‘gap’ for lower risk and lower complexity work. Health professionals should not feel like they need to ‘do it all’. Delegating well in a system that recognises the risks and benefits of delegation and supports workers at all levels, provides for a more efficient health service, facilitates career development and job satisfaction of delegated workers, and also helps top of scope professionals to manage their workloads.

Career development opportunities: providing opportunities for career development and diversification of skills, even within a narrowed scope of practice, cultivates a sense of professional growth and satisfaction. Feeling valued and motivated through career development reduces burnout risk, and career development opportunities at the organisational level can be used to keep top of scope AHPs aligned with evolving health care needs. This can be a formal initiative, such as the Allied Health Career Pathways Blueprint set up by the Department of Health, Victoria.

Recognition and reward systems provide a sense of accomplishment, and encouragement, to health care professionals. Establish recognition and reward systems that acknowledge and compensate for the increased demands placed on practitioners. These can be financial, or rely on other mechanisms, such as professional acknowledgement. Inspire your workforce by recognising the great things they are already doing.

Models of care that support workload variety: rotations through different clinical areas, or opportunities to mix non-clinical work with clinical workloads can help to break up the intensity of high acuity practice, and provide a more satisfying mix of work. Programs like the Australian Government Department of Health and Aged Care’s Innovative Models of Care (IMOC) program, which supports organisations in trialling new ways of providing primary care in rural and remote communities, place top of scope AHPs in care environments in a way that supports workload variety.

Use underspend from unfilled positions to drive innovation and efficiency: unremitting top of scope work is sometimes caused by an inability to recruit sufficient staff to meet normal clinical needs. Lack of recruitment generally means budgetary underspend. Re-allocate underspend to projects or other activities that can increase efficiency and innovation, while stimulating your workforce—such as investment in AI-assisted technologies or funding for internal research grants — or to reduce the acuity of the patient load (for example, through prevention).

In Summary

The shift towards top of scope roles and the narrowing of practice in acute care settings are understandable responses to the pressures faced by healthcare systems. They should also be viewed as exciting developments in the evolution of healthcare; they can genuinely improve patient outcomes, and workplace efficiency.

There are mechanisms, as described in this article, to ensure that these positive impacts are not overshadowed by negative outcomes, like declining job satisfaction and burnout.

As health care continues to evolve, it is imperative that strategies to optimise system efficiency are balanced with measures to support the health and satisfaction of the professionals at its heart. Only through such balance can the healthcare system sustainably meet the needs of both its patients and its practitioners.

View our archive of scope of practice articles here. | In this article, occupational therapist Helen Whait describes strategies to reduce burnout. Alison Battye describes strategies to maintain healthy boundaries as an allied health professional.

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