Professor Sharon Mickan is known for her extensive research and contributions to evidence-based practice in healthcare. As a Professor of Healthcare Innovation at Bond University, her work has focused on the translation of research and innovation into clinical practice. She teaches and uses implementation science strategies to improve healthcare delivery systems and patient outcomes.
Professor Mickan is also an advocate for continuous professional development and actively engages in mentoring healthcare professionals.
We were very pleased to speak with Sharon about a broad range of current issues affecting allied health professionals: how research capacity building and evidence-based practice intersect; the relationship between the COVID pandemic and innovation in allied health; her thoughts on leadership in health care; and the ongoing Commonwealth Scope of Practice Review.
Tell us about your academic work in evidence-based practice
I was immersed in evidence-based practice, commonly referred to as EBP, in the eight years I spent working at the Centre for Evidence-Based Medicine in Oxford. Like many of my peers, I wanted to support health practitioners to use research to inform their practice.
As we progress in our careers, however, life becomes busy and complicated, and there are many competing interests for our time. I recognised that keeping up-to-date could be challenging, both in terms of reading and finding research papers. Over the last few years, the strategies and technologies for searching for research evidence have changed significantly.
What I have seen is that the research evidence changes in many areas of practice across our working lifespan, and there are differences between the way research is applied across different healthcare organisations. I have also realised that not all clinicians are interested in learning about research, so it’s important to create a range of strategies for clinicians to keep up-to-date.
I think there are some basic searching strategies that clinicians can learn to find research evidence that is important to their practice. I have noted that some clinicians are more interested in learning from local experts and others are keen to work with researchers in their areas of interest. This set me on a path to better identify and understand strategies that clinicians can use to engage in research.
How does something like research capacity building fit with evidence-based practice?
The demands of clinical work environments are so high that many of us don’t get to hear about research that’s happening. Clinicians have to be super motivated to even think about reading research and looking at research in their own time. To address this, clinicians and researchers have been working together over the past 20 years to look at ways of building research capacity in healthcare organisations.
At a practical level I have been looking for ways to boost clinicians’ engagement in research, which looks different for each individual. Ideally we want to support them to be able to participate in research that is being led by either a clinician or a researcher. In most health services there are only a few clinicians who really want to lead research, and we want to identify these people and help them do that.
In bigger organisations, where you’ve got groups of allied health professionals working together, a journal club can support clinicians to engage with and use research more constructively. We’ve worked with a group of EBP champions and research fellows to develop a practical format for clinicians to conduct regular journal clubs. The TREAT format of journal clubs supports clinicians to choose a research article that addresses an important clinical question and guides them to constructively and critically appraise the research paper. Clinicians discuss with each other and determine whether the findings of that paper confirm current practice or suggest changes. This discussion builds engagement amongst clinicians about using research. It also identifies areas for future implementation studies and new research studies.
When I was working at Gold Coast Health, our team gave many clinicians real experiences of using and doing research. To drive research projects, we created strategies to connect clinicians with active researchers and clinical research fellows to provide initial ‘taster’ experiences of doing research. When clinicians are paired up with a researcher who’s got a bit more experience, and who also knows about their clinical work environment, together they can actually help clinicians produce helpful research.
Over time, some clinicians enjoyed it so much, that they decided to enrol in a PhD. While this has only been a small number of clinicians, they are investigating an area of their clinical practice that they’re absolutely passionate about. This ultimately positions them to really change their clinical practice, to improve it, and uphold evidence-based practice.
Let’s talk about innovation. How would you emphasise the importance of innovation in an allied health?
As allied health professionals, we’re very good at making incremental improvements—we see a clinical problem, we address it and make things better. But there are times when our health system feels so uncertain and complex and we can’t seem to address important problems in front of us. Sometimes, we have good ideas and we try and share them, but it feels frustrating when can’t move things forward.
Business academics talk about innovation being the appropriate response in times of complexity and uncertainty. They also acknowledge that leaders need to facilitate a more collective approach for innovation—but that is the tip of a much bigger discussion!
But in healthcare, the process of innovation identifies a new or good idea that addresses an important problem and creates valuable outcomes. Innovations can be new products or processes of working. Innovation is occurring in allied health, even though we don’t always recognise it.
One way in which a great many clinicians experienced innovation was during the recent pandemic. Everyone talks about COVID as being a big disruptor, and it did disrupt those ways in which most clinicians worked: patients could not come into the clinics, and many professionals couldn’t do home visits. Everyone had to stop and think about what else they could do.
That’s the most classic example of innovation, but there are quite a few other examples of thinking innovatively, such as 30 years ago when we were using a domiciliary allied health service in an inner-city Brisbane hospital; we introduced allied health clinicians to the emergency department, where, if patients didn’t need a hospital bed, they could receive immediate and timely therapy at home.
When the business world talks about innovation, they talk about repeated failure and getting up and learning from your failures. In healthcare, we don’t like the word failure at all, and we try and manage the risk out of any possible failure. However, I think there are options around important problems for groups of clinicians to experiment with good ideas about doing things differently. With clear expectations and careful monitoring and evaluation, leaders can support innovation in clinical practice.
Do you think that COVID was a catalyst for innovation in the allied health space?
COVID made the whole healthcare system become much more complex and less certain. One excellent example of innovation from the pandemic was in the way many of us pivoted to use telehealth to maintain continuity of care.
In Australia we were lucky because we also had a strong body of research evidence to say that telehealth works in rural and remote areas, which enabled leaders and clinicians to work together to think about ways they could we use telehealth in current practice.
The process of innovation applied an existing idea—telehealth—that we know works, to address the most pressing problem where patients can’t come in to healthcare facilities. Many health services experimented with using telehealth in different ways to address that problem of meeting patients and clinical service care needs.
Do you think the pandemic altered the way we perceive allied health and healthcare scopes of practice?
I think the pandemic made it safe to question whether patients always need to go to hospital or a clinical centre for their healthcare. Ultimately the pandemic raised the value of asking healthcare users about where and how they would like their healthcare delivered. It has also raised the profile of several examples of expanded scopes of practice that actually deliver innovation in our healthcare system right now.
We see expanded practice physiotherapists working in emergency departments, and speech pathologists and audiologists working with ENT surgical teams, and—sometimes—exercise physiologists working in back clinics, where people have chronic low back pain.
We have found that when allied health clinicians select and assess appropriate patients, they can provide treatment which patients are really satisfied with. Patients on surgical waiting lists may take themselves off the waiting list. When there is a patient that urgently requires surgery, allied health clinicians can alert surgeons directly. So in some clinics, the surgeons have an enhanced level of triaging and prioritisation that enables them to work at their peak, more often.
However, these programs are built on trust and an agreed way of working. We have to make sure that the allied health professionals have sufficient skills and professional support.
Do you see any overlap between concepts inherent to evidence-based practice and current dialogue around AHP scopes of practice?
Some of the AHPs working in advanced scope of practice areas are generating research to support what they’re doing, which is so important, because this knowledge will help future programs know what to do to get started and what strategies might be helpful to address key barriers and enablers to change.
Sometimes, doctors may perceive that we’re asking them to relinquish some of their control. That’s a tough call, and we need to show them that we’ve got the evidence, and the patients are satisfied and getting high quality care, without additional increased costs.
How do you feel about the increasing likelihood that a lot of allied health service delivery will be AI-adjacent or even be driven by AI applications?
I think it’s both exciting and scary. I think the scary bit is everyone’s really worried about privacy and data. Privacy is a big issue, but I think it’s surmountable.
The benefits AI offers us are twofold. One is a lot of the repetitive work that we do in terms of diagnostic testing and screening could be supported by AI, so our skills then are used to assist patients who have more complex needs. Secondly, AI offers us the opportunity to individualise care, so we can look at what a patient’s profile is, and then tailor what we offer them.
Both are future potentials that will still require a fair bit of experimentation and evaluation to identify the best innovations that address the most important problems. We will also benefit from using implementation science to bring these innovations into everyday use. I do think there is a need for us to integrate some of the wearables that we’re wearing—and I know there’s a debate that a lot of wearables are not approved by Therapeutic Goods Administration—but I wonder whether at some point we can integrate those into the way that we actually collect data and individualise care.
What does leadership in allied health mean to you?
I think it’s a paradox, because nobody trains to be an allied health practitioner, we choose our profession before we become “allied health practitioners”, and then we end up working in a system that calls us allied health professionals. Currently allied health is a management construct—when we group together the numbers of allied health professionals, that generally equals the numbers of doctors in a hospital, and if you put the numbers of doctors and allied health together, that’s almost as many nurses as there are. At management levels the clinical workforce can then be separated into nurses and midwives, doctors and surgeons and allied health professionals.
For my first formal leadership position, I was asked to be an allied health representative on the hospital’s executive, and what I realised was the executive saw us all as “allied health”, but at the same time, everyone wanted to validate their profession to me, and they wanted me to talk about their profession at the executive!
I became a sort of broker, where I had to validate every profession that I was representing and recount how valuable they were, but when I spoke at the executive, I had to bring it all together. Then when I shared executive messages, it was a mixture because I wanted to let everyone know that they saw us as a group, and they saw us interacting. It was difficult when there was competition within the allied health professions. This is still a challenge, but I believe that with good leadership, this competition can be addressed; there are enough patients and work to go around to keep us all busy. We can report to the executive how, as a team, we make healthcare experiences and outcomes better for our patients.
Scope of Practice Review: how do you feel that it’s progressing? And what do you personally hope to see come out of it when the final report is released later this year?
It’s a powerful review and a really good process because I think there is some unrealised potential in the allied health workforce. I think that’s going to be really important to “unleash” it, as they say. The thing that came out the strongest for me in this review is, when we look at primary healthcare services, we’ve got a whole lot of independent practitioners and services working around a patient.
But we don’t have any formal mechanisms to coordinate and prioritise our healthcare services. There’s no financial model for doing that, and few practical models. This is quite a big challenge and risk for us as allied health. Ideally, we would like to be able to contribute to shared decision making from a team-based point of view with our clients, to maximise the health outcomes for those people using primary healthcare services.
At the same time, I think there are amazing opportunities for allied health to get in there and be leaders around that coordination of care and engage our future clients. For the current generation (and myself), we’re more interested in understanding our health condition and working out how to manage it. This is a change from my parents’ generation who thought that ‘doctors know best’. We have an opportunity as allied health professionals to engage our patients and educate them to be better advocates for their own care. Then we can build a more integrated healthcare system with better outcomes because people will only be accessing when they actually need healthcare.
Why do you think there seems to be a bit of anxiety on the part of medical peak bodies such as the AMA about the Scope of Practice Review?
I think there’s a perceived risk that the GPs may lose some of their power. At the moment they are the gatekeepers of our healthcare system, and the way the healthcare system has been designed is if anything happens to you, you go to your GP and they will tell you what to do. They refer out to everybody, and they have a sense of control and management of patient journeys. But what we’re finding is that there aren’t enough GPs to do that anymore; the model is not sustainable.
I think we’re going to require more team-based, interprofessional care in primary care, where GPs are one of many players. A lot of GPs that I speak to now, realise that allied health professions offer the patient something that they can’t, and there’s a lot of trust and respect being built in small and local networks. However, as a professional group, GPs are scared about losing income, and opening more risks from wider AHP involvement. There is also a lot of uncertainty around how greater allied health involvement in primary care will be regulated and funded.
Follow Sharon Mickan on LinkedIn, and view her Research Profile here. AHP Workforce provides allied health workforce planning, strategy and consulting for employers, managers and stakeholders. Contact us today to learn more about our service offerings.
