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Community for AHP Research (CAHPR) South West team

Leadership Representation and Scope of Practice with AHP Leader and Researcher Katie Williams

Katie Williams is a UK-based allied health leader and researcher who is passionate about creating opportunities for allied health professionals (AHPs) to develop their capabilities and capacity across the clinical, leadership, research, and education pillars of practice.

Her initial clinical work as a dietitian gave her an appreciation of multi-disciplinary team (MDT) work, which led Katie to widen her scope of practice to work in leadership and change management roles, supporting apprenticeships, placement expansion, and the AHP support workforce in the South West of England.

We’re speaking to Katie today about her current work, which includes two projects that have important implications for allied health leadership representation and scope of practice.

In her research associate capacity at University of the West of England (UWE) Katie is leading the regional project Advancing Research Careers for Under-Recognised Groups in AHPs across the South West. In its first phase, 66 AHPs and AHP support workers contributed by sharing their perspectives on which groups in AHPs were under-recognised and what barriers and enablers existed for those groups when progressing their research careers. Although the team saw 190 AHPs and AHP support workers express an interest to participate, it was revealed that only 4.5% were from a Black, Asian, and Minoritised Ethnic background. Therefore phase two is underway which is working specifically with this group to ensure a diversity of voice within the findings.

Her other current project takes an evidence-based approach to upskilling therapy assistants in the assessment of stroke admissions—of note is the utilisation of the Calderdale Framework for this project. The Calderdale Framework is a workforce transformation tool developed in the UK which focuses on managing safe and effective workforce re-design within multi-disciplinary teams, particularly in the context of allied health services.

What was the ‘pivot’ moment that made you want to move into research? And how did that lead to the ‘Advancing Research Careers for Under-Recognised Groups in Allied Health Professions (AHPs) Across the South West’ project?

I thoroughly enjoyed my research modules at university, undertaking a master’s module in parental and enteral nutrition, and investigating my clinical practice through audits and service evaluation. I have experienced incredible opportunities in strengthening my clinical, leadership and education pillars and therefore research was a pillar I wanted to explore more.

I noticed disparities in opportunities for AHPs to grow their careers across certain pillars of practice, and research seemed to be one of the more challenging career paths. While navigating my own allied health career, I realised how the opportunities I was seeking lacked job security, and required me to work outside of contracted hours and contribute to voluntary roles whilst working on continuing professional development (CPD) modules.

This often left me sacrificing elements of my social life and anxiously looking for the next job; there were privileges that allowed me to do this. For example, I don’t have caring responsibilities, I have a partner who is in a secure job, and I have family nearby that I could stay with while securing further work if needed. I could see the inequalities that the system lent to AHPs without those privileges.

So when a National Health Service (NHS) England-funded project role was advertised looking at ‘advancing research careers for under-recognised groups in AHPs across the South West’, I instantly applied as it combined two areas of passion and importance to me: developing the South West AHP workforce across all pillars of practice, and most importantly; making sure opportunities were equitable, especially for under-recognised groups.

And how has ‘Advancing Research Careers for Under-Recognised Groups in Allied Health Professions (AHPs) Across the South West’ been progressing?

Community for AHP Research (CAHPR) South West team
Left to Right- Jessica Coggins, Katie Williams, Dr Jen Pearson presenting the CAHPR project at the regional ‘Developing a Research Skilled Workforce Conference’ Plymouth November 2023.

Phase one was extremely successful as we, the Council for Allied Health Professions Research (CAHPR) South West team, engaged with 190 AHPs who expressed an interest in our project.

We utilised purposive sampling to ensure all 14 allied health professions as determined by the NHS England website, all seven systems of our region, and a range of service types and career stages were included in our project sample. We utilised focus groups to work with our South West workforce to understand who they believed were the under-recognised groups, and what the barriers and enablers were for those groups in advancing their research careers.

We secured further funding to carry out phase two, which is working with our AHP colleagues from a Black, Asian and Minority Ethnic background. We are working with key link champions in our regional equity, diversity and belonging (EDB) committee to utilise network sampling techniques to improve our engagement with this group in phase two. We are working with a researcher with lived experience to lead virtual individual conversations to ensure we are working towards a safe environment for participants. Additionally, we are ensuring that this is not just an extraction exercise, but we are linking with regional EDB champions to understand how it can be mutually beneficial for the participants.

This project is being fed into other UK-wide projects to ensure the recommendations are utilised to shape future policy.

Tell us about your other project, upskilling therapy assistants to work to the top of their scope in assessing minor strokes, utilising the Calderdale Framework.

I was fortunate to be offered a training place on the Calderdale facilitator training course which seeks to train individuals in applying a systematic method of reviewing a skill mix within a service to ensure each individual is working to the top of their scope to provide maximum productivity while maintaining the best and safe care for patients.

The framework empowers and engages clinicians to co-design and co-produce all elements of the change to ensure sustainability.

We are utilising the framework to provide an opportunity for stroke therapy assistants to work to the top of their scope in assessing minor strokes. The aim is to provide the assistants with increased job satisfaction and autonomy in their practice and to ensure the registered workforce is strengthening delegation skills that allow them to focus on more complex tasks. Additionally, patients admitted with minor strokes are assessed and discharged more quickly to optimise patient flow.

Key learnings so far:

  • Calderdale Framework 2
    Calderdale Framework: North Bristol Trust Stroke Therapies Clinicians idea-storming

    Identify champions: Identifying key champions within the team will help to sustain engagement. For our project it was the OT and PT lead who supported engagement through the utilisation of internal communication channels such as WhatsApp to ensure regular communication, circulating crucial documents and supporting the team with queries outside of the workshops. Without the link champions driving the change, the project wouldn’t have had the same outputs, so you need to understand their motivators and work with them from the start.

  • Regular communication: Our clinicians are working extremely hard to see the rising number of complex admissions and our project was rolled out through winter pressures. Therefore, regular communication via the link champions and regular updates to the Chief AHP and professional leads was key in ensuring engagement during interim periods.
  • Curiously challenge: The initial sessions saw the team analysing their service as it ‘currently is’ and idea-storming which tasks are currently being carried out by registered members of staff that could be delegated to the therapy assistants. These conversations required a safe space where the team felt they could be honest and brave to voice suggestions. Sometimes a long pause is okay, it’s just the team processing the idea of change and it’s okay to sit with the silence for a little while, as uncomfortable as that can feel. These conversations and silences can generate the best innovation and change ideas.
  • Present leadership: While virtual working is fantastic, especially for our large region with rural and coastal communities, meeting the team in person helped build the strong relationships and trust needed for this project. It was essential for me to demonstrate present leadership and to provide an open-door policy for the team to be able to email me or contact me for discussions where needed.
  • Be flexible: Health and social care settings are living environments as they are forever changing, developing and growing. Personally, that’s why I love leadership in this space as change
    Calderdale Framework 3
    Calderdale Framework: North Bristol Trust Stroke Therapies Clinicians idea-storming

    needs to be driven by clinicians, innovative and moving within the living environment. For example, due to room and time shortages we carried out the workshops in the therapies’ gym with no presentation equipment or desks but actually, sat together in a circle on the floor with tea and biscuits. While this was unplanned, the team fed-back that actually they found the gym setting more relaxing for them, as opposed to being in a corporate space. They believed it strengthened engagement and creativity. Therefore, if you can be open-minded, flexible and ride the project wave as it happens, I believe you will be successful in leading change. It’s important to understand how to stay in scope but still meet the needs of the ever-changing living environment the project exists in.

Do you think AHP academics are under-represented in leadership roles?

Yes, I do. One of the key findings from our project was that our AHPs colleagues feel under-recognised in comparison to their nursing and medical colleagues who have had historically clearer and protected clinical academic pathways.

I believe it is imperative that there is a more balanced representation within the leadership roles to ensure that those who are a part of strategic decision-making have a voice for our AHP workforce to continue to champion AHPs and provide visibility for the value AHPs can bring to research.

We do have hope in the South West, secondary to fantastic voluntary committees such as the CAHPR South West Consortium, which supports AHPs across our region to connect and raise awareness of fantastic initiatives being offered by institutions such as the National Institute of Health Research (NIHR) UK and smaller, local schemes. AHPs within the South West are incredibly committed to supporting each other to develop and we believe that by continuing to connect, reviewing our inclusivity and championing those who feel under-recognised, we will continue to grow our AHP academic workforce and thus provide experiences to gain those leadership opportunities.

Leadership can be interpreted variously in the allied health context. What does ‘leadership’ in allied health mean to you?

I define a leader as an individual who can inspire, guide and influence others collaboratively and compassionately with bravery, openness and transparency.

I strongly believe that leadership is not defined by someone’s role title or pay bracket. Some of the best engagement and project outcomes we have achieved have been led by AHP therapy assistants driving change upwards in their organisations. I was fortunate enough to undergo the NHS Leadership Academy ‘Rosalind Franklin Leadership’ training programme. For me this was invaluable as a leader across a system where I work with new teams regularly, as the training allowed me to reflect and understand my own internal bias and reflect continually on what it’s like to receive my leadership. This has strengthened my ability to empathise and ensure I am compassionately leading teams and individuals who are able to drive change within their trusts.

Have you been following the Scope of Practice Review in Australia, and if so, what are your thoughts on that?

Yes, I have. I think this is a crucial piece of work for our allied health colleagues to understand where they can collaboratively provide the best care for patients by working to the top of scope and expanding their skill set.

I have found the feedback to the review interesting regarding concerns of fragmented care and identifying individual tasks instead of care as a whole. I believe it is incredibly important to understand those concerns and to openly and honestly discuss the risks of staying ‘as is’ versus the risks of extending scope of practice.

For example, in the Calderdale project we worked through a decision table with the clinicians to understand where the risks were and how to mitigate them. Through scoring the risks we were then able to identify if it would be safer to continue the service as it was or to extend the therapy assistants’ scope of practice.

I believe by exploring risk and demonstrating how mitigating practices can reduce likelihood and harm, it may help build the trust between stakeholder colleagues to instil confidence in extending AHPs’ scope of practice. I am going to continue following the review and I look forward to the publishing of the third paper.

Do you feel that advanced allied health practitioners could be better utilised in primary care settings?

Absolutely, I believe we should be harnessing the diverse and unique skills and expertise that AHPs can offer.

Our allied health colleagues could be utilising these valuable skills, expertise, and holistic understanding of patient care to an even greater extent in primary care, especially regarding healthcare inequalities. Through collaboration with general practitioners, I strongly believe our allied health colleagues can support the strategy to move care closer to home and enhance the overall quality, continuity, and efficiency of care delivery. However, where there is an opportunity to upskill and extend a clinician’s scope of practice, I believe supervision, mentorship and peer networks are essential. While some may view this additional support as a burden, I believe this will only further develop mentorship and leadership skills within primary care and should be viewed positively.

If primary care AHP colleagues’ scope of practice can be extended to encompass more assessing, diagnosing, scanning, counselling, prescribing and referring, it not only benefits the patients served but it can help address healthcare workforce shortages, improve job satisfaction, retention and support recruitment into primary care.

Connect with Katie Williams on LinkedIn, follow her on Twitter, or reach out directly.