One of the most common frustrations of allied health professionals—from all backgrounds—is the lack of career development pathways.
While this varies a little between disciplines and countries or states, one of the main reasons for this is that allied health professionals are already practicing in a niche field of practice, whether it is a focus on a specific philosophy of practice, way of working, body part, or treatment modality. While some disciplines may facilitate more specialised areas of practice (such as paediatrics, hand therapy, mental health, alcohol and drug therapies) few of these areas are ‘endorsed’ areas of specialisation either by the profesisonal body themselves or by a professional regulator (we describe specialisation in allied health in more detail in this book).
Some settings (particularly more acute settings, such as hospitals) facilitate the development of more specialist areas of practice, but many allied health professionals will work across a diverse workload.
This article looks at the supports employers can provide allied health professionals to ensure they have continued development within their role so they can provide the best care to their patients and community and continue to grow in their role in a way that adds the greatest value to your organisation.
1. Provide a clear career progression pathway
Ideally, all members of your team will have a clear understanding of the career progression pathways within your organisation and the steps required to get there. The NHS Agenda for Change Pay Scale is an example of a grading and pay system which is applied across every NHS employee except doctors, dentists and senior managers. Agenda for Change harmonises pay and career pathways for NHS employees. Agenda for Change is supported by a comprehensive Job Evaluation Handbook which provides a framework for job grading and benchmarking for all NHS roles.
Other large employers may have similar kinds of models, but they may be developed or supported at an organisation level, sometimes by a specific profession, and perhaps at a wider system (such as a state government) level of employment. A number of professional associations have undertaken and published information about career pathways for their professions. For example, the Australian Physiotherapy Association Physiotherapy Career Pathway , the Occupational Therapy Australia Scope of Practice Framework. The Victorian Department of Health and Human Services published the Allied Health Career Pathways Blueprint, which provides a framework for potential career progression that can be adopted by any allied health professional (and arguably other professions).
In some cases, progression occurs automatically over time. Normally some new level of competence will need to be demonstrated to move between different levels, but again this will depend on the organisation and potentially the profession.
Your development framework should be explicit and identify where your employee can grow within your organisation. Smaller organisations are less likely to have access to the formal career structures facilitated by the NHS, however by looking at existing frameworks either proposed by your profession or within your jurisdiction (e.g., state government departments of health) you can benchmark the level of expertise required within the role. Similarly, the growth and development opportunities available in a smaller organisation will be vastly different to those in a much larger organisation. Typically, in larger organisations, career hierarchies such as management and administration may be available. Larger organisations are also more likely to be able to offer diversity within the professional role itself because of a wider variety of clinical settings and options available.
Smaller organisations offer different options for career development, which may include the potential to specialise in a specific area of clinical practice or expertise; possibilities to grow in more entrepreneurial areas such as building new areas of practice (telehealth has spurred the growth of several new allied health business opportunities); greater opportunities to understand small business models and administration.
Access to research careers for allied health are patchy at best and funding and support vary widely across jurisdictions, however research is an important contributor both to the profession and individual development (for example, see this recent publication). Opportunities for career growth may arise from the implementation of quality improvement projects, knowledge translation and clinical education, although again, these normally require the support and infrastructure of a large organisation for implementation.
Provide a clear framework for progression so that your employee knows where they can progress to, exactly what is required for them to progress in their role, what progress looks like (in terms of a position description and potential pay), timeframes and / or milestones for progression, and so they can be supported in their progression.
2. Ensure a variety of work
Regardless of how niche an allied health role is, if the work is repetitious and boring, you risk losing your staff member. Arguably, if a role is highly repetitive and can be codified into a series of guidelines or a program, it could be delegated to an allied health assistant or another type of worker, freeing the allied health professional to focus on areas requiring higher order skills such as assessment or analysis.
Opportunities for variety come from more than just the clinical workload and can include a change of setting or the location of care; supervision, support or delegation to or from other workers; clinical audit, research and quality improvement activities; secondments to other roles within or across organisations; exchanges (allowing staff to work between different organisations); relief or locum work – allowing staff to backfill others’ workloads; preparing reports or other administrative responsibilities requiring allied health expertise; care coordination; triage and assessment; marketing and promotion of the service including social media or visiting other local practitioners; as well as providing opportunities for rotations through different types of roles.
Being able to offer variety in your clinical workload, and particularly opportunities for growth and learning, are a valuable differentiator of your role as an employer. Make those opportunities explicit in your job advertisement when you are recruiting and build them into your employee’s development plan as milestones to support their growth.
3. Provide access to opportunities to grow and learn
By providing a clear career progression pathway and a varied workload, you are already providing a rich environment to support the growth of your employees. However be on the lookout for explicit opportunities to support your employee development. This might include in-house training, case study presentations by members of your team, well-structured case-conferencing, a journal club, subscriptions to appropriate periodicals such as professional journals, a ‘big ideas’ forum where team members are invited to bring new and innovative ideas into the workplace, or conference attendance.
Foster an organisational culture that supports individual growth and learning. Sometimes this will require that your team members challenge existing ways of working and suggest new options. An environment that is supportive of growth is also a learning environment.
Who should pay for training?
One of the questions that is often posed by employers is ‘who should pay for employee training – and shouldn’t this be the responsibility of individual employees?’ In reality, most registered professions have ongoing professional development requirements for the profession to sustain their registration status, therefore there is an onus on individual employees to take responsibility for their own learning. However, in a highly competitive employment market with large workforce shortages, several employers provide explicit opportunities for training their workers, including a training budget and protected time to pursue training. You want to employ motivated individuals who will pursue their own learning and growth agenda, but it is also in the interests of your patients and your organisation to support this.
Won’t my staff leave?
A second concern of employers is that they invest time in developing their employees only to have the employee leave for another role. This is a real challenge in the workplace right now. Hopefully, by building a strong career progression pathway, you will have sufficient opportunities to entice your staff member to stay. However, if you have provided a strong training and support platform for your employees, the whole workforce benefits through improved capacity and expertise. You should also benefit through having good relationships with external providers, and be a competitive employer because of the excellent growth and development opportunities in your own workplace.
4. Ensure staff have access to support, supervision and mentorship to support progress
Appropriate supervision and support is necessary both to support the growth and learning of your employee, but in many cases it is also essential to minimise clinical risks. I have interviewed a number of allied health professionals who have started their own private practice soon after graduation only to realise that they are way out of their depth in terms of clinical work and also in terms of business management. A supportive environment ensures a clear line of accountability for management decisions (where appropriate), and access to support for clinical decision making. The need for supervision and support changes over the lifetime of every professional, but is no less important.
Several organisations have created supervision and support frameworks for allied health professionals, including the Victorian Allied Health Clinical Supervision Framework, The Superguide for allied health involved in supervising others, although a recent systematic review highlighted some of the limitations of allied health supervision frameworks while also providing an excellent summary of a range of internationally available supervision framework. There is also some good current research on the benefits of allied health supervision.
The supervision approach you use will be context and discipline specific. Each of the different supervision frameworks is based on slightly different principles, however, ensuring accessibility, accountability, consistency, and support for the supervisee are underpinning approaches.
Your employees are a valuable investment for your organisation—and generally the most costly investment your organisation makes. A little extra investment in your employees to ensure that they can continue to grow and learn within a safe and structured environment should support the best clinical outcomes, but also increase the likelihood of growth and retention of your workforce.