Workforce Redesign Research Articles

Boosting hospital falls prevention using health assistant staff alongside usual care

ObjectivesPatient education is crucial for preventing hospital falls, yet workforce constraints can hinder targeted delivery. Utilising supervised healthcare assistants can enhance standard care. This study sought to understand factors that impact the feasibility of supplementing usual care with patient falls education delivered by supervised allied health assistants. MethodsIn a qualitative study nested within a randomised controlled trial, focus groups and interviews were conducted with twelve health assistants, seven allied health professionals and two managers from the participating hospital. This elicited insights on barriers and facilitators to implementing workforce redesign to deliver tailored patient falls education. An inductive approach was used to thematically analyse the data. ResultsThree key themes emerged: (i) it was feasible for health assistants to deliver hospital patient education; (ii) patients engaged with hospital falls prevention education delivered by assistants; (iii) hospital workforce redesign can be successfully implemented provided there is system-wide buy-in. ConclusionsHealth assistants can be trained to successfully deliver hospital falls prevention education provided they have adequate supervision, training, and resources. Practice implicationsSustained implementation requires dedicated staffing hours for service delivery and staff education.

The Deployment and Utilization of the Allied Health Professions Support Workforce: A Scoping Review.

The demand for healthcare services internationally continues to increase, exacerbated by patient backlogs resulting from the COVID-19 pandemic and the difficulties in recruiting and retaining healthcare staff. These difficulties have led to increased interest in workforce redesign, and the upskilling of existing staff in all areas of healthcare, including within the Allied Health Professions (AHP). Clinical support staff are a key component of workforce redesign, yet little has been documented on the utilization of this workforce across the wide range of professions that collectively form the AHP workforce. Existing research is also unclear due to the variety of titles used to describe them (eg, allied health assistants, therapy assistants, etc). This study aimed to review how Support Workers and Assistant Practitioners (SWAPs) are utilized within the AHP professions. Electronic databases (MEDLINE, CINAHL complete, Scopus, and Google Scholar) were searched to find English Language primary research articles that explored the deployment of clinical support staff within Allied Health. Following the scoping review methodology, data from each study were analyzed in terms of design, key findings, and implications. A quality assessment was also completed. Thirty-nine articles met the eligibility criteria. Studies were undertaken in Australia, UK, and USA, and covered a range of AHPs and methodological approaches. Most articles employed qualitative methods, with highly variable research quality identified. Key findings were that cost-effectiveness of this workforce has not been formally evaluated in any setting or AHP discipline, and that support workers are a largely underutilized staff group potentially due to inconsistencies in their deployment and scope of practice, and the lack of a clear career pathway. Rigorous, quantitative, and mixed methods research into the deployment and impact of this staff group is needed in order to gain a clearer understanding of how they are optimally utilized across the different AHP disciplines.

Preventing hospital falls: feasibility of care workforce redesign to optimise patient falls education.

To examine the feasibility of using allied health assistants to deliver patient falls prevention education within 48h after hospital admission. Feasibility study with hospital patients randomly allocated to usual care or usual care plus additional patient falls prevention education delivered by supervised allied health assistants using an evidence-based scripted conversation and educational pamphlet. (i) allied health assistants and (ii) patients admitted to participating hospital wards over a 20-week period. (i) feasibility of allied health assistant delivery of patient education; (ii) hospital falls per 1,000 bed days; (iii) injurious falls; (iv) number of falls requiring transfer to an acute medical facility. 541 patients participated (median age 81years); 270 control group and 271 experimental group. Allied health assistants (n = 12) delivered scripted education sessions to 254 patients in the experimental group, 97% within 24h after admission. There were 32 falls in the control group and 22 in the experimental group. The falls rate was 8.07 falls per 1,000 bed days in the control group and 5.69 falls per 1,000 bed days for the experimental group (incidence rate ratio = 0.66 (95% CI 0.32, 1.36; P = 0.26)). There were 2.02 injurious falls per 1,000 bed days for the control group and 1.03 for the experimental group. Nine falls (7 control, 2 experimental) required transfer to an acute facility. No adverse events were attributable to the experimental group intervention. It is feasible and of benefit to supplement usual care with patient education delivered by allied health assistants.

The Postpandemic Nursing Workforce: Increasing Fill Rates and Reducing Workload Through a Generational Design of Workforce Layers.

Inequities between nursing workforce supply and demand continue to challenge nurse executives in creating the vision for a postpandemic nursing workforce. Health system's workforce redesign strategies must prioritize the changing needs of the multigenerational workforce to maximize the available supply of nurses willing to remain in the workforce. A test of a newly designed flexible workforce framework, aimed to meet the needs of the multigenerational workforce, resulted in increased fill rates and decreased costs of labor.

Speech pathology prescribing in the outpatient setting: A review of requirements, considerations and barriers.

As health systems face increasing demands, non-medical prescribing is a workforce redesign strategy adopted within some services. Despite successful implementation in other professional groups, non-medical prescribing within speech pathology (SP) has not yet been described. To provide a descriptive account of the development and planned implementation of two SP prescribing models. The evolution of two SP-led prescribing models, including relevant training and credentialing, for use of (1) nystatin oral drops (100,000 units/mL); and (2) lidocaine (lignocaine) and phenylephrine nasal spray (5mg/500μg/spray), in the outpatient setting is detailed. Challenges to implementation are outlined. The development of relevant governance structures, a research evidenced-based project evaluation framework, and an overview of training pathways and credentialing was successfully completed. However, implementation of the models was unable to be achieved. A thorough review of the requirements and a discussion of contextual considerations that had a negative influence on the implementation of SP-led prescribing within this specific service context is provided. The successful implementation of SP-led prescribing is complex and highly context dependent. This work offers a discussion and review of the complexities of introducing a non-medical prescribing model in an outpatient hospital setting. What is already known on the subject Allied Health prescribing is an emerging practice area aiming to reduce current pressures on health services. SP-led prescribing has not been thoroughly investigated in the Australian context. What this study adds to existing knowledge This study describes the development of a SP-led prescribing process in the outpatient setting, and a thorough review and discussion of the drivers and barriers to the model's implementation. What are the potential or actual clinical implications of this work? The successful implementation of SP-led prescribing was identified to be complex from a legislative and operational perspective, as well as being highly context dependent. This study further highlights the importance of a thorough context evaluation and workflow mapping prior to full-scale implementation of SP prescribing trials.

The role of intermediaries in US workforce and education innovation

Intermediaries are specialised organisations that perform bridging and integrative functions to achieve improved results of social policies. Intermediaries have been most effective in the United States (US) when aligned with education and workforce system improvements and redesign, not as parallel and separate efforts. Intermediaries operate in many US social policy domains, including workforce and education, where they contribute to overcoming fragmented institutions and solving mismatch problems that interfere with hiring, career pathways and educational achievements. Intermediary solutions are especially important for creating better outcomes for low-income students and workers and improving overall racial and ethnic equity. Five mismatches especially prevalent in the US labour market require intermediary solutions: organising business to improve human resources, creating improved pathways from school to work, integrating and focussing multiple education investments, linking workforce and economic development, and improving access and use of data for design, performance management and advocacy. This paper discusses these mismatches and related intermediary solutions in more depth, offers examples of specific intermediaries in action and identifies intermediary challenges and opportunities faced by intermediaries to function better. The paper also points out that, more broadly, intermediaries are only a part of the solution to labour market and education inequalities and that broader changes in the political economy and policies are required to effect wage growth and labour market participation.

The clinically led worforcE and activity redesign (CLEAR) programme: a novel data-driven healthcare improvement methodology

BackgroundThe NHS is facing substantial pressures to recover from the COVID-19 pandemic. Optimising workforce modelling is a fundamental component of the recovery plan. The Clinically Lead workforcE and Activity Redesign (CLEAR) programme is a unique methodology that trains clinicians to redesign services, building intrinsic capacity and capability, optimising patient care and minimising the need for costly external consultancy. This paper describes the CLEAR methodology and the evaluation of previous CLEAR projects, including the return on investment.MethodsCLEAR is a work-based learning programme that combines qualitative techniques with data analytics to build innovations and new models of care. It has four unique stages: (1) Clinical engagement- used to gather rich insights from stakeholders and clinicians. (2) Data interrogation- utilising clinical and workforce data for cohort analysis. (3) Innovation- using structured innovation methods to develop new models of care. (4) Recommendations- report writing, impact assessment and presentation of key findings to executive boards. A mixed-methods formative evaluation was carried out on completed projects, which included semi-structured interviews and surveys with CLEAR associates and stakeholders, and a health economic logic model that was developed to link the inputs, processes, outputs and the outcome of CLEAR as well as the potential impacts of the changes identified from the projects.ResultsCLEAR provides a more cost-effective delivery of complex change programmes than the alternatives – resulting in a cost saving of £1.90 for every £1 spent independent of implementation success. Results suggest that CLEAR recommendations are more likely to be implemented compared to other complex healthcare interventions because of the levels of clinical engagement and have a potential return on investment of up to £14 over 5 years for every £1 invested. CLEAR appears to have a positive impact on staff retention and wellbeing, the cost of a CLEAR project is covered if one medical consultant remains in post for a year.ConclusionsThe unique CLEAR methodology is a clinically effective and cost-effective complex healthcare innovation that optimises workforce and activity design, as well as improving staff retention. Embedding CLEAR methodology in the NHS could have substantial impact on patient care, staff well-being and service provision.

Compression garment service model: Facilitating access to compression garments through workforce and service redesign.

Patients in Queensland have had difficulty in accessing lymphoedema services, particularly in rural and remote locations. The aim was to trial and evaluate a compression garment service model, to provide care for patients with lymphoedema closer to their homes. The service model trialled compression garment, selection, fitting and monitoring services for stabilised malignancy-related lymphoedema undertaken by generalist therapists. Ten Hospital and Health Services in the Queensland public sector. The patients would have access to safe, quality services closer to their homes. The generalists were supported by telehealth coaching and supervision by lymphoedema therapists, an education program, resources and governance processes. Compression garment selection, fitting and monitoring by generalists (physiotherapists and occupational therapists without Level 1 Lymphoedema training), as defined in the service model, was safe, effective and evaluated positively by patients and health professionals. There was increased access to compression garment services provided by generalist therapists in rural and remote locations. The service model implemented has the capacity to address workforce and service provision issues. It provides resources, education and training for clinicians to improve access to the provision of compression garment services.

Combining Integration of Care and a Population Health Approach: A Scoping Review of Redesign Strategies and Interventions, and their Impact.

Background and aim:Many health systems attempt to develop integrated and population health-oriented systems of care, but knowledge of strategies and interventions to support this effort is lacking. We aimed to identify specific redesign strategies and interventions, and to present evidence of their effectiveness.Method:A modified scoping review process was carried out. Fifteen relevant examples of integrated care organizations that incorporated a broad population health approach in countries of the Organization for Economic Cooperation and Development described in 57 articles and reports were included in analysis.Results:Seven key redesign strategies and multiple redesign interventions have been identified and are described. Most commonly used redesign strategies included focusing on health and wellness, embracing intersectoral action and partnerships, addressing health in vulnerable groups, and addressing a wide range of determinants of health, including making improvements in health services. Redesign interventions included creative and innovative ways of addressing clinical and non-clinical issues such as establishing housing surgeries in primary care, establlishing vast social and provider networks to support patients with complex needs and also broadening of the scope of services, workforce redesign and other. Potential reductions in the utilization of care and costs could be derived by the wider adoption of these strategies and interventions.Conclusion:Development of integrated and population health-oriented systems of care requires the redesign of how services are organized and delivered, and how organizations and care systems operate. Combining integration of care with the population health approach can be supported by a set of cohesive strategies and interventions aimed at preventing disease, addressing social determinants of health and improving health equity at both population- and individual-level.

An inter-professional advanced practice approach to Frailty @ the front door; optimising outcomes for patients with frailty through workforce re-design

Purpose: To respond to the increasing number of frail older adults and the complexities of their presentation (Clegg et al, 2013), a diverse and advancing skill set is required (BGS, 2017). Service redesign was undertaken to transform the workforce to improve patient experience in patients presenting with frailty by providing alternative pathways to acute admission and supporting patients as close to home as possible, using a patient centred approach. The team promptly recognises deterioration of the older adult and ensures appropriate pathways are identified for patients who require acute hospital care.

Evaluation of the State-Wide Implementation of an Allied Health Workforce Redesign System: Utilisation of the Calderdale Framework

Background: Increasing demand for allied health services is driving workforce redesign towards greater productivity within budgetary constraints. To date, there has been limited research into workforce redesign tools at an organisational level. The aim of this article was to evaluate an implementation of The Calderdale Framework for state-wide service delivery workforce redesign within allied health settings across Queensland.
 Method: A multi-phase methodology with mixed methods of data collection was used. This included analysis of documents, staff surveys, and semi-structured, in-depth interviews with staff from work units utilising the Framework across the state.
 Findings: The primary mechanisms for implementation were staff training and provision of centralised resources. Across the state, all health services engaged in training and most completed associated workforce redesign projects. However, the number and type of projects varied across the state as did the successful projects. Feedback from staff indicated the structured nature of the framework was viewed positively, but was time intensive to perform. Local contextual factors heavily influenced workforce redesign success.
 Conclusion: Key factors pertaining to state-wide workforce redesign include: providing coordinated and centralised systems to support staff, ensuring adequate training, prioritising the development of key local staff, and proactively managing local contextual factors.

Its not, me it’s you! - Integrated systems and workforce re-design

Background: As experienced in the rest of the world, Australia’s largest limiting factor is not lack resources but, rather the lack of an organizing principle that can link funding, people, technology and ideas into a system that delivers more cost-effective care. This is evidenced by current research which indicates neither organisational integration alone, nor government direction in the integrated delivery systems space will bring the type of change at the pace and scale required to transform our health system into what it needs to be in the future.Aims and Objectives: The way forward is to gain consensus of the key building blocks for systems thinking and analysis.This workshop offers a solution by demonstrating the Netherland’s conceptual framework for integrated care (based on the integrated functions of primary care), combined with Skills for Care (UK’s adult social care workforce design framework), and interprets these as a direction for integrated multi-level systems analysis and workforce re-design.This workshop will raise delegates awareness, capacity and capability for sustainable workforce development by using horizontal and vertical integration elements across each level of the system in order for workforce and client to be developed and integrated in synergy with the system.Format:Section 1: 30 minsOverview of the principles of workforce redesign (speaker delivery)The principles of workforce integration for health and social care (speaker delivery)Section 2: 30 minsInteractive experience using tools to link funding, technology, people and infrastructure into a cohesive force (interactive exercise)Section 3: 30 minsTools and methodology to manage the people side of change (interactive exercise)Note: this workshop is 90 mins but can also be a can be a full day or half dayTarget Audience: This workshop is suitable for health professionals operating at any level in our health system. Delegates will be exposed to a range of tools and methodology used to bring people together from across the whole system to co create and co-design new ways of working.Learnings/Take away:- Coordinating patient centred care requires a commitment and a cultural shift to improving working relationships within and across organizations.- Redesigning a workforce to provide integrated care is complex, adaptive and ever evolving; it takes time to mature- Re-designing the workforce to become more patient-centred requires:early involvement of people, those receiving and those delivering care, in the re-design processMeasuring the progressBetter understanding of integrationUnderstanding integration is everybody’s responsibility- Urgent need for a central framework design and implementation of integrated systems of care- Champions play key roles in promoting shared values and enabling buy in at all levels- Combined leadership creates a supportive cultural for workforce re-design and integrated care

Beyond the legislation- investing in sustainable transformation

Introduction: From April 2015, landmark legislation in Scotland established 31 new integrated health and social care organisations[1]. The Public Bodies (Joint Working) (Scotland) Act (2014) required NHS Boards and Local Authorities to establish one of two organisational models by April 2016. Each integration authority, with their health, social care and housing providers, community partners, patients, carers and service-users, developed a strategic plan and is using an integrated budget to commission the range of integrated services and community support to improve local population health. This paper discusses the critical capacity building support required to enable progress towards integrated care at scale. Description: Each new Integration Authority oversees an integrated budget of more than 60% of the health and social care resources, including all adult social care, adult primary and community health care, and some aspects of adult hospital care. Local progress is being measured through nine health and wellbeing outcomes supported by a suite of 23 indicators that track activity, resources and care experience. Targeted population: Local integration of adult community health and social care services with the option to include children’s health and social care services, criminal justice social work and housing support. Highlights: Capacity building to enable progress in implementing integrated care includes: Additional local analytical capacity to inform commissioning decisions and to make progress in linking health and social care data. Ringfenced funding of £300 million to enable investment in preventative supports and new models of anticipatory care and person centred care in the community. Technology Enabled care programme that has enabled over 25,000 more citizens to live safely in their own home, monitor their health at home and /or access specialised services remotely. A collaborative leadership programme and action learning to support practitioners to build new relationships and design new models of integrated care. Community intermediate care and advanced practice models that have enabled older people to spend around 3 million more days at home than would have been expected based on previous institutional care rates. Transferable lessons: Introducing new models of integrated care has been enabled by a new GP contract and development of enhanced interdisciplinary practice in primary care, supported by education and leadership programmes on people centred integrated care, including a new Masters programme. Progress on data sharing has been slower and a fully integrated electronic record remains elusive. Conclusions: Implementation of integrated care at scale is a long game requiring enabling supports across all dimensions of integration. Legislation, structural and financial integration have built a strong foundation for transformation but continuing support for leadership, workforce redesign, professional and functional integration remain priorities if we are to make integration 'business as usual'.

Exploration of an allied health workforce redesign model: quantifying the work of allied health assistants in a community workforce.

The Victorian Assistant Workforce Model (VAWM) enables a systematic approach for the identification and quantification of work that can be delegated from allied health professionals (AHPs) to allied health assistants (AHAs). The aim of the present study was to explore the effect of implementation of VAWM in the community and ambulatory health care setting. Data captured using mixed methods from allied health professionals working across the participating health services enabled the measurement of opportunity for workforce redesign in the community and ambulatory allied health workforce. A total of 1112 AHPs and 135 AHAs from the 27 participating organisations took part in the present study. AHPs identified that 24% of their time was spent undertaking tasks that could safely be delegated to an appropriately qualified and supervised AHA. This equates to 6837h that could be redirected to advanced and expanded AHP practice roles or expanded patient-centred service models. The VAWM demonstrates potential for more efficient implementation of assistant workforce roles across allied health. Data outputs from implementation of the VAWM are vital in informing strategic planning and sustainability of workforce change. A more efficient and effective workforce promotes service delivery by the right person, in the right place, at the right time.

Nurse practitioners and pharmacist prescribers in primary health care: A realist evaluation of the New Zealand experience

Introduction: A key component of achieving integrated care for patients is to improve use of health providers by reorienting models of care. Developing advanced practitioner roles, as part of workforce redesign, offers potential solutions to burgeoning demands on health systems. In New Zealand, original policy objectives for advanced practitioner roles sought improved quality of patient care and service access. Currently, the uptake of training and employment of nurse practitioners and pharmacist prescribers (advanced practitioners) is not meeting policy makers’ expectations. New Zealand-specific research on advanced practitioner role development is limited, making informed implementation of these roles difficult. This research offers the first rigorous evaluation of New Zealand nurse practitioner and pharmacist prescriber development in primary health care to inform better policy and practice decisions. This presentation focusses on contextual factors within policy and practice that affect the development of advanced practitioner roles. Theory/ Methods: This research follows a realist evaluation methodology. Realist evaluations generate, test, and refine theories of how programmes work within contextual constraints. This research involves semi-structured interviews with policy and training stakeholders, nurse practitioners, pharmacist prescribers, general practitioners, and patients. Further information supporting these interviews derives from (1) reviews of documents on specific advanced practitioner roles and (2) field notes. Results: Key contextual factors (such as funding, legislation, and responsiveness to change) affecting advanced practitioner role development exist within three domains: (1) policy creation, (2) role creation, and (3) role realisation. Preliminary results are that in each of these domains there is poor understanding and recognition of these advanced roles. This has negatively affected practitioner training uptake and their employment as advanced practitioners. Discussions: This research examines processes by which nurse practitioner and pharmacist prescriber roles evolve within the complex and ever-changing New Zealand health system. Informed health professional deployment needs to take into account the impact context has on policy creation, role creation, and role realisation. Conclusions: Advanced practitioners operate in environments ill-equipped to gain full benefit from their employment. Improved understanding of their roles, funding supporting policy, and recognition by patients and health professions, can enhance role clarity, reduce legislative and operational barriers, and improve service delivery. This research widens the traditional health system focus to include factors influencing effective, efficient, and sustainable integrated care. Lessons learned: Effective health workforce redesign requires an appreciation of the interaction of many factors. Recognition of these influences may localise a problem and facilitate dialogue, furthering employment of all health professionals, and subsequently improving workforce skill-mix. Significant challenges remain in effectively developing advanced practitioner roles; these are outlined along with suggestions for tackling them. Limitations: Theories formulated from this research may require modification to reflect country-specific needs and resources. Suggestions for future research: Developing new health professional roles often occurs without evaluating the impact these roles have on patients or providers. Further research will improve clarity in role definitions and skill-mixes, leading to enhanced integration and realisation of practitioner potential. This should improve both quality and continuity of care for patients.

Paradoxical perceptions towards the introduction of assistants in speech-language pathology and potential impact on consumers.

Working with assistants has the potential to be an economically and professionally sustainable solution to workforce shortages in speech-language pathology. However, there is some resistance to the workforce redesign, and factors that determine how assistants are utilised are not well understood. The aim of this study was to understand the perceptions that engender professional resistance and identify factors that may lessen such resistance. Semi-structured interviews were conducted with 20 speech-language pathologists (SLPs) to learn about perceptions towards implementing assistants into the profession. While assistants were seen as augmenting existing capacity, findings demonstrated ambivalence towards their utilisation, with tension between perceived benefits and risks of SLPs utilising assistants. Sharing workload and reducing administrative duties in favour of increasing clinical output was an important positive perception. However, this perception was moderated by the concern that the introduction of assistants would result in a decrease in consumer focus, which was seen as being at odds with the strongly held values of the profession. Findings provide insight into professional acceptance of this vocationally trained group and highlight discrepancies between perceptions and actualities, both of which may influence how assistants are utilised. They suggest that implementation of a workforce redesign involving assistants may result in paradoxical perceptions among SLPs. Understanding the way SLPs think about working with assistants and how this workforce redesign may be realised will impact on how SLPs view their role and their relationships with co-workers. This understanding will also be useful in a wider sense for organisations seeking to introduce assistants, by allowing enhanced understanding of likely areas of resistance, as well as highlighting possible strategies that may be useful to address such issues.

The governing body nurse as a clinical commissioning group nurse leader.

Aim The aim of this study was to understand governing body nurses' perspective of their effect on, and leadership of, clinical commissioning groups (CCGs). Method Semi-structured face-to-face and telephone interviews were conducted with a sample of governing body nurses, CCG chairs and regional chief nurses. A total of 23 individuals were interviewed. Findings Governing body nurses were overwhelmingly positive about their role and believed they had a positive effect on the CCG governing body. Specifically, they provided leadership for the quality agenda and compassionate practice. Challenges experienced by some governing body nurses related to their capacity to undertake the role where this was on a part-time basis, time restraints and difficulties working with colleagues. Conclusion The role of the governing body nurse was not well defined when it was introduced, and as a result its development across CCGs has varied. Governing body nurses have used their leadership skills to advance important agendas for their profession, such as workforce redesign, new integrated care pathways and co-commissioned services.

Acceptance of primary practitioner physiotherapists in an emergency department: A qualitative study of interprofessional collaboration within workforce reform

ABSTRACTPrimary contact practitioner physiotherapists (PPs) are increasingly common in emergency departments (EDs) and provide targeted care to people with uncomplicated musculoskeletal conditions such as sprains, strains, and simple fractures. Workforce redesign can be challenging and success is influenced by staff attitude and opinion. The current study aimed to explore the experiences and perceptions of ED team members about a recently introduced PP service on existing staff and services in a large regional ED. Forty-two staff from eight professional groups participated in semi-structured interviews or focus groups which were audio recorded and field notes were taken. Data were transcribed verbatim and subsequently underwent thematic analysis. Acceptance emerged as one key theme. Acceptance of the PP service by ED staff was not automatic, unconditional, or implied and represented a continuum from PPs being tolerated as transient visitors to being subsumed as integrated members of the ED team. Acceptance of the service and its members was contingent upon the PPs demonstrating three interdependent qualities: being trustworthy, valuing learning, and complementing (not competing with) ED practices to achieve ED goals. Given that staff acceptance was crucial for the successful integration and performance of the service, understanding and manipulating the factors that influence acceptance might increase the likelihood of successfully implementing PP services in EDs. The results might also be applied to facilitate workforce reform in other settings.

Redesigning care delivery with patient support personnel: Learning from accountable care organizations

Accountable care organizations (ACOs) are a value-based payment model in the United States rooted in holding groups of healthcare providers financially accountable for the quality and total cost of care of their attributed population. To succeed in reaching their quality and efficiency goals, ACOs implement a variety of care delivery changes, including workforce redesign. Patient support personnel (PSP)-non-physician staff such as care coordinators, community health workers, and others-are critical to restructuring care delivery. Little is known about how ACOs are redesigning their patient support personnel in terms of responsibilities, location, and evaluation. We conducted semi-structured one-hour interviews with 25 executives at 16 distinct ACOs. The interviews were recorded, transcribed, and coded for themes, using a qualitative coding and analysis process. ACOs deployed PSP to perform four clusters of responsibilities: care provision, care coordination, logistical help with transportation, and social and emotional support. ACOs deployed these personnel strategically across settings (primary care, inpatient services, emergency department, home care and community) depending on their population needs. Most ACOs used personnel with the same level of training across settings. Few ACOs planned to conduct a comprehensive evaluation of their PSP to optimize their value. ACO strategies in workforce redesign indicate a shift from a physician-centered to a team-based approach. Employing personnel with varying levels of clinical training to perform different tasks can help further optimize care delivery. More robust evaluation of the deployment of PSP and their performance is needed to demonstrate cost-saving benefits of workforce redesign.

Building a sustainable workforce in a rural and remote health service: A comprehensive and innovative Rural Generalist training approach.

Historically it has been challenging to recruit and retain an appropriately trained medical workforce to care for rural and remote Australians. This paper describes the Queensland North West Hospital and Health Service (NWHHS) workforce redesign, developing education strategies and pathways to practice, thereby improving service provision, recruitment and retention of staff. The Mount Isa-based Medical Education Unit sought accreditation for a Rural Generalist (RG) training pathway from Internship to Fellowship with the Australian College of Rural and Remote Medicine (ACRRM) and the Regional Training Provider (RTP). This approach enhanced the James Cook University (JCU) undergraduate pathway for rurally committed students while improving recruitment and retention of RMOs/Registrars. Accreditation was achieved through collaboration with training providers, accreditation agencies, ACRRM and a local general practice. The whole pathway from ignore Internship to Fellowship is offered with the RG Intern intake as a primary allocation site beginning in 2016. Comprehensive supervision and excellent clinical exposure provide an interesting and rewarding experience - for staff at all levels. Since 2013 RMO locum rates have been <1%. Registrars on the ACRRM pathway and Interns increased from 0 to 7 positions each in 2015, with similar achievements in SMO staffing. Three RMOs expressed interest in a Registrar position, CONCLUSIONS: Appropriate governance is needed to develop and advertise the program. This includes the NWHHS, the RG Pathway and JCU.