Jiminy Cricket and Innovations in Allied Health
The notion of change in allied health, and for that matter in health, is not new. Health professionals, including allied health professionals, are required to change what they do and how they do it regularly. There are a number of drivers for these changes including demographics of the workforce and patients, changing work patterns and mobility, emerging models of care, evolving evidence base to justify and underpin health care service delivery, fluctuating funding opportunities, the move towards patient-centred care and the continual need to improve quality and safety of health care.
Recognising these drivers for change in allied health has recently brought about several new initiatives which have been proposed and trialled. Examples of these initiatives include the expanding role of allied health assistants, the advanced and extended scope of practice for allied health professionals, and the overt role of allied health professionals in multidisciplinary and trans-disciplinary health care services. While many of these initiatives start off quite well, driven by passionate and committed allied health professionals on the ground, it is unclear if they are sustained (or were even sustainable to start with), and if so what outcomes these initiatives actually achieve. As someone who is passionate about improving the quality and safety of health care, I often wonder why these initiatives, despite starting off well, are often not sustainable and are underpinned by weak evidence. Part of the reason for this could be due to a lack of rigorous evaluation of clinical outcomes which can be difficult to capture and evaluate.
However, from my experience of being an evaluator on some of these initiatives, it has become increasingly clear that there are some important constructs that need to be considered prior to, during and after the implementation of these innovations in allied health. To some extent, these constructs are like Jiminy Cricket, the comical and wise partner of Pinocchio, who accompanies him throughout his adventures and serves as his official conscience. Outlined below are the constructs which, from my experience, are important to consider when considering innovations in allied health.
One of the first constructs that requires consideration and reflection is the readiness for innovation. While there may be many drivers for innovation, these drivers may be extrinsic to the local context and may not reflect the needs and requirements of the local context (“on the ground”). Therefore, readiness for innovation, taking into account local context and drivers is essential. Any innovation requires identification and engagement of key stakeholders. In the health care context, an important stakeholder is staff. Individual staff members need to be engaged early on, and communicated with, throughout the process. Equally important is the need for credible and strong leadership locally. Local leaders and change champions are required to address potential hurdles, build relationships and networks and communicate the importance of the new innovation. As with any change, it is imperative allied health innovation is underpinned by dedicated resources, targeted support and carefully planned implementation process. Often these constructs are inadequately considered, leading to adverse impact on the overall innovation itself, both in the short term and in the long term. Ensuring that local stakeholders (be they staff, administrators, funders) have ownership over the innovation will help in canvassing ongoing support and commitment as it is considered to be locally driven (rather than externally driven). Once the innovation is in place, it is important to demonstrate, through regular collection and sharing of evidence of outcomes, the impact of the innovation. If the outcomes are positive, they act as drivers to continue the innovation and if not, they provide opportunities for reflection and modifications. Through regular monitoring and fine tuning, the innovation can evolve to reflect the locally changing contexts.
The constructs outlined above are by no means exhaustive. There is a significant body of evidence to inform implementing change and innovation in health care. However, in allied health recognition for, and the importance of, these constructs seem to be missing. Without such recognition, well intentioned and crucially needed innovations in allied health are at risk of not being sustainable and not having the intended impact. Just as Jiminy Cricket helped Pinocchio, reflecting on these constructs can also assist in the success and sustainability of innovation in allied health.
Kumar S. Jiminy Cricket and Innovations in Allied Health. The Internet Journal of Allied Health Sciences and Practice. 2011 Jul 01;9(3), Article 3.