Downie Sharon, Gavaghan Belinda, D'Atri Megan, McBride Liza-Jane, Kirk-Brown Andrea, Haines Terry P
The Royal Children's Hospital, Melbourne, Victoria, Australia.
Executive Health Management PhD Candidate, Monash University, Melbourne, Victoria, Australia.
Int J Health Plann Manage. 2025 Jan;40(1):130-155. doi: 10.1002/hpm.3850. Epub 2024 Oct 3.
Health workforce supply is critical to ensuring the delivery of essential healthcare and may be enhanced via mechanisms which alter the scopes of practice of health professions. The aim of this paper is to study the collective perspectives of allied health decision-makers on factors which influence their development and implementation of advanced and extended scope of practice initiatives, and how they contribute to scope of practice change. The reasoning for the selection of each factor will also be examined.
A grounded-theory, qualitative study of the experiences of allied health directors and senior managers across two Australian State/Territory jurisdictions.
Twenty allied health decision-makers participated in the study. Data coding of interview transcripts identified 14 factors specific to scope of practice change, spanning rational (n = 8) and non-rational (n = 6) decision-making approaches. Leadership, Governance, Needs of organisational leaders, Resourcing, Knowledge, skills & experience - clinical, Supporting resources, Knowledge & skills - change and Sustainability were identified as being rational and enabling in and of themselves, with Leadership seen as being most influential. Comparatively, the non-rational factors of Socio-economic & political environment, Perceived patient need, Organisational environment, Change culture & appetite, Perceived professional territorialism and Actual professional territorialism were more varied, and primarily influenced the timing/catalyst and application of decision-making. The complex interplay between these factors was conceptually represented as a decision-making construct.
Allied health decision-makers hold a complex, systems-level understanding of scope of practice change. Whilst rational decision criteria were predominant and seen to enable scope change, non-rational influences reflected greater variation in decision timing/catalyst and application, thus emphasising the human dimensions of decision-making. Further research is required to better understand how decision-makers integrate and weight these decision-making factors to determine their relative importance and to inform the development of structured decision tools.
卫生人力供应对于确保提供基本医疗保健至关重要，可通过改变卫生专业人员执业范围的机制来加强。本文旨在研究联合健康领域决策者对影响其制定和实施高级及扩展执业范围举措的因素的总体看法，以及这些因素如何促成执业范围的变化。还将考察选择每个因素的理由。
对澳大利亚两个州/地区辖区的联合健康领域主任和高级管理人员的经验进行基于扎根理论的定性研究。
20名联合健康领域决策者参与了该研究。对访谈记录的数据编码确定了14个特定于执业范围变化的因素，涵盖理性（n = 8）和非理性（n = 6）决策方法。领导力、治理、组织领导者的需求、资源配置、知识、技能与经验 - 临床、支持资源、知识与技能 - 变革以及可持续性被确定为本身具有合理性且能起到推动作用的因素，其中领导力被视为最具影响力。相比之下，社会经济与政治环境、感知到的患者需求、组织环境、变革文化与意愿、感知到的专业领地意识以及实际的专业领地意识等非理性因素则更为多样，主要影响决策的时机/催化剂和应用。这些因素之间的复杂相互作用在概念上被表示为一个决策构建体。
联合健康领域决策者对执业范围变化有着复杂的、系统层面的理解。虽然理性决策标准占主导地位且被视为能够促成范围变化，但非理性影响在决策时机/催化剂和应用方面反映出更大的差异，从而突出了决策的人为因素。需要进一步开展研究，以更好地理解决策者如何整合和权衡这些决策因素，以确定它们的相对重要性，并为结构化决策工具的开发提供参考。
