ESTABLISHMENT OF A CENTRAL ADELAIDE LOCAL HEALTH NETWORK ALLIED HEALTH LEADERSHIP STRUCTURE

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1 ESTABLISHMENT OF A CENTRAL ADELAIDE LOCAL HEALTH NETWORK ALLIED HEALTH LEADERSHIP STRUCTURE CENTRAL ADELAIDE LOCAL HEALTH NETWORK November 2013 November

2 1.0 INTRODUCTION Central Adelaide Local Health Network (CALHN) was established in July In keeping with the aim of greater involvement and leadership by clinicians, six clinical directorates were formed - Cancer, Critical Care, Surgery, Medicine, and Renal with Mental Health and Dental being added more recently. Each of these clinical directorates is developing a multiple sites model with appropriate governance and structures as outlined in Single Service, Multiple Sites Strategy (2012). The establishment of the Allied Health Directorate will consolidate existing Central Adelaide allied health departmental and teams structures into a single support directorate which will operate across all clinical directorates and strongly support clinical team development within the clinical directorates. For all allied health staff, the Allied Health Directorate will provide an essential professional link into the highest levels of the organisation. The leadership structure outlined in this document provides: opportunities to develop allied health leadership across all levels of the organisation opportunities for staff to move seamlessly across sites and services clear professional leadership to ensure supervision arrangements are in place a starting point for multidisciplinary team development, consistent with the clinical directorates. Once the leadership changes have been enacted, consideration and consultation will occur to determine the make-up of clinical teams. This will create an allied health team structure that has strong links with the clinical directorates further enabling patient focussed, team based care. It is anticipated that this will occur throughout Significant work on allied health leadership structures was commenced during and this work has been re-examined and tested with current leaders in allied health, medicine, nursing and administration to inform this proposal. Critical consideration has been given to the clinical directorate structures and nursing leadership structures to provide points of intersection across the multi-disciplinary team. The future of health care delivery will be increasingly interprofessional and allied health must be in a position to participate and lead these teams. November

3 2.0 KEY POINTS 2.1 The Central Adelaide Allied Health Directorate will operate as a single Central Adelaide clinical service with an Executive Director Allied Health reporting to the Chief Executive Officer Central Adelaide. 2.2 The Executive Director will have professional accountability for all allied health (AHP classified) staff for professional matters such as credentialing, scope of practice, supervision. 2.3 The Executive Director will have operational accountability for Allied Health staff contained within acute and sub-acute allied health discipline departments, and a range of other team-based care settings. 2.4 Allied health staff based in the Mental Health Directorate will have a professional reporting line via relevant Principle Leads into the Allied Health Directorate. 2.5 A Director of Allied Health Reform position will be created, reporting directly to the Executive Director Allied Health to provide leadership on key reform initiatives across Central Adelaide. The initial focus of this position will be within the Complex Medical Stream of the Medical Directorate, an area rich in allied health staff and undergoing a series of rapid reforms. 2.6 The Director of Allied Health Reform will also provide additional management capacity for the Reform and Quality functions within the allied health directorate. The Director Allied Health Reform will have operational and professional accountability for staffing and budgets delegated from the Executive Director Allied Health. 2.7 Single Discipline Directors positions will be created for the larger allied health disciplines across Central Adelaide. These will operate across the acute sites (RAH and TQEH), subacute areas and rehabilitation (HRC & SMRH) with professional links into Primary Health Care and Mental Health. Discipline Directors will have operational and professional accountability for staffing and budgets delegated from the Executive Director Allied Health. 2.8 The Executive Director, Director of Allied Health Reform, Discipline Directors and business support team will form the Executive Management Team (EMT) for the Allied Health Directorate. 2.9 The Executive Management Team will be supported by an Allied Health Clinical Cabinet. This will be the key advisory forum for the Allied Health Directorate. November

4 2.10 Existing positions which support professional functions such as research, quality improvement, data and information management will be centralised within the Allied Health Directorate and will report to the Director Allied Health Reform. A position of Principal Allied Health Consultant will be created reporting to the Director Allied Health Reform, to coordinate professional workforce issues across all allied health disciplines in Central Adelaide The clinical team structures and other operational arrangements for the Allied Health Directorate will be formulated once the Discipline Directors are in place. There are a number of interdependencies with the Clinical Directorate that will inform this work Professional reporting lines will be negotiated with other significant groups of AHP classified staff, notably the Medical Radiations group and the Perfusionists The Aboriginal and Torres Strait Islander Health Services based in the acute hospitals are a portfolio responsibility of the Executive Director Allied Health. It is proposed that these services are consolidated across sites and report as a single service via the Manager Aboriginal Liaison to the Central Adelaide Director Social Work The Wellness Centre, based at the Royal Adelaide Hospital, is a portfolio responsibility of the Executive Director Allied Health and will have an important role in promoting the Arts in Health agenda in the new Royal Adelaide Hospital. The Manager of the Wellness Centre will maintain a direct report to the Executive Director Allied Health for six months at which stage the management will be provided by the Central Adelaide Director Occupational Therapy Hospital Chaplaincy will transition under the management of the Executive Director Allied Health with reporting lines to be confirmed following further consultation. November

5 3.0 PROPOSED STRUCTURE ALLIED HEALTH DIRECTORATE An Allied Health Directorate will be created which will have oversight of: clinical governance, safety and quality education & professional development workforce & service redesign research clinical data, outcomes & information to inform performance The Allied Health Directorate will play an important role in linking planning, strategy and performance to the operational delivery of Allied Health services in the Clinical Directorates in Central Adelaide. It is anticipated that the proposed Allied Health Directorate structure will provide: Improved patient focus of allied health services and enable patient flow between acute, primary care and mental health services. Greater opportunities for staff to work across the continuum of care from primary care to the highest level of acuity. Assurance of professional quality and practice consistency within and between disciplines, sites and services. Local management for each discipline group for operational and professional supervision Clear lines of operational and professional management for clinical staff to allow flexibility and efficiency between sites, disciplines and Clinical Directorates Clear allied health advice into the Clinical Directorates and efficient and effective deployment of allied health staff into Clinical Directorates within the disciplinary structure Transparent financial and staffing processes tied to the activity within Central Adelaide The following existing positions will now report to the Executive Director Allied Health and have a remit across the disciplines and the network: Allied Health Quality Position at HRC Physiotherapy Research Coordinator RAH & Research Coordinator BIRS Clinical Information Management Team A new position will be created, Principal Consultant Allied Health Workforce to lead on workforce issues for allied health including clinical education, graduate recruitment and retention, workforce redesign, continuing professional development. Existing Allied Health Director positions at Hampstead Rehabilitation Centre and The Queen Elizabeth Hospital will be abolished and replaced by a single Director Allied Health Reform. This position will provide leadership on specific change and reform initiatives relevant to allied health with an initial focus on the Medical Directorate, specifically the Complex Medical Stream. November

6 Allied Health Leadership Structure Chief Executive Officer Central Adelaide LHN Clinical Reform and Quality Executive Director Allied Health Principal Consultant Allied Health Workforce Allied Health Research Coordinator Allied Health Quality Manager Director Allied Health Reform Allied Health Clinical Information Manager Data Officer Allied Health Safety Quality Risk Manage Cood Allied Health Business Support Manager Business Operations Assistant Business Officer Administrative Officer/EA Other Professional Reports Director Radiotherapy Perfusion Allied Health Departments Director Social Work Director Physio and Exercise Therapies Director Occupational Therapy Director Speech Pathology and Audiology Director Dietetics and Nutrition Director Psychology State-wide Manager Orthotics & Prosthetics Director Podiatry Senior Manager Social Work Manager Social Work Manager Aboriginal Health Services Senior Manager Physiotherapy Manager Physiotherapy Manager Exercise Physiology Senior Manager Occupational Therapy Manager Occupational Therapy Manager Wellness Centre Managers Speech Pathology Manager Audiology Managers Dietetics and Nutrition Manager Clinical Psychology Clinical Manager Neuropsychology Professional Leads Mental Health Manager Orthotics and Prosthetics Team, Leader Orthotics and Prosthetics Manager Podiatry Professional Leads Mental Health & Primary Health Manager, Clinical Support Professional Leads Mental Health Health [VH1] November

7 4.0 SCOPE 4.1 In scope services for professional and operational restructure are considered to be: Professional departments for the following professions: o Physiotherapy o Occupational Therapy o Social Work o Dietetics and Nutrition o Speech Pathology o Orthotics and Prosthetics o Podiatry o Audiology o Clinical Psychology o Neuropsychology o Exercise Physiology 4.2 Staff employed pursuant to the AHP, OPS, ASO, TGO, WHA, PO classification streams within the Allied Health departments of the Royal Adelaide Hospital, the Queen Elizabeth Hospital, St Margaret s Rehabilitation Hospital and Hampstead Rehabilitation Centre (including Centre for Active Ageing and Brain Injury Rehabilitation Service). 4.3 Staff employed pursuant to the AHP, OPS and ASO classification streams within the following team-based units: o Brain Injury Rehabilitation Service (BIRU and BIRCH) o Spinal Outreach Rehabilitation Team o Day Rehabilitation Centre o Diabetes Centre o RAH Wellness Centre o PE & Recreational Therapists o Pregnancy Advisory Centre o Palliative Care o Ageing & Falls 4.4 A range of other services and teams will report professionally via the Allied Health Directorate to the Executive Director Allied Health. These arrangements will be reviewed 12 months following implementation to determine whether further alignment is required. In-scope services for review of professional reporting lines are: Primary Health Care: o Paediatric Speech Pathology o Street to Home o Migrant Health Service o Sefton/Port Adelaide o Aboriginal Health Medical Radiation staff employed as AHPs Perfusion Staff employed as AHPs Mental Health Services Central Adelaide Mental Health has a well-established operational and professional matrix in place which ensures both professional and operational accountability. Principle Discipline Leads in Mental Health for November

8 Social Work, Occupational Therapy and Clinical Psychology will report into relevant Discipline Directors in Central Adelaide Local Health Network. Appropriate professional reporting lines will be negotiated for smaller disciplines within Mental Health Services Out of scope are State-wide Clinical Support Services 5.0 KEY ROLES 5.1 Executive Director Allied Health The Executive Director Allied Health provides professional advice on Allied Health to the Chief Executive Officer, Central Adelaide Local Health Network. The Executive Director Allied Health is accountable for Allied Health standards, ethics and education and for the planning, development and maintenance of systems to support the clinical and professional practice of all allied health staff employed within Central Adelaide Local Health Network. The Executive Director Allied Health assumes responsibility for the overall management of the Allied Health Directorate and, via the Discipline Directors, for the provision of services to the Clinical Directorates. The Executive Director Allied Health provides allied health representation on Strategic Executive and Operational Executive Committees. 5.2 Director Allied Health Reform The Director Allied Health Reform will report to the Executive Director Allied Health and provide management direction to the Department of Allied Health Quality and Reform. The other key function of this position is to provide additional leadership, change and reform capacity for the allied health directorate in addressing key reform challenges across Central Adelaide. The initial focus will be within the Medical Directorate with particular attention on the Complex Medical Stream where significant numbers of allied health staff deliver services to subacute and rehabilitation patients. It will play a role in translating strategy into operational planning in conjunction with the Executive Director Allied Health and the Discipline Directors. 5.3 Discipline Directors The Discipline Directors have overall responsibility and accountability for supporting governance and planning of their discipline group. Discipline Directors will be established for each profession where complexity and scope justifies this position. The following positions are proposed: Central Adelaide Director of Social Work Central Adelaide Director of Occupational Therapy Central Adelaide Director of Physio and Exercise Therapies Central Adelaide Director of Dietetics and Nutrition Central Adelaide Director of Speech Pathology and Audiology November

9 Central Adelaide Director of Podiatry Central Adelaide Director of Psychology (Clinical and Neurology) State-wide Director of Orthotics and Prosthetics [appointed] Detailed organisational charts can be seen in Appendix 1. Disciplines Directors will have responsibility for: Working as allied health leaders as part of the Allied Health Directorate Executive Management Team. Advising Chief Executive Officer, Executive Director Allied Health and Allied Health Directorate Leads on profession specific matters. Formally represent allied health in the Clinical Directorates. Working as part of multi-disciplinary change teams to develop new services and to prioritise service delivery according to the SA Health Plan, Central Adelaide Transition Plans and allied health strategic and operational plans. Managing services and change, coordinating attraction, recruitment, selection, retention, deployment and succession planning for their discipline across Central Adelaide. Ensuring that staff are appropriately skilled to perform the clinical roles that are undertaken Operational budgeting and resource management: Staffing and non-staff budgets for their professional service where operational responsibility is identified. Clinical & Professional governance within their profession across Central Adelaide including compliance with credentialing, scope of practice processes, continuing professional development and supervision across Central. 5.4 Other Management Positions Other leadership and management positions will be implemented across the allied health structure in ensure industrial compliance and clinical safety. The composition of the discipline department s management structures may include Senior Manager, Clinical Manager and Clinical Support Manager positions. These positions will support the work of the Discipline Directors to ensure that the responsibilities are exercised across Central Adelaide. 5.5 Program Managers Program Managers will continue to exist within program based teams and will have reporting lines internal to the relevant clinical directorates. It is proposed they will be responsible for: Delivering the model of care Quality and safety KPI s Program evaluation Workflow monitoring Implementing program reforms Implement state-wide plans Overall budgetary management of the team November

10 Professional issues, recruitment and performance management will be managed via the Discipline Director (or delegate) in partnership with the Program Manager. With the realignment of discipline reporting lines for staff within these teams, opportunities existing to review the capacity of the Program Manager positions with a view to consolidate the number of Program Manager positions. A review of the Program Manager positions would encompass current positions within Day Rehabilitation Centre (DRC), Rehab in the Home (RITH), Ageing, Brain Injury Rehabilitation Service (BIRS) and South Australian Spinal Injury Service (SASCIS). 5.6 Clinical Team Leaders Team Leaders are responsible for operational management of clinical staff at a local level. This relates to roles and responsibilities that support the day to day management of clinical services, including supervision, staff management, service reporting, and clinical quality improvement. Team leaders will be responsible for the clinical & professional leadership within their team. Will work as part of multi-professional leadership teams to implement new services and to prioritise service delivery. Will move towards an allied health (cross-professional) function as well as a welldefined discipline function within the multi-disciplinary team. Once the leadership structure has been implemented, each Discipline Director will be required to review the composition of their clinical teams to develop a team based structure that can interface with the service delivery structure within the Clinical Directorates. This will be informed by service delineation within the Clinical Directorates and the proposed nursing and medical leadership structures. November

11 6.0 Governance Professional and operational matters for allied health will be managed in a number of ways: 6.1 Allied Health Executive Management Team (EMT) Each Clinical Directorate in Central Adelaide is required to develop an EMT structure to bring together professional, operational and financial expertise in a transparent way. The EMT for the Allied Health Directorate will consist of: Executive Director Allied Health Director Allied Health Reform Allied Health Discipline Directors Manager Allied Health Business Support The Allied Health EMT will manage Central Adelaide Allied Health quality of care, operational planning and monitoring and can refer items to the Clinical Cabinet for broader consultation and advice as necessary. It will ensure that high quality Allied Health services are delivered as part of the multi-disciplinary team, within the allocated resources. 6.2 Allied Health Clinical Cabinet (AHCC) The AHCC will be the key forum for identifying Allied Health professional and operational issues and for the provision of advice and recommendations to the Chief Executive Officer and Central Adelaide Local Health Network Executive Management Team via the Executive Director Allied Health. Membership of the Clinical Cabinet will include: Patients, carers and users of Allied Health services Clinicians both junior and senior from across disciplines and parts of the care journey Specialist allied health representatives with research, quality improvement, clinical education as a key component of their work New graduate representatives Member of Allied Health EMT Nominations will be sought by expression of interest. The AHCC will be chaired by the Executive Director Allied Health. The AHCC will ensure clinical leadership is at the heart of all decisions about patient care and services. Its members will be active leaders of change to inform the Allied Health Directorate vision and how this is translated into high quality integrated services. The AHCC has future directions and responses to current challenges as its core business and a key focus on quality of care and promotion of clinical leadership and engagement. 6.3 Subcommittees or Work Groups The Executive Management Team and Allied Health Clinical Cabinet will be supported by sub-committees; each chaired by Allied Health EMT members and will cover areas such as Safety & Quality, Workforce, Clinical Information, Research & Education and Redesign & Innovation. Each subcommittee will be responsible for cross November

12 organisational engagement to deliver service redesign, quality improvement, performance improvement and integration across Central Adelaide. Representatives from the Allied Health Clinical Cabinet may be co-opted to provide representation on other committees or working groups for Central Adelaide Local Health Network, SA Health, Allied and Scientific Health Office or other external bodies. 6.4 Professional Governance and Accountability The Executive Director Allied Health is working as a matter of priority to ensure that all allied health staff have clearly defined professional supervision arrangements in place. This will be supported by a clinical supervision framework to provide the necessary support to staff and supervisors regarding the requirements and support for this professional relationship. The move to universal supervision for all allied health represents a significant change for some disciplines and services and will require consultation and a graduated approach. In addition, an analysis of any gaps in supervisor capacity will need to be undertaken by Discipline Directors for resolution. Work has commenced, and will continue, to identify the positions which will provide key links into the system-wide development of professional governance structures and processes. In some instances this may require the identification of Principal Clinician roles or Head of Profession roles across services or Clinical Directorates to enable professional advice, oversight, compliance and supervision. The establishment of robust clinical governance arrangements will help ensure the safety and quality of Allied Health services and the best support for the staff delivering these services. 6.5 Quality and Safety Allied health clinical staff will participate in and support quality and safety activities within the Clinical Directorates. The Allied Health Directorate has access to a component of a Safety Quality Risk Management Coordinator in line with other parts of the organisation. November

13 7.0 CONSULTATION PROCESS Consultation Sessions with Staff across Central Adelaide Local Health Network Preliminary discussions in relation to the proposed establishment of the Central Adelaide Allied Health Directorate have taken place at a number of management forums across 2013 (29 April & 9 September). The purpose of the sessions was to bring together a broad group of Allied Health Leaders and Managers to discuss the concept of the Allied Health Directorate, to build on previous work regarding an Allied Health Directorate and to discuss the role and functions of the directorate. Classification of positions Approved new and changed structures will be reflected in appropriate and relevant role descriptions. The duties and outcomes related to the role, as well as the requirements of a person to perform each role should be clearly defined. The classification assessment of new/changes positions will be conducted in accordance with the approved procedures for classifying positions, which requires approval by the appropriate delegate. The classification of positions will be in accordance with the work level definitions described within the South Australian Public Sector Wages Parity Enterprise Agreement: Salaried Transition to the new Allied Health Structure Positions within the organisational structure will be filled in accordance with the Human Resources Principles and Procedures. The Human Resources Principles from the SA Health (Health Care Act) Human Resources Manual will be used. These will apply for the duration of the transition to the new structure. In accordance with SA public sector unassigned employee policy, any unplaced ongoing employee will be provided with suitable work at his or her substantive remuneration level until placed in a suitable ongoing position. It is recognised that the transition to the new Allied Health structure may increase anxiety and concerns for staff. We acknowledge the genuine concerns of staff and are committed to ensuring that staff are provided with appropriate support services, resources and information to reduce these concerns and to identify the opportunities that will arise during this change process. November

14 8.0 TIMELINE Ongoing communication with in-scope staff and other key stakeholders will occur via staff forums, s and other meetings in February. Staff are invited to reply to this consultation paper via the Survey Monkey link below. A series of questions is provided to guide the consultation. Next Steps Consultation Paper released December 2013 Staff Consultation Sessions January- February 2014 Consultation Closes - February 13 th Final Leadership Structure released March 2014 Recruitment for positions commences April 2014 November

15 Consultation Questions 1. How do you see the Allied Health Directorate operating along-side the Clinical Directorates of Medical, Surgical, Critical Care, Cancer, Renal, Mental Health and Dental? 2. What are the opportunities in creating research, education and workforce development capacity within the directorate? 3. How best should allied health ensure that we can continue to work effectively across clinical areas (directorates) and across physical sites? What needs to be done to ensure that effective management and leadership are in place? 4. How can quality and safety functions be embedded in the new structure? Do they link to the allied health directorate or more to the Clinical Directorates? 5. What needs to be done to clarify and explain the roles of Executive Director Allied Health, Director Allied Health Reform, Clinical Directorate Allied Health Leads and Discipline Directors? 6. The changes and transitions pose potential risks for loss of corporate knowledge across the whole health system. How can we best manage this in order to manage the day to day work and also embrace the innovation and reform agenda? 7. What support will the Discipline Directors need to work effectively across the Network? 8. What do we need to put in place in order to make the single service multiple site concept work for allied health? 9. How do we learn from each other in the period of change and how do we build on the successes to date? 10. How do we keep our colleagues (nursing, medical and allied health) informed of the changes that are taking place and what measures would we use to judge effectiveness of the new arrangements? 11. How should other portfolio responsibilities (ATSI Health and Wellness Centre) report though the proposed structure? 12. For services with a professional reporting line, are the distinctions clearly articulated between what is an operational and what is a professional responsibility? November

16 Social Work Director Social Work Manager Aboriginal Liaison Unit Senior Deputy Manager Director Social Work Social Work Administrative Staff Manager Social Work Principle Lead Social Work, Mental Health Professional Lead Social Work, PHC Medical Surgical Critical Care Renal Cancer Mental Health Senior Practitioner Social Work Social Work Practitioners, PHC Practitioner/Team Coordinator Social Work Graduate Practitioner Social Work Assistant Practitioner/Welfare Workers Recreation Officers November

17 Speech Pathology & Audiology Director Speech Pathology and Audiology Manager Speech Pathology Manager Speech Pathology Administrative Staff Manager Audiology Clinical Lead Speech Pathology, PHC Medical Surgical Critical Care Renal Cancer Mental Health Senior Practitioner Speech Pathology Senior Practitioner Audiology Practitioner/Team Coordinator Speech Pathology Graduate Practitioner Speech Pathology Assistant Practitioner Speech Pathology November

18 Physiotherapy & Exercise Physiology Director Physio and Exercise Therapies Senior Deputy Manager Director Physiotherapy Manager Physiotherapy Physiotherapy Administrative Staff Manager, Clinical Support Manager Exercise Physiology Medical Surgical Critical Care Renal Cancer Mental Health Senior/Advanced Physiotherapy Practitioner Physical Educators Practitioner/Team Coordinator Physiotherapy Graduate Practitioner Physiotherapy Assistant Practitioner Physiotherapy November

19 Occupational Therapy Director Occupational Therapy Manager Wellness Centre Senior Manager Occupational Therapy Occupational Therapy Administrative Staff Manager Occupational Therapy Manager Clinical Support Occupational Therapy Principle Lead Occupational Therapy, Mental Health Medical Surgical Critical Care Renal Cancer Mental Health Senior Practitioner Occupational Therapy Practitioner/Team Coordinator Occupational Therapy Graduate Practitioner Occupational Therapy Assistant Practitioners Occupational Therapy November

20 Nutrition & Dietetics Director Dietetics and Nutrition Manager Dietetics and Nutrition Nutrition & Dietetics Administrative Staff Manager Dietetics and Nutrition Manager Food Service Quality Professional Lead Dietetics PHC Medical Surgical Critical Care Renal Cancer Mental Health Senior Practitioner Nutrition & Dietetics Practitioner/Team Coordinator Nutrition & Dietetics Graduate Practitioner Nutrition & Dietetics November

21 Psychology Director Psychology Manager Clinical Psychology Manager Neuropsychology Principle Lead Clinical Psychology, Mental Health Medical Surgical Critical Care Renal Cancer Mental Health Senior Practitioners Psychology Practitioner/Team Coordinator Psychology November

22 Orthotics & Prosthetics State-wide Manager Orthotics & Prosthetics State-wide Orthotics and Prosthetics Steering Committee Manager Orthotics and Prosthetics Orthotics & Prosthetics Administrative Staff Medical Surgical Critical Care Renal Cancer Mental Health Senior Practitioner Orthotics & Prosthetics Practitioner/Team Coordinator Orthotics & Prosthetics Graduate Practitioner Orthotics & Prosthetics Technical Officers November

23 Appendix 1 Departmental Leadership Org Charts Podiatry Director Podiatry Manager Podiatry Podiatry Administrative Staff Medical Surgical Critical Care Renal Cancer Mental Health Senior Practitioner Podiatry Practitioner/Team Coordinator Podiatry Graduate Practitioner Podiatry November

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