Expanding speech pathology delegation practices: engaging Allied Health Assistants (AHAs) in dysphagia management in the acute hospital setting

Abstract

Speech Pathologists (SPs) are under increasing workforce pressures as a result of an ageing population and greater prevalence of chronic conditions. Considering this increasing workforce demand, within the context of limited health resources, workforce flexibility such as the consideration of task delegation is increasingly being encouraged within the literature and government policy. Though the use of delegation models within speech pathology has received some attention, particularly in the management of paediatric speech and language disorders, there is a paucity of evidence to support the use of delegation models in dysphagia management. This presents a significant gap, as dysphagia management is an integral part of the SP's role in the inpatient hospital setting and accounts for a significant proportion of workload demand in that context. Delegation of dysphagia related tasks to a trained Allied Health Assistant (AHA) offers a means to address increased workforce demand, while potentially improving workforce efficiency. Appropriate delegation of 'low value' tasks to another professional group may support the SP; to dedicate more time to high risk caseloads; increasing intensity of intervention; and contributing to quality and innovation initiatives. Hence the overall objective of this thesis was to generate new knowledge regarding the design, clinical implementation and evaluation of AHA delegation models in the clinical area of dysphagia management. Two specific aims were identified to achieve this. The first was to design, develop, implement and evaluate AHA delegation models for two key dysphagia related tasks, (mealtime observations and dysphagia screening), to establish accuracy and feasibility of task completion. The second aim was to evaluate I acknowledge that copyright of all material contained in my thesis resides with the copyright holder(s) of that material. Where appropriate I have obtained copyright permission from the copyright holder to reproduce material in this thesis and have sought permission from co-authors for any jointly authored works included in the thesis. v