Skill sharing and delegation practice in two Queensland regional allied health cancer care services: a comparison of tasks

Abstract

Objective. Delegation and skill sharing are emerging service strategies for allied health (AH) professionals working in Queensland regional cancer care services. The aim of the present study was to describe the consistency between two services for the types and frequency of tasks provided and the agreement between teams in the decision to delegate or skill share clinical tasks, thereby determining the potential applicability to other services.Methods. Datasets provided by two similar services were collated. Descriptive statistical analyses were used to assess the extent of agreement.Results. In all, 214 tasks were identified as being undertaken by the services (92% agreement). Across the services, 70 tasks were identified as high frequency (equal to or more frequently than weekly) and 29 as not high frequency (46% agreement). Of the 68 tasks that were risk assessed, agreement was 66% for delegation and 60% for skill sharing, with high-frequency and intervention tasks more likely to be delegated.Conclusions. Strong consistency was apparent for the clinical tasks undertaken by the two cancer care AH teams, with moderate agreement for the frequency of tasks performed. The proportion of tasks considered appropriate for skill sharing and/or delegation was similar, although variation at the task level was apparent. Further research is warranted to examine the range of factors that affect the decision to skill share or delegate.What is known about the topic? There is limited research evidence regarding the use of skill sharing and delegation service models for AH in cancer care services. In particular, the extent to which decisions about task safety and appropriateness for delegation or skill sharing can be generalised across services has not been investigated. What does this paper add? This study investigated the level of clinical task consistency between two similar AH cancer care teams in regional centres. It also examined the level of agreement with regard to delegation and skill sharing to provide an indication of the level of local service influence on workforce and service model decisions. What are the implications for practitioners? Local factors have a modest influence on delegation and skill sharing decisions of AH teams. Practitioners need to be actively engaged in decision making at the local level to ensure the clinical service model meets local needs. However, teams should also capitalise on commonalities between settings to limit duplication of training and resource development through collaborative networks.

Dietitian assistant opportunities within the nutrition care process for patients with or at risk of malnutrition: a systematic review

“…In the current healthcare climate of increased service demands and hospital costs, healthcare professionals are exploring alternative approaches to care that aim to de‐implement low‐value activities and ensure high‐value care is delivered 10,21‐24 . Delegation of care is an effective opportunity to address these issues, indicating that promoting the increased utilisation of the dietitian assistant workforce through exploring delegated models of care is warranted 10,20,27,52,53 . However, the lack of studies exploring delegation of nutrition care activities to dietitian assistants in the last 5 years suggests this is not being given adequate attention, or where delegation to dietitian assistants is occurring, practice implications have not been published.…”

“…However, the lack of studies exploring delegation of nutrition care activities to dietitian assistants in the last 5 years suggests this is not being given adequate attention, or where delegation to dietitian assistants is occurring, practice implications have not been published. While skill sharing opportunities, for example by nursing staff, is also worthy of particular attention, this was beyond the scope of this systematic review 27,31,32 …”

“…Further investigation of opportunities for de‐implementation of low‐value activities and alternative value‐based models of care are vital to ensure nutrition care practices progress in accordance with healthcare reform 10,21‐24 . To support this shift in practice, opportunities may exist for delegating or skill‐sharing components of the nutrition care process (NCP) to the dietitian assistant workforce; how these opportunities are enacted will be dependent on local and country‐specific factors 25‐30 . Used internationally as a guide to providing nutrition care, the NCP has four steps: nutrition assessment, nutrition diagnosis, nutrition intervention, and nutrition monitoring and evaluation 28 .…”

Barriers and Enablers to Delegating Malnutrition Care Activities to Dietitian Assistants

“…Our results reiterate that where not already embedded, delegation of malnutrition care activities to dietitian assistants will require attention to the process of implementation. Teams must work together to identify and implement improved delegation activities and apply locally tailorable models, together with theories, models, and/or frameworks that have proven successful in other settings and are considerate of local contexts [ 8 , 22 , 42 , 43 , 44 , 45 ]. Iterative, data-informed action cycles are needed to move towards delegation.…”

Identifying Low Value Malnutrition Care Activities for De-Implementation and Systematised, Interdisciplinary Alternatives—A Multi-Site, Nominal Group Technique Approach

“…Despite the existence of guidelines and governance delegation to nutrition assistants and skill sharing in many settings, delegation and skill sharing of nutrition care processes are limited or do not occur at all [ 6 , 13 , 28 , 29 , 30 , 31 , 32 , 33 ]. Studies reporting outcomes associated with delegating or skill sharing nutrition care in healthcare settings are limited [ 13 , 34 , 35 , 36 , 37 ]. However, recent national and international nutrition care programs have demonstrated promising approaches through models of care that provide systematised, delegated, and interdisciplinary nutrition care, with evidence of sustainability and spread [ 13 , 38 , 39 ].…”