The Transition to Rural and Remote Practice Toolkit is an online resource designed to support allied health professionals with establishing a practice in a rural or remote setting. The resource bridges the gap between training and becoming a rurally based allied health service provider.
The resource supports allied health service providers through:
The Transition Toolkit consists of five modules that can be navigated like a book at the bottom of the page:
The Transition Toolkit includes a series of online learning modules that relate to topics contained as part of the toolkit and include:
When practicing in a remote or rural setting it is important you develop an understanding of the contextual factors that impact the health of your clients, and the ways services are delivered.
This section provided as brief overview of some of the elements that influence the remote and rural context. Read through each of the pages and think about these issues in the context of your community, and consider how this will change the way you provide services.
When working in a remote or rural setting it is vital to recognise the importance of access and how this impacts service delivery and client care.
Almost invariably remote and rural communities experience reduced access to health services, including allied health. Remote and rural communities are characterised by limited local health care services, limited private health services, and an absence of specialist services. The reduced access generally increases with remoteness, that is, the more remote the community the more limited access. Further access to the existing services is often disrupted by workforce shortages, and high staff turnover, which interrupt continuity of care.
The access to health care services is often compounded by several other elements of remote and rural life. Travelling distances for example, are often significant with population widely dispersed, and transport options limited and costly.
Access to health services is also affected by cultural factors. When working with Aboriginal people for example, access to the health service will be affected by: the appropriateness of the services available; English language competency; and a host of other issues. Refer to the Cultural Safety page for more information.
Health services have adopted several service delivery models that go some way to overcome these disparities in access, including Outreach, Primary Health Care and Telehealth. Refer to these pages for more information.
The above summary highlights some of key issues arising limited access to health services, however to broaden your understanding seek out more information. Think about access within the community you work with:
The way remoteness and ruralilty are defined and understood is important. Defined remoteness or rurality is used to assess health and workforce needs, and the resources allocated to meet these needs, include staff and physical resourcing, and other funding.
Several different classification systems have been developed to define remoteness and rurality in Australia. These tend to define in terms of the size of a community, distance from population centres, and access to services. The three systems most commonly used include:
In 2009, the Australian Government made the decision to replace the RRMA system with that of the ASGC for administering programs targeting rurala and remote regions.
Click here for information about the ASGC-RA .
Take the time to find out where your community lies within these classifications and the implications this has in terms of access to resources and the ways services are delivered. To find the classification for your community search here.
Below are links to some resources that will help to develop your understanding of the ways remoteness and ruralilty are defined and the diversity within these categories.
Approximately a third (31.5%) of the Australian population live in remote or rural areas of the country. Of these, about 45% live in regional cities, large towns and surrounding agricultural areas, about 45% live in small country towns and their surrounding agricultural areas, and about 10% live in remote and very remote areas.
The population profile and demography of remote and rural areas varies from that in metropolitan or urban centres. While it varies between communities, remote and rural areas generally have slower population growth than metropolitan and urban centres, with some areas experiencing population declines. Rural communities tend to have more children but fewer young adults. Remote areas tend to have even more children, but fewer older people.
In terms of education and employment, people living in remote and rural areas generally have lower levels of education. Employment opportunities are often limited within remote and rural communities, and household incomes also tend to be lower than in metropolitan or urban areas.
The type of diversity within remote and rural areas also varies from that of metropolitan and urban centres. Over two thirds of Australia’s Indigenous population reside in remote and rural areas. Additionally, immigration to remote and rural communities tends to be lower than in metropolitan and urban centres.
Access to resources is lower for people living in remote and rural areas, and tends to decrease with remoteness. The affordability and availability of commodities such as food and petrol is often significantly lower, again decreasing with remoteness. Remote areas in particular are less likely to have access to basic food items, including fresh fruit and vegetable.
Think about the population within the community you work with:
People living in remote and rural areas generally experience poorer health than their metropolitan counterparts. Being aware of this health differential, and how it impacts on service delivery will increase you understand of remote and rural health and inform the way you deliver services. It is also important to recognise the difference between remote and rural, and variation between individual communities.
The health profile of remote and rural areas are characterised by:
Additionally, social determinants of health impact the health of people living in remote and rural areas, with people living in remote and rural areas experiencing reduced educational and employment opportunities, income, access to goods and services and in some areas access to basic necessities, such as clean water and fresh food.
When considering the health profile of remote and rural Australians it is important to include the specific health profile of Indigenous people. Indigenous people experience significantly poorer health than the broader population. This health disparity is evident in both morbidity and mortality statistics. The health profile of Indigenous people is characterised by:
Think about the health profile of the within the community you work with:
Rurality and remoteness can be considered as a set of characteristics, including greater distances, lower socioeconomic status, lower educational levels, higher proportions of Indigenous people, specific occupational health and safety risks, a relatively close relationship with nature, specific cultural attitudes, poor access to services and smaller population centres.
There are a number of ways in the above characteristics can impact of health services, including the:
What is most important to note, is that each of these characteristics has both a downside or risk (on which the sector has traditionally focused) and a potential upside or benefit.
For example, the relative scarcity of services means poor access and stretched services, with the potential consequence of poor staff morale and considerable queuing. The upside of this might be that the services are better integrated and more easily navigated by consumers because of their relative scarcity, and their delivery more rewarding for those who provide them. Certainly, there do seem to be fewer professional turf wars in more remote areas. As another example, the ‘greater distances’ characteristic can be seen as ‘distance from help’ (risk or downside) or ‘greater independence’ (benefit or upside).
When considering the impact of rurality and remoteness of the way you delivery your services, think about the impact from both a risk (downside) and benefit (upside) perspective. Remote and rural practice brings many opportunities for innovative health services and practice, as well as the traditionally considered challenges.
Spend some time developing a better understanding of the context of remote and rural health, broadly and in relation to the specific community you are working with.
Below we have identified some useful resources. It addition to these and those identified in this section, you should find out more about the area or community you’re working in. This will give you a better understanding of the particular local context, and the issues you should be mindful of. Begin with the local shire office, library and tourist centre.
The philosophies that drive remote and rural practice and the way services are delivered within these settings often vary from those applied within a larger metropolitan or urban setting.
This section describes some of the opportunities and challenges of remote and rural allied health practice, and provides an introduction to the philosophy of Primary Health Care and some of the ways services are delivered in remote and rural practice. Read through the pages and consider each of the identified topics influences your practice.
The way that health is practiced in the metropolitan areas, rural settings and remote areas differ greatly. The features that distinguish remote and rural practice often become more prominent the more remote you become. The environment is different, as are the health issues encountered. The population is small, dispersed and in some places highly mobile, with significant variations in the health team and services accessible to the community.
These features, combined with the individual features of each community, create many opportunities for allied health professionals in remote and rural practice. Opportunities of remote and rural allied health practice, as identified by the Literature Review and Key Informant Interviews include:
Whilst remote and rural practice provides many opportunities it does present some challenges, especially those new to the community. These challenges are not experienced by all Allied health professionals, but are dependent on the individual and the context in which he/she practices. It is important to be aware of these potential challenges in order to put in place strategies to address them before they become an issue. This page aims to give you the tools and knowledge to address these challenges (and turn them into some fantastic opportunities).
Primary Health Care is a key philosophical underpinning of remote and rural health care. We have created a learning module to help you develop your understanding of Primary Health Care in remote and rural allied health context. The module will take about 20 minutes to complete. Click on the below tab to access the module, which will open in a new window.
After you have completed the learning module reflect on the following questions:
In remote and rural settings allied health services are often delivered in quite different ways, drawing on various service delivery models specific to the remote and rural context. Some of these strategies are employed in metropolitan or urban centres but have a particular relevance in remote and rural health service delivery, others are unique to remote and rural practice.
Below are some of the service models that particularly relevant to working in a remote or rural practice setting.
In addition to office-based practice, many rural and remote allied health professionals also provide outreach services to surrounding areas. Outreach service provision is unique to rural and remote practice and can present particular challenges and rewards.
We have created the below learning module to develop your understanding of outreach service delivery and to support you in your delivery of these services. The module will take between 30-40 minutes to complete. Click on the below tab to access the module, which will open in a new window.
Complete the learning module and think about:
We have also put together some tips to help you provide outreach services: Outreach Tips
Telehealth is becoming an increasing popular tool in allied health service delivery in remote and rural settings. In short, Telehealth refers to the delivery of health-related services and information via telecommunications technologies. Telehealth involves the transmission of images, voice and data between two or more sites using telecommunications to provide health services such as clinical advice, consultation, education and training services.
Telehealth can be delivered through a variety of mediums, including telephone, videoconferencing, fax, emails, and computers for data/imaging, virtual reality, and tele-robotics.
There are three key types of Telehealth:
The use of Telehealth has many benefits, particularly in a remote or rural setting. For the client, Telehealth improves access to clinical services closer to home.
For the clinician it increases access to: clients; professional development and education opportunities; specialist services. Telehealth increases the information exchange between inter-professional teams and enhances client care. It reduces the need for clinicians to travel, and provides savings in associated costs for travel and accommodation.
The possible applications of Telehealth are broad. In remote and rural allied health, Telehealth is most often used as a service delivery tool, a professional development medium, and a supervision and support tool.
Examples of Telehealth applications in service provision include:
Videoconferencing (VC) is a great medium to access professional development, with many organisations now offering training via VC.
Telehealth can be fantastic way to build a relationship and communicate with supervisors, mentors or coaches. The article Telehealth: A Model for Clinical Supervision in Allied Health provides useful information when engaging in supervision and support relationships via Telehealth.
Think about Telehealth within your workplace:
Allied Health Assistants support the deliver of allied health services, under the direction of Allied Health Professionals. They may be have a generalist role, working with a number of allied health professionals such as occupational therapy, physiotherapy, podiatrists, dieticians and speech pathology, or they may be employed specifically to work with one occupational group.
Allied Health Assistants must work under the supervision of the relevant Allied Health Professional (i.e. tasks must be delegated to them by an Allied Health Professional). The level of supervision and monitoring will depend on the experience, skill and qualifications of the assistant and the practicalities of the work environment. Supervision may range from face to face daily interaction to less frequently and by telephone or video.
The scope of practice for assistants (what they can and can’t do) is guided by the employing organisational and professional associations/regulatory bodies.
Allied Health Assistants have benefits to the clients (more contact time), the clinician (freeing up time for higher level clinical practice) and the local community in developing positions and career opportunities that may not otherwise be available.
In terms of workforce, Allied Health Assistants can facilitate a continuity of service with a stable workforce sector (Allied Health Professionals tend to come and go), opportunities to develop a local health workforce where for a number of reasons tertiary education is not an option, and providing employees with a ‘taste’ of what an Allied Health Professional does that may lead on to a career in an allied health field.
In a remote and rural practice context you will likely encounter Allied Health Assistants with a range of skills and qualifications. Some have no formal qualifications; some will have a TAFE Certificate II, III, or IV in Allied Health Assisting, others may have qualifications and/or experience in areas such as enrolled nursing, aged care, community care, rehabilitation, etc. In remote and rural areas Allied Health Assistants most often receive their training in-house and on the job. The level of training and experience of the Allied Health Assistant will determines what roles they are able to undertake.
As an Allied Health Professional in a rural or remote area you will very likely be working with support staff, particularly Allied Health Assistants. If you are working with an Allied Health Assistant, think about:
Community engagement is a philosophy that underpins remote and rural service delivery. Community engagement is one of a number of terms used to refer to the process of involving the community in the decision making about health services including health service planning, policy development, implementation of health services and evaluation of services.
The term community, within the philosophy of community engagement refers to people who either directly or indirectly use health services. In this sense community may include people who are currently use, or have used health services, carers of people receiving health care, consumer groups (who may share common experiences of health need), consumer organisations (such as advocacy, self-help groups), members of the community who may be future uses and community members who benefit from health care services.
The process of engagement facilitates community participation. This participation can occur at a number of levels including the local (community level), state/territory or national levels. At a community level consumers of services and local community members may be involved in service development (service planning), implementation and evaluation for health services within the local area. At a State / Territory and National level consumers of services and community members may be involved in broader policy development and service planning.
The potential benefits of engaging the community in health service delivery are plentiful for both the community and the Allied Health Professional. They may include:
There are a range of strategies to involve consumers in health service decision making. Some of these include:
In determining appropriate strategies to engage the community, particular consideration needs to be given to how to effectively include, and represent, the diversity of individuals and communities.
Private health services are an important part of health care in rural and remote Australia. Private providers include private hospitals and individual private practices. It is important for both public and private Allied Health Professionals to understand the private health system and the types of clients able to access such services.
Individuals with ancillary private health insurance may be able to claim a portion of out of pocket expenses for private allied health services back from their health fund. Clients are only able to access a rebate from their health fund for nominated allied health services and if the Allied Health Professional holds a provider number with that particular health fund. Private Health Fund’s websites contain further information about obtaining a provider number.
Currently there are Medicare Initiatives that allow for participating allied health professionals to claim items via Medicare such as:
The providing Allied Health Professional must be registered with Medicare, and meet provider eligibility requirements. All items require an initial referral from a GP or medical specialist. The Medicare Benefit Schedule Items by Allied Health Profession table available on the Health website provides a summary of all items.
Allied health services funded by other Commonwealth or State programs are not eligible for Medicare rebates, except where a subsection 19(2) exemption has been granted.
'Medicare and You’ is an eLearning program comprised of seven interactive modules on topics that health care professionals need to know when they commence Medicare billing.
DVA cardholders can access a wide range of allied health services at a determined fee. Cardholders are able to access allied health services provided by health care providers (including private allied health professionals) who have a provide number with DVA. For further visit the DVA website.
The National Rural and Remote Health Infrastructure Program (NRRHIP) aims to improve access to health services by providing funding to rural and remote communities where the lack of infrastructure is a barrier to the establishment of new, or the enhancement of existing health services. One of the project aims is to increase the range of privately insurable health services available to rural and remote Australia. Allied Health Professionals, who are providing privately insurable health services, and dentists in private practice, are eligible to apply.
Allied Health Professionals working in remote or rural practice settings are often required to perform a pecialist Generalist role. While we are using the term Specialist Generalist, there are many terms for this role including: Expert Generalist; Professional Generalist; and Advanced Generalist. Regardless of the title, the role involves advanced general clinical and non-clinical professional skills. While this is not a service delivery model per say, delivering services as a Specialist Generalist is a central component of remote and rural allied health service delivery.
In terms of clinical skills, the broad range of conditions, and ages of the client group demands ‘specialist generalist’ skills with a breadth and depth of knowledge to successfully manage such a diverse caseload.
Additionally, Allied Health Professionals working in remote and rural settings tend to have flexible role boundaries with tasks shared across professions in a trans-disciplinary model of service delivery. Often they will respond to issues outside of their agency, agenda or mandate that would normally be left to colleagues or other occupational groups who may not be available in the area or at that time. This generalism is appropriate, both because it is the most efficient way of overcoming a lack of specialist resources, and because it is most culturally compatible with rural life.
The professional role of Allied Health Professionals in rural and remote areas, and the professional skills needed to fulfil this role, extends far beyond the clinical arena. It may include administration, management, education and research, to name just a few. The administrative component of the position involves the usual record keeping, collation of client related data, preparation of reports, and the planning and designing of new initiatives There are a myriad of additional non clinical tasks include documenting the extent of disability in communities, participating in and encouraging the development and planning of appropriate rehabilitation services, educating and advocating for Indigenous people with disabilities and developing valid processes for identifying community needs.
For the clinician, working as a Specialist Generalist provides an opportunity to develop advanced clinical and professional skills across all areas of practice. As well providing a strong skill base, this gives clinicians the chance to experience all practice areas and identify areas of interest for potential later specialisation.
For the client, Specialist Generalist Allied Health Practitioners can manage a diverse range of presentations and conditions. This provides greater access to appropriate care within the community and in some instances reduces the need for specialist referral.
Think about your practice in a remote or rural setting:
Allied Health Professionals working in remote or rural communities may find themselves as the only provider (sole practitioner) of services from their discipline in that geographic area.
By definition, sole practitioners work independently. They are required to exercise independent professional judgment without ready face to face access to other Allied Health Professionals within the same discipline, and miss out on the much of the informal consultation, assistance, advice and networking available inherent to workplaces with larger teams.
Service provision for the sole practitioner in remote and rural settings often extends beyond the area of discipline specific skills and expertise into areas of community participation, health promotion and health education. See the SG page for more information. While this is often the case in remote and rural practice more broadly, it tends to be more pronounced in a sole practice setting.
In sole practice, service provision will often take place in multiple settings. This includes not only the practice site (e.g. one or a mixture of private practice, community health centres, rural hospital, outpatient clinics, GP practice), but also local schools, aged care centres, industry and commercial settings and in client homes.
Sole practitioners in remote and rural settings need the ability to:
For the sole practitioner the ability to be alone in the analysis, planning, submission, preparation, implementation and evaluation of development in their specific services can be both a challenge and a reward.
The achievement of advanced skills levels across a range of clinical and non-clinical areas is rewarding. Remote and rural sole practitioners may be on a higher pay scale within state awards. Check with the relevant jurisdiction if this applies to you.
Sole allied health practitioners in remote and rural communities holds a privileged position in remote and small rural communities. You will be called on to be involved in community activities unrelated to your particular discipline skills. Whilst issues relating to confidentiality, defining boundaries between professional, social and family life in small communities, time management can increase stress levels, the rewards for becoming a community advocate, holding a position of privilege and making a contribution to building community capacity cannot be underestimated.
Think about your practice in a remote or rural setting:
Working as a team in the delivery of health services is a cornerstone of primary health care and one of the greatest benefits of working in a remote and rural context. Health teams are composed of members from different healthcare professions with specialised skills and expertise, who communicate and collaborate to plan and provide quality health services.
Collaborative team practice can be articulated in a number of ways. It is important to understand the different models of team practice and the attributes and functions attached to each.
Multidisciplinary approaches utilise the skills and experience of individuals from different disciplines, with each discipline approaching the patient from their own perspective. Each team member conducted separate assessment, planning and provision with varying degrees of coordination. The team, directly or indirection, shares information regarding the patient and discuss future directions for patient care, and consequently relies on a good communication system (e.g. team meetings, case conferences etc). Essentially health professionals work in conjuction with each other, but act autonomously. This is also called multiprofessional practice.
Interdisciplinary approaches expand the multidisciplinary team through collaborative communication (rather then shared communication) and interdependent practice. Members contribute their own profession specific expertise, but collaborate to interpret findings and develop a care plan. Team members negotiate priorities and agree by consensus. The analogy of the hand is appropriate: individual digits of differing ability, function and dexterity work together to achieve more than the sum of the individual fingers (Crawford and Price, 2003). This is also called interprofessional practice.
For an example of an interprofessional approach, read the article Team Working: Palliative Care as a Model of Interprofessional Practice (Crawford & Price, 2003).
Transdisciplinary team approaches are the result of the evolution of the team approach. The transdisciplinary team model values the knowledge and skill of team members. Members of the transdisciplinary team share knowledge, skills, and responsibilities across traditional disciplinary boundaries in assessment, diagnosis, planning and implementation. Transdisciplinary teamwork involves a certain amount of boundary blurring between disciplines and implies cross-training and flexibility in accomplishing tasks. Transdisciplinary practice becomes especially relevant in the remote and rural context, where health professionals need to be more flexible about their roles and responsibilities.
Community Based Rehabilitation, or CBR, is becoming increasingly recognised as an appropriate model of service delivery to provide effective rehabilitation and therapy services to rural and remote communities, with particular relevance for remote and rural Indigenous communities.
In simple terms, CBR refers to the delivery of basic services to disabled people within their community, including all services necessary to improve the participation and functioning in daily activity. More broadly, the UNESCO and WHO define CBR, as:
A strategy within community development for rehabilitation, equalization of opportunities, and social inclusion for all children and adults with disabilities. CBR is implemented through the combined efforts of people with disabilities themselves, their families and communities, and appropriate health, education, vocation and social services.
The basic concept of CBR centres on decentralising responsibility and resources, both human and financial, to community level organisations. CBR models are based on a collaborative relationship between the Allied Health Professional, Community Based Workers and the broader community.
While traditional rehabilitation frameworks tend to be based on a medical model CBR is built on a social, community focused, frameworks. This community orientation is designed to address barriers (medical, social and cultural) that affect a person’s ability to engage in activities and participate in the community, and build the capacity of remote and rural communities.
CBR has many benefits for both the clients and the clinician, particularly in remote and rural practice settings. For communities, CBR increases the accessibility of rehabilitation and therapy services for clients. These models increase the services available to people living in rural and remote areas and allow clients to stay in their communities when receiving therapy services.
Additionally, the community development orientation of CBR builds on community capacity and both the individual and community level. At the individual level, CBR models facilitate the training and employment of Community Based Workers, increasing the skills, income, and employability of local community members. At a community level the collaborative relationship between communities and health services empowers communities and develops leadership.
For the clinician, CBR increases the service coverage that can be achieved. It also reduces the frequency of travel to communities, and as a consequence saves time and money.
Does your organisation work with CBR models? If so, think about:
There are several skills and competencies that are vital in a remote or rural practice context. Many of these are skills that you would need in any practice setting, however they have particular relevance in remote and rural areas. We have grouped these skills into three broad categories, rural and remote, clinical and professional. Review each of these sections the consider how you develop your skills and competence in each of the identified skill areas.
There are a host of professional skills that you need working as an Allied Health Professional. While we can not cover all of them we have identified some key skills that will serve you well in a remote and rural context which are available in this module.
In addition, the WA Country Health Service has developed competency frameworks to measure professional clinical skills. While these are WA specific, they may guide your thinking around monitoring the development of your professional skills. See http://www.wacountry.health.wa.gov.au/alliedhealthcompetencies for more information.
Working as an Allied Health Professional you will likely have some sort of managing role. This may include managing your caseload, program area, other Allied Health Professionals, support staff such as Allied Health Assistants, or students. Developing administrative and management skills will enable you to better fulfil these aspects of your role.
Management and administrative tasks form an important part of many remote and rural Allied Health Professional's roles. Some of your duties may include:
Think about the management and leadership element of your role. Make a list of all the management/administrative tasks you need to undertake (you might need to seek assistance from your line manager) think about:
Check out the www as a great source of information on general management skills. Some good websites include:
The following articles may also be useful:
Working as an Allied Health Professional you will likely provide and receive many different kinds of supervision. Some of these include:
Well-structured and supported supervision can improve work practice and client outcomes and reduce burnout. It is an important part of ensuring the quality and safety of health services. Skills in both giving and receiving supervision will increase the likelihood of successful supervisory relationships.
Successful supervision depends on developing a relationship based on trust. There are a number of principles to remember when providing or receiving supervision:
Once goals have been established and a supervision plan implemented then monitoring and follow-up are critical. Likewise it is also important to evaluate the supervision process itself.
As a clinician time is precious. In a remote or rural practice setting caseloads tend to be high and staff numbers are often low. You may be required to juggle many different duties (clients, administration, resource development, reports etc). As a result strong time management skills are a great advantage.
Well developed time management skills will help you to make the most of your day and retain a positive work/life balance. This will make your workload more manageable and increase the quality of time you spend undertaking each task. Poor time management on the other hand can result in a work load that seems ‘out of control’, heighten stress and anxiety levels and reduce the effectiveness of your work.
There are many strategies to manage your time effectively. Some will be more relevant to your work role and personal style than others. Some simple time management tips include:
Good communication is essential to teamwork, developing successful relationships with clients and colleagues, and managing conflict. It can also contribute to preventing many treatment related adverse events. Achieving effective communication can be particularly challenging when working in remote and rural areas with virtual teams, visiting services and working across cultures. Given the importance of communication in your role, it is worth investing some time in developing these skills, to help you communicate effectively.
We have created the following learning module to develop your understanding of communications skills and increase competence in the management of these issues. The module will take between 30-45 minutes to complete. Click on the below tab to access the module, which will open in a new window.
As you complete the module think about your communication skills:
Information Management refers to collection, storage, retrieval, communication and optimal use data, information and knowledge. Information management systems are localised to the organisation that you work in. It is recommended that you spend time with your manager discussing systems, policies, procedures and guidelines relevant to your place of work. This may include:
Patient Records: Documentation in client records forms an essential part of health professional activities. A high standard of patient record documentation is important to meet legislative and professional requirements, and to facilitate communication between health staff. Documentation of patient records is guided by standards and principles of good practice. Your organisation will most likely have guidelines for how to document, record and store medical records.
Patient Management Systems: Patient and client management systems are used to support all functions associated with the administration and management of patients and clients. These systems can include the ability to electronically record and access patient records, make referrals, access results, or manage your caseload.
Patient Statistical Data Collection: Typically, most health services and organisations have systems in place to collect information on the services you provide. This may include information on the types of patients you see, how often you see them, how long you see them for, and where you see them (to name a few). Data collection may be either paper based or electronic.
Document Management: Document management is the process of managing documents and other information. It involves the indexing, storage and retrieval of documents in an organised method. Some organisations have formal document management systems, whilst for others it can simply refer to how you organise electronic and hard copy documents in your department.
Library Services: Many organisations offer library services that provide you access to books, journals and other reference material. Increasingly these library services are becoming electronic (i.e. online).
Intranet: An Intranet is a private computer network that uses Internet technologies to securely share organisational information or systems with its staff. Intranets are often a ‘one stop shop’ for information specific to the orgnaisation, including forms and templates, directories, key documents, policies and procedures to name a few.
Telecommunications: Telecommunications include technologies such as the telephone, fax, computer, Internet and Telehealth. The computer can be an important tool for all remote and rural allied health professionals. It may include access to the Internet or your local Intranet, email, electronic record systems or applications such as Microsoft Word or Publisher.
Managing workload is perhaps one of the most challenging aspects of allied health practice. Workload refers to all activities required and performed by Allied Health Professionals within their role. It includes activities related to client/patient services, as well as other roles that you may be required to undertake such as student supervision, training of staff, research, service planning, administrative activities, etc. The term caseload typically refers to the number of clients AHPs serve through direct and/or indirect service delivery options.
Allied health workload tends to reflect four key activity clusters (as described by the National Allied Health Casemix Committee):
Clinical Care: Activities that provide a service to an individual, group or community to influence health status. Services may be diagnostic, therapeutic, consultative, dispensing or preventative in nature. This includes direct (screening, assessment and intervention) and indirect (case conferences, reports, program development etc) services. Time required for travel should also be considered.
Clinical Service Management: Professional and management activities that support and are essential to clinical care. This includes activities such as staff management, statistical gather and reporting, quality activities, professional development, program evaluation etc. See the Clinical Leadership and Administration & Management pages for further information.
Teaching and Training: Formal teaching or training activities which relate to the imparting of knowledge, skills and clinical competency to undergraduate and post graduate students, practitioners in own discipline, and other practitioners as part of a structured program. This may include clinical supervision.
Research: Activities undertaken to advance the knowledge of the delivery of care to an individual, group or community. Research is limited to activities that lead to and follow formal approval of the project by a research committee or equivalent body.
Your ability to manage your workload across these four clusters is influenced by:
A workload analysis process is necessary for Allied Health Professionals to ensure that time available to perform required activities is consistent with the time available. A continuous cycle of analysis and planning is necessary to ensure time is available for all activities and that the workload is 'balanced'.
Conflict is a normal part of human interaction. In health care conflict of some sort has been estimated to occur in the management of a half to two thirds of patients. This conflict most commonly arises between clinicians, but also occurs between the clinician and the patient.
Given this prevalence, it is inevitable that you will experience conflict in your role. This makes skills in conflict resolution very important. Conflict resolution skills will help you manage workplace conflict effectively and will reduce the stress conflict can bring to you and those around you.
Conflict can be productive when, as a result of listening to other perspectives, a solution is found that may not have been considered previously. It can be destructive when issues are left unresolved or there is coercion and dominance by one group over others. Conflict management and resolution is an essential part of successful teamwork. Central to managing conflict is good communication, as ambiguity or uncertainty can heighten any potential conflict.
The level of conflict can vary. Think about conflict as continuum from minor disagreements and differences of opinion, to personality clashes, to blatant hostility. The type and level of conflict will determine what response is needed to address it.
Katz (2007) suggests conflict resolution requires approaches at both the institutional and personal level. Focus on what you can control: how you identify, address and manage conflict. Some suggestions for resolving conflict include:
Think about the way you manage and resolve conflict:
At some point most health professionals will have questions about what or why things happen in the clinical or health service setting. A systematic approach to investigating these questions will optimise the chance of a meaningful result (positive or negative) and minimise time and effort in doing work or collecting data that is of limited use or that really doesn’t answer the question.
Research can be defined in many ways, but for simplicity let’s define research as any activity that is conducted to increase our knowledge or understanding of the world around us. In allied health, research might be considered as the systematic investigation of a problem, issue or question which increases knowledge and understanding of health and of the provision of care.
While research can seem intimidating it doesn’t have to be. In fact, research is something that, as health professionals, you are probably already doing without realising you are doing it. For example, at some stage you have probably been asked to prepare a report regarding your workload. No doubt you would have started by thinking about what this report needed to contain: How many clients did I see last month?; What did I see them for?; What procedures did I do?; How many people didn’t turn up?; What was the average time taken for the different appointments or procedures?; and so forth.
To answer these questions you would have needed data or information from various sources to give you insight. Perhaps you thought about whether anyone before you had done similar work and, if so, you might have obtained copies of these reports to see how they went about the task. You would then have considered what data you needed to collect, where the data might come from and how you were going to collect it. Perhaps you thought about how reliable the data were and its limitations. You would have analysed the data in some way, interpreted the results and written your report. This report might have compared your current workload with your workload over previous periods; or, with the workload of other departments. You might also have made recommendations about changing systems or about streamlining future reporting processes.
If you have done something like the above then you would have successfully begun your engagement in the research process, which essentially consists of:
Research may be quantitative or qualitative or involve a mixed methods approach. Each paradigm has its disciples, and differences of opinion regarding the appropriateness of the application of different methodologies have been the source of vigorous debate over the years. There is now general agreement, at least in the public health arena, that public health research benefits from multi-method approaches; that is, by the application of qualitative and quantitative methods, and incorporation of reflective and participatory action methods into the research process as required.
While some concepts can be challenging, methods daunting and the terminology confusing, research can also be fun and rewarding. So don’t be dissuaded from conducting your own research. Consider your practice and reflect on the following questions:
There are many books and other references available to help guide you. Even better, there are many people who will be willing to help and offer advice; academic staff based at any of the 11 University Departments of Rural Health or, working in one of the more than 20 Primary Health Care, Research Evaluation and Development (PHCRED) programs around the country. Refer to the PHCRED webpage for more information. Also refer to the resources below for more information.
Evaluation is a periodic, systematic, in-depth analysis of program performance to assist decision making. It relies on data generated through monitoring activities as well as information obtained from other sources (e.g., studies, research, in-depth interviews, focus group discussions, surveys etc.). Evaluations are often (but not always) conducted with the assistance of external evaluators. Evaluation skills are useful to have in a remote or rural practice setting as they allow you to ensure you are delivering services in the most appropriate and effective way.
The main objectives of program evaluation are:
Other objectives of evaluation can include:
There are different evaluation types, or approaches, that can be employed at different stages during the life of a project or program. Some of these include:
The very first decision in the development of a program is 'Should a program be implemented?' If so, 'What type of program is required?'. To answer these questions, the need for the program must be assessed. This type of evaluation activity is called needs assessment.
Once the needs of particular groups are well established, various program concepts may emerge. The next question that must be posed is 'Is our program idea feasible?' This is often called feasibility analysis.
Early in the implementation phase, it is important to check the health of the program and to answer questions such as: 'Is implementation consistent with the way the program was planned?' and 'How can the program be improved?'. This is often called interactive evaluation. This type of evaluation focuses on what the program does and for whom.
For well established programs monitoring evaluation is undertaken to 'keep a finger on the pulse' of a program to ensure it is reaching targeted populations and performing well. The type of evaluation that occurs during program implementation is also referred in other literature as process evaluation.
At program completion, or once the program is well established, outcome evaluation is used to assess the impact the program is having, or has had. In-depth evaluation of program effectiveness, impact and sustainability ensures that lessons on good strategies and practices are available for designing the next program cycle. This type of evaluation examines the changes that occurred as a result of your program and whether it is having the intended effect. In other literature this type of evaluation falls under the impact form of evaluation.
Program evaluation should be an integral part of program management for the availability of timely evaluation information to inform decision-making and ensure the Program Management is able to demonstrate accountability to its stakeholders. The plan for process, outcome and impact evaluation should be built into your overall program plan prior to its actual launch. While it is never too late to evaluate a program, you should plan your evaluation as early as you can.
In planning evaluation activities, decisions should be made in advance about:
Evaluations can cover entire programs; program components; thematic areas such as gender, capacity building strategies and other management issues within the program; and innovative or pilot projects.
There are several clinical skills that are particularly relevant in a remote or rural practice setting. We have identified some of these skills which may be relevant to you role as a remote or rural practitioner.
Clinical leadership refers to '…both a set of tasks to lead improvements in the safety and quality of health care, and the attributes required to successfully carry them out' (Victorian Quality Council, 2005). As an Allied Health Professional working in a remote or rural area your role is likely to include a clinical leadership element.
Clinicians can lead in many ways, both formal and informal, as part of their organisational position and/or through their collegiate relationships. There are many ways in which you can act as a clinical leader including:
Adapted from the Medial Leadership Competency Framework (NHS, 2008).
Using one of the competency frameworks identified below, assess your leadership skills. Reflect on the opportunities to further develop leadership skills relevant to your work context and role. Consider:
Caseload management refers to the ability to manage a number of clients, within a given amount of time and provide optimum services (this is the client specific aspect of workload management). Rural and remote practice is one of the most challenging in terms of implementing caseload management strategies. However it also has excellent potential for change and innovation by health professionals who already demonstrate many new ways of looking at things, flexibility and non-traditional thinking.
Both positive (supporting) and negative (impeding) factors must be considered when implementing caseload management strategies in a rural or remote context:
Sound caseload management can allow more effective use of the limited resources you have available allowing a greater scope of service provision across the continuum from preventative services to treatment services. Understanding the factors that influence the way you manage your caseload, the number of clients you see and the way you provide your services is a great starting step.
Contact Frequency: Specific types of clients or intervention may require a high contact frequency at specific points in their patient journey.
Complexity: Complexity is a significant variable in decision making about workload
management at individual, team and service level. Case complexity is multi-dimensional and includes consideration of co-morbidities, social circumstances and emotional factors, complexity of intervention/s, identification and management of clinical risk and factors relating to complex decision-making.
Allied Health Assistants and Other Support Workers: The delegation of tasks to Allied Health Assistants can increase workload capacity. However, consideration must be given to factors such as training and supervision of assistants, and the development of intervention programs that are appropriate for the assistant to implement.
Use of Technology: Telehealth (phone, videoconferencing etc) can be used to reduce travel time required to provide and access services. Telephone triage strategies have also proven effective in supporting appropriate prioritization of patients. See the Telehealth page for more information.
Service Model: Service delivery models are another means of managing workload. Adoption of each of these different models can have significant implications for the delivery of allied health services. Common service models utilised by Allied Health Professionals include:
Inter-professional (Team) Practice: Working with team members across the professions is highly regarded by allied health professionals. Multi-professional work is a very effective means of delivering best care to the client and has been found to be an important means to share ideas, improve skills, network and communicate with other health professionals. See the Team Practice page for more information.
Patient/Client Clusters: The extent to which you can cluster or group clients can have a significant effect on caseload management. Clusters allow for the development of pathways (see below) and one to many type service arrangements (e.g. groups).
Care Pathways and Packages of Care: Pathways describe the steps and components of services. They include information on eligibly/entry criteria, assessment and interventions process and discharge strategies. Utilisation of pathways can streamline services and assist in understanding the capacity requirements of a particular pathway.
Caseload Maturity: More time may be required when seeing new clients, as opposed to those that have been on the caseload for some time. Caseload turnover may impact of workload capacity.
Location of Clients: Additional time must be factored in for planning, travelling, and post visit activities when undertaking outreach services. See Outreach for more information.
Competencies: Allied Health Professionals must possess the necessary competencies the management patients with their caseload. Lack of competency (or confidence) may impact on service capacity.
Additional Roles: In the rural and remote setting, Allied Health Professionals often wear multiple hats. Additional roles and responsibilities may impact of workload capacity and must be considered.
Some simple strategies to assist in caseload management include:
Rural and remote allied health practitioners often have to manage demands from many sources, as well as working in areas which may be resource poor. In these environments clinical prioritisation can be particularly challenging.
We have created this learning module to develop your understanding of what is involved in clinical prioritisation and present some tools that will support your clinical prioritisation decisions. The module will take between 30-45 minutes to complete. Click on the below tab to access the module, which will open in a new window.
Think about the way you prioritise your time, workload and resources:
Successful team practice is an essential component of effective health service delivery, particularly in rural and remote practice. Rural and remote allied health practitioners may work in a number of teams that are likely to have quite different characteristics and dynamics to urban-based teams.
The following learning module has been developed to increase your understanding of teams and what makes them successful in a rural and remote context, and to increase your skills in these areas. The module will take between 30-45 minutes to complete. Click on the below tab to access the module, which will open in a new window.
As you complete the module think about the way you work within the teams:
The scope of practice of an Allied Health Professional refers to the broad frameworks and context of allied health practice of the individual professions including: (1) the range of roles; (2) functions and responsibilities; and (3) decision making capacity which the professional performs in the context of their practice.
The scope of practice of an individual Allied Health Professional includes (1) education, training and development (in the widest sense); (2) authorisation to undertake scope of practice and
(3) competence to perform. An individual’s scope of practice is influenced by his/her education, knowledge, experience, currency (recentness of practice) and skills. The scope of practice of an individual may be more specifically defined than the scope of the profession. To practice within the full scope of practice of the profession may require the individual to update or expand their knowledge, skills and competence.
Advanced scope of practice is taken to mean an increase in clinical skills, reasoning, knowledge and experience so the practitioner is an expert working within the scope of traditional practice. Extended scope is seen to include expertise beyond the currently recognised scope of practice.
Most professional associations or regulatory bodies have document describing the scope of practice for the profession within Australia.
As discussed on the Specialist Generalist page, Allied Health Professionals working in the remote and rural context have a broad scope of practice. There may also be specific circumstances (eg in rural or remote settings) where Allied Health Professionals are required to undertake activities or functions that are broader than is generally accepted as being within the scope of practice of their profession or outside of their own individual scope of practice, in order to meet the needs of the client/communities to which they provide a service.
In consideration of this, it is important you have a sound understanding of your professional and individual scope of practice. Whilst a task might be within scope of practice for your profession, it may not be within your individual scope of practice. This occurs more frequently for remote and rural Allied Health Professionals who are often required to work within the full scope of their profession, but may not have had the opportunity to develop and consolidate specific skills across such a broad range of practice areas.
In the team environment, it is important to have an understanding your own scope of practice as well as the scope of practice of other team members. This is particularly important when working with Allied Health Assistants. In delegating to tasks, it is critical you understand the scope of practice assistant in general, as well as the individual’s scope of practice.
Allied Health Professionals have responsibility to self assess, articulate and work within their own competence and scope of practice. Some useful questions to assist in determining if an activity/task is within your scope of practice include:
Reflective practice is a key skill for developing as an Allied Health Professional. Reflective practice refers to the process of thoughtfully considering your experiences. This allows you to identify your strengths and weaknesses, and improve your practice through the reflective process.
Donald Schon (1983) introduced the concept of reflection in practice. He talked about two types of reflection: reflection on action and reflection in action. Reflection in action is the process where the clinician recognises a new problem and thinks about it while still acting.
Reflection on action is the retrospective contemplation of practice undertaken in order to uncover the knowledge used in a particular situation by analysing and interpreting the information that you recall. This involves remembering the detail of the incident, how it happened, the feelings and thoughts that it elicited. In the reflective process you may think about how the situation might have been handled differently, and whether further knowledge might have changed the situation.
Since Schon developed the reflective practice concept, reflective practice has become an important component of health practice. It is recognised as a way to learn from our experience as clinicians and is an important component of clinical reasoning.
Remote and rural practice offers many opportunities for reflection. The issues that are faced by clients and practitioners in a remote or rural context are often complex and difficult and require problem solving to reach the best solution. Emphasis is often placed on reflection upon situations that did not go well, but it is important to reflect on situations where a situation went very well. This provides a more holistic picture of your practice, including strengths as well as weaknesses.
Reflective practice can take place privately or in a group. It may occur through keeping a reflective diary or journal, mentoring or discussions with colleagues. Other Allied Health Professionals, Allied Health Assistants, Community Based Workers, Aboriginal Health Workers, nurses and other people based in the communities can provide a deeper understanding of the context and assist in your reflection.
Engaging in reflective practice will help you to grow as a clinician and develop your clinical reason. Make reflection a part of your practice. Keep a reflective journal and reflect on your practice with your manager and colleagues. Think about:
The ability to translate evidence into a remote or rural practice setting can be challenging, particularly when you’re just starting out. Much of the evidence has been developed in a metropolitan or urban setting, and may seem to have limited relevance and transferability to a remote or rural context.
We have created a learning module to build your skills in translating evidence to a remote or rural practice setting. The module will take about 20 minutes to complete. Click on the below tab to access the module, which will open in a new window.
Complete the learning module and refer to the references within the module. Consider:
Clinical practice improvement is a way of improving and maintaining the quality of the care you provide and are accountable for. Put simply, you have a role to:
Although you may well feel you are providing a good quality service and are always trying to improve it, you also need to prove it through documented evidence that is complete and reliable. Clinical improvement (and associated tools and strategies) can be demonstrated across the following areas:
Consumer: This relates the communication and engagement of consumers. Some examples include informed consent, complaint management, patient satisfaction surveys and providing information about services to patients, their families and carers.
Clinical Performance and Evaluation: This relates to the use, monitoring and evaluation of evidence-based clinical standards such as policy, protocols, pathways and guidelines, and includes the use of clinical indicators, clinical audits or peer practice reviews.
Clinical Risk: This relates to the identification and reduction of clinical risks. It involves reporting of clinical incidents and adverse events.
Professional Development and Management: This relates to ensuring staff possess the necessary competencies to undertake their role. It includes consideration credentialing, competency standards and ongoing professional development.
There are some great resources listed below to further develop your clinical improvement skills and knowledge. These include:
There are some particular skills that are associated with remote and rural practice. Spend some time developing your competence in these areas.
In remote and rural allied health practice you are likely to see clients from various cultural backgrounds. In particular, depending where you are practicing, it is like you will be providing services to Indigenous clients. It is important that you develop skills in cultural safety and awareness to ensure your practice is appropriate.
Many workplaces will have cultural safety / awareness / competence or cross-cultural communication training. If you are working with clients from different cultural backgrounds, particularly Indigenous clients, seek this training out. If your workplace does not provide this training, speak to your manager about other training options.
To further develop your cultural safety and provide you with the opportunity to reflect on your practice we have created a learning module. The module will take about 20 minutes to complete. Click on the below tab to access the module, which will open in a new window.
Complete the learning module and refer to the useful resources below to develop your cultural safety. Consider:
Working in remote and rural practice can be challenging as you adapt to living and working in a different environment. There are different pressures and clinical challenges that you may face, in a small and sometimes isolated community. Most health professionals who have worked ‘in the bush’ also say how intensely rewarding the experience can be. Many stay or return later in their careers to settle in a remote or rural community. Knowing how to care for yourself is critical. This module seeks to help you in your transition to your new role and provide some strategies to assist you in the challenges you may face.
The ability to look after yourself, or self care skills, are important for Allied Health Professionals working in remote or rural practice settings. Many self care issues may arise as you adapt to living and working in a different environment and to the different pressures that you may face in a small and sometimes isolated community.
We have created a learning module to develop your awareness of the self care issues in remote or rural practice, and to build you capacity to manage these issues. The module will take about 20 minutes to complete. Click on the below tab to access the module, which will open in a new window.
Complete the learning module and refer explore the self care references provided in the module. Consider:
Working in remote and rural areas requires a well developed understanding of issues of confidentiality and a strong ability to define and maintain professional boundaries.
We have created a learning module to develop your understanding and increase your competence in the management of these issues. The module will take about 20 minutes to complete. Click on the below tab to access the module, which will open in a new window.
Complete the learning module and think about:
Professional isolation refers to a sense of isolation from your professional peers. It can result in a sense of estrangement from your professional identity and practice currency, or feel like you have ‘no one to turn to’ to discuss and share professional issues and ideas.
For Allied Health Professionals, professional isolation can be an issue in remote and rural practice. However it is important to understand that professional isolation is not about distance, it is about lack of professional networks and contact. The most remote Allied Health Professionals may not consider himself or herself professionally isolated if he/she has strong professional networks.
Each individual will experience differing degrees of professional isolation (if at all). Ask you self the below questions to gage how professional networked you are.
Remember networking does not necessarily need to be face to face. Telephone, videoconferencing and online technologies are creating new and exciting ways for professionals to network, no matter where you are located.
And most importantly:
Social Isolation can be one of the hardest parts of remote or rural practice, particularly when it involves moving to a new community and starting ‘all over again’. Learning to manage and overcome your social isolation is a skill that will make your transition into remote or rural practice a lot easier.
Everyone feels lonely from time to time. It comes in many forms and for many reasons. It is usually when you have little contact with familiar people or familiar culture and lifestyle. Moving to a new community and workplace can be lonely and quite isolating (at least initially). You may have moved away from you’re your family and friends, or feel isolated because of you culture (see the Johnson story).
It initially takes time and energy to replace 'loneliness' with involvement, and 'isolation' with a ‘sense of community’. Moving to a new community and workplace can be a big and overwhelming thing. Big and overwhelming things don't disappear easily - you have to chip away at them bit by bit.
Long distance relationships can be any type of relationship, including family, romantic or a friendship. For many Allied Health Professional commencing in remote and rural practice, relationship may change to a long distance relationship because you have had to move to a new community.
Long distance relationships can have both positive and negatives. On the positive side, you may now feel you have more space and independence. You can take the opportunity to explore different ways of communicating (try skype!). You also begin to value to relationship more – when you do see them it is special and exciting. On the negative side not having someone you are care close to you, especially when you need support can be tough. You may also feel a little lonely about not being part of their life anymore. Distance can also lead to jealousy and insecurity, and you worry that you may lose closeness.
Sustaining a long-distance relationship can be challenging, but there are some things that you can do:
The title of this section, safety and survival skills, sounds a little dramatic really. However, living and working in a remote or rural setting is likely to be quite different from metropolitan or urban settings, and with these differences come some specific safety concerns.
Travel in remote and rural areas is a particular safety concern. We have identified some skill and knowledge areas that may make your transition into, and experience within, remote or rural communities a lot safer.
It is likely that the roads you are travelling on are unfamiliar roads, as are many of the places you will be travelling to. Particularly in remote areas many of the roads may be unsealed, in poor condition, and subject to flooding. Wildlife on remote and rural roads also add to the potential hazards. Depending on where you are working, you may encounter kangaroos, wombats, emus, snakes, stray cattle and any number of other animals. Extreme weather, including cyclones, flooding, extreme heat and other severe weather conditions can also present additional safety concerns.
If you are moving to an unfamiliar environment take the time to develop some local knowledge. Find out about the weather, geography, safe practice protocols, and any other safety issues. If you are travelling outside the community: get good directions, take a map, find out what emergency procedures are in place, and check weather conditions. Make sure you take the appropriate equipment: water, emergency contact details, a satellite phone if available, spare tyre. Don't be blasé about your safety, don't take unnecessary risks or be caught unprepared.
If your role involves the provision of outreach services or travelling find out if your organisation has policies or guidelines for safe travel or visiting. If so review these documents and adhere to them in your provision of services. Also find out if your organisation has emergency protocols, these will cover what you should do in an emergency situation such as in the event of a cyclone.
There are some formal training options to increase your ability to manage your safety. If you are frequently driving off road, look in to an advanced driving or 4x4 driving course. An emergency first aid course may also be appropriate. Some workplaces will provide this training, or fund you to undertake it with other providers. Speak to your manager about how you can access appropriate safety training for your role.
The particular skills you will need will depend on where you are working and your role. Think about the safety skills you need in your role. What training you have had to develop these skills, and what other training is necessary? Think about:
Orientation, development and support are central elements in your transition to any work place, but they have special significance when practicing in a remote or rural context. It is important you develop an understanding of the orientation, support, and development opportunities available to you, and make the most of them.
This section provides an overview of some of the important elements contained within orientation, support and development. It also provides links to support and development resrouces for students, and some information pertaining to scholarships and grants. Read through each of the pages and think about how these best apply to your situation.
Orientation is an essential process when you start a new job, more so when it involves moving into a new community. By definition, orientation is a systematic approach used to welcome new employees and provide necessary information for the employee to become familiar with the workplace. The orientation process will give you an understanding of how the organisation works, your expected roles and responsibilities, and help you become familiar with your workplace and colleagues.
We have put together a brief overview of some of the key elements of orientation you should receive or seek out. Read each of the pages and think about how you can best engage in the orientation to your new role and community.
Your role will vary significantly depending on the location. The support available to you and your scope of practice will also vary depending on your workplace – from sole practitioner to part of larger team, private practice to government health service position.
Research your new job by talking to health professionals who are out there doing it - find out what it's like for them. This is all information you can find out before you apply for the position, at interview or after you have been successfully secured a position.
Below are some particular issues you might want to look into.
Some employers will offer assistance with relocation. This may involve reimbursement of relocation costs or provision of accommodation allowances. Find out if you have access to relocation support.
Place of residence is a big part of moving to the country. This is the place that you spend the second most amount of time in (outside of work). Some health services may offer short term or long-term subsidised accommodation options. Prior to starting explore your accommodation options.
If accommodation support is available make sure you investigate:
If accommodation support isn't available make sure you investigate:
It's also a good idea to get to know as much as you can about the community before you arrive. Much of this information you can find on the Internet. Alteratively have a chat to people who live in the community (the local tourism centre can be extremely helpful, as can other local health professionals). Another option is to visit the community before you start, this gives you a good chance to have a look around.
Some things to find out about the community include:
When you start in a new job you may receive several types, or levels, of orientation to your employment. These may include organisational, site and workplace orientations. Below we have provided a brief description of these types of orientation.
Organisational orientation provides information relevant to all those working in the organisation. This is mainly relevant for large organisations, government and private, that have health facilities across many sites.
You may be required to undertake this type of orientation independently (often on-line or in written format) or as part of an integrated site orientation. Ask your manager if there is an organisational orientation (sometimes called a corporate or general orientation) to your organisation.
A site orientation will introduce you to the people, policy and practices that operate within your work site (not just your department or work area). These sessions are typically scheduled regularly, and may include mandatory skills training and assessment. All people new to the health service attend them.
Talk to your manager or your local Staff Development Team for further information regarding health service sites orientation.
Workplace orientation assists staff to learn more about their new job, work role, to get to know their new colleagues and to master the detailed procedures of their new job. This type of orientation may take up to three months, during which staff will develop their knowledge and performance levels to acceptable standards of quality and timeliness. This orientation is about what you do everyday.
The first month of a new job can be quite stressful. Here are some simple tips to help you settle into your new workplace.
The National Rural Health Alliance have some additional advice:
Take a look at our Strategies to Support Orientation page for some more tips and hints.
For many Allied Health Professionals commencing work in a remote or rural setting means settling into a new community as well as a new job. In order to make the best of remote and rural practice it is vital that you take the time to become orientated to the community. Spend some time investigating or asking people about:
|• Sport and recreation
• Library and facilities
• Clubs and groups
• Weekend activities
|• Local night-spots
• Schools & child care
• Post Office
|• Travel and transport options
• Local events
• Local sights
• Local health services
Below are some suggestions for helping you settle into your new community:
There are several strategies you can employ to get the most out of your orientation. We have identified a few for you below. Review the strategies and think about how you can get the most out of the process.
Orientation is a two way process. The organisation has a responsibility to provide a comprehensive orientation and induction to new employees. It's also important that you take an active role in your orientation process. Be active. Ask questions.
You can do this by:
Some workplaces will assign a “buddy” to assist with orientation. If you workplace doesn’t offer a buddy system, ask your manager to help you find one. An orientation buddy is a great resource, and gives you someone you can ask about local procedures and who can help you figure out how things work. Responsibilities of a buddy may include:
Work shadowing can be a really good way to get a better understanding of your job and your work environment. Developing these understandings will better facilitate your orientation.
Mentors are fantastic resources to support your orientation. Some workplaces will have existing mentoring programs in place. If your workplace doesn’t, talk to your manager about finding one for you.
If you’re moving to a new community with a partner and/or family, orientation is more than just you to your job. The orientation process needs to extend to the members of your family to ensure that they settle into the community with you. There a plenty of strategies you can employ to ease the transition of you family, see below for some hints and tips.
Some tips to help partners settle into a new community:
Some tips to help children settle into a new community:
We have generated two checklists that might be useful to help guide orientation, and also ensure that you are orientated to everything that you need to be:
Print off these checklists and tick off items as they are completed.
If there are items that you have not been oriented to check with your line manager.
As part of the orientation process, it is useful to establish an orientation table (see below). The timetable ensures that sufficient time is allocated and quarantined for orientation.
Orientation (or lack of it) will make a significant difference to your employees’ attitude about their position, co-workers and organisation. It will also contribute to how quickly they can be welcome into the workplace, become more productive, and become part of the team. Over the long term, this can even influence overall job satisfaction and determine whether a staff member decides to stay.
Below are some strategies to help you successfully orient your new staff.
The Orientation Checklist & Schedule page provides some tools that may be helpful.
Your continued professional development is an important facet of your growth as a clinician. Development is a broad process and requires clinicians to be actively involved. We have put together a brief overview professional development, including the process, pathways and some of the developmental opportunities available. Read each of the pages and think about how you can be proactive in your development.
Continuing Professional Development (CPD) is an interactive process by which health professionals maintain, enhance and extend their knowledge, expertise and competence throughout their careers. Alsop (2000) described the key features of CPD as:
All practising professionals want to develop their careers and strive for excellence. Effective CPD will make you:
CPD can be of enormous profession and personal benefit. It can improve your professional effectiveness, career opportunities and work satisfaction. As Allied Health Professionals, we are also ethically, legally and professional bound to life-long learning through our Code of Ethics, professional regulations and standards of practice.
When we talk about CPD, we automatically think formal training. However, professional development can include a wide range of activities. Attending lectures, conferences and courses remains a key aspect of life-long learning, but it is important to realise that the majority of learning comes from experience in a day-to-day practice.
The following list of CPD activities (based on the framework developed by Health Professions Council, UK) is not exhaustive, but it will provide you with some idea of the types of activity that you can undertake which will contribute to the achievement of your learning outcomes:
Work Based Learning
Formal / Educational
One of the most important parts of CPD is planning. Typically planning for CPD includes 5 key steps:
Alsop, A. (2000). Continuing Professional Development: a guide for therapists. Oxford: Blackwell.
Spend some time developing a Learning Plan (if you don’t already have one). Remember when developing your learning plan:
Competency frameworks provide a means of benchmarking your professional competence and development against determined standard. They can be a useful way of making sure you’re on the right track, and give you an idea of areas you would like to focus your professional development towards. Health professionals have many different types competencies, which can include:
Profession Specific Competencies: Competencies unique to a clinical situation of clinical profession (e.g. physiotherapy specific competencies). All professional associations have available competency frameworks specific to the allied health profession. Some organisations also have developed profession specific technical competencies.
Shared Profession Competencies: Compencies shared by a number of health professions in the delivery of health services. This may include competencies for a practice setting (e.g. rural and remote), a particular program area (e.g. mental health, aged care, child development), or working with a particular patient cohort (e.g. cultural competencies).
Generic Competencies: Competencies shared by staff working within the health organisation (e.g competencies such as basic life support, fire and safety, hand hygiene etc). Regular training in these competencies is typically provided by an organisation.
The Australian Government is currently undertaking a project to identify core competencies for Australian Health Professionals.
Effective learning is not just about attending a courses and conferences, it requires you to reflect on your practise and integrate new information where it is relevant to improve your practice. It may include:
There are three types of reflection:
Reflection in Action: Reflection-in-action is the ability to conduct such reflection not only after the experience, but also during the experience – the ability to think on your feet, to understand what is happening and why, and to deal with the uncertainties of practice in situations.
Structured Reflection: Structure reflection involves systematically moving through one or all of the following:
Informal Reflection: Most of us engage in reflection activities without even being aware that we are, in activities such as:
These activities however often tend to lack a focus on change or learning points. Try in improve the effectiveness of informal reflection by including a ‘what will I change/improve’ question in your discussion.
Becoming a reflective practitioner requires time, practice, and an environment supportive to the development and organisation of the reflection process. This is a highly individualized process and you should find the structure and method of reflection that best you.
Some examples of reflective practice options include:
|Immediately after the experience
At the end of the day
During my planning time
First thing in the morning
Wednesday during my lunch
|In my office
In the shower
On the way to work
|On the computer
Verbal reflection with peer
With the increasing availability of flexible learning, access to post graduate studies is becoming more accessible for remote and rural allied health professionals. Postgraduate studies can be a great way to improve your knowledge and skills and develop your career. Just because you are remote and rural, doesn’t mean that you can’t undertake post-graduate studies. For many AHPs this is actually a great time to consider further studies, especially with access to remote and rural Scholarships & Grants.
There are many postgraduate courses that may be of interest to remote and rural allied health professionals. These include profession specific, program specific or remote and rural specific. Deciding which postgraduate course is best for you is very personal decision, guided by your interests and future career aspirations. Flexible learning also means that your choice of university is also extensive (you are not just limited to those in your back yard).
The Australian Government’s Higher Education Loan Programme (HELP) includes the following loans for postgraduate studies:
JASON is a postgraduate scholarship search engine. Scholarships in the database apply to Australian students wishing to study at home or abroad, and to international students wishing to study in Australia.
Also see Scholarships & Grants for scholarships specific to remote and rural allied health.
The Good Universies Guide: Information for Post Graduate Students provides some useful information to help you answer the above questions.
Work shadowing quite simply refers to a process where one staff member 'shadows' or follows another in their work role for a period of time. In practice, work shadowing provides an opportunity to increase knowledge, skills and understanding of a particular job role through first hand observation. It also provides a means of gaining insight into how the local health service operates, and how a particular work role fits within the overall organisational structure.
Actively seek out work shadowing opportunities. They allow you to better understand your role, that of others within your team, the health service, and the community. They also allow you to develop your professional networks. Use work shadowing to support your orientation and your ongoing development.
Potential people to shadow may include:
The time spent shadowing will vary depending upon the person you are shadowing, the direct relevance of their role to yours, and the particular context. A day is a good start. It may be useful to organise several work shadowing opportunities with the same or different people spread over a period of time to maximise your learning opportunities.
Talk to your line manager and identify relevant work shadowing opportunities.
Performance Development is a tool for rewarding, encouraging, supporting and developing all employees. Organisations use many different terms to describe performance development, including performance management and performance appraisal (to name a few). Performance development aims to develop, maintain and improve your skills, knowledge and job performance in order to achieve individual career goals and contribute to the achievement of team and organizations business goals.
Performance Development is an ongoing cyclical process, which provides time and a structure for you and your manager/supervisor to:
Many people have reservations about performance development, thinking that it is an opportunity for your manager to ‘critique’ your performance. This couldn’t be further from the truth. It is an opportunity to recognised your achievements and developments and to make a plan together to develop the competencies and capabilities you require for your role now and in the future. It is a chance to let your manager know what you are capable of and where you want to take your career. It can be also be a way to open up communication channels about how your job contributes towards the organisation goals and objectives, how the job could be done better, what you need to achieve this and how the organisation can help you.
Duraisingam V, Skinner N. Performance Appraisal. In N. Skinner, A.M. Roche, J. O’Connor,Y. Pollard, & C. Todd (Eds.), Workforce Development TIPS (Theory Into Practice Strategies): A Resource Kit for the Alcohol and Other Drugs Field. National Centre for Education and Training on Addiction, Flinders University, Adelaide, Australia; 2005.
A Professional Portfolio is a reference folder that allows you to gather evidence that you can use to demonstrate your goals, competencies, ongoing professional development, career achievements and accomplishments and experiences. Professional portfolios are valuable tools to: help you to demonstrate that you are developing, maintaining and enhancing your skills; assist you in identifying current and future training needs; and prepare profile statements linked to registration.
Professional portfolios are also useful to:
Professional Portfolio’s are very personal. It is a document that will differ considerably from person to person. Typical components of a professional portfolio may include:
Do you have a professional portfolio? Does your professional association have a template for professional portfolios? If you don’t have one, start making one now. Some tips when creating your own personal portfolio include:
Whilst remote and rural practice can provide a rich environment for CPD, there are a number of barriers for remote and rural Allied Health Professionals, mostly due to the difficulty in accessing events hosted in the city, or the effect of small department size on CPD opportunities. Below are some tips for addressing some of the commonly recognised barriers.
Formal CPD frequently requires funding (e.g. registration costs and study leave). Funding required to attend CPD can be higher for remote and rural practitioners as travel and accommodation costs are often incurred. Tips:
Finding time to undertake CPD can also be challenging. It can often be hard to squeeze CPD (especially self directed) into your busy schedule. Tips:
Much work has been done to address the issue of access to CPD. A larger range of CPD is now available via videoconference or in self-directed format. Access to the Internet has also enhanced the ability of allied health professional’s to keep up to date with current research and directions. Tips:
Frequently learnings from CPD are specific to a context or practice situation that may not be directly applicable to remote and rural practice. This often means that you have to apply these learning to your context. Tips:
Research shows that CPD is optimised when you identify the knowledge and skills needed for professional competence, use appropriate educational methods, and develop individualised strategies when applying what has been learned to professional practice.
You will learn best when you are motivated, and your CPD:
Continuing Professional Development information for Health Professionals (ACT Health, 2005)
After every CPD opportunity, there are several questions you can ask to maximise learning:
In any work role you need to receive support, and feel supported. When you first start in a position, this support will help you to become orientated to your role. As you settle in, the support will help you to stay there and get the most out of your job.
We have put together a brief overview of some of the elements of support available to you. Read each of the pages and think about how you can get the support you need to thrive, and make the most living and working in a remote or rural community.
One of the best ways to build your confidence in your work performance is to seek professional or clinical supervision. High quality supervision will ensure that you and your manager are ‘on the same page’ and guide your development. When you first start in your role it will help you to become orientated more quickly to the position and help you to understand what’s expected of you. As you settle into your role, professional and clinical supervision provides support, builds on your strengths and develops the areas that challenge you.
At a basic level supervision can be a used to ensure that your work is at a suitable standard to ‘pass probation’ or to renew a contract. However, it can also be much more. Supervision can provide an opportunity to formally reflect on your strengths, pinpoint areas for development, and discuss strategies (and budget) to address your needs. A committed manager will provide feedback to promote your growth and development as a professional.
Most workplaces will have a formal performance management process, which will include clinical and professional supervision. If your workplace doesn’t have a formal process, discuss this with your manager. Ask for regular appointments, particularly during your formal orientation and in the first year of your position.
If your manager is ‘off-site’, or in the case of clinical supervision not of your discipline, alternatives, such as teleconferencing or internet technologies such as Skype may be appropriate forums to schedule protected discussion time to reflect on your performance and to ask for assistance with challenges. Refer to our Telehealth page for more information. If your manager is unable to provide supervision, think about other ways you can access supervisory support. Possible sources include:
Mentoring refers to a formal or informal relationship between an experienced and a less experienced staff member. Within the business world mentoring is frequently viewed as a strategy to accelerate your career, however, for a rural and remote health professional the benefits are far greater and quite different.
Being able to access support and advice from a more experience staff member can greatly influence the ease of your transition and your ongoing development. It can focus on professional issues as well as broader information to help you ‘thrive in the bush’.
A productive mentoring relationship can offer you increased networking opportunities, access to resources you might not have known about, enhanced clinical skills, support in difficult or new situations, and increased job satisfaction while reducing your risk of burnout and stress. Of course career planning can be included within the mentoring discussions as can your leadership potential.
Many workplaces have mentoring programs in place. Speak to your line manager and find out what is available to you. Your professional association may also have a program. Contact your association to find out what you can access. If your workplace doesn’t have a formal process, discuss this with your manager.
If you are unable to access mentoring at within your workplace take the initiative to seek out a mentoring relationship. Below are some strategies to identify a mentor:
Establishing networks is really important when you first commence rural and remote practice. Professional and social networks will anchor you in the community and your workplace, and provide support to get yourself established.
Time spent getting to know people within your workplace and community is not time wasted! Think of it instead as an investment in your success in a remote and rural practice setting. Below are some professional and community networks to get involved in.
Developing professional networks is a great way to establish links with other health providers, existing services, resources, and professional support. Start within staff in your immediate team and then expand out from there. Take the time to find out what other people are doing, how their role fits in with yours, and how you may be able to work together.
There several ways you can identify professional networks. Ask your manager and others within your workplace who you should connect with. Pick up the phone and call health services and private practitioners in the area. Look on the state Health Department website, search for a health service directory. Alternatively, look in the local community directory for other providers in your area.
Below is a list of possible professional networks you should explore. Look both to state health services and private practice. You may not have access to all groups, but find out who is available to you and make the most of them.
Living and working in a remote or rural area is so much more than work. Getting hooked into the community will make the transition much easier and allow you to get the most out of living in a remote or rural area. However, for many of us it’s really hard work to put yourself out there, and it’s often a bit challenging knowing where to start.
Start by find out what social, sporting and cultural activities happen within the community. Visit the local shire office, tourist information centre and library, read the local newspaper, look at noticeboards, and ask people. Knowing what’s available is not enough though; you have to get actively involved. Join a team. Try something new. Never say no to an invitation. Getting involved is the best way to met new people and settle in.
As an Allied Health Professional working in a remote or rural practice setting, there will likely be times when you will need specialist support. It is important to remember that you are not expected the know everything. When these situations arise seek the support you need.
Given this, an important part of being a remote and rural practitioner is knowing where to access support. There are three main sources of support:
The best way to find out about support strategies is to ask your manager/supervisor/mentor, another member of your team, or a colleague. Good questions to ask include:
One important resource you should develop is your own personal specialist support directory. This contains names and contact details for specialist supports available specific to your practice area. This may take a little time to establish, as you become more familiar with your work and the support and specialist services available.
There are several support and networking avenues available to students with an interest in remote and rural health.
Student placements in remote or rural settings are a fantastic opportunity to develop your skills and experience remote or rural life. There are several resources available to support student undertaking rural placements:
Most University Departments of Rural Health provide information pertaining to local student placements on their websites, including regional and site details and support options.
Funding and scholarships are available to support student clinical placements:
A range of scholarships and grants are available to support the professional development of rural and remote Allied Health Professionals and students.
Scholarships and grants are offered by many State and Territory Governments, the Commonwealth Government and other organisations. How these scholarships and grants can be used will vary: some will be for the costs of formal studies; some may be for conference or short course attendance; and others may support student placements.
Below is a limited list of some of scholarships and grants available to Allied Health Professionals and students in remote and rural areas. In addition to these, speak to your line manager, speak with your colleagues, review your state Health Department website, or get in touch with your Professional Association. These scholarships and grants provide you with an opportunity to invest in your professional development.
More information on State specific scholarships is available on the Scholarships page at the SARRAH website
One of the best tools to support your transition is other clinicians working in remote or rural settings. Speaking to other clinicians and listening to their stories, regardless of their professional group, will give you a great insight into the experience of transition into a remote or rural community and work place. It will give you a better understanding of some of the challenges, pitfalls and struggles you may encounter. It will also highlight the benefits and joys of remote and rural practice. Other clinicians can help you settle into your work role and your community as well as offer so much support.
We have collected stories that highlight the experiences of clinicians working in remote and rural communities across the country. We have tried to capture both transition stories and develop a picture of a ‘normal’ day for clinician working in rural and remote areas. Take the time to read though them. Think about the clinicians within your workplace, and find out their story. Think about your story, how will it read?
A day in the life of an OT working in the West Kimberley…
By Casey McRobb
|6:00am||Rise and shine. It’s going to be a long day…|
|6:30am||Walk across to the hospital and around through the back entrance (it’s too early for the main doors to be open)|
|6:35am||Unlock the OT office, double check have all the necessary gear for the day.
NB: Remote trips require lots of planning! Equipment needs to be arranged, tools need to be gathered in case wheelchairs need mending, paediatric assessments need to packed for the new referrals, therapy sessions need to be planned and the appropriate games and toys packed. It all has to be taken with you as there are no resources in the community itself other than the fantastic knowledge of the clinic nurse and Aboriginal health workers.
Load up the car with OT, SP and PT equipment and paperwork. It’s often a tight squeeze and requires good problem solving skills to fit it all in! Especially when you’re trying to take a wheelchair, kitchen stool, and shower chair out on the same visit! As well as three crates of notes (one for each discipline) and not to mention the spare tyre (very important!).
|8.00am||Turn off the main highway onto a gravel road. Pull over and click the 4wd hubs into lock ready for the unpredictable road ahead. Heavy rains have probably washed away parts of the road.|
|8.30am||Drive through the main gates of the community and towards the clinic. A few stray dogs, a number of car bodies and a friendly wave from passing locals.|
|8.35am||Discuss case load with the health workers at the clinic to establish who is present in the community today. Aboriginal people are often very transient. Unload equipment from the car and confirm with PT and SP how the day will run.|
|9.00am||Pop across to the school to complete an initial assessment with a child referred for handwriting difficulties. Also complete two separate therapy sessions. One with a child who has difficulty with letter formation and directionality. The other with a child who is having difficulty grasping the concept of visual closure.|
|11.30pm||Dart back to the clinic and meet back up with the PT to complete joint visit. Locate elderly patient in the community who requires a shower chair. Deliver and set to appropriate height. General discussion with patient reveals patient sleeping on the floor and having extreme difficulties with transfers. PT to advocate for appropriate bedding for the client back in Derby.|
|12.00pm||Call past palliative client to see how managing. Patient in high spirits and sitting up in bed eating lunch at time of visit. Brief check of wheelchair to see that repairs have held since last visit (pusher rims had fallen off so the chair was taken back to Derby for maintenance to repair). Bumped into another client unexpectedly and discover that he has in fact moved house and will require minor home modifications and rail installations. Time thus taken to assess his new house for exact specifications.|
|12.45pm||Back across to the school with the PT and SP to present a talk to the staff advising of our individual roles and how to refer their students to the service.|
|1.30pm||Back to the clinic for lunch with a quick stop off to the local store to check on a client with suspected carpal tunnel syndrome. A splint was made when the patient came to the hospital for an xray two weeks ago thus checking how it’s fitting now.|
|2.00pm||Write up progress notes for the clients seen today.|
|3.30pm||Pack up car and depart the community. The 90 minute journey home begins.|
|4.30pm||The girls take advantage of the drive home and catch some shut eye.|
|5.00pm||Arrive back in Derby. Re-fuel vehicle on the way to the hospital.|
|5.15pm||Unload car and literally dump equipment and notes in OT office to be sorted out tomorrow.|
|5.30pm||Home time - what a day!! I wouldn’t trade it for anything else.
Transitioning from student to professional, city to rural: All in one effortless motion…
By Renae Strugnell
In my fourth year of an Occupational Therapy Course at the University of South Australia I was given the chance to undertake a rural placement in Port Pirie, South Australia.
So here I was heading to Port Pirie with five other OT Students for a three month adventure that truly set the pathway for unforgettable memories, experiences, opportunities and friendships that grew stronger than we had ever imagined.
The knowledge and skills that we developed working in Port Pirie have carried on till this very day as a clinician. I learnt the importance of including communities in practice and service delivery. To have an understanding of the rural living and social determinants that impact on health. My confidence to communicate and develop working partnerships effectively was increased, as was my capacity to build professional networks. All of these have greatly benefited my clinical work since.
During the placement there were some challenges. The biggest was dealing with the realities of working within an organisation, the ‘red tape’ and time pressure and stress management. We all maintained work / life balance by becoming involved in the community through sport, the gym, and other social events which extended our friendships with locals and many other students.
So here I am April 2009…having officially graduated, I am now working on a 12 month contract as an Early Intervention Occupational Therapist in Port Pirie. I am applying my knowledge of Primary Health Care principles and clinical expertise in the area of Paediatrics.
I continue to embrace the learning journey, expanding my knowledge on Paediatric OT, PHC practice, working in a multi disciplinary environment, time and stress management, and balancing work and life.
As a new graduate the transition from student to clinician has been smooth not only due to the support of PPRHS in training and development, clinical and administrative supervision, mentoring opportunities and accommodation, but through the prior networks and experience I had gained as a student.Of course there are ups and downs, moving away from friends/family to the ‘unknown’, anxieties of my clinical judgement and working with complex clients and communities. However, embracing the challenge, learning from mistakes, taking on advice and direction from colleagues, meeting new friends and living life - playing sport, camping, dinners, quiz nights and road trips has made this transition truly effortless.
Anything but a Normal Day in Remote Queensland...
By Marrisa Arnot & Danielle Charles
As we fumble around our bedside tables to switch our alarm clock off as quickly as possible, in the vain attempt to silence it before it wakes up the bloke sleeping next to us, it is a small comfort to know at least one other person is doing the same thing just around the corner. It’s 5:20am, it’s dark, it’s not really cold because we live in Far North Queensland and for the “Foot Lady” and “Food Lady” (as many of our clients refer to us) it’s the beginning of an outreach trip.
The Torres Strait and Northern Peninsula Area Health Service District has 22 primary health care centres spread across 16 islands and the tip of Cape York. For most Allied Health staff working here, you are a sole practitioner servicing a district which consists of approximately 10000 people. For many staff outreach trips are a regular part of their weekly work. The Podiatrist and Dietitian make up two thirds of the diabetes educators outreach team with a Diabetes Nurse Educator completing the trio.
After our early wake up, we catch a ferry from Thursday Island to Horn Island and then a bus to the airport. It’s now about 6:45am and we’re not even half way there. The flights to the outer island communities range from a short 15 minute trip to Moa Island, to an hour-long flight to Murray Island. Sometimes we are on the “milk-run” and find ourselves stopping at 1, 2 or 3 other islands on the way. Luckily the views of the islands and reef are spectacular; the kind people pay money for.
We usually arrive at the clinic about 8:30am to find familiar faces sitting patiently, waiting to see the “Foot Lady” or “Food Lady” and we are greeted with a friendly hello. This wasn’t always the case, but after 4 years in the Torres Strait we have earned a certain fond acceptance.
Our work consists of an incredibly diverse caseload, which continually challenges us to employ an innovative approach. This makes the job interesting but there are so many other aspects to life in the Torres Strait that make it really special here:
The days are long on outreach trips, usually not getting home until 7pm 2 days later. But it is all made worthwhile by the little things . . . . when you can conduct a diabetic foot check in Creole and no one batts an eyelid . . . . when the locals prefer your modified healthy Semur Chicken to the traditional island recipe.
The Torres Strait is an amazingly place to live and work as an Allied Health Professional. No two days are the same; the service is provided in a variety of settings, from the hospital to primary health centre to under a tree, and the workload continually challenges and extends you. It is a friendly and social place that gets under your skin, a place that gives back as much you give.
Out of comfort and into the Outback...
By: Felicia Koh
Felicia is a Physiotherapsit working in South Australia. In the below stroy, Felicia speaks about her experience in rural and remote practice.
In January 2006, I arrived in 48 degree heat to begin the challenge of taking on a 6-month locum position as a Paediatric Physiotherapist in the Flinders & Far North Community Health Service (A service of Port Augusta Hospital & Regional Health Service) Port Augusta, South Australia. My position was within the Child Health Team & Women’s Health Team.
Port Augusta has a population of approximately 15,000, 25% of whom are Aboriginal. It is situated at the tip of Spencer Gulf, located at the foot of the spectacular Flinders Ranges, and is widely known as the 'Crossroads of Australia'.
The specific challenge of rural, remote, indigenous and paediatric health each attracted me to the position. My role was predominantly based at the Flinders Terrace Community Centre alongside a multi-disciplinary team consisting of a speech pathologist, occupational therapist, dietician and allied health assistants. Within this team setting, we were able to provide more holistic assessments focused on family-centred practice. I have learnt that a multi-disciplinary setting is invaluable in creating a platform for further learning, development and partnerships across the allied health field.
Part of my job involved regular monthly “outreach” trips aboard the Royal Flying Doctor Service (RFDS) planes, which provided a unique opportunity for our team to service isolated and remote areas. A typical outreach day to Roxby Downs involved an early 7am start, followed by a 45-minute ride aboard an 8 seater plane across barren, dusty red landscapes of open sunburnt land. Upon arrival, the team’s allied health assistant helps to organise our transportation and consulting rooms for time efficiency. It’s a full 2-day outreach trip with clients and health promotional work back-to-back due to the limited health access in remote areas.
Some of my primary health promotional work during outreach involved giving talks about age appropriate play to a group of young mothers, doing a radio talk on the typical development of children’s leg and feet postures and providing information and practical skills for improving the local “Kindergym” program that targets children 0-5 years.
Managing and supporting children and families in remote areas can be a challenge as access to both consistent day-to-day support and equipment is not as easily accessible. Most specialist appointments and wheelchair or orthotic fittings need to be accessed in Adelaide – a good 6 hours away by road. There are some families who have limited financial resources. I found that being creative & flexible, such as incorporating cheaper home-made play activities was important in supporting these families.
Some of the challenges during my time in Port Augusta included being the sole paediatric therapist without direct day-to-day supervision. However, I have learnt that it is during moments of clinical challenges that confidence, initiative and perseverance are best developed. Some of the important initiatives that I undertook include establishing long-distance mentoring with well established paediatric physiotherapists back home in Melbourne; becoming a member of the APA’s Paediatric Special Interest Group and making contact with local paediatric physiotherapists from Novita Children’s Service and Adelaide’s Women’s and Children’s Hospitals. All my professional mentors were invaluable, as they were able to support me both clinically and personally during my locum period.
One of my on-going primary health care projects called 'Have a Ball' included working closely alongside the team’s dietician to develop a “toolkit” with the aim of improving nutrition and physical activity in children from birth to six years old in Port Augusta. The toolkit included the development of culturally appropriate and easy to read pamphlets on appropriate play and nutrition, home-made play toys such as mobiles, shakers and posting tubs. The project was launched with an initial 8 weeks trial at 'Families SA' and within the hospital’s Child Health Team itself with great feedback for further development. Through the process of working on this project, I have realised that physiotherapists need to play a greater role in primary health care and in being more active health ambassadors within our own local communities.
Aside from all my professional growing, I was able to experience many other facets of living in Port Augusta, such as watching a live rodeo, fishing and crabbing in the Gulf, walking and hiking trips through the Flinders Ranges and camel riding through the outback. The slower paced lifestyle also gave me the opportunities to step out of my comfort zones by taking on more extra-curricular activities such as learning to sail, attending Spanish and painting classes and singing in an a’capella choir. I also enjoyed being a part of the local Aboriginal church as it gave me the opportunity to embrace more of our indigenous culture. I fondly recall the sacred Dreamtime stories that were shared with me and the patience taken to help me understand more about the continued challenges and complexities that face our Aboriginal people, both on a social and health care level. Together, these experiences have added to my appreciation of country living, the Outback and being Australian.
The Outback is a place rich and unique in its culture, spirituality, scenery and peoples and I would strongly encourage anyone with a sense of adventure to take up the challenge to spend some time in this setting. I am a now a strong believer that inexperience should not be seen as a barrier, but rather as a hurdle to be overcome through motivation and dedication. Working as a paediatric physiotherapist in the Port Augusta enabled me to embrace both my career and my personal life to a very full & rich degree.
From India to regional Victoria...
By Johnson Mathew
Before I came to Australia, I was working with different conditions, like de-addiction, psychiatry, child labour, Counselling etc. I got my registration done with the Australian Association of Social Workers and came to Australia and started working in regional Victoria.
In terms of my experience in the rural setting I must say that I love the place so much. It is really beautiful, pleasant, relaxing and less crowded than home. It has got something in it which refresh you every time. The locals in my Camperdown are really great people. You get to know everyone in town and everyone knows you as well. Small groups, sports clubs, recreational activities makes it lively in its own ways. Rural setting is the best to learn a lot more about the real culture and taste of Australia, we get time to talk to people more and to learn more in many ways.
It is not always easy. The hard side of life in rural setting can be concluded in one word which has many meaning “Social Life”. When I say about social life, it includes your friends, contacts, fun, entertainment, social well being, and social support. Anything to do with life outside work. I am the only Indian in this area, and that can be really hard in many ways. Many of the local groups and people have their own network of people and friends, there own group of friends and it is really hard to be one among that group or to be part of that network. Many relationships are really professional or ‘hi-bye’.
This can lead to a situation where you start missing your friends back in your country, your family, all the good things and relationships which you left behind to work in this country. But to conclude I should say that “this is life”, and I thank all the good people who find time for me, support me and make me feel that I am not alone.
T.I. TIME: Developing Patience & Celebrating Small Successes
By Marissa Arnot
Marissa is a Deitician working in Remote Queensland.
TI time, Island Time or whatever you call it, basically sums up the laid back, easy going and relaxed way things happen in the Torres Strait and I suspect many other island and rural/remote communities. There is no rushing anything in the Torres and at first when moving from the city, where everything is running by a clock and you are expected to squeeze in as much as you can to everyday, TI time can be a little frustrating.
The concept of appointment times and meeting times were replaced with drop in clinic days and mid morning or mid afternoon yarns. Hours were spend perfecting the art of waiting for pick ups, ferries, planes and clients and the old saying ‘patience is virtue’ developed new meaning during my first few months in the Torres.
Obesity, diabetes, cardiovascular disease and renal disease are all huge problems in the Torres and obviously lifestyle changes play an important part in preventing and managing these diseases. The thing about lifestyle change is that it isn’t generally something that happens overnight, nor is it something that shows its benefit immediately. Being a dietitian I signed up for a job trying to help people improve their lifestyles so inevitably I’m up for my share of frustrations, disappointments and delayed job satisfaction.
These frustrations, disappointments and lack of immediate job satisfaction came thick and fast in my early days in the Torres. Language barriers, cultural differences, food supply and economic issues make education and influencing lifestyle change even harder and seeing little or no change in your client’s results or lifestyle can make you question your abilities as a clinician. Self evaluation is important and I worked hard at developing my skill in communication and education and at finding some common ground between good nutrition, cultural differences and social influences.
Support from peers, friends and family, finding the right balance between work and home life and most of all experience and time have helped me handle these frustrations better and develop more of an understanding of why life is the way it is in Indigenous and Rural/Remote communities. I have learnt a lot from my indigenous colleagues and clients over the years and this has increased my understanding and appreciation of the impact culture, environment and social circumstances can have on health and lifestyle and fuelled my desire further to offer the best education and care I can to the Torres community.
I celebrate small successes now, things like no weight gain in a person who had previously been putting on kilo after kilo, a family’s change in cooking habits to include more vegetables and simply seeing more people walking in the afternoons around the community. These small successes keep me positive; they keep me sane. Because if I focussed on the breath of the problem and the failures I am sure I would have burnt out by now. I continue to learn and keep trying to share all of the knowledge that I can in the hope that my small successes together with others’ small successes will bring able significant improvements not too far down the track.
Sydney to South Australia...
By Katie Fitzgerald
Katie is a Occupational Therapist working in South Australia. In the story below Katie talks about her tansition to rural practice.
Born and bred in Sydney, I have come to love the rolling surf, famous harbour, vibrant atmosphere and busy lifestyle. And because of this love for my home city I caused shock and alarm amongst my family and friends when I told them that I was moving to a town named Port Augusta in South Australia.
In August 2005, I accepted an occupational therapy position with the Child Health Team of the Flinders and Far North Area Health Service. I drove 20 hours via Broken Hill with my best friend with little knowledge and no expectations of our destination. I was motivated by a sense of adventure, lured by the chance to work with the Royal Flying Doctors Service and excited to be embarking on a unique professional experience. As we crossed the Salt Lakes that welcome visitors to this town, I had no idea what I would encounter or what the months ahead would entail.
From my first weekend here I was struck by the magnificent regions that surround Port Augusta. Looking back now my past few months read like a South Australian tourist brochure including treks through the Flinders, horse riding near Wilpena, cycling in Clare and exploring Port Lincoln. However my favourite adventures have been through outreach work to remote and rural outback communities. One trip in particular typifies the kind of experience you can gain when you take on a role like mine.
At 7.30am our group took off for the 45 minute flight to Roxby Downs. Our team comprised of a speech pathologist, podiatrist, mental health worker and our trustworthy pilot. My two day schedule involved home visits, therapy sessions at the health centre at the school and health centre, and childcare visits.
Upon arrival a client was referred who needed immediate attention. He had suffered a workplace injury and was returning home from Adelaide post surgery. He required a home assessment, equipment and home modifications. I was concerned about the situation as I knew that modifications can take weeks and he needed them immediately. However when I arrived at his home, I was met by his family and work colleagues who had already begun work. They had installed a standard ramp and were waiting with tools and supplies to implement my recommendations as I made them. When I left there was a large team measuring, sawing, removing furniture and organising materials, which for me was amazing to see. I was so impressed to see such practical community support and I have come to be less surprised every time I encounter this spirit in this region.
Another appointment was a visit to a home near Andamooka. Not sourced by town water or electricity, this opal miner generated power with wind and solar energy. He used underground tunnels to air condition his home that he had built over 40 years a go with whatever materials he could find. It was fascinating to hear stories of opal mining and farming, and watch demonstrations of inventions he had come up with.
The outreach visit was most exciting (and somewhat frightening) when we were due to leave Roxby. The winds were at 90km an hour and our departure was delayed by 80 minutes. When the pilot got the okay we took off flying through turbulent conditions for much of the flight. Our landing was rocky but very safely controlled by our skilled pilot.
Other outreach visits have involved a health expo in Woomera, presenting on the radio and talking to new mothers about child development. The exciting part of working in rural and remote areas is that you never know what to expect. You can be faced with new clients, new environments and new challenges, and you have to be able to make decisions and deal with situations on the spot. The other great aspect of doing outreach work is the variety of people you get to meet.
My move to Port Augusta was the largest risk I have ever taken, as I didn’t know how I would cope or what to expect. The memorable experience has become one of the most exciting and rewarding times of my life. I will return to my home in Sydney but I’ll return with a new appreciation for the country, knowledge of the resilience and spirit of the people I’ve met, amazed by the beautiful surroundings I’ve explored and grateful I had the opportunity to come to Port Augusta.
A day in the life of a PT working in the WA Goldfields…
By Alex Ellis
Leave home and make the 5 minute trek across the railway line to the physio department at Kalgoorlie Hospital. Get stopped at least four times to chat to staff and patients along the way (everyone loves a chat here).
After putting away lunch/bag, turn on computer and sift through the numerous emails which have strangely arrived between 4:30pm the day before, and now. These include anything from an HCN form to approve, a global email about a new policy/procedure which needs to be read, or a meeting request to be accepted/rejected.
Glance at the department diary and remember it’s Fracture Clinic day today. Get the equipment ready from theatre and ED and rearrange the department, as this morning the Orthopaedic Surgeon and his entourage see all their public clients post-fracture.
Busy, busy morning but a great opportunity to build rapport with the surgeon regarding protocols and best practice, and have some influence on the treatment of these clients (giving them supports/crutches, going through an exercise regime, or booking them in for an individual appointment). As an added bonus, there’s often bikkies or cakes on offer too, such is the confectionary-filled life of a doctor!
As Fracture clinic winds down, there’s time to see a couple of outpatients. These vary from an initial assessment of a cardiac rehab client, to a routine musculoskeletal client, or perhaps performing a pre/post nebuliser spirometry test on a client referred by their GP.
Lunch…finally. The 20+ allied health professionals all working at the site (both in the hospital and over the road at the Rural Paediatric Unit) come together to eat lunch in our ‘Therapy Activity Room’. This is the perfect time to chat about our day so far, plan social events, and generally forget about work for half an hour. Of course, one of us usually gets dragged away by a staff member or patient who just happens to ‘pop their head around the door’.
The rest of the staff clear out of the room as the Head Of Department (HOD) meeting with the Allied Health Coordinator begins. Here we discuss any pertinent issues which can range from staffing levels and recruitment outcomes, upcoming promotional events, professional development opportunities, students, potential outreach visits, formation of business plans, etc.
Head down to maternity ward, check on any recent arrivals and go through postnatal education/treatment for any relevant mums (sometimes even scoring a baby hold!). Important information includes the pre/postnatal exercise classes we hold on and off site, and also the weekly Incontinence Clinic run by us, held at the local Women’s Health Care Centre.
Participate in arranged Performance Development with one of the ward physiotherapists. Spend an hour going through their achievements, goals, requirements based on the Rural and Remote Allied Health Professionals: Entry to Practice Competency Framework, and formulating their objectives and professional development needs for the next six months.
Somehow the emails have banked up again. Sift through and complete some admin duties (updating timetables and procedures manuals, arranging PD topics, setting meeting agendas, etc).
Home time! Make the 5 minute trek back home.
Meet up with the team aka 'All Saints', to take out the social ladies netball comp premiership at the local rec centre. Of course, we’re all workmates as well and even get some dedicated supporters who come down every week to cheer us on! Uniforms supplied courtesy of the ’07 WA Country Health Service Health Promoting Health Regions Grant.
All congregate at Judds (one of the 30+ local pubs) to celebrate our court prowess and another eventful and totally satisfying day in the life of a country allied health professional.
This project was undertaken to better support the transition of Allied Health Professionals to remote and rural practice. It was funded by the Department of Health and Ageing, through the Rural and Remote Health Education and Training (RHSET) program. The final resource includes a transition toolkit and several learning modules. The development of these resources involved several stages:
At the commencement of the project a Steering Committee was convened. The committee included representatives from all states and territory, and collectively had a wide range of a expertise in allied health and remote and rural practice. The management of all aspects of the project was overseen by the Committee.
To identify the identifying the orientation, support and skill requirements of Allied Health Professionals new to rural / remote practice we undertook several phases of research and stakeholder consultation.
First, a Literature Review was undertaken by the Centre for Allied Health Evidence.
Second, we undertook a series of key informant interviews. A total of 25 interviews were undertaken to incorporate the perspectives of those that had make the transition to remote and/or rural practice themselves.
Finally, based on the literature review and the key informant interview we develop a map of the support, orientation and knowledge gaps identified for Allied Health Professionals starting in remote and rural practice settings. We then conducted a broad stakeholder survey to validate our findings, and identify any additional gaps. A total of 626 people participated in the survey.
Based on the research and consultation phase, it was determined that the resources developed within the project would include two key elements.
1. A Transition Toolkit, coving topics under the domains:
2. Five interactive Learning Modules, including:
The Steering Group and the Project Manager then developed content for the Transition toolkit. The content of the learning module was outsources to content experts, including Rural Health Education Development (RhED) (Confidentiality and Professional Boundaries, Cultural Safety, and Self Care), the Centre for Allied Health Evidence (Translating Evidence Based Practice), and Tanya Lehmann (SA Country Health) adn Suzanne Spitz (WA Country Health) (Primary Health Care). The learning platform for the learning modules was developed by Nine Lanterns. The platform is based on instructional design elements to support learning.
To ensure the appropriateness and relevance of the Toolkit and the Learning Modules the Centre for Rural Health & Community Development were contracted to undertake a pilot and an external evaluation of the project. The results of the evaluation have been incorporated into the final resource.
The development of these resources would not have been possible without the contributions of the project Steering Group and the Allied Health Professionals who participated in the consultation elements and the piloting of the project. A sincere thanks to all who were involved.
This education resource to support allied health professionals on entry to remote and rural practice is funded by the Australian Government Department of Health and Ageing. The views expressed on this website do no necessarily represent to position of the Australian Government.
The nine online learning packages are available below. They will assist you with learning about the key issues faced in rural practice.
|Confidentiality & Professional Boundaries|
|Translating Evidence Based Practice|
|Primary Health Care|
|Remote and Rural Outreach|
|Communication in Remote and Rural Practice|
|Healthcare Prioritisation in Remote and Rural Practice|
|Working as a Team in Remote & Rural Practice|