Skills & Competencies

The Transition to Rural and Remote Practice Toolkit is currently under review and content may be out of date. The toolkit will be updated following the review.

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.

Professional Skills

The Transition to Rural and Remote Practice Toolkit is currently under review and content may be out of date. The toolkit will be updated following the review.

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.

Administration and Management

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. 

 

Administration & Management 

Management and administrative tasks form an important part of many remote and rural Allied Health Professional's roles. Some of your duties may include:

  • Human Resources (recruiting and retaining staff, completing performance development/management sessions, rostering staff, exit interviews, succession planning)
  • Learning & Development (organising and planning training and professional development for self and others, supervising staff)
  • Governance (writing and contributing to business/operational and strategic plans, policies and guidelines)
  • Health Information Management (maintaining records systems, collecting and reporting on statistics)
  • Quality and Safety (developing quality improvement plans, reporting clinical incidents)
  • Other (research and evaluation, writing grant submissions etc). 

 

Administration, Management & You

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:

  • The task areas you feel you need further skill development in
  • What management and leadership learning development opportunities can you access?
  • How will strong management skills influence your practice?

 

Useful resources

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:

  • Schoo AM, Stagnitti KE, Mercer C, Dunbar J. A conceptual model for recruitment and retention: Allied health workforce enhancement in Western Victoria, Australia. Rural & Remote Health, vol 5, pp. 1-18; 2005. Avaliable at: www.rrh.org.au.
  • Stagnitti K, Schoo A, Reid C, Dunbar J. An exploration of issues of management and intention to stay: Allied health professionals in South West Victoria, Australia Journal of Allied Health, vol 35, pp. 226-232; 2006.

Supervision

Working as an Allied Health Professional you will likely provide and receive many different kinds of supervision. Some of these include:

  • Supervision by managers or supervisors during performance development/management
  • Supervision of support workers such as Allied Health Assistants and other support staff
  • Supervision of students on placement.

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:

  • Use adult learning principles. Adults prefer supervision to be goal-oriented, relevant, practical, and respectful treating the supervisor/supervisee as equal partners.
  • Appreciate different learning styles – what works for you may not work for someone else!
  • Always provide high quality feedback (specific, factual, descriptive, constructive, understood, timely, sensitive and directed at the behaviour).
  • Make a plan – plan how often and what methods will be used, make some supervisory goals and plan how you might deal with conflict.
  • Determine how you will assess or evaluate performance – this could be by observation, written materials of self-assessment.

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.

More information is available on the Supervision page in the Orientation, Development & Support section.

 

Supervision & You

  • What supervisory relationships are you involved in? Who supervisors you? Who do you supervise?
  • How effective are you as a supervisor?
  • How effective are you as a supervisee?
  • What do you think are your supervisory strengths and weaknesses?
  • Are you supervisor/supervisee relationship working well?
  • How can you improve the quality of your supervisory relationships?

 

Useful Resources

  • The WA Country Health Service/Combined Universities Centre for Rural Health Introduction to Supervision training package
  • Adult Learning Australia
  • Lake F, Ryan G. Teaching on the run tips 2: Educational guides for teaching in a clinical setting. Medical Journal of Australia, vol 180, iss 10, pp. 527-528; 2004.

Time Management

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:

  • Prioritise tasks and set goals
  • Plan your time and stick to the plan
  • Allocate time to complete essential non-clinical tasks
  • Avoid procrastination and interruptions
  • Seek help and delegate when you need to 

 

Time Management & You

  • Do you think you manage your time well?
  • How could you manage your time more effectively?
  • How would good time management influence your practice?

 

Useful Resources

Communication In Remote and Rural Practice

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.

 

Communication in Remote and Rural Practice Learning Package

 

Communication & You

As you complete the module think about your communication skills:

  • Do you think you communicate well with your colleagues and clients?
  • What do you think are your communication strengths and weaknesses?
  • How can you develop your communication skills?

Information Management

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.

 

Information Management & You

  • What IT systems and software is available in your organisation?
  • How is data stored in your organisation?
  • Does your organisation have patient record management policies and procedures?
  • Does your organisation have an intranet?
  • What library services do you have access to?
  • Does your organisation have a statistical data collection system or requirements?
  • How competent are your computer skills? Do you need to develop your skills in any particular program?

 

Useful Resources

Workload Management

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:

  • Activity: the work required to be undertaken by the role
  • Capacity: all of the resources required to do the work (including time and equipment)
  • Demand: all requests or referrals from all services and sources.
  • Capabilities: the skills and competencies required to carry out the activities.

 

Workload Management & You

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'. 

  • Brainstorm all the roles, responsibilities and activities necessary as part of your job (activity and demand). Sort them into the four activity clusters identified above.
  • Discuss with your manager the percentage of time that should be allocated to each cluster (and if possible each role).
  • Reflect on your capacity to do the required work/activity. Is there a balance?
  • Discuss with your manager or supervisor strategies to cope with an imbalance between demand/activities and capacity.

 

Useful Resources

Conflict Resolution

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:

  • Anticipate conflict. It is normal!
  • Develop good communication skills - speak clearly, listen carefully, and receive feedback constructively
  • Accurately identify the precise source of the conflict including an accurate history and identify primary players and other stakeholders
  • Find a nonjudgmental starting point for the discussion
  • If confrontation with a colleague is necessary, it should be conducted in a private setting
  • It may be useful to seek the perspective of someone outside the conflict, such as a manager or neutral mediator
  • If conflict is ultimately irreconcilable, transfer patient care to an uninvolved colleague. 

 

Conflict Resolution & You

Think about the way you manage and resolve conflict:

  • Do you have well developed conflict resolution and management skills?
  • What do you think are your conflict resolution and management strengths and weaknesses?
  • How can you develop your conflict resolution and management skills?  

 

Useful Resources

  • Katz J. Conflict and its resolution in the operating room. Journal of Clinical Anaesthesia, vol 19, pp. 152-158; 2007.
  • Porter-O'Grady T, T. Porter-O'Grady. Embracing conflict: building a healthy community. Health Care Management Review, vol 29, iss 3, pp. 181-187; 2004

Research

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:

  • identifying the issue or problem
  • determining the research question
  • conducting a literature review
  • determining the study methodology and method
  • designing your data collection instruments
  • collecting the data
  • cleaning, analysing and interpreting the data
  • reflecting on your findings
  • comparing your findings with similar research conducted by others
  • identifying questions for further research
  • disseminating your results, perhaps as a conference paper or by publishing an article in an academic journal.

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.

 

Research & You

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: 

  • Have you conducted research in your role? If so, which research method did you use? What did you learn from the research process?
  • How can you incorporate research into your practice?
  • How would research impact your practice?

 

Useful Resources

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.

Research design and methods

Quantitative Research

Qualitative Research

Books

  • Polgar S, Thomas, SA. Introduction to research in the health sciences , 6th ed, Elsevier, Edinburgh; 2013.
  • Leedy PD. Practical Research: planning and design, 9th ed, Prentice Hall PTR, Upper Saddle River; 2009.
  • Hickson M. Research handbook for health care professionals , Wiley-Blackwell, Oxford; 2008.
  • Creswell JW. Research design: qualitative, quantitative, and mixed methods approaches , 3rd ed, Sage Publications, Thousand Oaks, Calif; 2009.

Evaluation

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.

 

Why evaluate?

The main objectives of program evaluation are:

  • To inform decisions on operations, policy, or strategy related to ongoing or future program interventions
  • To demonstrate accountability to decision-makers (donor and other program stakeholders). It is expected that improved decision-making and accountability will lead to better results and more efficient use of resources.

Other objectives of evaluation can include:

  • Enable corporate learning and contribute to the body of knowledge on what works and what does not work and why
  • Verify and/or improve program quality and management
  • Identify successful strategies for extension/expansion/replication
  • Modify unsuccessful strategies
  • Measure effects/benefits of program and project interventions
  • Give stakeholders the opportunity to have a say in program output and quality
  • Build capacity of program participants, managers and other agency staff 
  • Justify/validate program to donors, partners and other constituencies.

 

Types of Evaluation

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:

Needs Assessment

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.

Feasibility Analysis

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.

Interactive Evaluation

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.

Monitoring Evaluation

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.

Outcome 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.

 

Planning 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: 

  • WHY: the purpose of the evaluations, including who will use the evaluation findings and how
  • WHAT: the main objectives of the evaluation and the questions it should address
  • HOW: the data sources and collection methods to be used in the evaluations
  • WHO: who will undertake the evaluations: what expertise is required? Which evaluations should project stakeholders undertake (an internal evaluation)? Which should be conducted with the assistance of external consultants (national and/or international) What should be the extent of stakeholder involvement?
  • WHEN: the timing of each evaluation so that their results in each case or in combination can be used to take important program related decisions
  • RESOURCES: the budget required to implement the evaluation plan.

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.

 

Evaluation & You

  • Are programs or projects evaluated in your workplace? If so, what type of evaluation is used? What has the evaluation found? How do these findings influence practice?
  • How could you be involved in the evaluation of projects of programs in your workplace? What projects or programs could be evaluated? What would be the benefit of evaluation?

Useful Resources

Books

  • Knowlton LW, Phillips CC. The logic model guidebook. Better strategies for great results. Sage Publications Inc; 2009.
  • Evaluating health promotion prpgrams. Valente TW. Oxford University Press; 2002.
  • McKenzie JF, Neiger BL, Thakeray R. Planning, Implementing and Evaluating Helath Promotion programs. Pearson-Cummings; 2005.

Clinical Skills

The Transition to Rural and Remote Practice Toolkit is currently under review and content may be out of date. The toolkit will be updated following the review.

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

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:

  • Developing Personal Qualities: Qualities such as self-awareness, self-reflection, self-management, professionalism, and self-development.
  • Working with Others: Developing networks, building and maintaining relationships, team building, developing others, engaging with clients and consumers, and collaborating with other service providers.
  • Improving Services: Ensuring patient safety, critically evaluating, encouraging innovation, evaluating services, improving health care processes, developing new services and roles.
  • Managing Services: Planning, managing resources, managing people, and managing performance.
  • Setting Direction: Identifying opportunities for change, applying knowledge and evidence, making decisions, evaluating impact and outcomes.

Adapted from the Medial Leadership Competency Framework (NHS, 2008).

 

Clinical Leadership & You

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:

  • Where are you in your career, and could you be a leader?
  • What aspects of clinical leadership would you like to further develop?
  • How will clinical leadership skills influence your practice and career development? 

 

Useful Resources

Caseload Management

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:

Impeding Factors

  • Distance
  • High level of variance
  • Lack of homogeneity
  • Lack of other options (private, public, non-government)
  • Restricted ability to specialize
  • Lack of access to specialist support
  • Poorer health status

Supporting Factors

  • Defined community
  • Defined health status
  • Closer links with stakeholders
  • Great capacity for teamwork
  • Community support

Factors Influencing Caseload Management

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.

Prioritisation & Demand Management systems

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:

  • Direct service to one client (one on one)
  • Consultation (Allied Health Professional determines intervention targets, procedures and contexts, but relied on another agent to carry out the program);
  • Direct service in groups;
  • Collaborative model (Allied Health Professionals works with carer, teacher, parent, volunteer or other personnel).

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:

  • Understand your caseload and how you delivery services (see above).
  • Know all the resources you have to allocate to your caseload.
  • Establish a caseload database (this can be as simple as a excel spreadsheet), including new referrals, waiting list information and service requirements (current and future)..
  • Keep an appointment diary or planner. Schedule clinical and non-clinical activities into your diary.
  • Take the time to plan your caseload (individual, as a department and as a team).
  • Constantly review and evaluate the way you manage your caseload.

 

Caseload Management and You

  • How are caseloads allocated and organised within your department/organisation?
  • Consider your caseload in terms of the above factors. What factors enhance capacity? What factors limit capacity?
  • What strategies can you utilised to better manage your caseload?

 

Useful Resources

Healthcare Prioritisation

Healthcare Prioritisation in Remote and Rural Practice

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.

 

Healthcare Prioritisation Learning Package

 

Clinical Prioritisation & You

Think about the way you prioritise your time, workload and resources:

  • Is there a waiting list for your services? If so, how is this waiting list managed?
  • What are the agreed priorities for your department, team and organisation?
  • Does you department have a framework or tools to assist with prioritisation of clients?
  • How can you develop your prioritisation and demand management skills?

Working as a Team

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.

 

Working as a Team in Remote & Rural Practice Learning Package

 

Team Practice & You

 As you complete the module think about the way you work within the teams:

  • How effective is your team work, as an individual, and as a broader team?
  • What could you do to improve your team practice skills?
  • How could effective team practice impact your service delivery?

Scope of Practice

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.

 

Scope of Practice in a Remote and Rural Context

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. 

 

Scope of Practice & You (Determining Your 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:

  • Is it in the best interest of the patient?
  • Is it within the scope of practice for your profession (legislative, professional association guideline documents)? Is it accepted practice within your profession?
  • Is there organisational support (e.g. guidelines, within job description, management approval)
  • Is it within my own scope of practice (Do I have education preparation and clinical practice? I am I competent and confident to perform the task safely?) 

 

Useful Resources

  • Please refer to your relevant professional association or regulatory body for further information specific to your professional scope of practice.

Reflective Practice

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. 

 

Reflective Practice & You

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:

  • Do you have a good understanding of the principles of reflective practice?
  • Do you actively engage in reflective practice?
  • How can reflective practice influence your practice?

 

Useful Resources

Translating Evidence Based Practice

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.  

 

Translating Evidence Based Practice Learning Package

 

Translating Evidence Based Practice & You

Complete the learning module and refer to the references within the module. Consider:

  • How can you better translate evidence into your practice?
  • How will evidence based practice influence your development?

Clinical Practice Improvement

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:

  • Be aware of the quality, efficiency and safety of the care you provide.
  • Be accountable, individually and collectively, for it.
  • Continually try to improve it.

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.

 

Clinical Practice Improvement &You

  • How are you demonstrating that you are providing quality services and working to improve them?
  • Does your department/site have a clinical improvement plan?
  • Does your site have a dedicated role for clinical improvement? Who is this person? How can they help you?

 

Useful Resources

There are some great resources listed below to further develop your clinical improvement skills and knowledge. These include:

Remote and Rural Skills

The Transition to Rural and Remote Practice Toolkit is currently under review and content may be out of date. The toolkit will be updated following the review.

There are some particular skills that are associated with remote and rural practice. Spend some time developing your competence in these areas.

Cultural Safety

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.

 

Cultural Safety Learning Package

 

Cultural Safety & You

Complete the learning module and refer to the useful resources below to develop your cultural safety. Consider:

  • How culturally safe is your practice?
  • How can you develop your cultural safety?
  • How will practicing in a culturally safey way influence your service delivery?

 

Useful Resources

Self Care

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.

 

Self Care Learning Package

 

Self Care & You

Complete the learning module and refer explore the self care references provided in the module. Consider:

  • Have you identified your self care needs?
  • What measures do you take to look after yourself?
  • How well do you manage stress?
  • How can you improve self care?
  • How important is your self care to your practice?

 

Useful Resources

Confidentiality and Professional Boundaries

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.

 

Ethical Practice: Confidentiality & Professional Boundaries Learning Package

 

Confidentiality, Professional Boundaries & You

Complete the learning module and think about: 

  • Do you understand the importance of confidentiality and professional boundaries in the remote and rural context?
  • Have you access and read the confidenitality guidelines for your workplace?

Professional Isolation

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.

 

Professional Isolation & You

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.

  • Do you have collegial networks at your work site (within your own profession or the broader health care team)?
  • Do you belong to your professional association?
  • Do you meet regularly with professional peers and colleagues?
  • Do you have a clinical/professional supervisor or mentor?
  • Do you belong to any professional networks, interest groups or discussion groups?
  • Do you regular participate in CPD events with your peers?
  • Do you know how to contact professional peers in your community, region, and state?

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.

 

Strategies to Reduce Professional Isolation

  • Join your professional association. Find out more about networking opportunities available within the association. Volunteer to be on a committee or participate in special interest groups.
  • Join SARRAH.
  • Get a mentor or professional/clinical supervisor.
  • Ask you colleagues or mentor/supervisor about professional networking opportunities.
  • Find out if there are any professional networks/interests groups within your organisation and local community.
  • Access a copy of a professional directory/facilities list.
  • Join an interest group. If you can’t attend in person (and the interest group doesn’t offer remote access) ask to be on the circulation list for minutes.
  • The www is a fantastic place to become networked. Join discussion forums, e-news updates, or list-serves in topic areas you are interested in.
  • Make the most of face-to-face opportunities (e.g. professional development events). Introduce yourself and make contacts.
  • Organise site visits to ‘meet and greet’ professionals in centre nearby you or the city.
  • Think bigger than your organisation. Other organisations in your community may employ like professionals.
  • Remember professional networking is not just about your own profession. Your other professional team members can help you feel less professionally isolated.
  • Keep in touch with professional contacts you have made in the past (past student supervisors, colleagues etc).
  • Build your own small networks – be proactive. This could be as simple as an email group.

And most importantly:

  • Be an active participant in any opportunity to network with peers.

Social Isolation

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). 

 

Social Isolation & You

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.

  • Think about what is contributing to your loneliness.
  • Tell someone you trust how you are feeling.
  • Put your fear aside and take a risk (go to the party when you are asked).
  • Be open to meeting new people. Let them know you are interested in them (but don't try too hard at first - just be friendly without asking for too much too soon).
  • Connect with other people. See Community Orientation for some ideas about how to meet new people and get involved in the community.
  • Seek help if you need it.
  • Don’t forget to help others too. We can all help each other to feel welcome and included.

 

Maintaining Long Distance Relationships

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. 

 

Long Distance Relationships & You

Sustaining a long-distance relationship can be challenging, but there are some things that you can do:

  • Maintain regular contact (emails, letters, sms, skype, and phone).
  • Talk to your partner, friends and family about the relationship and how you are feeling (share with them that you miss them and they are still an important part of your life).
  • Share similar interests, even if you are doing them apart (this give you something common to talk about).
  • Plan time to meet up in person (this can give you something to look forward to).

 

Useful Resources 

Several of the pages within this toolkit will provide you with strategies to deal with social isolation. Refer to the Self Care page and learning module, and the Networking and Community Orientation pages in particular.  

Safety and Survival Skills

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.

 

Safety & Survival Skills, & You

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: 

  • Does your organisation have policies or guidelines for safe travel?
  • Does your organisation have policies or guidelines visiting?
  • Does your organisation have emergency protocols?
  • Do you require advanced driving training?

 

Useful Resources