The what, the when and the how: A qualitative study of allied health decision-maker perspectives on factors influencing the development and implementation of advanced and extended scopes of practice in Australia

BackgroundHealth workforce supply is critical to ensuring the delivery of essential healthcare and may be enhanced via mechanisms which alter the scopes of practice of health professions. The aim of this paper is to study the collective perspectives of allied health decision-makers on factors which influence their development and implementation of advanced and extended scope of practice initiatives, and how they contribute to scope of practice change. The reasoning for the selection of each factor will also be examined.MethodsA grounded-theory, qualitative study of the experiences of allied health directors and senior managers across two Australian State/Territory jurisdictions.ResultsTwenty allied health decision-makers participated in the study. Data coding of interview transcripts identified 14 factors specific to scope of practice change, spanning rational (n = 8) and non-rational (n = 6) decision-making approaches. Leadership, Governance, Needs of organisational leaders, Resourcing, Knowledge, skills & experience - clinical, Supporting resources, Knowledge & skills - change and Sustainability were identified as being rational and enabling in and of themselves, with Leadership seen as being most influential. Comparatively, the non-rational factors of Socio-economic & political environment, Perceived patient need, Organisational environment, Change culture & appetite, Perceived professional territorialism and Actual professional territorialism were more varied, and primarily influenced the timing/catalyst and application of decision-making. The complex interplay between these factors was conceptually represented as a decision-making construct.ConclusionAllied health decision-makers hold a complex, systems-level understanding of scope of practice change. Whilst rational decision criteria were predominant and seen to enable scope change, non-rational influences reflected greater variation in decision timing/catalyst and application, thus emphasising the human dimensions of decision-making. Further research is required to better understand how decision-makers integrate and weight these decision-making factors to determine their relative importance and to inform the development of structured decision tools. Allied health senior decision-makers hold a complex, systems-level understanding of scope of practice change. Both rational and non-rational factors are evident in their decisions to pursue advanced and extended scopes of practice. Rational factors are generally enabling of scope change in and of themselves, as compared to non-rational factors which are more varied and generally reflect the timing/catalyst and application of decision-making. Further research is required to better understand how decision-makers integrate and weight factors in their decision-making to determine the relative importance of individual factors and inform the development of structured decision tools.