Mechanisms for the effective implementation of an allied health assistant trainee: a qualitative study of a speech language pathology assistant

Mechanisms for the effective implementation of

an allied health assistant trainee: a

qualitative study of a speech language

pathology assistant

Susan A. Nancarrow A D , Anna Moran B and Rebecca

Sullivan C

A Southern Cross University, PO Box 157, Lismore, NSW

2480, Australia.

B Charles Sturt University, School of Community Health,

PO Box 789, Albury, NSW 2640, Australia. Email:

[email protected]

C Eastern Health, Arnold Street, Box Hill, Vic. 3128,

Australia. Email: [email protected]

D Corresponding author. Email: [email protected]

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This is the authors’ pre-print version of the manuscript.

The final published manuscript can be found here: Australian

Health Review - http://dx.doi.org/10.1071/AH14053

Submitted: 23 March 2014 Accepted: 29 September 2014

Published online: 11 December 2014

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ABSTRACT

Aim: This paper explores the impact and mechanisms for

successful implementation of a speech-language pathology

assistant (SLPA) role into a rehabilitation setting using a

traineeship approach.

Methods: Multiple data sources were used including

interviews with key stakeholders, documentary evidence and a

workload audit.

Results: The SLPA role increased clinical service

capacity by 28 hours per week across the service and required

a total of 3 hours per week of supervision input (the

equivalent of 38 minutes per speech and language pathologist

(SLP)). The SLPA used non-clinical time for training and

administration. Mechanisms that facilitated the implementation

of the SLPA role were: support for existing staff; formal

knowledge and skills in training; consultation and engagement;

access to a competency framework; close working with the

Registered Training Organisation; clearly defined role and

delegation boundaries; clear supervision structures,

confidence in own role, supportive organisational culture;

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vision for expansion of the role; engaging the SLPs in

training and development; and a targeted recruitment approach.

Conclusion: The development and implementation of a new

trainee SLPA role using a traineeship approach required a

large amount of supervision and training input from the SLPs.

It was perceived that these efforts were offset however by the

increased service capacity provided by the introduction of a

trainee role and the high levels of satisfaction with the new

role.

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What is known about this topic?

Efficient delegation to assistants requires supervising

staff to have a clear understanding of the roles and

experience of assistants. There has been little evaluation of

assistant training models to date.

What this paper adds

The net benefit of an allied health assistant in speech

pathology far outweighs the input required to provide training

and supervision. The paper identifies a range of mechanisms to

facilitate the implementation and efficient use of the

assistant role.

What are the implications for practitioners?

The implementation of assistant roles requires support

for both the assistant and the supervising staff member.

Engaging the supervising staff in training the assistant

enhances the role understanding and effective delegation to

the assistant staff member. While the role development

requires a great deal of local investment, there is potential

for more efficient implementation of new roles through sharing

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of resources, such as competencies, assessments and training

tools.

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Introduction

Workforce reform, through the introduction of new roles

and extended scope of practice has been prioritised as way to

respond to workforce health shortages . A growing body of

evidence demonstrates that employing Allied Health Assistants

(AHAs) (or other assistant practitioners) frees clinician time

, increases service capacity and may be associated with

better patient outcomes in some client groups .

A range of AHA training models exist incorporating

combinations of on-the-job and formal training to achieve

specific competencies, or cycles of observation, practice

under observation until competency is reached, followed by

ongoing documentation and supervision . Efficient delegation

to AHAs requires supervising staff to have a clear

understanding of AHA roles and experience . Therefore,

workplace based training that involves supervisors may

increase their understanding of AHA roles and consequently,

enhance their efficient use of the roles.

Despite the link between training and outcomes, there is

a dearth of evidence pertaining to assistant training models .

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This paper reports on a study examining the mechanisms to

enable the successful implementation a trainee SLPA role in a

rehabilitation setting utilising a traineeship approach.

Background to the traineeship and trainee SLPA role

The Australian Capital Territory (ACT) Government Health

Directorate (hereafter called The Directorate) introduced seven

new roles using a traineeship approach in 2010 . The

traineeship model is based around an apprenticeship model in

which formal training is interspersed with on-the-job

training, over a 12 month period. At the successful completion

of the training, the practitioner is awarded a Certificate IV

in Allied Health Assistance. In this project, the SLPA Trainee

was employed on a two year, prescribed, temporary employment

contract, which specified that they must meet the training

requirements within a two year period.

Within the team, all staff, including the assistant were

supported using a hierarchical supervision structure, with all

staff reporting to their own supervisor. This model supported

the SLP in developing and training the trainee through their

own supervision.

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The trainee had direct and explicit lines of

accountability and formal supervision through weekly meetings

with a single line manager. Extensive informal supervision

involving observation, instruction and demonstration, practice

and feedback was provided by all SLPs in relation to specific

patients with which the trainee was working. Once the trainee

was competent to work autonomously on specific tasks,

supervision involved verbal and written feedback, routine

formal supervision sessions and routine patient reviews by the

SLP. Box 1 provides an example of an Assessment Plan for a

specific SLPA competency. Table 1 illustrates the breadth of

competencies developed for the role.

Insert Box 1 and Table 1 about here

This study addresses the following questions;

1. What mechanisms are required to effectively implement a

new traineeship assistant role in speech-language

pathology to a rehabilitation setting; and

2. What is the perceived impact of the trainee role and

traineeship approach?

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Methods

Semi structured interviews with service managers,

qualified practitioners, assistants, service users and their

carers were used to explore the implementation process; the

traineeship approach; the underlying mechanisms that help or

hinder the implementation, sustainability and impact of the

trainee role. Data sources included interviews, focus groups

and documentary analysis of competency frameworks and policy

documents. Data were collected after the trainee had completed

all their ‘classroom’ based competencies and was working

towards the end of their workplace based competencies. A

purposive sampling method was used to ensure representation

from the following stakeholders:

3 speech-language pathologists (SLPs) who work closely

with the trainee SLPA

The trainee SLPA

5 Allied Health (AH) managers involved in the support /

development of AHA roles

4 service users and 1 carer (who had had received input

from the trainee, either on a ward, or in a group

setting) Interviews were tailored to the communication

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ability of the service user and an additional member of

staff and /or carer was present throughout the

interviews.

1 activities coordinator who conducted communication

based diversional therapy groups with the trainee once a

fortnight on an aged care ward

In addition, the impact of the trainee SLPA on workload

was captured through a workload audit of all SLP activities

for four consecutive weeks, of which the trainee SLPA was

absent for two weeks. Ethics approval was obtained from the

ACT Health Human Research Ethics Committee (ref ETHLR.11.038).

Analysis

All focus groups and interviews were recorded and

transcribed and analysed using the Ritchie and Spencer

qualitative “Framework” approach . This involved two

researchers familiarising themselves with all of the interview

data. A thematic framework was developed, based on the key

research questions, then each document was coded using against

the thematic framework. As new themes emerged, they were added

to the coding framework, and the transcripts were re-analysed

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to incorporate the emergent themes. The final results were

presented to, and discussed with the staff participants for

verification. The results are presented around these themes.

Due to the small number of participants, some verbatim

quotes have not been labelled to protect participant identity.

The audit results are presented as a descriptive comparison of

the difference in time use with and without the trainee SLPA.

Results

The results are structured around headings describing the

roles and responsibilities of the SLPA, the mechanisms that

supported implementation of the role, specific aspects of the

traineeship, the human resource considerations and the

organisational support that helped to introduce the role.

The roles and responsibilities of the trainee Speech-Language

Pathology Assistant

The roles undertaken by the trainee SLPA are summarised

in Table 1. The greatest proportion of SLPA time was spent in

group work (16 hours) and direct one-to-one therapy (15 hours)

(Table 2).

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Mechanisms that supported implementation of the trainee SLPA

role

Traineeship

The team introduced an integrated training plan for each

competency that incorporated observation, teaching,

supervision and an assessment tool to confirm achievement of

the competency. Consequently, when the trainee SLPA

demonstrated competence in a specific task, the SLP staff felt

confident to delegate higher level tasks.

“The way she has developed I am now much more confident in giving her

more complex tasks. Now I could just hand over and say ‘here is the task’, she has

done it a million times with lots of different types of people, we don't need to spend

lots of observation time and training time.” [SLP]

The perceived benefits of the traineeship model over a

traditional training approach included the richness of the

approach, where the trainee is embedded in the workplace,

enabling them to understand the culture of the organisation

and receive extensive workplace training.

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"I think developing that basic understanding of the body and whatever [the

trainee] learns at CIT but the speech specific stuff seems to be more on the job…and

how the hospital works." [SLP]

The flexibility of the traineeship approach also

facilitated implementation. The traineeship was initially

designed so that the trainee SLPA could achieve competencies

serially, in specific activities, before moving on to new

areas, however the patient mix did not permit this model.

Instead, several competencies were developed and achieved

simultaneously as demanded by the patient needs.

A strong, consultative relationship between the

Directorate and the RTO around the development and delivery of

the AHA training was perceived as key to implementation of the

trainee SLPA role. For instance the Senior SLP had direct

input into the training resources delivered as part of the RTO

programme.

There was no established competency framework to support

the development of this role. This meant that the supervising

staff had to develop these competencies and assessment

procedures as the role was being developed (Table 1).

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Participants reported that the competencies in the National

Certificate IV AHA Health Training Package were not specific

enough for the roles required by the trainee SLPA in the adult

rehabilitation health care setting. Consequently, a range of

workplace specific competencies were developed specifically

for the aged care and rehabilitation setting. The service

identified tasks that were skill based, required no online

clinical assessment / judgement or reasoning skills, that

could be delegated to an SLPA. Examples of the types of

workplace competencies are illustrated in Table 1.

Insert Table 1 about here

“The CIT competencies were too generic e.g. student can implement a therapy

task. But being competent in that is about engagement, infection control, cueing,

setting up a room. I had to develop far more structured competencies. [Senior SLP]

All of the competencies developed and tasks delegated to

the trainee SLPA were codified so the role could be

transferred to a different setting or to new staff. The role,

and the complexity of the tasks delegated to the trainee

evolved as the knowledge and competency of their role

developed.

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“I have never been asked to do something that I feel uncomfortable with or

don’t feel ready to do.” [Trainee SLPA]

One service user reported that it was very important that

the SLP and the trainee work together in a coordinated way

towards the delivery of a care plan that would meet her goals,

and believed that this happened in this service (and was

strongly driven by the SLP). She also valued the SLP having a

clear understanding of the trainee’s level of ability or the

extent of achievement of her goals, and wanted these clearly

reinforced and monitored.

The personal attributes of the team members and the

trainee were important to successful implementation of the

trainee role. From the trainee’s perspective, coming into new

‘experimental’ role did not create any tensions within the

team. The trainee felt that the staff were “supportive and

accepting” and always felt comfortable to ask questions. The

team described the trainee as mature, flexible and adaptable.

Human resource considerations

The SLPA trainee position was advertised as a discipline

specific trainee, whereas a subsequent recruitment process was

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for 5 generic AHA positions. It was perceived that the

discipline specific recruitment process attracted applicants

with a specific interest in speech pathology which was

considered important to the sustainability of the new role.

The industrial classification of the new roles presented

an administrative challenge. The Directorate proposed the

introduction of a new industrial classification linked to the

traineeship, but this differed from the award used by the

existing AHA staff. This resulted in a two-tiered industrial

relations system in AHA roles, with different pay scales, and

lack of comparability between settings.

At the time of interview, the trainee was seen to be

functioning at the full scope of the role. However with

additional training, it was identified that a range of new

therapy techniques could be applied to existing skills

included screening, and expansion into therapies that are

currently not supported, such as lunch time feeding practice.

Organisational support

Organisational support was visible at all levels of the

organisation, from the national and local policy and

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organisational levels (The Directorate, and the Allied Health

Advisor specifically) to the clinical level.

The SLPs perceived that having support for their own

roles, through existing supervisory relationships, enabled

them to support the trainee. For many staff, this was their

first experience of clinical supervision. The SLPs were given

explicit guidance around what and how to delegate, but

perceived that more training may be required to support staff

to train the trainee.

"You do need to be taught how to train. It doesn’t come naturally to some

people." [Senior SLP]

Professional confidence was important to the

implementation of the trainee role by reducing the potential

for resistance to the new role and/or role boundary threats.

This was highlighted in the below exchange.

Interviewer: “You suggested there was some resistance to the introduction of

the trainee.”

Senior SLP: "The particular people we are talking about are newer to the

profession, particularly new grads, so I guess they weren’t confident in what they

were doing to start with let alone trying to teach someone how to do it as well. But

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once the trainee had a bit more experience, and was up and running with the senior

staff, that was when the new grads felt more confident to give [the trainee] things. I

think it was the new grads are trying to find their feet and are trying to learn and it

is hard to teach and learn at the same time." [Senior SLP]

Supervision was key to the successful implementation of

the trainee role.

The hierarchical supervision structure supported the

implementation of the SLPA role by also providing support for

the supervising SLPs.

“If she was seeing patients independently she would report back verbally and

I would read the medical records as well.” [SLP]

The supervisors found it beneficial to have formal

qualifications in training and assessment, skills in teaching

and the ability to break down tasks and activities into their

component parts; an understanding of adult learning

principles; and a passion for teaching.

"It is all well and good to have a competency saying that people can

implement a therapy task but there are so many elements within that. They need to

introduce themselves, set up a room properly, take data. So you need to be able to

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break down the task and teach individual aspects of that task across a bunch of

different learning styles." [SLP]

All participants reported that strong leadership for the

introduction of the role was a key facilitator;

“..they’ve [SLPs] needed a champion for the role who could take it on and work

with the team to develop it in the way that is most appropriate to the team”

[Managers]

The introduction of the trainee SLPA role was led by the

Senior SLP using a consultative approach with the SLP team.

‘My good bit of advice, … you have to consult with them’. ‘You can’t just go

‘here’s what we’re doing’, you have to let go of those roles now’. [Senior SLP]

The SLPs were involved in the initial development of the

new role by influencing the job description, reviewing

policies around the new role and providing feedback on the

SLPA competencies. For example the SLPs discussed several ways

“to train someone who initially probably didn’t know how to wash their hands in a

hospital environment” [SLP].

“…they [SLP team] discussed what they thought they could delegate, what they

couldn’t, looked at association guidelines; developed the plan together” [Senior SLP]

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Impact

The audit findings suggest the trainee role increased

service capacity, releasing qualified staff from tasks

(enabling them to undertake other activities (Table 3).

The employment of the trainee increased service capacity

by providing more therapeutic and non-therapeutic activity

groups (Table 3). Clinical service capacity increased by 28

hours per week across the service (Table 2) and required a

total of 3 hours per week of supervision input (the equivalent

of 38 minutes per SLP). The SLPA used non-clinical time for

training and administration.

The SLPs used their time to increase clinical services

management, administration, direct and indirect patient care,

quality improvement (QI) projects and supervision. The SLPs

spent less time preparing client resources, delivering group

work and professional development (PD). Staff also perceived

that the trainee role improved continuity of care by allowing

care to continue when one of the SLPs was absent.

“We know that we are getting better quality and more therapy” [Senior SLP]

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Service user perceptions

The speech pathology service user group were a difficult

group to access equitably to reflect on the role of the speech

pathology assistant due to the varied nature of their

communication difficulties.

One service user was aware that she had seen a speech

pathologist and a speech pathology assistant. She could

clearly delineate between their roles, and understood that the

speech pathologist established the care plan, while the SPA

carried out the instructions of the SP. She felt that it was

very important that the SP and the SPA work together in a

coordinated way towards the delivery of a care plan that would

meet her goals, and believed that this happened in this

service (and was strongly driven by the SP). She also valued

the SP having a clear understanding of her level of ability or

the extent of achievement of her goals, and wanted these

clearly reinforced and monitored.

Service user A “[SP] used to tell [SPA] what she had to do with me. [SP] was the

one who used to write all the things down that I needed to do. You could see that

[SPA] got some lectures from [SP]. You could see that she was not the one who was,

not the boss, but she was trying very hard to tell [SPA] what she had to do. Because

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she knew how well I was and what things I could do. I was very keen to tell her that I

had difficulties to write a letter. [SPA] gave me homework to do, to write down what

these things are and what they really mean.”

Another service user had not considered the

differentiation between the roles until interviewed, but was

able to articulate the supervisor / supervisee relationship

when interviewed.

I think that [SP] is slightly more professional in the way she goes about the

job, but you know that they’re trying to get to the same results. I think that [SPA]

knows the shortcuts in a way that [SPA] doesn’t. That doesn’t mean [SPA] isn’t doing a

good job, she is doing a wonderful job. (Service user B)

A service user with aphasia, and his carer were unable to

differentiate between the SP and SPA, and were unaware that

the service user had been seen by the SPA however, they did

not object to the idea of an SPA.

Two of the service users were able to identify nuanced

differences between the role of the SP and the SPA. For

instance, one service user perceived that the SP is

“concentrating on another aspect of why she’s talking and what we’re saying”,

whereas the SPA “just talks to you” (Service user B), reflecting

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perhaps the difference in the assessment approach of the SP

and SPA. In referring to group therapy, one said that there

was a difference in the questions and the way they go about

it, but “they are trying to get to the same results” (Service user C).

In all cases, the service users reported that they would

have preferred to receive a greater quantity and frequency of

SP input during their rehabilitation and all were happy be

treated by an SPA if it increased the volume of treatment

received.

Interviewer: Did you feel that you got enough SP treatment in [rehabilitation

unit]?

Service user C: No – not really. I think they were quite busy. I would get it only

twice a week at the beginning, then once a week. Then she would come to me and

say I’m sorry I can only give it you once a week now.

Interviewer: How much do you think you should you have been seen?

Service user C: It would have been nice to have it every third day. Because you

do forget things, you know. But I know there are other patients, they are busy.

Interviewer: Would you be happy to receive that treatment from an SPA?

Service user C: Yes – I’d be just as happy with that.

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They were also happy to receive group interventions at

appropriate stages in their rehabilitation.

Staff satisfaction and workload implications

There was little resistance to the introduction of the

SLPA.

“no one has said to me no you can’t do it … all the staff have been really good

and really accepting of me” [Trainee SLPA]

Furthermore, the SLPs said that they did not miss any

components of their previous work as they were still seeing

and working with clients.

However, SLPs and AH managers were concerned about the

resource implications of the 12 month traineeship program. The

managers proposed that the training may be better offered in

an intensive 12 week placement prior to undertaking the work-

based training. As such, it was felt that there was a need for

greater RTO flexibility so that formal learning coincided

better with on the job learning.

“You can see the difference when you get someone on the 2 week placement

who is doing the [RTO] course. They have done the 2 week placement and by the end

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of the 2 weeks, they’re working with patients, but we spent 3 months of observations.

Twelve months is a big investment in time.” [Senior SLP]

Discussion

This study has identified several mechanisms to

facilitate the implementation of a trainee SLPA role to an

adult rehabilitation setting and explored the impact the

traineeship approach and role on service, patient and staff

outcomes.

The unique contribution of this model is the traineeship

approach. The traineeship was successful in terms of producing

an SLPA whose skills were shaped by the practitioners and the

service context. Engaging the supervising SLPs in the

development and implementation of the role is an important

strength of this approach. In contrast to previous examples of

assistant implementation , the traineeship approach enabled

the supervising SLPs to have a clear understanding of the

trainee SLPA roles, abilities and competence, and delegate

work accordingly. As a result, the trainee SLPA enabled gains

in workforce efficiency resulting in increased client contacts

and greater time for service quality improvement activities.

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Only one other Australian study explores the use of AHAs

in the context of SLP and identified significant barriers to

the introduction of the role due to poor consultation, and

lack of understanding of roles and tasks . The traineeships

approach largely overcomes several of these difficulties.

Indeed, our study reinforced findings that successful

implementation of new AH roles is linked to strong leadership;

clearly defined and understood roles; unambiguous delegation

models; and contexts where delegating practitioners have

confidence in delegation, which comes from understanding the

roles, training, and competencies of the practitioners to whom

they are delegating . Further, the traineeship model developed

trust between practitioners due to the time and exposure to

the new role which is important for establishing appropriate

delegation practices.

An important challenge to introducing AHAs reinforced by

this study is inconsistencies in the use of employment awards

and a lack of a clear career pathway for AHAs . Staff

satisfaction is associated with career development

opportunities , however, many career pathways for AHAs have

largely failed because of the need to ‘step-off’ from clinical

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work to attend formal university training to achieve the

status of a qualified health professional . There needs to be

greater attention to career development opportunities for

AHAs.

Further, despite the encouraging outcomes of the

traineeship approach, it was considered by managers to be

resource intensive. As a developmental role, the competencies

had to be developed from scratch. Consequently, a great deal

of on-the-job planning, development and training was needed to

create an appropriate competency framework for the new SLPA.

It is unclear whether these competencies could have been

developed if an external training model was used. However, the

competencies developed in this study may be transferrable to

other settings. There is the potential for substantial

resource and knowledge sharing among health care providers

when developing a traineeship approach to implement AHA roles.

Study limitations

This study examined the implementation of one new trainee

assistant role. As such, the extent to which the conclusions

can be generalised are limited, however we have attempted to

overcome this by embedding the findings in existing

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literature. The clinical audit was based on staff self-report,

and coincided with annual leave for the SLPA, which may not be

representative of a typical time-period. Additionally, in

performing the audit at two different time periods, we have

assumed that there were no other confounding factors across

the organisation that may have accounted for the differences.

However, this is the first evaluation a new trainee SLPA

traineeship in an adult population in Australia, and the first

attempt to quantify the impact of the role in practice. There

are limited quality tools to facilitate this.

Conclusion

The AHA Traineeship model developed by the Directorate

appears to be an innovative and effective way to implement a

new role in a health care setting. There is no question about

the added benefits of the new role to the service in terms of

developing capacity, however implementation requires adherence

to a number of enabling mechanisms including strong

leadership, good coordination, and substantial resources to

support training and supervision.

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References

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Box 1: Example of an Assessment Plan for Dysphagia File Review Competency

Purpose and context of assessment

The purpose of this assessment it so ensure Speech pathology

Allied Health Assistants are competent in independently

conducting file reviews. It is to be used within the Aged Care

and Rehabilitation Speech Pathology Department.

Assessment Benchmarks

Each element of the workplace competency may be achieved at

different times as different components of the task are

delegated to the Speech Pathology Allied Health Assistant. The

knowledge component of the assessment will consist of multiple

choice and short answer questions and will be conducted under

exam conditions. This component will be completed upon the

achievement of all workplace competencies. Competency must be

achieved in each element in order to be deemed competent in

the tasks of file reviews.

Method and tools used to collect evidence

The assessment consists of two components. The first is a

checklist of workplace standards. This will be obtained by

observation of 2 file reviews and 3 independent file reviews

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(that is the examiner will review file reviews completed by

the candidate without the candidate present and provide

feedback on these). The second component is a quiz, which

examines the candidates underpinning knowledge.

Timeline for collection of evidence

Evidence will be collected once all duties have been

transferred. The evidence may be collected over a period of 2

weeks (depending on the amount of file reviews conducted in

that 2 week period).

Reasonable adjustments

The workplace assessment is unable to be adjusted. The exam

component of the assessment may be conducted verbally if

required.

Recognition of prior learning

Nil recognition of prior learning will be awarded.

Resources

Writing equipment

Assessment tool

Client file

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Table 1: Examples of workplace competencies developed for the SLP and SLPA

Group work tasks for the SLPA included:Administrative work associated with group running (room bookings, contacting patients, sending letters, organising physical resources for the smooth running of the group)Facilitating the group ensuring active client participation to meet specified goals (for example social interaction, social communication skills)Group work tasks for the SLP included:Identifying suitable patients for the groupWorking with patient to construct suitable goals to be achieved during the groupSetting the group activitiesDirect patient contact for the SLPA included:Implementing therapy programs under the direction of the SLPAReporting patient progress to SLP to facilitate adjustment of programDirect patient contact for the SLP included:Patient assessmentSetting goals with patient and family/carerSetting therapy programs and adjusting programs as relevantPlan for appropriate discharge and ongoing support in conjunction with MDT and patient

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Table 2 Activity audit data for the SLPA (2 weeks)

Activity Time

Preparation of resources: making

communication boards, photocopying, preparing

programs

3 hrs

Administration 4 hrs 45 mins

Group work: organisation, preparation,

attendance, therapy with patients, notes

16 hours

Indirect patient contact: file reviews,

preparation of files

8 hrs 45 mins

Direct patient contact: direct one to one

therapy

15 hours

Quality Initiative Project 3 hrs 45 mins

Professional Development 2 hrs 45 mins

Formal training at the Registered Training

Organisation

2 hrs 15 mins

Total hours 56 hours 15

mins

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Table 3 Time-audit study based on 4.8 Full Time Equivalent SLP activity data collected over two, two week periods while the SLPA was at work and then absent

Activity

SLP activity data

for 2 weeks when

the SLPA was

working (time)

SLP activity data

for 2 weeks when

SLPA was not working

(time)

Additional 4.8 SLP

services / roles

in 2 weeks

Mean impact of

employing the SLPA

per week on

activity *

Clinical services management 30 hrs 15 20 hrs 30 9 hrs 45 + 63 minutes

Preparation of resources 2 hrs 5 hrs -3 hours (- 31 minutes)

Administration 33 hrs 45 27 hrs 45 6 hrs + 38 minutesGroup work 13 hrs 15 0 -13 hrs 15 (- 83 minutes)Indirect patient contact 48 hrs 44 hrs 15 4 hrs + 25 minutes

Direct patient contact 106 hrs 89 hrs 30 17 hrs + 107 minutes

QI Project 6 hrs 30 30 mins 6 hrs + 38 minutesPD 9 hrs 15 10 hrs 30 -1 hr 15 (- 8 minutes)Supervision 11 hrs 45 5 hrs 45 6 hrs + 38 minutesTotal +187 minutes

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*+ denotes an increase in service capacity, - denotes a decrease in service capacity in

specified area

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Appendix 1: Interview questions

The questions to the staff participants (the Trainee SPA, managers, and speech

pathologists) explored the following issues;

• Background to the implementation of the role

• The implementation of the role: how it was done, what helped, hindered, and the role

of champions, initiators and drivers of the role, importance of organisational culture

• Tensions around the introduction of the role

• Accountability, supervision and regulation of the role

• Perceptions of the traineeship model

• The role of leadership in the implementation of the new post

• Effectiveness and impact of the role

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• What they would do differently

• Sustainability issues

Questions to the service users included the following points, but were tailored to the

ability of the service user / carer to respond;

• Exploration of their use of the service

• Exploration of their interface with the speech pathologist and Trainee SPA

• General feelings about the use of assistant practitioners

• Understanding of, and preferences for levels of training of SPAs

• Important qualities of SPAs

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