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2 The Australasian Allied Health Benchmarking Consortium (AAHBC) was convened in 1997 as the National Allied Health Benchmarking Consortium (NAHBC) to develop a standardised method of recording allied health practitioners’ activity in Australia’s public hospitals.

3 Its current aim is to enable a network of collaborative teaching hospitals to develop and maintain a standardised approach to benchmarking and subsequently improved practices.

4 AAHBC provides input into allied health and whole of health strategies and projects through the utilisation of quality data sets and the combined input of experienced members across the network of participating hospitals.

5 Membership criteria WILLINGNESS TO PARTICIPATE IN GROUP DISCUSSION AND PROJECTS Established allied health governance structure Tertiary or teaching hospital with approximately 500 beds with significant annual separations Allied health data collected using the Australian Allied Health Classification System Allied health data collection system/s in place Allied Health membership of The Health Roundtable is beneficial and encouraged. Further information Contact Cherie Hearn, Chair AAHBC

6 Clinical Care Ratios for Allied HealthAustralasian Allied Health Benchmarking Consortium

7 Definition of Clinical Care Ratio CCRsTime spent on direct clinical activities (IPA + NIPA) Compared with non-direct clinical care activities (CSM + TT + R) Expresses as a % of total time work Will use the direct clinical % in this presentation

8 Project Aim Determine how much non-direct clinical time is appropriate for allied health professionals Study sought to: Quantify and recommend CCRs according to seniority and role type Assess whether CCRs are associated with seniority level or profession

9 Definitions Tier 1- Entry level practitioner, who is generally employed to rotate between work areas. Tier 2 Practitioner who is employed as a more experienced clinician, who is less likely to rotate between work areas, and is developing more specialised skills. Tier 3 -Staff with clinical expertise who in smaller facilities will be site managers Tier 4 -These staff will be programme leaders in large sites or heads of discipline with clinical loads at smaller sites. Tier 5 - Staff will have responsibilities extending across a number of sites or in larger facilities and will have minimal to no clinical case load.

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11 Tier 3 – Advanced ClinicianExperienced clinician with high level of clinical expertise and advanced skills. They would be leading service development and quality improvement initiatives and be involved in research in there area of clinical expertise. There would be no team leader or management responsibility in this category

12 Tier 3- Clinical Leader/SupervisorStaff with clinical expertise and a clinical caseload who also supervises a team of clinicians +/- manages a clinical work area. They would be leading service development and quality improvement activities in their clinical work area.

13 Tier 3 – Clinical EducatorA clinical educator who in addition to delivering clinical education has a role either in the coordination of placements, university teaching or other strategic activity related to clinical education. A Tier 2 Clinical Educator is delivering the clinical education

14 No. of Responses Tier Physiotherapy (PT) Occupational Therapy (OT) Speech Pathology (SP) Nutrition & Dietetics (N&D) Social Work (SW) Total 1 343 162 87 111 152 855 2 287 149 59 115 131 741 3 82 38 45 68 364 4&5 15 25 14 16 6 76 776 418 198 357 2036

15 Senior/Clinical LeaderPhase Responses- Tier 3 Tier 3 Category PT OT SP N & D SW Total Senior/Clinical Leader 56 54 14 18 32 174 Advanced Clinician 39 42 10 9 11 111 Clinical Educator 4 1 3 2 13 99 97 27 30 45 298

16 Responses 2012- Clinical EducatorsCategory PT OT SP N & D SW Total Tier 2 Clinical Educator 60 50 22 35 24 191 Tier 3 Clinical Educator 2 4 16 62 54 26 37 28 207

17 Mean CCR (95% Confidence Interval)Tier OT SP PT ND SW All 1 80.05 ( ) 76.39 ( ) 83.54 (81.69, 85.39) 73.57 (69.39, 77.75) 75.63 (73.19, 78.07) 77.93 (76.51, 79.35) 2 74.46 ( ) 72.79 (68.19, 77.38) 73.98 (70.32, 77.74) 68.45 (63.70, 73.21) 73.17 (69.54, 76.81) 72.52 (70.74, 74.31) 3 Advanced Clinician (50.35, 79.32) 71.17 (61.73, 80.60) 76.29 (69.49, 83.08) 60.33 (40.82, 79.85) 69.25 (55.00, 83.50) 69.54 (64.22, 74.86) All of above 75.46 (72.60, 78.31) 74.22 (71.61, 76.82) 78.58 (76.20, 80.96) 70.06 (66.69, 73.43) 73.89 (71.50, 76.27) 74.54 (73.27, 75.80)

18 Mean CCR (95% Confidence Interval)Tier OT SP PT ND SW All 3 Advanced Clinician (50.35, 79.32) 71.17 (61.73, 80.60) 76.29 (69.49, 83.08) 60.33 (40.82, 79.85) 69.25 (55.00, 83.50) 69.54 (64.22, 74.86) 3 Clinical Team Leader 58.33 (52.28, 64.38) 58.90 (49.42, 68.38) 58.30 (52.23, 64.37) 50.67 (33.13, 68.20) 62.78 (53.59, 71.96) 58.33 Clinical Educator 65.40 (51.50, 79.30) 33.29 (16.23, 50.34) 59.83 (38.08, 81.58) 55.00 (42.73, 67.27) 35.80 (16.66, 54.94) 48.83 2 64.33 (56.66, 72.00) 64.00 (55.52, 72.48) 53.50 (37.25, 69.75) 49.00 (28.57, 69.43) 73.00 (N/A) 58.65

19 2 Way ANOVA- Seniority 2 way ANOVA was done on Tiers with a predominant clinical load (Tier 1, Tier 2 and Tier 3 Advanced Clinician) Significant Difference between Tiers More senior staff-lowest CCR Tier 3 > Tier 2 > Tier 1

20 2 Way ANOVA - ProfessionsSignificantly higher CCRs for Physiotherapy compared with the other professions Significantly lower CCRs for Nutrition & Dietetics compared with the other professions No significant difference in CCRs between Speech Pathology, Social Work and Occupational Therapy

21 Considerations Variation within Tiers is expectedRange of experience Variation in clinical area Variation in role Is CCR size and context of service dependent?- Based on current practice and should not be considered a “gold standard” Do higher CCRs indicate better performance and better patient outcome??? Why is there difference between professions?

22 Conclusion CCRs are a useful tool in workload management and determining staffing levels Can be quantified and benchmarked between like roles CCR decreases with seniority Differences exist between professions

23 AHHBC Staffing Models Jim Sayer

24 Background Benchmarking: Service Performance / ActivityEpisodes Occasions of Service Hours of Activity Per Episode Level Service Growth / Business Case Development The classic Ring-around How many beds do you have ? How much eft do you have ?

25 Past Models 2009-10? Excel Spreadsheet? Excel Spreadsheet Ver 2.0

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33 New Model Access Database Used 2011-2012 data Uses SRG goupsUses Eft per bed as the comparator! Allows quick identification of areas for benchmarking Allows meaningful comparison at each level, Dept vs SRG vs DRG

34 The Trick Translation of Clinical Hours to EFT. Assumptions FlawsStats Entry is Perfect ! Data Matching is Perfect Allied Health Factor 100 % Beds Occupancy Reflects previous activity not necessarily ideal activity Flaws Its Assumptions !!

35 Assumptions - 1 Translation of Clinical Hrs to EFTAllied Health Factor Direct Clinical Care Ratio – (75.0%) Leave Annual Leave ADO Sick Leave Professional Development Leave -> 1 Clinical Hr = Actual / EFT Hrs -> 4.58 Clinical Hrs = 8.0 Actual / EFT hrs 2088 Hrs per EFT Year

36 Assumptions - 2 Translation of Separation Activity to BedsNormally have Number of Seps Avg LOS Bed days: Seps x Avg LOS Assume 100% Occupancy ->Beds: Bed Days / 365

37 AAHBC Model AAHBC Model SRG -> DRG

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39 AAHBC Model 2014-2015 AAHBC Model 2014 -2015Clinical Group -> Local Unit Data will be wrapped up: Allied Health -> Discipline -> Clinical Group

40 ClinUnit AH CPSY NPSY NUT OT O&P POD PT SP SW ClinUnit2 BURN 0.356 0.006 0.000 0.041 0.120 0.015 0.084 0.033 0.056 EMER 0.321 0.002 0.075 0.110 0.001 0.131 ENDO 0.174 0.045 0.018 0.010 0.014 0.047 0.005 ENT1 0.182 0.040 0.054 0.058 0.017 ENT2 0.086 0.004 0.035 0.027 GAST 0.136 0.048 0.030 0.036 GenMed 0.311 0.063 0.061 0.003 0.096 0.066 GMA NEUR 0.232 0.022 0.029 0.046 NSUR 0.340 0.039 0.124 ORTH 0.278 0.064 0.007 0.023 STRO 0.455 0.053 0.116 0.127 0.103 0.052 VASC 0.138 0.019 0.032 0.050 0.016

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