Paradoxical perceptions towards the introduction of assistants in speech‐language pathology and potential impact on consumers

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Healthcare reform typically focuses on creating a health system which is responsive to changing consumer health needs in an equitable and sustainable way 1. To provide the right skill mix in order to increase sensitivity to consumer need and involvement in health service delivery, new roles and working practices have been introduced internationally 1. Such changes have led to considerable emphasis on workforce role redesign. Role redesign is concerned with reorganising the design or configuration of healthcare roles within the overall healthcare system 4. The availability of an appropriately skilled workforce is vital for the ongoing effective delivery of quality healthcare services. While there is evidence to support the success of some redesign initiatives 5, many efforts to tackle workforce reorganisation and job redesign have been unsuccessful 6 with the majority of stakeholders remaining unconvinced about the potential benefits of the change 7.
Research is being conducted in health organisations internationally exploring how the workforce redesign of utilising assistants may be of benefit to consumers, professionals and organisations 8. An allied health assistant is a worker whose role it is to complement and provide support to qualified allied health professionals, allowing them to work on more complex or specialised tasks 9. For consumers, there is evidence that assistants may be able to increase sensitivity to consumer need given their close demographic proximity to the local community 1. For organisations, potential benefits associated with this workforce redesign include alleviating workforce shortages and increasing service capacity while being a more financially viable resource than a qualified allied health professional 1.
Despite the potential benefits, resistance to such a workforce redesign, and in particular, the introduction of assistant roles, continues to be documented. For example, qualified professionals raise concerns that assistants may represent a challenge to job security 5. Other studies have reported poor role clarity 11 and unrealistic expectations for the role of assistants 12 leading to perceptions of threat to professional identity 1. This in turn has been shown to be a precursor to interprofessional conflict and potential failure of interprofessional practice 13. It appears, therefore, that while there is evidence of beneficial outcomes, such as increased access to and efficiency of health services 9, there is also evidence of substantial resistance to such workforce redesign 14. This has the potential to negatively impact on successful uptake 15 and professional acceptance of assistants as a useful workforce redesign initiative 16. Our understanding of the factors that engender such resistance is relatively limited 17. This represents a significant research gap as a clearer understanding of the perceptions that trigger resistance is likely to better inform strategies that aim to minimise resistance and facilitate the integration of assistant roles into the complex hierarchy of healthcare occupations 18.
In an effort to address this research gap, our study investigates how a group of healthcare professionals, speech‐language pathologists (SLPs), interpret the consequences of assistants for their profession. In addition to building a better understanding of the perceptions that may contribute to resistance against the introduction of an assistant workforce, we also aim to identify possible levers available to lessen resistance or, at least, safeguard against misinterpretation that may exacerbate opposition. In doing so, we respond to a need in the broader literature by moving beyond describing perceptions of a workforce redesign and attempting to understand how the perceptions of a group are formed and the ways in which these perceptions may be influenced 20. This contributes to both the workforce redesign literature and the study of professional identities and subgroups in an organisational context.
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