Abstract
Allied health clinical placements take place within an increasingly overstretched health care system where demand for services often exceeds availability of resources. Within this environment, student placements are often perceived as an additional burden to an already overwhelmed workforce. This study explored whether the quality of patient care was enhanced when services were re-designed using a collaborative partnership approach to more purposefully integrate students into delivery of care. Using an embedded multiple case study design, data were collected through focus groups and interviews, patient experience surveys, and secondary administrative data sources. Cases were across physiotherapy and occupational therapy in six different hospital settings. Perception of care provided by students was viewed positively by all stakeholders, including patients. Perceived health outcomes of faster improvement of health condition, improved mobility and function identified through our qualitative findings were supported by quantitative service delivery markers such as increased therapy sessions, more patients being discharged home instead of to other care facilities and reduced length of stay. Health care providers and students alike perceived improvements in service efficiencies whilst maintaining high quality care. This study has provided preliminary evidence towards improved patient care when a partnering approach is adopted whereby students are intentionally integrated into services that otherwise might not have been delivered. Furthermore, it has shifted the associated narrative from students as additional burden to students as benefit.
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Acknowledgements
The authors thank the patients, students, placement educators, allied health professionals and multidisciplinary team members who participated in this study. We would also like to acknowledge the work of the broader project team who contributed their expertise at various times throughout the project: Justine Dougherty, Christina Eagleton, Maria Quinlivan, Gerard Regan, Lily To, Reggie Daguio, Stephen Harvey.
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GN, TT, SM, MJ, MP, and BK contributed to the conception and design of the project. BB, LC, GN and SM lead the analysis of the qualitative data. TT led the analysis of the quantitative data. All authors were involved in the discussions for interpretation of the data. GN, TT, and SM drafted the initial versions of the manuscript with all authors contributing to subsequent versions by providing feedback. BB prepared the initial draft of Figure 1. TT prepared Figures 2-6. All authors reviewed the manuscript.
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Appendices
Appendix 1
Semi-structured focus group and interview guided questions and prompts related to impact on quality patient care
Students | Clinical Educators, Clinicians, managers and MDT |
|---|---|
1. How do you think you have contributed to [insert discipline] services provided to patients? Prompts: a. Can you give an example to illustrate this? How were you involved? b. What about to the patient’s journey through health system? What were your key contributions? 2. How do you think you have contributed to patient care outcomes? Prompts: a. Can you give an example to illustrate this? b. What were your key contributions? | 1. Compared with how you previously ran placements at your site / [insert allied health discipline] placements have previously run in your ward/ service/ unit, what do you see as the benefits of this current placement model? Prompts: a. To how services are delivered? i. If so, can you give me an example? b. To patient care? ii. If so, can you give me an example? 2. Compared with how you previously ran placements at your site/ [insert allied health discipline] placements have previously run in your ward/ service/ unit, what do you see as the drawbacks or challenges of this current placement model? Prompts: a. To how services are delivered? i If so, can you give me an example? b. To patient care? ii If so, can you give me an example? 3. Are these drawbacks or challenges ‘fixable’? Clinical Educators only 4. How, if at all, have students contributed to patient care services? Can you give an example to illustrate this? How were the students involved? Prompts: a. What about to the patient’s journey through health system? b. What about the range of services provided by students? c. Were any additional services provided by the students that would not have otherwise been provided? 5. How, if at all, have students contributed to patient care outcomes? Can you give an example to illustrate this? |
Appendix 2
Items included in the Patient Experience Questionnaire (adapted from Bureau of Health Information New South Wales patient questionnaires) (Bureau of Health Information, 2017).
Item | Response options |
|---|---|
Q1. Did your [insert discipline therapist/ student discipline therapist] spend enough time with you during your hospital stay? | Yes, always Yes, sometimes No |
Q2. Did your [insert discipline therapist/ student discipline therapist] listen carefully to you? | Yes, definitely Yes, to some extent No |
Q3. Did your [insert discipline therapist/ student discipline therapist] explain things in a way you could understand? | Yes, definitely Yes, to some extent No |
Q4. Did you have confidence and trust in your [insert discipline therapist/ student discipline therapist]? | Yes, definitely Yes, to some extent No |
Q5. Did the treatment you received from [insert discipline therapist/ student discipline therapist] help you? | Yes, definitely Yes, to some extent No |
Q6. Were you involved as much as you wanted to be in decisions about your [insert discipline] goals and treatment while you were in hospital? | Yes, definitely Yes, to some extent No I was not well enough I did not want to or need to be involved |
Q7. Did your [insert discipline therapist/ student discipline therapist] involve you about getting ready for leaving hospital? | Yes, definitely Yes, to some extent No I was not well enough I did not want to or need to be involved |
Q8. Did your [insert discipline therapist/ student discipline therapist] make suggestions for any services you needed after you leave hospital? | Yes definitely Yes to some extent No I was not well enough I did not want to or need to be involved |
Q9. Overall how would you rate the care you received from your so far during your stay in hospital? | Very good Good Neither good nor poor Poor Very poor |
Q10. Do you have any other comments about the [insert discipline] care provided to you during this admission? | Open ended response |
Appendix 3
Summary of results from Patient Experience Questionnaire
Question | Student responses | ||
|---|---|---|---|
Response category | N value | % | |
Q1. Did your student [insert student discipline therapist] spend enough time with you during your hospital stay? | Yes, always | 80 | 87.91% |
Yes, sometimes | 9 | 9.89% | |
No | 1 | 1.10% | |
No answer | 1 | 1.10% | |
Q2. Did your student [insert student discipline therapist] listen carefully to you? | Yes, always | 85 | 93.41% |
Yes, sometimes | 4 | 4.40% | |
No | |||
No answer | 2 | 2.20% | |
Q3. Did your student [insert student discipline therapist] explain things in a way you could understand? | Yes, always | 79 | 86.61% |
Yes, sometimes | 10 | 10.99% | |
No | 1 | 1.10% | |
No answer | 1 | 1.10% | |
Q4. Did you have confidence and trust in your student [insert student discipline therapist]? | Yes, always | 82 | 90.11% |
Yes, sometimes | 7 | 7.69% | |
No | 1 | 1.10% | |
No answer | 1 | 1.10% | |
Q5. Did the treatment you received from your student [insert student discipline therapist] help you? | Yes, definitely | 71 | 78.02% |
Yes, to some extent | 18 | 19.78% | |
No | |||
No answer | 2 | 2.20% | |
Q6. Were you involved as much as you wanted to be in decisions about your [insert student discipline therapist] goals and treatment while you were in hospital? | Yes, definitely | 59 | 64.84% |
Yes, to some extent | 21 | 23.08% | |
No | |||
I was not well enough | 3 | 3.30% | |
I did not want to or need to be involved | 1 | 1.10% | |
No answer | 7 | 7.69% | |
Q7. Did your student [insert student discipline therapist] involve you about getting ready for leaving hospital? | Yes, definitely | 54 | 59.34% |
Yes, to some extent | 26 | 28.57% | |
No | 3 | 3.30% | |
I was not well enough | 2 | 2.20% | |
I did not want to or need to be involved | |||
No answer | 6 | 6.59% | |
Q8. Did your student [insert student discipline therapist] make suggestions for any services or)[insert discipline] you needed after you leave hospital? | Yes, definitely | 48 | 52.75% |
Yes, to some extent | 22 | 24.18% | |
No | 9 | 9.89% | |
I was not well enough | 4 | 4.40% | |
I did not want to or need to be involved | 1 | 1.10% | |
No answer | 7 | 7.69% | |
Q9. Overall how would you rate the care you received from your student [insert student discipline therapist] so far during your stay in hospital? | Very good | 69 | 75.82% |
Good | 19 | 20.88% | |
Neither good nor poor | 3 | 3.30% | |
Poor | – | ||
Very poor | – | ||
No answer | – | ||
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Nisbet, G., Thompson, T., McAllister, S. et al. From burden to benefit: a multi-site study of the impact of allied health work-based learning placements on patient care quality. Adv in Health Sci Educ 28, 759–791 (2023). https://doi.org/10.1007/s10459-022-10185-9
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DOI: https://doi.org/10.1007/s10459-022-10185-9