initiative 6 allied health project 6.1 allied health

Initiative 6 Allied Health Project 6.1 Allied Health Infrastructure December 2004

Allied Health Infrastructure

© Winnipeg Regional Health Authority, 2004 i

Table of Contents

Section 1 Organizational Structure, Regional Director Role Definition, Authority, and Accountability

Executive Summary .............................................................................................. iii I. Introduction.................................................................................................... 1 II. Impetus for Change....................................................................................... 1 III. Description of Proposed Regional Model ................................................... 4 IV. Recommendations ........................................................................................ 7 V. Financial Implications ................................................................................. 10 VI. Benefits ........................................................................................................ 11 VII. Implications of Maintaining the Status Quo.............................................. 13 VIII. Performance Measurements ...................................................................... 14 IX. Description of Project Process .................................................................. 14

Goal Guiding Principles Objectives Vision Statement for the Allied Health Infrastructure Project Methodology References

Section 2 Recruitment and Retention

I. Introduction.................................................................................................. 19 II. Project Overview ......................................................................................... 19 III. Overview of Allied Health Recruitment and Retention – Ongoing WRHA

Initiatives...................................................................................................... 19 IV. Review of Relevant Literature .................................................................... 22 V. Recruitment and Retention - Standards and Goals ................................. 23 VI. Methodology ................................................................................................ 23 VII. Recommendations for Recruitment and Retention.................................. 24 VIII. Summary ...................................................................................................... 26 IX. Plan for Implementation.............................................................................. 26 X. Funding Requirements to Support an Education Funding Plan............. 26 XI. Evaluation .................................................................................................... 26


© Winnipeg Regional Health Authority, 2004 ii

Section 3 Allied Health Infrastructure Sub Tasks

I. Overview.............................................................................................. 28 a. Professional Support and Education Strategies

b. Adjusted Staffing Levels

c. Relief Pools

Section 4 Conclusion ................................................................................................................... 32 Next Steps.................................................................................................................... 32

Appendices Appendix 1 Communication Plan....................................................................... A33 Appendix 2 References ....................................................................................... A37 Appendix 3 Responsibilities Matrices................................................................ A39 Appendix 4 Regional Director Allied Health – Discipline Specific Position

Description....................................................................................... A55 Appendix 5 ABC 6.1 Allied Health Infrastructure Team Members................... A60


© Winnipeg Regional Health Authority, 2004 iii

Section 1 Organizational Structure, Regional Director Role Definition, Authority, and Accountability

Executive Summary The Deloitte and Touché (D&T) Report July 2002 identified consistent themes related to the role and support for Allied Health professionals across acute facilities. The key phrases used were: fragmentation, decentralization, increase in meeting time, inconsistencies in adoption of program management structure, unclear and ineffective communication channels, lack of support in management/administration, insufficient support for professional practice, significant competition between facilities, limited access to services, perception of low corporate and regional priority, and lack of effective/consistent workload measurement tools.1 Although these comments were made in the acute care context, the Allied Health Regional Directors have been tasked with addressing these factors for their respective disciplines across the full care continuum. The Achieving Benchmarks through Collaboration (ABC) Allied Health Infrastructure Team developed a reorganization plan that addresses the issues identified by D&T and is consistent with the Winnipeg Regional Health Authority (WRHA) Board strategic plan and vision.2 The plan sets direction for the WRHA that is innovative, progressive, supportive of Clinical and Community Programs, and assures the delivery of the most effective care in the most appropriate environment. By clearly defining roles, responsibilities and accountabilities, and by aligning resources with each discipline, the Allied Health Regional Directors will be in a better position to ensure effective and efficient utilization of Allied Health resources, optimize service delivery in the community, and ultimately improve continuity in the provision of services across the continuum.3 This report contains specific recommendations regarding Allied Health infrastructure that define a model in which the Regional Directors assume responsibility for delivery of their disciplines’ services throughout the Region. It is predicated upon an approach to planning and implementing service delivery that includes collaboration and consultation with sites, program teams, and community area directors, to improve productivity, patient/client/resident flow, and patient/client/resident outcomes. Specific recommendations include:

1. Accept and implement the proposed model across all sites for all disciplines involved in the project.

2. Accept and implement the proposed Allied Health Regional Director position description.

3. Assign accountability to the Allied Health Regional Directors for the overall services provided by their disciplines at each site similar to the Clinical Program Management structure.


© Winnipeg Regional Health Authority, 2004 iv

4. Develop strong partnerships and agreements with stakeholders to ensure a collaborative approach.

5. Eliminate the designation Professional Leader and replace these positions with discipline-specific Managers.

6. Ensure Site Managers are accountable to the site/community area management team for day-to-day operations and to the Allied Health Regional Director for discipline specific issues.

7. Provide Site Managers with responsibility for managing staff and supplies within a discipline-specific budget, consistent with MIS guidelines, consolidated into a single regional report monitored by the applicable Allied Health Regional Director. This will facilitate the appropriate alignment and distribution of resources.

8. Adopt a decision making model that will enable decisions that are binding on, and supported by, all members of the health care team.

9. Implement Allied Health initiatives regionally once approved by WRHA senior management.

10. Develop a model to ensure Allied Health representation at site senior management.

11. Ensure Allied Health Regional Directors participate with Site Management in the performance evaluation of Site Managers.

12. Redefine job classifications/descriptions in collaboration with WRHA Human Resources.

The implementation of the proposed organizational structure will result in a strengthened regionalized approach enabling the Allied Health disciplines to manage their staff resources as a collective whole, in collaboration with programs, sites, and community areas, to ensure seamless delivery of Allied Health services across the full care continuum. The implementation of these recommendations will improve clinical outcomes and quality of life for patients/clients/residents, provide a high quality of work life for staff, and ensure effective and efficient utilization of human and material resources.


© Winnipeg Regional Health Authority, 2004 1

I. Introduction

This section will focus on the initial phase of ABC Project 6.1 dealing with Allied Health Organizational Structure including the role of the Allied Health Regional Director and the resources required to support a regionalized approach to Allied Health service delivery across the continuum of care. The disciplines included in this project are Occupational Therapy, Physiotherapy, Respiratory Therapy, Clinical Nutrition, Social Work, Audiology, and Speech-Language Pathology.

II. Impetus for Change The ABC 6.1 Project Team was tasked with creating and implementing a supportive infrastructure for Allied Health that describes the manner in which authority, accountability, and information are distributed: • To improve the efficiency and effectiveness of the delivery of health care

across all sites in the WRHA • To provide clarity and consistency around Allied Health structures in the

region • To increase the role of Allied Health in the care continuum.

Drivers for this change initiative include: the WRHA Strategic Plan, the Deloitte and Touché (D&T) External Review, the Allied Health Worklife Survey, and the ABC Project 8.2 Regional Program Structure and Accountability: Conceptual Design Phase Report. WRHA Strategic Plan The recommendations for Allied Health organization outlined in this report provide the framework for moving forward with a structure that enables change consistent with the WRHA Board of Directors Strategic Plan and its Mission, Vision, Values, and Principles. The WRHA Strategic Plan describes the WRHA mission as:

- To deliver and administer health services in the Winnipeg region and to promote and protect health.

- To improve health and well being by leading Winnipeg’s health services and building partnerships with the community.

Specific goals, measurements, and strategies are defined within the strategic plan that support the five key components of the Board’s Vision: prevention and promotion, treatment and support, working with our community, working with our staff, and accountability.



Allied Health has a unique opportunity to support the Vision provided appropriate structures are in place to enable the disciplines’ active and meaningful participation. For example:

- Providing better access to primary health care services in the community as an alternative to hospital-based services through the provision of a wide network of services and delivery of the right care, in the right place, at the right time, by the right provider, to meet people’s needs.

- Addressing accountability through centralized Allied Health budgets that increase adherence to national MIS guidelines (which include functional centers and accounting structures specific to Allied Health) that will enable the ability to collect and analyze information to assess impacts and cost effectiveness of services.

Deloitte and Touché External Review The External Review conducted by Deloitte and Touché identified a variety of issues that were negatively impacting the Allied Health professionals of Audiology, Occupational Therapy, Physiotherapy, Respiratory Therapy, Clinical Nutrition, Social Work, and Speech-Language Pathology.

The External Review observed that in general the Allied Health staff had been decentralized into clinical program structures at each of the facilities and that most facilities had reduced their administrative structure supporting the disciplines, replacing that role with a combination of part-time professional practice leaders and multidisciplinary professional advisory committees. The variability and inconsistency in organizational structures across sites and disciplines is not sustainable or acceptable in an evolving health system and is inconsistent with the WRHA values and principles, specifically shared leadership and accountability, continuous improvement and willingness to change, and high quality of work life. Therefore, a primary directive for this project has been to define an organizational structure for Allied Health that will address these issues, including the elimination of the designation of professional leader and the appointment of managers with clearly defined roles and responsibilities. Further issues identified by the External Review driving the need for change in the organization of Allied Health include: Management Structure • Fragmentation of staff into programs has resulted in disconnection from

peers within the professions and from the other Allied Health disciplines. • Decentralization of staff from core departments/services limits ability to

recruit and retain staff and provide relief coverage for vacations, sick time, weekend coverage, etc.



• Meeting time is substantially increased through multiple reporting structures.

• Inconsistencies in adoption of the program structure between some facilities and for some disciplines.

• Communication channels are unclear and not effective. • Need to provide clear direction for the role and authority of the regional

directors in comparison to the roles and authority of the sites and program teams.

• Need for ongoing leadership and professional development. Professional Voice/Support • Clinical planning does not sufficiently involve Allied Health professionals. • Lack of support (management and administrative) for professionals within

disciplines. • Insufficient support for professional practice and educational needs of the

disciplines at the site/program level. • Not all Allied Health professionals are working within their full scope of

practice. • Allied Health has limited professional voice/support in the region. • Need to establish regional strategies and approaches in the areas of

recruitment and retention of Allied Health professionals. Systemic Issues • Need to reduce the barriers between regional programs and site-based

programs to improve communication and reduce unhealthy competition. • Limited access to hospital-based outpatient/day services and community-

based services. • Allied Health is perceived to be a low corporate and regional priority. • Lack of effective/consistent workload measurement for Allied Health

disciplines. Other Issues • Inconsistent distribution of Allied Health staff across all sites and

programs. • No consistent methodology for allocating Allied Health Resources. • Accurate MIS reporting should occur at all sites, with Allied Health

resources being centralized back to core department functional centres rather than distributed within individual patient care cost centers.

• Work performed for outside agencies/organizations should be reflected in revenues attributed to Allied Health functional centers.

• Select disciplines in Allied Health have substantially lower staffing than peers with impact on the Allied Health range of service and scope of practice, particularly respiratory therapy, social work, and clinical nutrition.



WRHA Allied Health Worklife Survey The Allied Health Worklife Survey identified a number of issues affecting work life satisfaction for Allied Health including:

o Workforce shortages o Heavy workload o Lack of continuing education opportunities o Lack of career laddering opportunities o Inadequacy of workplaces o Compensation issues

Surprisingly, even in those sites and disciplines where more centralized structures had been maintained, strong dissatisfaction with program management was expressed (especially Respiratory Therapy and Physiotherapy), mainly related to the inability to address cross-program issues such as continuity of care. ABC Project 8.2 Regional Program Structure and Accountability: Conceptual Design Phase Report and Presentation The team reviewed ABC Project 8.2’s report to ensure our recommendations were consistent with and supportive of the concepts identified by this project, such as accountability (authority, responsibility, performance management), integration of services, and team decision-making. Consistent with the report recommendations, the term “Clinical Support Program”, defined as “programs consisting of health care providers that offer clinical services to programs”, has been adopted by each of the Allied Health disciplines in this project. This is consistent with Laboratory Medicine, Diagnostic Imaging, and Pharmacy programs. Alternatively the term Clinical Support Service could be used.

III. Description of Proposed Regional Model Consistent with the regional strategic plan, the WRHA Allied Health Regional Directors for Occupational Therapy, Physiotherapy, Respiratory Therapy, Clinical Nutrition, Social Work, and Communication Disorders (Audiology and Speech-Language Pathology) were tasked with the responsibility of ensuring the provision of their disciplines’ services across the full continuum of care with the aim of improving service delivery and enhancing continuity of care. The concept of exploring alternative settings of care, including moving care into community areas, where appropriate, versus the traditional hospital setting is inherent in the Regional Directors’ role definitions.



The ABC Project Team developed a position description and matrices that clearly define the roles, responsibilities, and accountabilities of the Allied Health disciplines. (Appendix 3 – Responsibilities Matrices; Appendix 4 – Regional Director Allied Health – Discipline Specific Position Description) In order for the Allied Heath Regional Directors to be truly accountable for restructuring their disciplines’ service delivery across the continuum, they require the information and authority to influence the management of the discipline’s resources as a whole, recognizing the need for collaboration with all stakeholders while doing so.

The implementation of the proposed organizational structure will enable the Allied Health disciplines at the Site level to manage their staff resources as a whole, thus decreasing resource fragmentation, especially in smaller Sites, and improving local resource utilization. Provision of Site financial reports to the Regional Directors will provide the necessary information to enable discussions with stakeholders regarding consistent resource allocation and implementation of regional service initiatives to enhance delivery of care in the most appropriate setting across the continuum.

It is recognized that project recommendations defining responsibility for resource allocation may be inferred as a return to the former traditional departmental structures separate from the program management model. However, the Allied Health disciplines are committed to maintaining the positive aspects of program management while acknowledging the need to restructure the disciplines in order to meet the goals and objectives of the Region’s strategic plan. Strong partnerships and agreements will be developed with sites, clinical programs, and community areas to ensure all parties are working collaboratively to meet mutual goals. The relationships are well defined in Appendix 3 – Responsibilities Matrices. By aligning staff with central departments/services, the proposed structure reduces staff fragmentation and facilitates adequate staff coverage to meet the needs of the clients, patients, residents, clinical programs, and the region overall. The ability to recruit and retain staff and provide relief coverage for vacations, sick time, etc. as well as weekend coverage has been compromised within the current model; the proposed structure will maximize efficient use of limited resources. The proposal eliminates the professional leader designation and replaces this role with Site Managers with a dual reporting relationship to the Site and their Allied Health Regional Director. Where workload and complexity is sufficient, single Site Managers are recommended (and already exist in some disciplines at some sites). The plan will ensure that job responsibilities for site management staff will be consistent across the region in regards to levels of responsibility and accountability.



Site Managers will be accountable to both their Allied Health Regional Director and Site Senior Management as defined in the Responsibilities Matrix – see Appendix 3 – Responsibilities Matrices. Site Managers will have day-to-day responsibility for insuring that their discipline’s particular site related needs are met. Site Managers will have accountability to the Region for discipline specific issues as defined in the Responsibilities Matrices. Additionally, Regional Directors will be accountable for ensuring inclusion of their disciplines in budget review and business planning processes.

The proposal further supports the principle that all front line professionals will be able to have direct access to a Manager, Charge, or Director within their discipline at either a site or regional level. For certain disciplines, the level of complexity in sectors such as long term care and community may warrant the addition of a Regional Manager, a model that has already demonstrated significant success in Respiratory Therapy and Speech-Language Pathology. The existing Regional Managers in these disciplines have assumed responsibility for sector-specific practice issues and standards, special projects, quality and risk management, clinical education, research into best practice, and, in some instances, supervision of staff. Creation of these positions will be determined through consultation between the Regional Directors and their responsible Vice Presidents as needs are demonstrated. Acceptance of these recommendations will ensure consistent, high quality care for patients, clients, and residents and will alleviate the negative impacts of program management on Allied Health service delivery by providing a consistent approach to the management of Allied Health across the region and defining consistent expectations in regards to job functions.

Key to the success of this model is ongoing and meaningful collaboration between the Regional Directors of the Allied Health disciplines and their stakeholders, specifically site management, program teams, and community areas, to ensure no one entity is functioning in isolation of the others. It is recommended that agreements and deliverables be created to clearly define expectations for achieving mutual goals in service delivery and program planning.



IV. Recommendations

Recommendation #1 Accept and implement the proposed model for the Allied Health disciplines of Occupational Therapy, Physiotherapy, Respiratory Therapy, Clinical Nutrition, Social Work, and Communication Disorders (Audiology and Speech-Language Pathology) at all sites within the WRHA. Rationale All disciplines that are represented by Regional Directors should be organized across the region in a manner consistent with the principles of the project, while recognizing the variability in size and complexity of the disciplines, to ensure consistent service delivery and to decrease confusion in regards to accountabilities and responsibilities. The implementation of the proposed organizational structure will enable the Allied Health disciplines to manage their staff resources as a collective whole, which will enable the implementation of regional service initiatives and enhance the ability to deliver care in the most appropriate setting across the continuum. Recommendation #2 Accept and implement the Allied Health Regional Director position description outlining accountabilities and responsibilities. Rationale The proposed Regional Director job description and the matrices clearly outline the accountabilities and responsibilities. Acceptance of the proposed job description will provide the Regional Directors with the information, authority, and accountability to improve the efficiency and effectiveness of the delivery of services across the continuum. Recommendation #3 The Allied Health Regional Directors will be accountable for the overall services provided by their disciplines at each site. This accountability will be fostered through the establishment of working relationships with site CEOs/COOs/CADs or designates through regular meetings to discuss site and regional Allied Health issues, to inform regarding regional initiatives, and to solicit input as to the effectiveness of the specific discipline’s clinical support program. Rationale CEOs/COOs/CADs will have access to strong leadership in the area of Allied Health and can rely on the Regional Directors for collaboration in regards to service delivery and assistance with problem solving. CEOs/COOs/CADs can be assured of consistent Allied Health service delivery that reflects current practice and is based on data and experience from across the region.



Strong partnerships and agreements will be developed to ensure that Allied Health disciplines and programs are not acting in isolation, but rather, collaboratively to meet mutual goals. Recommendation #4 Develop strong partnerships and agreements with sites, clinical programs, and community areas. Rationale Strong partnerships and agreements are required to ensure a collaborative approach in the achievement of mutual goals and the seamless provision of Allied Health services across the continuum. Recommendation #5 (Requires Reinvestment) Eliminate the designation Professional Leader, replacing these positions with discipline-specific Managers. Support the concept of single site discipline-specific managers provided the level of responsibility and complexity, staffing numbers, regional responsibilities, community role, etc. supports the allocation of 1.0 EFT. Where workload does not support a single-site manager, other models will be considered, such as multi-site management, Regional Managers, Charges, or a hybrid of site and regional roles. Rationale Aligning staff with central departments/services under the leadership of a discipline specific manager reduces staff fragmentation and facilitates adequate staff coverage to meet the needs of the clients, patients, residents, clinical programs, and the region overall. The ability to recruit and retain staff and provide relief coverage for vacations, sick time, etc. as well as weekend coverage has been compromised within the current model; the proposed structure will maximize efficient use of limited resources. This plan will ensure that job responsibilities for site management staff will be consistent across the region in regards to levels of responsibility and accountability. Recommendation #6 Site Managers will be accountable to both the Allied Health Regional Director and the Site/Community Area Management Teams as defined in the Responsibilities Matrix – see Appendix 3 - Responsibilities Matrices. Site Managers will have day-to-day responsibility for insuring that their discipline’s particular site related needs are met. Site Managers will have accountability to the Allied Health Regional Director for discipline specific issues. Rationale The proposed dual reporting relationship will ensure that site-specific needs and issues are addressed, and that allied health services are delivered consistently across the region.



Recommendation #7 That site budgets for each discipline’s Allied Health staff and supplies be managed by the site discipline specific manager, in collaboration with site Clinical Program teams. Budget reports will be provided to the applicable Allied Health Regional Director to facilitate discussions regarding the appropriate alignment and distribution of resources. Rationale Budget alignment by discipline will ensure consistency with MIS guidelines and will facilitate effective management and distribution of limited resources across the full continuum. The alignment of resources will result in improved distribution of resources, improved budget control, and overall improved management of work force issues. Recommendation #8 Adopt a site/regional team-decision-making model that enables the discipline-specific team to make decisions binding on, and supported by, all members of the group. Rationale Principles would be developed to define the level of support (i.e. simple majority, consensus, unanimity) required for specific types of decisions. The need for unanimity would be reserved for exceptional circumstances. All team members would be held accountable for supporting and implementing group decisions. Appropriate stakeholders would be consulted for decisions with clinical program impacts or significant financial implications. This will ensure the ability to implement Allied Health initiatives region wide. Recommendation #9 Allied Health Regional Clinical Support Programs’ initiatives, once approved by WRHA senior management, will be implemented regionally. Rationale This will result in discipline specific policies, procedures, and clinical practice guidelines being integrated and coordinated across the region. Recommendation #10 In collaboration with WRHA Senior Management, develop a model to ensure Allied Health representation at site senior management. Rationale The ABC Project team recognizes the need for the Allied Health disciplines to have a strong link with site senior management and will work closely with site management and WRHA senior management to develop an acceptable model.



Recommendation #11 Allied Health Regional Directors will participate with Site Management in the performance evaluation of Site Managers. Rationale The inclusion of the Regional Directors in the performance evaluation of Site Managers will ensure a consistent approach to service delivery, practice standards, and resource utilization across the region. Recommendation #12 In collaboration with WRHA Human Resources, the Allied Health Regional Directors will redefine job classifications/descriptions for staff within the Allied Health Clinical Support Programs. Rationale The refinement of job classifications/descriptions will ensure a level of consistency across the region.

V. Financial Implications Realignment and reinvestment of resources will be required to:

• Support the elimination of the professional leader positions and the replacement of these positions with Site Managers

• Provide appropriate, equitable compensation for Site Managers across the region

• Provide adequate administrative support for the Regional Directors • Assist with the development of business and program plans, e.g.

access to Financial Analyst and/or Administrative Director • Provide support for education services • Develop and implement discipline-specific, regional, quality plans

including access to resources within the Decision Support portfolio • Provide technological support

The External Review conducted by Deloitte and Touché recommended that accurate MIS reporting should occur at all sites, with Allied Health resources being centralized back to core department functional centres rather than being distributed within individual patient care cost centers. Additionally, work performed for outside agencies/organizations should be reflected in revenues attributed to Allied Health functional centers. Following approval in principle by ABC Steering Committee, the specific infrastructure funding requirements for each discipline would be determined and brought forward to WRHA and Site Senior Management for final approval. The Project Team recognizes that funding for ABC initiatives may not be made available in the near future. However, agreement in principle with the



defined infrastructure will allow Allied Health to begin implementation and evolve into this model as resources become available.

VI. Benefits

a. Patients/Clients/Residents • Improved patient/client/resident safety and clinical outcomes, across

the region • Evidence based care delivery across the continuum • Improved ability to move patients/clients/residents across the system

as the ability to shift resources will be enhanced • Continuity of care as patients/clients/residents transfer across the

continuum and through various sectors – gaps in service will be decreased

• Consistent, high quality Allied Health services throughout the region • A service delivery model that is more responsive and flexible in

meeting patient/client/resident needs • Assured of a high level of accountability in the delivery of Allied Health

services • Wide network of services and delivery of the right care, in the right

place, at the right time, by the right provider, to meet people’s needs with an emphasis on primary health care services

• Increased ability to respond to changing demands in care delivery • Enhanced ability to move services to the most appropriate environment

for patient/client/resident needs to be met along the continuum of care

b. Staff • Improved staff satisfaction • Greater assurance of the ability to work within full scope of practice • Decreased confusion regarding reporting relationships • Improved management of work force and work life issues • Enhanced ability to identify and address discipline-specific

patient/client/resident quality and safety issues across the region • Through the performance appraisal process, the site Manager has the

opportunity to understand their role in the context of the regional plan, and establish goals and objectives to achieve the overall goals of the site and region, thus harmonizing efforts

• Enhanced professional voice within the site and region • Opportunities for career-laddering and branching • Enhanced ability to support clinical research and deliver consistent,

evidence-based, best practice across the region • Improved recruitment and retention



c. Sites

• Greater consistency regarding the provision of Allied Health services across all sites

• Discipline-specific patient/client/resident quality and safety issues addressed consistently at all sites

• Improved management of work force issues • Equitable allocation of and process for distribution of resources • Coordination of activity and standardization of practice • A regionally coordinated system in which CEOs, COOs, CADs, and

site designates have a mechanism to discuss and resolve issues • Increased senior management familiarity with the disciplines’ visions

and goals and how they link to the overall regional plan; improved awareness and knowledge of discipline-specific practice and service delivery approaches

• Open communication • Enhanced regional approach • Improved regional and site accountability • Increased ability to address work life issues e.g. recruitment and

retention • Improved staff satisfaction and professional support • Improved management of Allied Health resources • Improved ability to manage vacancies • Opportunities for career-laddering and branching for staff

d. Programs/Community Areas • A high quality of Allied Health service delivered in a consistent manner

across the region • Collaborative approach to managing limited resources • Efficient and effective use of resources • Discipline-specific patient/client/resident quality and safety issues

identified and managed consistently across the region • Evidenced-based care delivery • Increased satisfaction of Allied Health team members • Increased representation of Allied Health on clinical program teams

e. Region

• Enhanced regional approach to provision of Allied Health services across the health continuum

• Consistent standards of care across the region • Efficient and effective management and distribution of Allied Health

financial and human resources • Potential for service enhancements as a result of improved

management of resources • Improved management of work force issues



• Improved ability to control the budget • Potential to have a float pool managed regionally, decreasing

dependence on overtime • Ability to adjust coverage to reflect increased or decreased demands • Regional quality assurance and patient/client/resident safety

management • Research and education to support regional goals • Management of educational resources on a regional level • Enhanced ability to share clinical knowledge and expertise across the

region • Open communication • Decreased duplication of effort • Clear delineation of roles and responsibilities • Increase Site Managers’ regional perspective • Regional performance standards and expectations/best practice • Ability to reallocate resources across the full continuum of care to more

appropriately meet clinical demands in all sectors • Adjusted workloads and practices to achieve financial benchmarks • Equitable distribution of resources and equipment • Increasing ability to respond to changing demands in care delivery

VII. Implications of Maintaining the Status Quo

1. The Allied Health Clinical Support Programs will not be able to manage

their budgets as a collective resource, which will create significant obstacles to the implementation of regional initiatives intended to address gaps in service and improve continuity of care.

Examples include the inability to:

• Develop consistent standards of care across the region • Implement a standardized clinical Allied Health practice model, and

Allied Health practice expectations, throughout the region • Ensure efficient and effective management of Allied Health financial

and human resources • Realign staffing levels with workload across the continuum • Address discipline-specific quality and safety issues in a consistent

manner across the region • Establish consistent workload measurement reporting • Implement regional staff relief pools, where feasible • Implement regional education service and funding model • Implement regional human resource management strategies • Implement regionalized service delivery models



• Be accountable for Allied Health service delivery and resource management in the region with the authority to implement standards of practice and evidence-based care

2. Most regional initiatives are not viable without the participation of all sites.

3. The sharing of expertise and educational funding may not occur.

4. Addressing discipline-specific care delivery issues that cross programs

and sectors will continue to be a challenge for those centralized Allied Health disciplines/departments that are accountable to one clinical program, since: • These Allied Health disciplines are responsible for providing services

to multiple stakeholders yet are accountable for their resource management to a single clinical program with its own program-specific priorities

• When discipline-specific care delivery issues arise that cross programs and sectors, the disciplines struggle to find resolution of issues that do not directly impact the responsible clinical program and are therefore not viewed as a priority

VIII. Performance Measurements

• Monitor workload measurement and financial indicators for consistency

and appropriateness of resource distribution and utilization. • Measure quality and risk management indicators through the balanced

score card and critical clinical occurrence processes. • Monitor patient/client/resident and stakeholder satisfaction, including

complaints management. • Monitor clinical outcomes to ensure consistency with defined goals and

objectives. • Review the results of future WRHA Work-life Surveys. • Monitor Vacancy Tracking reports and exit interview results.

IX. Description of the Project Process

a. Goal The goal of the initial phase of the Allied Health Infrastructure Project was to identify and develop a regional infrastructure, philosophy and service delivery model for Allied Health with the authority, accountability and information to improve the efficiency and effectiveness of Allied Health resources required across the full service continuum.



A strengthened regionalized approach will improve clinical outcomes and quality of life for patients/clients/residents, provide a high quality of work life for staff, and ensure effective and efficient utilization of human and material resources. b. Guiding Principles The ABC Allied Health Initiative Project Team agreed to a number of guiding principles to assist them with the task of developing a plan that would reflect the needs of the patients/clients/residents, the project, the programs, the region, and the Allied Health disciplines. The principles are as follows: • Provide a structure that supports service delivery and

patient/client/resident care reflective of best practice. • Reflect the continuum of care. • Follow a population health model approach to service delivery. • Develop guidelines and principles that support a consistent approach to

Allied Health structures within and across disciplines. • Enhance the role of Allied Health within the region. • Establish collaborative working relationships with WRHA Programs and

Sites that ensure the interdisciplinary approach to health care delivery. • Retain the positive aspects gained from a program-managed model while

respecting the need for discipline-specific structures. • Provide career-branching and career-laddering opportunities that

recognize advancements in a variety of career paths. • Provide front line professionals’ with direct access to a manager or

director within their discipline at either a site or regional level. • Support the participation of Allied Health professionals in site-based

activities outside their discipline-specific role while ensuring that overall regional objectives of the discipline are met.

c. Objectives The objectives of the ABC Allied Health Infrastructure Project Team include:

• Define and implement the roles and responsibilities of Allied Health Regional Directors.

• Define and implement Allied Health structure, roles, and responsibilities at sites.

These objectives will be achieved by: • Increasing the profile and role of Allied Health professionals through the

role of the Regional Directors of Allied Health Clinical Support Programs. • Enhancing the team approach to patient/client/resident care planning and

delivery.



• Defining the role, responsibilities, relationships, and accountabilities between the Regional Directors of Allied Health disciplines/programs and the regional clinical and community program teams and sites.

• Redefining the roles and responsibilities of Allied Health site-based teams to facilitate the flow of patients/clients/residents and information across the continuum and to ensure consistency in clinical practice.

• Ensuring that the model for the Allied Health disciplines supports a collaborative approach to patient/client/resident care delivery between Allied Health and the clinical programs at the regional and site level.

• Developing a structure that supports the participation of Allied Health disciplines in the development and implementation of Regional Health Plans and Business Plans.

• Ensuring administrative, technological, and office support for the proposed discipline models.

• Designing Care Delivery Models to create an environment in which all regulated professionals are able to work within their full scope of practice in the most appropriate and effective environment.

• Increasing consistency in the use and distribution of Allied Health professionals across the Region.

d. Vision Statement for the Allied Health Infrastructure Project

As an integral and equal member of the healthcare team, Allied Health professionals provide expertise and leadership in the planning and delivery of evidence-based patient/client/ resident care across the health continuum.

Within the vision and mission of the WRHA and within the context of the ABC Project 6.1 the Allied Health vision will be achieved through:

• A regional and site based discipline specific structure, role, and function.

• Strong representation along the WRHA service continuum of health promotion, prevention, treatment (intervention), restoration (rehabilitation), and support in the community, acute care, personal care, and long term care facilities.

• Allied Health Regional Directors, with infrastructure support, who have the information, authority, and accountability to improve the efficiency and effectiveness of the delivery of services across the continuum.

• Partnerships that enhance the provision of health care services that are reflective of the needs of the patient/client/resident populations served.

• Liaison with program, community, and site teams, providing consultation and direction for utilization of resources.

• A collaborative framework that is both interdisciplinary and inter–sectoral.



e. Methodology

a. Review of Relevant Resources (see Appendix 1- References)

b. Presentations by Other Regional Programs 1. Diagnostic Imaging ⇒ Catherine Dalton 2. Pharmacy ⇒ Kevin Hall 3. eHealth ⇒ Geoff Besko/Paul Obirek 4. Population Health ⇒ Jan Trumble-Waddell Identified aspects of other regional programs that were working well and areas requiring improvement. Provided the framework for a population health approach to service delivery.

c. Review of Current Structure and Resources A detailed EFT/Positions inventory for each discipline was collected. Level of management, clinical, educational and research support, organizational structure, and staff resources vary from facility to facility, and discipline to discipline. As a result of program management, resources available for restructuring have been diminished.

d. Survey of Major Canadian Health Regions A survey was designed to identify key elements inherent in a successful regional Allied Health program. A number of areas surveyed reported that a program management approach had been tried and was not successful. Some disciplines had remained as centralized services supporting programs and others were returning to a more central department structure.

e. Review of the International Perspective – Australia The team contacted the Austin and Repatriation Medical Centre in Australia to discuss their experience with the program management model. The impact of program management on Allied Health staff was similar to the WRHA experience. The Australian group recognized a need for a more regional approach to the delivery of Allied Health services in the region while maintaining a strong sense of the individual disciplines. The Allied Health disciplines grouped together under the Allied Health Service and set up agreement contracts with the clinical programs. This established a high level of accountability for service delivery to the programs while maintaining high quality of service for the particular discipline.



f. Discussions with Leadership Groups

The Regional Directors have met regularly with their respective leadership groups to assist in identifying key issues and to solicit input as to how their respective organizational structures should be altered to better support the discipline and ensure a high quality of service for the region.

In general, it was felt that it was difficult to maintain best practice in the absence of a site and regional connection to their discipline. The need to have accountability for the delivery of high quality service was identified. To enable this a reporting relationship to a discipline specific manager was felt to be essential. A strong desire exists to retain the positive aspects gained from a program-managed model while respecting the need for discipline-specific structures.

g. Job Descriptions The team conducted a review of job descriptions from other Canadian and International health regions with the aim of developing a generic Regional Director job description and standardizing classifications for various positions within the disciplines.

h. Responsibilities Matrices The WRHA Responsibilities Matrix was reviewed and redrafted to include roles, responsibilities and accountabilities for Regional Allied Health Directors and the discipline-specific site managers. The team has also developed a responsibility matrix specific to Allied Health. (See Appendix 3)



Section 2

Recruitment and Retention I. Introduction This section of the report will focus on recruitment and retention for Allied Health disciplines and the resources required to support a regional approach. II. Project Overview The External Review conducted by Deloitte and Touché identified the need to establish regional strategies and approaches in the areas of recruitment and retention of Allied Health professionals. To help address these issues, the ABC Allied Health Infrastructure team was tasked with reviewing current processes in place for recruitment and retention and, where required, to further develop the specific allied health principles and strategies necessary to implement a framework for a regional allied health recruitment and retention effort. The Project team supports current regional recruitment and retention efforts and makes additional recommendations identified as necessary to achieve success. As the organizational structure changes and the Allied Health Clinical Support Programs are tasked with extending into the community, it is recognized that issues related to recruitment and retention will be even more critical. III. Overview of Allied Health Recruitment and Retention –

Ongoing WRHA Initiatives Allied Health Workforce Planning Strategic Plan

An Allied Health Recruitment and Retention Strategic Plan was developed in March 2002.

The goals of this Strategic Plan included: • To develop and implement plans for recruitment of allied health

practitioners. • To develop and implement plans for retention of allied health

practitioners. • To ensure that the allied health workforce more accurately reflected

the population demographics for the region. • To foster a culture of trust, exceptional service, and personal caring

and provide an environment where staff are proud of their work and are recognized, respected, and rewarded.



• To plan for allied health human resources required for WRHA programs and services to meet the needs for the next 3-5 years.

• To minimize risks associated with shortages in allied health human resources.

• To ensure allied health professionals within the WRHA maximize their scope of practice to encourage efficient and effective utilization of human resources within WRHA.

• To ensure allied health professionals provide a high quality of service to clients reflecting current research and best practice.

A. Allied Health Recruitment and Retention Fund

In 2002, the WRHA established a Recruitment and Retention Fund for Allied Health with a one-time funding base of $200,000. The purpose of this fund was to provide financial support to implement plans for the recruitment and retention of allied health practitioners within the WRHA, especially disciplines experiencing significant shortages. The funding was divided into two areas. The general area was aimed at the development of good quality print materials to support allied health recruitment and the development of the allied health section of the WRHA web site. In the area of targeted funding (funding aimed at the recruitment of disciplines experiencing high vacancies), the following areas were implemented: student incentives, special advertising, and consideration of initiatives that supported the recommendations from the External Review and the Rehabilitation Review. Strategies already in use include recruitment through job fairs, “Meet the Employer” sessions, and Career Symposia through HR. Student surveys have been conducted for some disciplines to determine intentions after graduation. At the time the Allied Health Recruitment and Retention Fund was established, each discipline was asked to develop a discipline specific Recruitment and Retention plan.

B. Allied Health Recruitment Tuition Relief In 2002/03 the WRHA implemented a tuition relief stipend targeting new graduates of allied health disciplines experiencing chronic shortages. The cost of the program is shared between the sites and the WRHA. Within the WRHA, funding was approved from the Allied Health Recruitment and Retention Fund. The criteria for awarding relief stipends included vacancy rates, private sector market competition, availability of local graduates, workforce analysis forecasts for disciplines, and anticipated demand. A rating scale is then applied for each of the criteria and the amount of stipend provided is based on the severity of the recruitment problem. The policy is evaluated on an annual basis.



C. Allied Health Position Vacancy Tracking

Position vacancy tracking is done on a quarterly basis through the WRHA. Site Human Resource Departments are asked to complete a form indicating the number of baseline positions and EFTs, as well as the number of term and permanent vacancies per discipline. It is recognized that the information is frequently inaccurate and additional monitoring is required. In the spring of 2003 a Vacancy Tracking Work Group was formed to address the inconsistencies in the data reported in the Quarterly Surveys of Allied Health Resources within and across disciplines. It was identified that reliable data is required for a number of purposes including HR planning, trending, tuition relief, etc. The Work Group’s report was submitted to the Human Resources Council February 2004, and a number of recommendations are in the process of being implemented, including validation of data by the Allied Health Regional Directors. At this time, the ABC Project Team is satisfied that the revised vacancy tracking system used by the WRHA meets the needs of the Allied Health disciplines. In the event that further information regarding vacancies and retention issues is required the Regional Directors will provide recommendations to the existing system.

D. Allied Health Worklife Survey The Allied Health Worklife Survey identified a number of issues affecting work life satisfaction for Allied Health including: o Workforce shortages o Heavy workload o Lack of continuing education opportunities o Lack of career laddering opportunities o Inadequacy of workplaces o Compensation issues Surprisingly, even in those sites and disciplines where more centralized structures had been maintained, strong dissatisfaction with program management was expressed (especially Respiratory Therapy and Physiotherapy), mainly related to the inability to address cross-program issues such as continuity of care.

E. Allied Health Workforce Analysis Reports Reports identifying factors affecting recruitment and retention for selected Allied Health Disciplines were completed. Disciplines included in the analysis were Clinical Nutrition, Pharmacy, Occupational Therapy, Physiotherapy, Respiratory Therapy,



Audiology, and Speech-Language Pathology. The final reports provide an assessment of rates of attrition, vacancy information, current requirements, age and gender distribution, number of graduates, potential retirements, and private sector competition. The reports also include recommendations regarding recruitment and retention for each of the disciplines studied and these have been used to assist in determining the need for tuition relief.

F. Allied Health Education Fund

An Allied Health Education Fund was established ($200,000) to provide support for continuing education of Allied Health practitioners. The fund was operational for two years. In fiscal year 2003/04, the Fund paid out 399 applications for a total of $102,079. In a memo sent out June 29th, 2004 it was stated that the Fund has been depleted and new funds are not available which necessitated the Fund being suspended effective immediately.

G. Allied Health Offshore Recruitment

In May 2002, a report describing the current status/opportunities in regards to offshore recruitment was created. The report addressed the following disciplines: Pharmacy, Respiratory Therapy, Physiotherapy, Ultrasound, Occupational Therapy, Speech-Language pathology, and Audiology. In the event of shortages affecting these disciplines, this information would be updated and could be used to assist in recruitment efforts. In general, the licensing bodies are familiar with issues affecting the recruitment and licensing of foreign trained professionals and would be used as a resource if needed.

IV. Review of Relevant Literature The American Hospital Association (AHA) Commission on Workforce for Hospitals and Health Systems developed a report outlining reasons for workforce shortages in the healthcare system and describing strategies to remedy the situation. Many of the recommendations described in the AHA document are included in the recommendations section of this report.4 In the area of fostering meaningful work the AHA recommends making work design an organizational priority, ensuring that staffing levels are adequate, and keeping staff informed and involved in decision making. The importance of creating a culture in which all workers feel valued is emphasized, including developing a process to measure, improve, and reward the capabilities of front-line managers to improve the workforce partnership. Supporting technology and providing consistent resources for data collection are identified as assisting in building societal support. As well, the report advises facilitating care by the right person doing the right task at the right time.



In a paper prepared by Charlene Skraba and presented March 15, 1999, it was noted that healthcare as a sector is under investing in employee training and development.5, 6 On average Canadian organizations spend 1.6% of their payroll on training and development. In comparison, training expenditures are 1.2% of the payroll for the health sector, 1.8% of payroll for the American Society for Training and Development Benchmarking Service Companies, and 4.4% of the payroll for leading edge companies. Considering an average income of $40,000 for an Allied Health professional, even using 1.2% this would result in an education allowance of $480. At this time there is not a set amount allocated for Allied Health education within the region. Many articles in the literature cite reasons for allied health professionals leaving the profession such as lack of professional status, unrealistic workloads, lack of career prospects, lack of financial rewards, stress related to role, decreased job satisfaction, and low morale.7, 8, 9 A key component related to retention, after salary and benefits, was the opportunity to develop new skills including continuing education opportunities and freedom on the job.10 One study noted that participation in particular professional development activities such as frequency of consultation with colleagues, reading articles, and attending educational courses resulted in a higher sense of personal accomplishment and a decrease in burnout.11

V. Recruitment and Retention – Standards and Goals

The goal of the Allied Health Recruitment and Retention plan is to develop and implement a regional plan to address the recruitment and retention of Allied Health staff across the region and to achieve vacancy rates that are 5% or below for a discipline on an annual basis (consistent with tuition relief criteria), or to resolve staffing shortages at a specific site/community area that are impeding service delivery. The plan will define an exit interview process and recommend the implementation of an Exit Interview Questionnaire that is standardized at all sites. The information from these surveys would be summarized and provided to the Regional Directors to be used to develop and implement strategies that will address any identified issues.

VI. Methodology The ABC Allied Health Infrastructure Project Team reviewed relevant information including:

• Recruitment and Retention Plans for Allied Health disciplines • WRHA Allied Health Recruitment Tuition Relief Allocation Proposal • Relevant Resources/Literature (See References)



VII. Recommendations for Recruitment and Retention

The ABC 6.1 Allied Health Infrastructure team recommends that the WRHA continue with the recruitment and retention initiatives already in place. The implementation of the recommended organizational structure will support consistent application of additional recruitment and retention initiatives within the discipline specific Clinical Support Programs. The organizational structure provides the Regional Directors with the ability to develop and implement regional policies/procedures and provides site support, in the way of discipline specific Site Managers or Charges, to ensure implementation and consistency in the approach to staff retention and recruitment. Recommendations Related to Infrastructure The following recommendations would be implemented as part of the proposed organizational structure and would become the responsibility of the Allied Health Regional Directors and their Clinical Support Programs. Implementation will proceed following approval of the infrastructure report.

1. Provide mechanisms to involve staff in decision-making. 2. Ensure manageable workloads by adjusting staff to appropriate

levels. 3. Seek funding to provide relief coverage and develop relief pools

where feasible. 4. Provide career-laddering opportunities for staff. 5. Address issues around inadequate physical work environments,

availability of support staff, technological support, and equipment. 6. Develop a work culture that is friendly, team focused, and

supportive.

Recommendations Related to Human Resource Management 1. Define an exit interview process and implement the consistent use

of an Exit Interview Questionnaire that is standardized at all sites as per WRHA policy – Exit Interviews 20.40.150.

2. Ensure that Allied Health Regional Directors receive exit interview information, with an emphasis on emerging trends and themes.

3. Ensure that all sites implement corporate policies regarding moving expenses and funding consistent with the WRHA relocation policy – Relocation Expenses 20.40.080.

4. Strive to develop a work force that is reflective of the cultural diversity of the region including the incorporation of recommendations to encourage the recruitment and retention of staff of Aboriginal background. The Clinical Support Programs will work with the Aboriginal Human Resource Initiative when



developing information packages for use in the Initiative’s targeted recruitment efforts and other projects, e.g. targeting Winnipeg schools with high Aboriginal populations, career fairs that are marketed towards potential staff of Aboriginal background, etc.

5. Address issues around salary equity including compression of management scales. Also compare salaries to other professions across the region.

6. Continue to use the Position/Vacancy tracking system to monitor recruitment and retention. Reinforce the need for a collaborative approach between site HR staff and site discipline representatives to ensure accuracy of data, with validation of final reports by the Allied Health Regional Directors.

7. Ensure that mobility is defined and managed consistently at all sites.

8. Involve Allied Health Regional Directors or designates in the bargaining process.

9. Continue to administer the Worklife Satisfaction Survey on a regular basis including questions specific to Allied Health.

10. Develop and implement a consistent approach across the region that supports increased participation of workers with young families in the workforce, including management positions.

11. Develop and implement initiatives to enhance quality of work life for all staff, such as the provision of flexible hours when able.

12. Develop recruitment material that is aimed at encouraging high school students to pursue careers in Allied Health.

13. Develop common job descriptions across each discipline.

Recommendations Related to Staff Recruitment and Retention 1. Develop a fair and equitable education plan for all regional Allied

Health employees that includes education support funding by providing a $250 educational allotment per EFT per year to be managed as part of the Allied Health (discipline specific) Regional Clinical Support Programs to ensure that the allocation of resources is in the best interests of the region and the discipline as a whole.

2. Acknowledge staff contributions by providing appropriate reward and recognition opportunities, including increased usage of existing programs such as site recognition programs, improving availability of education support, etc.

3. Develop a process to support staff participation in research, projects, committees, etc.

4. Create a culture and provide resources to support student placements. For example, depending on the discipline and situation there may be a need to provide time to coordinate placements, time to complete reports, backfilling, reducing caseloads, etc.



5. Continue to collaborate with universities to coordinate student placements. Ensure that supervision of students is included in job descriptions.

6. Participate in job fairs as required. 7. Institute the use of tuition relief/return of service agreements as

required. 8. Provide job-shadowing experiences for high school students.

VIII. Summary Overall the region needs to have a proactive, responsive regional plan to deal with work life issues impacting workers. The region must commit to dealing with issues before crises develop. The implementation of the proposed Allied Health Clinical Support Program’s organizational structures, including adequate site management support, will aid in staff retention and recruitment and result in a more stable and effective workforce. IX. Plan for Implementation Responsibility for implementing these initiatives, following their funding approval by the WRHA, would rest with each of the Allied Health Regional Clinical Support Programs. Involvement with Human Resources will be extremely important to ensure adherence with collective bargaining agreements and consistency across the region. X. Funding Requirements to Support an Education Funding

Plan

Annual Financial Implications

Recommended Operating Budget

Education Benefit (671.1 EFTs x $250) $167,775 The Project Team recognizes that funding for ABC initiatives may not be made available in the near future. However, the project team is seeking agreement in principle with the principles associated with recruitment and retention. XI. Evaluation Evaluation will focus on vacancy rates, recruitment rates, and turnover/retention rates. The goal of the Allied Health Recruitment and Retention plan is to achieve annual EFT vacancy rates that are 5% or less using the Position/Vacancy



Tracking System and to improve staff retention rates. Five percent will be used as the measure as a vacancy rate of less than 5% on a chronic basis scores a zero on the Allied Health Tuition Relief rating scale. At present turnover rates are not tracked within the WRHA. Individual Regional Directors may choose to track staff turnover and payroll data such as Magic 80 and age, specific to their discipline’s needs.



Section 3 Allied Health Infrastructure Sub Tasks The Allied Health Infrastructure Project Team was tasked with addressing issues in the areas of:

• Professional Support and Education Strategies • Adjusted Staffing Levels • Relief Pools

The Project Team has reviewed the tasks associated with these sub tasks and has elected to assign the completion of these tasks to the Regional Directors and the discipline specific Regional Clinical Support Programs to continue to develop strategies and to proceed to implementation. The Regional Directors will continue to work together in areas of common interest. I. Overview of Project Sub Tasks a. Professional Support and Education Strategies In regards to Professional Support and Education of Allied Health staff, the External Review conducted by Deloitte and Touché identified:

• Insufficient support for professional practice and educational needs of the disciplines at the site/program level.

• Lack of support (management and administrative) for professionals within disciplines.

The overall objective for this sub task was to develop and implement the framework and infrastructure for regional professional support and education strategies for Allied Health practitioners. It has been anticipated that the delivery of this objective will result in:

• A framework and infrastructure for regional professional support and education strategies for Allied Health practitioners.

• Care Delivery Models will exist that create an environment in which all regulated professionals are able to work within their full scope of practice in the most appropriate and effective environment.

• The emphasis on staff education/professional development for all disciplines and in all sectors (acute care and long term care, and community) will be increased with appropriate funding and will include supporting peer-networking opportunities at all levels in an effort to share innovative/new practices.

• Peer-networking opportunities will be supported at all levels in an effort to share innovative/new practices.



Performance Measurements will include:

• Increased work life satisfaction. • Equitable education and professional growth opportunities will be available

within the region.

Specific Tasks Associated with Professional Support and Education Strategies 1. Determine needs specific to allied health – include roles of clinical

specialists/educators/advisors to support practice within the discipline and within programs

2. Determine how to expand educational services regionally – communication across region, technical support.

3. Review and identify gaps in education funding and educational experience opportunities by site and disciplines including management opportunities.

4. Review and develop a recommendation regarding educational opportunities and standardize as able (# of days, funding, etc.)

5. Review current state and determine source of sustainable education funds.

b. Adjusted Staffing Levels In regards to Adjusted Staffing Levels, the External Review conducted by Deloitte and Touché identified:

• Inconsistent distribution of Allied Health staff across all sites and programs.

• No consistent methodology for allocating Allied Health Resources. • That select disciplines in Allied Health have substantially lower staffing

than peers with impact on the Allied Health range of service and scope of practice, particularly respiratory therapy, social work, and clinical nutrition.

The overall objective for this sub task was to ensure that a process is in place to effect and monitor adjustments to staffing levels to the recommended staffing level in targeted areas. It has been anticipated that the delivery of this objective will result in:

• The identification of opportunities for consistent Allied Health input in patient care delivery efficiencies across the full continuum of care, e.g. decrease length of stay.

• Adjustments to site staffing levels to the 25th percentile as recommended in the External Review.

• A plan for regional staffing adjustments to the 50th percentile will be determined and developed by the Regional Directors in collaboration with stakeholders.

• An overall savings as a result of balancing staff investments and efficiency opportunities.



Performance Measurements will include: • Staffing levels will be monitored and adjusted. • Sensitive to Hospital Adjusted Patient Days.

Specific Tasks Associated with Adjusted Staffing Levels

1. Review caseload guidelines for individual disciplines. 2. Review staffing level targets with Sites and Programs to evaluate

impacts on service delivery. 3. Determine process required to implement staffing adjustments – role of

regional director, site, and program. 4. Identify Human Resource implications of mobility. 5. Identify interdependencies with Rehabilitation Reconfiguration Project.

The Regional Director group has requested that information regarding HPPD be provided to each Regional Director to enable them to more effectively monitor staffing levels. c. Relief Pools In regards to Relief Pools, the External Review conducted by Deloitte and Touché identified:

• That for some disciplines, the creation of relief pools would ensure consistent delivery of care.

• Decentralization of staff from core departments/services limits ability to recruit and retain staff and provide relief coverage for vacations, sick time, etc. as well as weekend coverage.

The overall objective for this sub task was to determine the need for and to establish regional relief pools as part of the model of Allied Health if required. It has been anticipated that the delivery of this objective will result in:

• Relief pools that improve overall staffing responsiveness of Allied Health to meet care delivery needs.

• A coordinator for the relief pool will be hired if required and if funding is available.

Performance Measurements will include:

• A structure including a coordinator will be in place to support the need for Allied Health relief staff if determined to be required.

• Sensitive to Hospital Adjusted Patient Days.

Specific Tasks Associated with Relief Pools 1. Identify current relief dollars and gaps in relief budgets. 2. Determine disciplines requiring relief. 3. Review current number of casual staff. 4. Define site issues and determine regional fan out feasibility. 5. Determine process of prioritization regarding access to relief.



6. Identify training needs/regional orientation program. 7. Identify needs in regards to documentation standardization. 8. Explore Human Resource implications. 9. Identify infrastructure support required.



Section 4 Conclusion

The Project Team has presented a proposed model for the organizational structure of Allied Health for the WRHA and asks for approval to proceed to implementation. Implementation will become the responsibility of the Regional Directors and their discipline specific Allied Health Clinical Support Programs in consultation with stakeholders. The Regional Directors and their discipline specific clinical support programs will complete the sub tasks described in Section 3 - Allied Health Infrastructure Sub Tasks. The Allied Health Regional Directors are further committed to a portfolio approach to managing tasks and issues that cross disciplines and clinical programs. An example is the current process for Capital Equipment, where one Regional Director represents all the disciplines at the central table. Next Steps

The Allied Health Regional Directors will meet with Site Senior Management teams to discuss the approach to implementation of the proposed organizational structure. The Regional Directors will work closely together to ensure consistency in the approach to implementation.


© Winnipeg Regional Health Authority, 2004 A 33

Appendix 1 Communication Plan Regional Directors have discussed proposed plans with their respective leadership groups and responsible Vice Presidents. Presentations to Date:

• WRHA Senior Management • Allied Health Leadership Council • ABC Implementations and Operations Committee • Clinical Directors Program Coordinating Committee • Sites including: HSC, SBGH, CH, GGH, SOGH, VGH, MHC, RHC • CFOs and Administrative Directors • Urban Human Resources Council • Community Area Director Group • Nursing Leadership Council

Stakeholder Audience (Who) Message (What) Intent (Why) Media (How) When Responsibility

Allied Health Leadership

Describe recommendations

Reassure, inform, and involve. Seek feedback.

Presentation September 13 Helen Clark

WRHA Senior Management

Describe recommendations

Inform, and involve. Seek feedback.

Presentation/ Discussion

September 27 Helen Clark




ABC Implementations & Operations

Describe recommendations and discuss plan for implementation. Part of consultation process.



October 7 Helen Clark

Leadership Groups for all AH disciplines involved in project




Ongoing Regional Directors

Site Presentations will take place aimed at PAC and Senior Management - all 9 sites




October 25 to November 5

Regional Directors

Clinical Programs Describe recommendations and discuss plan for implementation. Part of consultation process.



October 27 Helen Clark

Urban CEO Council Describe recommendations and discuss plan for implementation. Part of consultation process.



November 5 or 18

Helen Clark




Steering Committee Describe recommendations and discuss plan for implementation. Part of consultation process.



November 16 or December 17

Helen Clark

Urban HR Council Describe recommendations and discuss plan for implementation. Part of consultation process.

Inform, request assistance with implications. Joint planning.


Helen Clark

Community Area Director Group




Helen Clark

Medical Leadership Group



Perhaps send 3 page summary document

Helen Clark

Nursing Leadership Describe recommendations and discuss plan for implementation. Part of consultation process.



December Helen Clark




CFO Administration Describe recommendations and discuss plan for implementation. Part of consultation process.



Helen Clark

Front line staff after ABC Steering Committee

Describe recommendations and discuss plan for implementation.

Reassure, inform, and involve.

At VGH hosted a clinical luncheon on Allied Health Leadership, Forums.

Regional Directors

PMO Project progress. Provide updates, and receive support as required.

Regular reports. Ongoing Project manager, project lead in consultation with team.

Other ABC Projects Potential impact of allied health structure changes.

Inform and identify interdependencies. Ensure that staffing adjustments are coordinated.

Through PMO and connections with other projects.

Ongoing Project manager, project lead in consultation with team.



Appendix 2 References

1. External Review of the WRHA Deloitte & Touché, July 2002. 2. WRHA Board of Directors Strategic Plan, March 18th, 2003. 3. Review of Winnipeg Hospital Authority’s Program Management Structure:

Jack Litvack, June 1999. 4. American Hospital Association Commission on Workforce for Hospitals and

Health Systems. In Our Hands: How Hospital Leaders Can Build a Thriving Workforce.

5. Bassi L, Van Buran M. Sharpening the leading edge. Training and Development. 1999 January: 23-33.

6. Souque J. Focus on competencies: training and development practices, expenditures, and trends. The Canadian Conference Board of Canada. 1996 December: 1-4.

7. Collins K, Jones ML, McDonnel A, Read S, Jones R, Cameron A. Do news roles contribute to job satisfaction and retention of staff in nursing and profession allied to medicine? J Nurs Manag 2000 Jan; 8(1): 2-12.

8. Greensmith CA, Blumfield MA. Beginning to look at why occupational therapists leave the profession: a survey carried out in Leicestershire.

9. Stoller JK, Orens DK, Kester L. The impact of turnover among respiratory care practitioners in a health care system: frequency and associated costs. 2001 Mar; 46(3): 238-42.

10. Oakerlund VW, Jackson PB, Parsons RJ. Recruitment and retention of allied health personnel. J Ambul Care Mark. 1994; 5(2): 115-36.

11. Sclenz KC, Guthrie MR, Dudgeon B. Burnout in occupational therapists and physical therapists working on head injury rehabilitation. Am J Occup Ther 1995 Nov-Dec; 49(10): 986-993.

12. Chan A, Heck CS. Emergence of new professional leadership roles within a health professional group following organizational redesign. Healthcare Management Forum Online Winter 2002: 47-54.

13. Miller P, Worth B, Barton D, Tonkin M. Redefining leadership responsibilities following organizational redesign. Healthcare Management Forum Online Fall 2001: 29-33.

14. Boyce RA. Organizational governance structures in allied health services: a decade of change. Aust Health Rev. 2001; 24(1): 22-36.

15. Boyce RA. Hospital restructuring – the implications for allied health professions. Aust Health Rev. 1991; 14(2): 147-54.

16. Boyce RA. Internal market reforms of health care systems and the allied health professions: an international perspective. Int J Health Plann Manage. 1993 Jul-Sep;8(3): 201-17.

17. Munley WE. Rehab staff retention. Rehab Economics; 1995 Jun-Jul 8(4): 104-106.

18. Richards G. Occupational therapy. Working knowledge. Health Serv J 1998 Apr 9; 108(5599): 30-31.



19. WRHA Allied Health Work-life Survey. 20. Site Organizational Charts. 21. WRHA Responsibilities Matrix. 22. WRHA Operating Agreement. 23. Surveys from Other Health Regions re: Allied Health Structure. 24. “A Population Health Approach to Health Care Services” Presentation. 25. ABC Initiative 8: Project 8.2 Regional Program Structure and Accountability:

Conceptual Design Phase Report and Presentation. 26. Information and correspondence with Austin and Repatriation Medical

Centre. 27. Allied Health Education Fund 2003/04 Annual Report, June 2004. 28. Memo Re: Allied Health Education Fund, June 29th, 2004. 29. Report on the Allied Health Education Fund, September 1, 2002 to March

31, 2003. 30. Winnipeg Regional Health Authority, Allied Health Disciplines, Off Shore

Recruitment Opportunities and Challenges, May 7th, 2002. 31. Winnipeg Regional Health Authority, Allied Health Recruitment, Tuition

Relief Proposal, January 7th, 2004. 32. Winnipeg Regional Health Authority, Allied Health Recruitment, Tuition

Relief Proposal, March 11th, 2003. 33. Pharmacy Recruitment and Retention Plan, Prepared by Kevin Hall,

Regional Director, Pharmacy, March 2003. 34. Occupational Therapy Recruitment and Retention Plan, Prepared by Marlene

Stern, Regional Director, Occupational Therapy, April 2003. 35. Respiratory Therapy Recruitment and Retention Plan, Prepared by Helen

Clark, Regional Director, Respiratory Therapy, January 17th, 2003. 36. Audiology Recruitment and Retention Plan, Prepared by Janet Clark,

Regional Director, Communications Disorders, January 20th, 2003. 37. Physiotherapy Recruitment and Retention Plan, Prepared by Mary Lessing–

Turner, Regional Director, Physiotherapy, 2003. 38. Audiology, Position Vacancy Information, May 15th, 2002 – March 15th,

2004. 39. Clinical Nutrition, Position Vacancy Information, May 15th, 2002 – March

15th, 2004. 40. Occupational Therapy, Position Vacancy Information, May 15th, 2002 –

March 15th, 2004. 41. Physiotherapy, Position Vacancy Information, May 15th, 2002 – March 15th,

2004. 42. Respiratory Therapy, Position Vacancy Information, May 15th, 2002 – March

15th, 2004. 43. Social Work, Position Vacancy Information, May 15th, 2002 – March 15th,

2004. 44. Speech–Language Pathology, Position Vacancy Information, May 15th,

2002 – March 15th, 2004.



Appendix 3 Staff Responsibilities Matrix

Function Regional Director Regional Manager Site Manager Charge

Clinical/Education/ Research

Coordinator Staff Patient Care and Support Services Management

See Regional Responsibilities Matrix for greater detail • Plans, coordinates

and evaluates discipline specific activities to provide safe, effective and efficient patient care and support services within the region

• Responsible for the discipline’s participation with clinical programs at the regional and site level

• Responsible for providing leadership and direction for the provision of (discipline specific) services

• Coordinates the assessment, planning and implementation of care for specific groups of patients

• Provides coordination, leadership and mentorship in the implementation of regional initiatives

• Identifies patient care issues within their sector to the Regional Director

• Accepts delegated responsibilities from the Regional Director

See Regional Responsibilities Matrix for greater detail • Participates in the

regional allied health program planning process

• Provides key information for the planning process including resource identification and outcomes tracking

• Reviews site practices and identifies opportunities

• Assesses and identifies inter-program allied health impacts of change at the site

• Responsible for implementing regional patient care initiatives at the site level

• May have patient care responsibilities

• Provides patient care

• In the absence of a Site Manager, may assume responsibilities described under Site Manager or as delegated

• Participates in the assessment, planning and implementation of patient care for a specialty population or area of practice

• Functions in an advanced clinical role

• Provides professional leadership and mentorship to front line staff

• May provide patient care

• Provides patient care

Human Resources Management

• Provides leadership and support for recruitment and retention

• Has input into hiring Site Managers and Charges

• Responsible for hiring of Regional Managers/ Regional Clinical

Within the assigned sector or geographic area • Manages direct reports • Manages discipline -

specific staff including performance management

• Identifies allied health human resource issues to the Site Senior

• Responsible for hiring and supervising site staff

• Ensures current licensure and registration of staff

• Manages staff including performance management

In the absence of a Site Manager or as delegated: • Supervises site

staff • Ensures current

licensure and registration of staff

• Manages staff

• May be responsible for the hiring/ supervision of research assistants





Coordinator Staff Coordinator

• Responsible for Performance Appraisals of Regional Managers and Regional Clinical Coordinators, and provides input into Performance Appraisals for Site Managers and/or Charges

• May be responsible for managing employees either within the program or another delegated service

• Ensures a process exists to verify current licensure and registration of regional and site professionals

• Allocates EFTs to regional services/ programs as determined by the discipline specific program in collaboration with the clinical program teams

Management and allied health program team(s)

• Tracks and evaluates trends, and identifies human resource issues to the Regional Director

• Accepts delegated responsibilities from Regional Director

• Identifies allied health human resource issues to the Site Senior Management, Community Area Management Team, and Regional Director

• In the case of a shared Site Manager or Site Manager with a large span of control may have Charge position to attend to site responsibilities

• Allocates EFTs to services/ programs at site as determined by the discipline specific program in collaboration with the clinical program teams and Regional Director

including performance management

• Identifies allied health human resource issues to the Site Senior Management and Regional Director

Fiscal Management • Leads the budget process for the discipline

• Reviews financial reports and variance analyses for discipline

• Accountable for managing within the regional budget allocation

• Establishes discipline service deliverables for each site, program team, and community area

• Establishes

Within the sector/geographic area and in consultation with the Regional Director, establishes, administers, and is accountable for the assigned budget • Accepts delegated

responsibilities from Regional Director

• With joint accountability to Site Senior Management/ Community Area Management Team and to the Regional Director:

• Identifies site budget requirements, issues, and specific action plans

• Manages resources within budget

• Provides variance

• May be responsible for the day to day management of the site budget in the absence of a Site Manager

• Utilizes resources associated with clinical practice in a fiscally responsible manner

• May be responsible for the coordination of continuing professional education (e.g. conference, books, journals) budgets

• Utilizes resources associated with clinical practice in a fiscally responsible manner





Coordinator Staff purchasing procedures related to discipline specific expenditures consistent with quality standards, budgetary constraints, regional efficiencies and site requirements

reporting, including trend information, causal factors and options for corrective action

• Recommends shifts in resources

• Participates in the development of regional and site allied health plans

Policy Development and Professional Standards

• Provides leadership in developing a regional vision for the discipline and is responsible for developing and implementing discipline specific strategic and operational plans

• Establishes standards and benchmarks in collaboration with clinical programs and community area directors

• In collaboration with stakeholders, develops and implements policies consistent with overall regional strategic direction

Within the assigned sector/geographic area e.g. Acute Care, Long Term Care: • Develops objectives for

discipline specific issues • Creates/implements

discipline specific policies based on best practice/professional standards

• Participates with Regional Strategic Planning

• Demonstrates leadership in identifying professional issues

• Provides input into discipline specific and program team policy development

• Implements site and program policies

• Provides input into discipline specific and program team policy development

• Implements site and program policies in the absence of a Site Manager or as delegated

• Researches best practice to inform policy development

• Provides care consistent with professional standards and policies

• Facilitates the implementation of discipline specific and program policies

• Provides care consistent with professional standards and policies

Program Planning • Accountable for the discipline’s participation with clinical programs at the regional and site level

• Aligns structures to meet regional needs

• In collaboration with site and regional program teams, negotiates and allocates allied health

Within the assigned sector/geographic area e.g. Acute Care, Long Term Care: • Analyzes activities and

compares to regional targets/goals.

• Recommends appropriate allocation of resources in line with regional vision

• Establishes key result areas and indicators and

• Participates in the regional allied health and clinical program models

• Implements discipline specific program plans

• Identifies need for discipline specific services




• Researches best practice to assist with program planning








Coordinator Staff resources

• Includes program teams, site and community area teams in regional processes

• Develops and fosters team processes

• Utilizes and evaluates benchmarking data and translates into action plans


evaluates results • Provides input into the

planning process • Accepts delegated

responsibilities from Regional Director

Quality Management • Responsible for standards of practice, quality and performance monitoring and reporting, risk management, education, program service and business planning

In collaboration with sites, program teams, and community area program management: • Establishes targets

and benchmarks • Develops the regional

quality plan • Participates in WRHA

sequential accreditation as appropriate and assigns discipline specific representatives

Related to the assigned sector/geographic area e.g. Acute Care, Long Term Care: • Provides input into the

discipline specific quality and business planning process

• Provides leadership in the continuous quality improvement plans

• Contributes to the regional program process of establishing targets and benchmarks

• Participates on accreditation teams as requested

• Ensures statistics and management reports are compiled and distributed


• Responsible for implementing program quality improvement initiatives at the site

• Develops and manages the discipline specific site quality plans consistent with the overall regional plan


In the absence of a Site Manager or as delegated: • Ensures statistics

and management reports are compiled and distributed


• Responsible for implementing program quality improvement initiatives at he site

• Develops and manages the discipline specific quality plans consistent with the overall regional plan


• Supports the implementation of changes to clinical practice related to quality improvement initiatives







Coordinator Staff Equipment/Space Management

• Evaluates and prioritizes equipment/ space requests in collaboration with sites, program teams, and community areas

• In collaboration with the Site Managers/Charges identifies and prioritizes equipment/space needs specific to assigned sector/geographic area

• Identifies and communicates equipment needs to the regional program

• Identifies and com-municates equipment needs to the regional program in the absence of Site Manager

• Assists in the identification of new technology and equipment/space needs that will address best practice

• Provides training and expertise in the implementation of new technology

• Identifies and communicates equipment needs to Site Manager/ Charge

Education/Research • Identifies the regional educational needs of the discipline

• Evaluates continuing education opportunities and ensures dissemination of related information

• Facilitates research that supports best practice

• Collaborates with stakeholders to facilitate university, site and agency activity related to education, clinical teaching, patient care and research

• Provides guidance and assistance to the Regional Allied Health Educational Fund committee

• Identifies education/research needs in assigned sector or geographic area

• Participates in/supports discipline specific research

• Coordinates regional student placements, i.e. non site based

• Identifies education/ research needs

• Coordinates student placements within the site

• Facilitates staff attendance at education sessions

In the absence of a Site Manager or as delegated: • Coordinates

student placements

• Facilitates staff attendance at education sessions

• Critiques and evaluates research findings relevant to specific area of care

• Develops relevant research studies/ proposals and disseminates results through presentations and publications

• Participates in/ supports discipline specific research

• Provides discipline specific education to staff, students, and clinical program areas

• Coordinates fieldwork education

• Develops standards for/critiques client education materials

• Supervises students as directed by Site Manager or Charge

Committee Participation

• Represents the Allied Health Clinical Services Programs and the Allied Health Leadership Council on specific committees

• Participates in and represents the discipline and/or WRHA portfolios on relevant committees,

• Represents the discipline on various program, community area, and regional committees

• Establishes appropriate committees within the assigned sector/geographic area

• Identifies gaps in committee participation




• Participates on committees as designated by Site Manager or Charge





Coordinator Staff task forces and/or working groups

• Meets with other disciplines and directors to facilitate good communication

• Takes a leadership role on projects as assigned

within the assigned sector

Communication • Maintains and facilitates communication and working relationships across the region

• Communicates approved allied health program plans and strategies to the program teams, sites and community area directors

• Accountable for timely and coordinated communication regarding inter-regional allied health program issues

• Communicates with contracted/ private sector groups with respect to discipline specific issues

• Networks with discipline specific or discipline related associations

• Supports inter-sectoral and intra-sectoral communication within the discipline

Related to the assigned sector/ geographic area e.g. Acute Care, Long Term Care: • Maintains and facilitates

communication and working relationships

• Fosters intersectoral collaboration

• Maintains and facilitates communication and working relationships

• Establishes and maintains a forum for regular staff meetings

• Liaises with facility management, site program directors, and other discipline managers

In the absence of a Site Manager or as delegated: • Maintains and

facilitates communication and working relationships

• Establishes and maintains a forum for regular staff meetings

• Liaises with facility management, site program directors, and other discipline managers



Administration • May share financial analyst, administrative director, and/or other resources with other Regional Directors and/or Clinical

• Responsible for aspects of the program in the absence of the Regional Director or as assigned

• Responsible for the day to day operation of the discipline specific department

• Responsible for the day to day operation of the discipline specific department in the absence of a site





Coordinator Staff Programs manager or as

delegated Site Responsibilities • Liaises with site senior

management to inform re: regional directives, solicit input, etc.

• Accountable for centralized programs/ services/projects/ new initiatives as assigned

• Manages allied health programs and inter-program/ site issues on a regional basis

• Accountable to the program teams, sites, and community areas for quality service delivery

• Assists with implementation of regional initiatives in conjunction with site managers

• May have site responsibilities in the absence of a site manager (i.e. sites with a charge only)

• Responsible for the day to day operation of the discipline specific department

• Works collaboratively with the WRHA allied health program team to resolve inter-facility and inter-program issues

• Responsible for the day to day operation of the discipline specific department in the absence of a site manager or as delegated

• Responsible for caseload and other specific respon-sibilities as assigned

• Responsible for caseload and other specific respon-sibilities as assigned

Reporting Relationships

• WRHA VP or equivalent

• Regional Director • Regional Director and Site Senior Management/ Community Area Management Team

• Site Manager if one exists

• Regional Director or Regional Manager if no Site Manager exists

• Site Senior Management

• Site Manager for site issues

• Regional Director or Regional Manager for regional issues

• Reports to Site Manager or Charge

Accountability • Accountable to the appropriate WRHA Vice President

• Accountable to the Allied Health VP for overall allied health program

• May be accountable for some centralized/ regional services

• Accountable to the Regional Director

• Joint accountability to the Regional Director and Site Senior Management/ Community Area Management Team

• Primary accountability to the Site Manager

• In the absence of a Site Manager accountable to Regional Director or Regional Manager

• Accountable to the Regional Director or designate for specific area of practice

• Accountable to the Site Manager for day to day operations

• Accountable to the Site Manager or Charge for day to day operations

Direct Reports • Regional Managers and Site Managers/ Charges

• As assigned by the Regional Director

• Site staff including support staff

• Staff in other areas as assigned

• Site staff including support staff in the absence of a Site Manager or as delegated

• May provide direction to assistants in the area of patient care

• May provide direction to assistants in the area of patient care

Note: In some instances a discipline may choose to combine the 2 distinct roles – charge/clinical coordinator into one position.



Regional Responsibilities Matrix

Function WRHA Senior Management

WRHA Program Teams

Regional Allied Health Programs

Community Area Management

Team

Hospital Site Senior

Management Site Program

Managers Site Allied Health

Managers

Planning the delivery of health care services and social services – system wide

• Leadership role in system organization, identification of the strategic plan and priorities

• Development and submission of the Regional Health Plan

• Managing responsibilities as defined under the Regional Health Authorities Act

• Links with other RHAs

• Planning and managing the continuum of services

• Managing inter-program impacts

• Designing a regional process for planning and obtaining input from stakeholders

• Leadership in planning related to the specific program area, including development of the strategic plan for the program

• Collaborate with allied health AH program teams, sites, and community areas regarding practices and opportunities

• Identify and make recommendations to address variations between sites and community areas

• Identify standards of care, best practices and innovations

• Identify regional program needs

• Planning jointly with the sites, community programs/services and community areas

• Assess and identify inter-program impacts of change

• Negotiate and collaborate with site senior management and community area director regarding

• Leadership in planning related to their specific discipline, including development of the strategic plan for the allied health program and providing input on clinical programs and community services

• Collaborate with program teams, sites, and community areas regarding practices and opportunities

• Identify and make recommendations to address allied health variations between program teams, sites, and community areas

• Identify standards of care, best practices and innovations

• Identify regional allied health program needs

• Planning jointly with the program teams, sites, community programs/ services and community areas

• Assess and identify inter-program impacts

• Negotiate and collaborate with regional program and allied health program regarding siting of programs and services across FS&H and WRHA

• Facilitate the interface between community area program and regional program issues

• Ensure that the community area can deliver on commitments

• Ensures the integrity of community area program plans

• Active participant in the regional program planning process

• Provision of key information for the planning process including resource identification and outcomes tracking

• Review community area practices and identify opportunities

• Assess and identify inter-program impacts of change at the community area

• Negotiate and collaborate with regional program and AH program regarding siting of programs and services

• Facilitate the interface between site program and regional program issues

• Ensure that the site can deliver on commitments

• Ensure the integrity of site program plans

• Active participant in the regional program planning process


• Review site practices and identify opportunities

• Assess and identify inter-program impacts of change at the site

• Active participant in the regional allied health program planning process


• Review site practices and identify opportunities

• Assess and identify inter-program allied health impacts of change at the site




WRHA Program Teams



Team




Managers

the delivery of programs and services

• Negotiate and collaborate with site senior management regarding the siting of program services

of change • Negotiate and

collaborate with program teams, site senior management and community area director regarding the delivery of programs and services

Regional Program Management (organizational structure)

• Leadership in developing the overall organization model including integration of the various sectors

• Modification of the organization as required

• Establish benchmarks for performance

• Aligning structures to meet regional needs

• Allocation of resources ($s, people, etc.)

• Inclusion of allied health program teams, site and community area teams in regional processes

• Negotiate resource allocations with sites and community areas

• Develop and foster team process

• Establish benchmarks for program performance


• Allocation of allied health resources ($s, people, etc.)

• Inclusion of program teams, site and community area teams in regional processes

• Negotiate allied health resource allocations with program teams, sites, and community areas

• Develop and foster team process

• Establish benchmarks for AH performance


• Managing inter-relationships between community area programs and services

• Working in collaboration with the region regarding regional initiatives and providing leadership in change implementation

• Implements program plans and manages day to day community area activities

• Establish benchmarks for performance


• Managing inter-relationships between site programs and services

• Working in collaboration with the region regarding regional initiatives and providing leadership in change implementation

• Participant in the regional program management model

• Implements the program plans

• Participant in the regional allied health program model


Information Sharing/ Communications

• Sharing information regarding Board and senior management discussions and decisions

• Listening and responding to the

• Communication of approved program plans and strategies to the site and community area managers

• Accountable for timely and

• Communication of approved allied health program plans and strategies to the program teams, sites and community area managers

• Communication with local community consistent with regional themes

• Accountability for issue specific communication and with the teams

• Communication with local community in context to regionalization

• Communication through WRHA beyond traditional community

• Accountability for program specific communication across departments and with the teams at the site

• Understanding and communicating

• Accountability for discipline specific communication to allied health staff and with site program teams

• Understanding and communicating internal and




WRHA Program Teams



Team




Managers

general public and health employees

• RHA inter-relationships

• National/Inter-provincial relationships

• Developing and coordinating the regional community strategies

coordinated communication regarding inter-regional program issues

• Communication with community programs regarding programmatic changes

• Regularly updating of senior management, site management and community area management and collecting and returning feedback

• Accountable for timely and coordinated communication regarding inter-regional allied health program issues

• Regularly updating of senior management, site management, program teams, and community area management and collecting and returning feedback

• Communication with the regional program teams with respect to discipline specific issues

• Communication with contracted/ private sector groups with respect to discipline specific issues

• Network with discipline specific or discipline related associations

• Inter-sectoral and intra-sectoral communication within the discipline

in the community area

• Communication through FS&H/WRHA beyond traditional community boundaries

• Inter-sectoral and intra-sectoral communication within the community area

• Collecting feedback and sharing information with the region

• Understanding and communicating internal and regional changes to community area program staff and volunteers

• Communication with the regional program with respect to program issues

• Collecting and communicating feedback to share internally and with the region

boundaries • Understanding and

communicating changes to site staff and volunteers

internal and regional changes to site program staff

regional changes to site allied health staff

Policy • Policy development and approval consistent with governance and strategic priorities

• Policy support and development

• Establish regional program policies

• Support development and

• Policy support and development

• Establish discipline specific regional clinical policies

• Support

• Implements regional policies and operating guidelines

• Supports implementation of

• Establishes facility policies

• Supports implementation of regional program policies

• Provides input to policy development and implements site and program policies

• Provides input to discipline specific and program team policy development and implements site




WRHA Program Teams



Team




Managers

implementation of policies in sites and community areas

development and implementation of policies for program teams, sites, and community areas

regional program policies

• Input to regional policies

• Input to regional policies

and program policies

Budgets • Global resource decisions and financial planning in accordance with the regional strategic plan

• Discussions with various sectors within Government with respect to the strategic and financial plan

• Balancing requirements between various programs

• Shifting resources between and within various programs, sites and community areas

• Monitoring regional financial performance and ensures corrective actions as required

• Ensuring joint sign off and arbitrates as required

• Make decisions regarding the management and allocation of funding based on the best available evidence and best practice (based on criteria that are commonly applied

• Accountable for managing within the regional budget allocation

• Responsible and accountable for the program budget envelope and budget evaluation

• Establishes service deliverables for each site, allied health programs, and community area

• Works closely with the site, allied health programs, and community area management teams

• Establishes standards and benchmarks in collaboration with sites allied health programs, and community areas

• Reviews variance reporting and monitoring program financial performance

• Prepares regional forecast from site and community area forecast information

• Reviews and

• Accountable for managing within the regional allied health budget allocation

• Responsible and accountable for the allied health program budget envelope and budget evaluation

• Establishes allied health service deliverables for each site, program team, and community area

• Works closely with the site, program teams, and community area management teams

• Establishes allied health standards and benchmarks in collaboration with sites, program teams, and community areas

• Reviews variance reporting and monitoring program financial performance

• Prepares regional forecast from site and community area forecast information

• Develops community area financial plans in collaboration with program and non-program areas

• Accountable for managing within the community area budget allocation for program and non-program areas

• Monitors both program and non-program spending at community area

• Leads in day to day financial and resource management

• Ensures joint sign off of program budget

• Keeps the regional program team informed regarding community area financial issues

• Variance reporting for program/non-program areas, corrective action

• Timely (monthly) financial reporting

• Integrated services financial reporting by the community area management team

• Accountable for managing within the budget allocation for program and non-program areas

• Monitors both program and non-program spending at site

• Identifies budget requirements for non-program areas

• Leads in day to day financial and resource management

• Ensures joint sign off of program budget

• Keeps the regional program team informed regarding site financial issues

• Provides timely financial reports

• Variance reporting for program/ non-program areas

• Timely (monthly) financial reporting

• Integrated program/non-program financial reporting by the site CFO to WRHA Finance with regional program sign off

• Accountable for managing within the program budget allocation

• Identifies site program specific action plans

• Identifies program budget requirements – prepares budget

• Manages the site program activities within the budget allocation

• Joint accountability to site senior management and to the WRHA program team for managing resources within budget

• Monitors variances regularly

• Provides input to the regional program for variance reporting including trend information, causal factors and options for corrective action

• Communication of financial issues to regional program teams and site senior management

• Accountable for managing within the allied health program budget allocation

• Identifies site allied health program specific action plans

• Identifies allied health program budget requirements – prepares budget

• Manages the site allied health program activities within the budget allocation

• Joint accountability to site senior management/ community area management team and to the WRHA allied health program team for managing resources within budget

• Monitors variances regularly

• Provides input to the allied health regional program for variance reporting including trend information, causal factors and options for




WRHA Program Teams



Team




Managers

to comparable facilities)

assesses trend information in collaboration with the sites allied health programs, and community areas

• Identifies corrective action in collaboration with the sites allied health programs, and community areas as required to manage regional program resources

• Develops regional action plans in collaboration with sites allied health programs, and community areas

• Recommends shifts in resources to meet regional program requirements

• Reviews and assesses trend information in collaboration with the sites, program teams, and community areas

• Identifies corrective action in collaboration with the sites, program teams, and community areas as required to manage regional program resources

• Develops regional action plans in collaboration with sites, program teams, and community areas

• Recommends shifts in allied health resources to meet regional program requirements

• Collaborates with the region to identify corrective action as required to manage within budget

• Participates in plans for program areas

• Recommending shifts in program resources to regional program team and senior management

• Develops plans for non-program areas

• Recommends shifts in non-program resources to WRHA senior management

• Participates in plans for program and AH program areas

• Develops trend information

• Causal factor feedback

• Recommending shifts in program resources to regional program team and site senior management

• Participates in development of regional and site plans

corrective action • Communication of

financial issues to allied health regional program teams and site senior manage-ment/ community area management team

• Develops trend information

• Causal factor feedback

• Recommending shifts in allied health program resources to regional allied health program teams and site senior management/ community area management team

• Participates in development of regional and site allied health plans

Government Relations

• Lead role in discussions/ negotiations with the Political and Bureaucratic elements of Government

• Work collaboratively with Government departments as required after consultation with the appropriate WRHA Vice President

• Work collaboratively with Government departments as required after consultation with the appropriate WRHA Vice President

• Identifies and relays all Government related issues/matters to program teams and senior management as appropriate

• Generally secondary to the WRHA senior management

• Minimal • Minimal

Media Relations • Lead role in coordinating media relations on regional matters

• Primary or secondary role depending on the issue

• As delegated by WRHA communications



• Primary or secondary role depending on issue

• Link to the regional communications structure for system issues

• As delegated by the site CEO

• As delegated by the site CEO/COO/ CAD




WRHA Program Teams



Team




Managers

Quality and Risk Management Program

• Establishes a regional framework for quality programming and monitoring

• Establishes the standards and benchmarks for an integrated quality management system

• Coordination of Regional Accreditation

• Establishes a framework and monitors a process for the management of complaints and incident reporting within the context of continuous quality improvement

• Provides direction and guidance to WRHA programs regarding opportunities for development

• Manages the programmatic quality monitoring process and establishes in collaboration with the site, allied health programs, and community area management team, the targets and benchmarks

• Coordinates the development of a regional quality plan in collaboration with site, allied health programs, and community area program management. This includes the development of targets and benchmarks

• Through the regional accreditation teams, and the analysis of complaints and incidents, identifies opportunities for development and establishes a process for monitoring quality improvement initiatives

• Manages the discipline specific quality monitoring process and establishes in collaboration with the sites and community area management teams, the targets and benchmarks

• Coordinates the development of a regional quality plan in collaboration with site, program teams, and community area program management. This includes the development of targets and benchmarks

• Through the regional accreditation teams, and the analysis of complaints and incidents, identifies opportunities for development and establishes a process for monitoring quality improvement initiatives

• Participation in the development of the regional quality plan

• Develop, manage and implement community area specific quality plans consistent with the overall regional plan

• Actively participates and supports the regional accreditation process through the encouragement of community area team members who participate on the regional accreditation teams

• Implement the WRHA regional complaint management and risk management process

• Reviews trends and provides support to the community area teams in implementing quality improvement initiatives

• Management of local issues

• Participation and support of regional quality initiatives

• Develop site specific quality initiatives

• Actively participates and supports the regional accreditation process through the encouragement of site team members who participate on the regional accreditation teams

• Establishes facility specific complaints and risk manage-ment programs consistent with the regional reporting requirements

• Reviews trends and provides support to the site programs in implementing quality improve-ment initiatives for the purposes of improving service delivery

• Contributing to the regional program process of establishing targets and benchmarks

• Responsible for managing site specific program quality improvement initiatives

• Develops and manages the site specific quality plans consistent with the overall regional plan

• Collaborates with the regional program team through representation/ participation on the regional accreditation teams for the development of an overall program strategy for quality improvement

• Participates as an integral member of the regional accreditation team to determine benchmarks and targets with an emphasis towards CQI

• Contributing to the regional program process of establishing targets and benchmarks

• Responsible for managing discipline specific program quality improvement initiatives

• Develops and manages the discipline specific quality plans consistent with the overall regional plan

• Collaborates with the regional program team through representation/ participation on the regional accreditation teams for the development of an overall program strategy for quality improvement

• Participates as an integral member of regional accreditation teams to determine benchmarks and targets with an emphasis towards CQI

Accountability • CEO accountable to the Board who is in turn responsible to the

• Program teams accountable to the appropriate Vice President at

• Allied health program teams accountable to the appropriate Vice

• Accountable to the Vice President Community Care, WRHA

• Accountable to the local Boards

• Accountable to the WRHA as per the

• Joint accountability to site senior management and to the WRHA

• Joint accountability to site senior management/ community area




WRHA Program Teams



Team




Managers

Minister of Health WRHA • Keep allied health

and community area management informed regarding community area specific program issues, community area performance and regional program issues

• Keep site senior management informed regarding site specific program issues, site performance and regional program issues

• May be accountable for some centralized services

President at WRHA

• Keep community area management and program teams informed regarding discipline specific issues, community area performance, and regional program issues

• Keep site senior management/ community area management team informed regarding discipline specific issues, site performance and regional/ community program issues

• May be accountable for some centralized services

• Accountable to meet specific program standards, policies and performance targets

• Keep program team and allied health program informed of specific program issues, community area performance and community area issues

Operating Agreement

regional program team(s)

management team and to the WRHA allied health regional program team(s)

Operational Management (Day to Day)

• Overview role in managing regional resources

• May be accountable for some centralized programs/services/ projects/new initiatives

• Manages programs and inter-program/ site issues on a regional basis


• Manages allied health programs and inter-program/ site issues on a regional basis

• Accountable to the program teams, sites, and community areas for quality service delivery

• Managing issues at the local level

• Works collaboratively with the region to resolve regional issues

• Managing program/ departmental and inter-program/ departmental issues at the local level

• Works collaboratively with the region to resolve regional issues

• Manages day to day operational issues at the site

• Works collaboratively with the WRHA program team to resolve inter-facility and inter-program issues

• Manages day to day operational issues at the site

• Works collaboratively with the WRHA allied health program team to resolve inter-facility and inter-program issues





WRHA Program Teams



Team




Managers

Equipment • Acquires equipment funding

• Define/process for prioritization and allocation

• Identification and prioritization of program based equipment in collaboration with sites, allied health programs, and community areas

• Identification and prioritization of allied health based equipment in collaboration with sites, program teams, and community areas

• Identification and prioritization of equipment needs and maintenance of equipment

• Identification and prioritization of non-program based equipment and capital projects

• Identification and communication of program based equipment and capital needs to the regional program

• Identification and communication of allied health discipline based equipment and capital needs to the regional allied health program

Capital Planning and Construction

• Link capital planning and construction to the regional health plan and priorities

• Managing and prioritizing planning and construction projects for the region

• Primary contact with Manitoba Health Capital Planning

• In collaboration with the sites, allied health programs, and community areas, identifies and prioritizes capital construction projects for the program along with an identification of resource impacts

• Provides consultative input in regards to identifying and prioritizing capital construction projects for the program along with an identification of allied health resource impacts

• Identifies and prioritizes community area specific capital projects

• Collaborating with the regional program teams regarding program based capital projects and obtain joint sign off prior to project submission to WRHA Capital Planning and Construction

• Assesses community area impacts of any service changes

• Identification and prioritization of non-program capital projects

• Working with the regional program teams regarding program based capital projects to obtain joint sign off

• Collaborating with program teams and regional capital planning regarding site development

• Undertaking the necessary steps to secure sponsor contributions as part of capital programming

• Identification of site specific program requirements

• Collaborate with regional program teams

• Examines options

• Identification of discipline specific program requirements

• Collaborate with regional program teams

• Examines options

Human Resources • Primary role for staff employed by the WRHA

• Broad HR Planning for the region

• Primary role for Labour Relations

• Integration of HR support across the region

• Collaborates with the sites and community areas to identify program specific human resource issues and strategies to address these

• Lead region-wide recruitment/ retention initiatives for employees, volunteers, and students

• Lead region-wide recruitment/

• Collaborates with the sites, program teams, and community areas to identify allied health human resource issues and strategies

• Lead region-wide allied health recruitment/ retention initiatives for employees, volunteers, and students

• Lead region-wide

• Managing human resources for employees of the community area which includes paid employees, volunteers and students

• Develops community area specific human resource plan

• Participates and implements regional human resource

• Managing human resources for employees of the facility which includes paid employees and volunteers

• Managing program staff

• Identifies human resource issues to the site senior management and WRHA program team(s)

• Managing discipline- specific staff

• Identifies allied health human resource issues to the site senior management/ community area management team and allied health program team(s)




WRHA Program Teams



Team




Managers

retention initiatives for centralized services and program teams

• Managing human resources for employees of the centralized services (delegated responsibility for staff employed by the WRHA)

recruitment/ retention initiatives for centralized services and program teams

• Managing human resources for employees of the centralized services (delegated responsibility for staff employed by the WRHA)

initiatives, including students



Appendix 4

Winnipeg Regional Health Authority Regional Director

Allied Health – Discipline Specific Position Description

I. Position Identifiers:

Position Title: Regional Director Allied Health (discipline specific) Winnipeg Regional Health Authority

Reports to: WRHA VP

II. Qualifications Required for Position Education:

• Degree or equivalent in (discipline specific). • Relevant Masters Degree (e.g. Masters in Health Care/Business

Administration) or an acceptable combination of education, training, and/or experience.

Experience:

• Minimum of five years experience in a health care setting, with at least three years in a management position with increasing levels of responsibility.

• Previous experience in clinical areas required. • Experience in program planning, development and evaluation, and

managing patient care services in diverse settings. • Knowledge of education and research processes an asset.

Other:

• Excellent analytical skills, rapid problem solving abilities, communication skills, judgment and interpersonal skills.

• Integrity, dependability, honesty, initiative, and tact. • Thorough understanding of complex health related issues. • Ability to work within a computerized environment. • Ability to manage non-routine, highly variable workload.

Licenses, Degrees, Registrations: • Registered/licensed with appropriate provincial allied health

professional college or association. • Member of the appropriate provincial and/or national professional

association.



Note to Applicants: The incumbent is required to travel extensively to sites within the Winnipeg area.

III. Position Overview This position is responsible for providing leadership and direction for the provision of (discipline specific) services across the care continuum. Working within an interdisciplinary program management model, the Regional Director – (discipline specific) liaises with programs, sites, agencies, support services, and Regional Directors of other Allied Health Disciplines to achieve mutual goals.

IV. Main Function The Regional Director – (discipline specific) provides the leadership role in developing a regional vision for (discipline specific) and is responsible for the development, implementation, and monitoring of (discipline specific) strategic and operational plans. This position assumes responsibility for professional practice of the discipline for all programs and sectors across the continuum of care for the following activities:

• Primary (discipline specific) liaison for the programs, sites, and community

• Strategic/business/resource planning and management • Integration of quality improvement, risk management, and utilization

management systems • Providing leadership and collaboration with relevant parties in the area

of education (continuing, training and in–services) • Identification of population health needs and incorporation in service

planning

V. Major Responsibilities The Regional Director – (discipline specific) works with all members of the discipline team to ensure that care is coordinated and integrated with the programs across all Winnipeg Regional Health Authority sites/agencies. A. Patient Care and Support Services Management

• Develops and implements the discipline specific vision, values, strategic plans, policies, goals and objectives. Ensures (discipline specific) values are consistent with those of the WRHA and are incorporated in all regional program initiatives and plans.

• Participates in region wide plans, coordinates and evaluates regional systems to provide safe, effective and efficient care and support services across the health care continuum.

• Monitors current (discipline specific) professional practice to ensure service delivery and resources are consistent and adequate.



• Participates in the resolution of interdisciplinary care issues. • Facilitates strong community linkages and partnerships with

clients/consumers, community partners and service providers to ensure integration of services.

• Ensures that services are coordinated and integrated across the continuum of care.

• Supports discipline role in patient/client/resident advocacy. • Plans, manages and evaluates policy/procedural changes to improve

quality care in a cost–effective manner. • Provides support, ongoing direction, and good communication to

resolve operational issues. • Represents the Allied Health Clinical Support Programs and the Allied

Health Leadership Council on specific committees. • Represents the discipline and/or WRHA portfolios on relevant

committees, task forces and/or working groups, and external organizations.

B. Professional Standards and Policy Development

• Participates in the development and implementation of WRHA vision, values, strategic plans, policies, goals and objectives.

• Ensures the (discipline specific) regional management structure supports the delivery of services compatible with regional needs.

• Takes a leadership role in the development, implementation, evaluation and on–going review of discipline policies/procedures/ standards that affect quality client care and support evidence based practice.

• Establishes evaluation and feedback mechanisms when implementing policy directives of Senior Management.

• Identifies scope of practice issues and provides guidance and advice to sites/agencies, ensuring staff are able to practice at the full scope of professional training/practice.

• Ensures professional services are compliant with standards defined by regulatory bodies.

• Ensures a standardized process to support clinical competency, including: development of job descriptions, recruitment and retention initiatives, training/orientation of new staff, performance evaluations, professional supervision/monitoring, clinical peer consultation and review, student supervision and continuing education activities.

• Collaborates and networks with allied health partners, other disciplines, educational facilities, discipline specific professional groups, and other related stakeholders in the development of a regional approach for the support of clinical training of students, education, and research.

• Works with provincial/national professional associations and licensing bodies to stay current on discipline specific issues.



C. Fiscal Management • Develops, reviews, prioritizes, and approves the (discipline specific)

program’s financial plan and budget process and establishes appropriate control mechanisms.

• Reviews the financial reports and variance analyses across the region. • Accountable for managing within the regional budget allocation for the

(discipline specific) program and other areas under direct control. • Negotiates and reallocates (discipline specific) resources in

collaboration with program teams, sites, and community areas. • Negotiates and manages purchased service agreements.

D. Human Resources Management • Ensures issues within the discipline are addressed to create a work

environment that supports the mission, vision, and values of the organization and improves work life and recruitment and retention efforts.

• Develops a regional approach to recruitment and retention including a discipline specific plan.

• Develops and maintains a regional inventory of vacant positions by site/agency and works closely with sites/agencies to resolve vacancy issues.

• Works directly with sites/agencies in recruiting, evaluating, and disciplining (discipline specific) site managers.

• Participates in labour relations matters as required, (e.g. collective bargaining, arbitration) ensuring consistency in practice across the region.

• Implements a consistent regional workload measurement system. • Collaborates with the sites, program teams, and community areas to

identify (discipline specific) human resource issues and strategies. • Develops leadership qualities within the discipline. • Provides leadership in reviewing, revising, and implementing staff

models (staff ratios, mix, roles, etc.) across the programs. • Participates in the job classification process.

E. Program Planning • Develops a discipline specific strategic plan and business plan in

collaboration with all stakeholders, consistent with the WRHA strategic plan and provincial directives, including justification for new and expanded programs to meet identified population health needs.

F. Quality Management

• Collaborates with WRHA agencies and sites to develop, monitor, evaluate and approve quality improvement and risk management initiatives, including performance measures, workload statistic analysis, and satisfaction surveys, as appropriate.



• Develops benchmarks for standards of practice specific to discipline. • Strives to achieve national and international best practice standards for

patient care. • Assists with meeting program/accreditation standards for (discipline

specific) care. • Represents (discipline specific) interest at a regional level in the

accreditation process and related quality improvement initiatives.

G. Equipment/Supplies/Space Management • Identifies and prioritizes the (discipline specific) capital equipment

requests in collaboration with site Allied Health managers and site and regional Program Teams.

• Advises program/sites/agencies on space needs related to the discipline.

• Provides consultative input in the identification and prioritization of capital construction projects along with an identification of (discipline specific) resource impacts.

• Promotes recognition, evaluation, and implementation of new technology.

H. Education and Research

• Assists with the identification of the regional educational needs of the discipline.

• Facilitates the development and evaluation of continuing education opportunities and dissemination of related information.

• Facilitates research that supports best practice through appropriate identification, consultation and participation.

• Collaborates and networks with appropriate stakeholders to facilitate university, site and agency activity related to education, clinical teaching, patient care and research.

• Provides guidance and assistance to the Regional Allied Health Educational Fund committee on issues related to the discipline.

I. Communication

• Facilitates and maintains ongoing communication, teamwork and working relationships within and across programs/sites/agencies.

• Collaborates with other Directors, Managers and Teams regarding trends and discipline issues in professional practice and patient care.

• Plays a role in facilitating conflict resolution and negotiation between and within disciplines, programs, and sites.

J. Supervisory

• Supervisory responsibility for direct reports.

All other duties and responsibilities as assigned.



Appendix 5

ABC 6.1 Allied Health Infrastructure Team Members Project Sponsors

Role Name Title Initiative Leader Janet Bjornson Regional Director Allied Health

Executive Sponsor Réal Cloutier VP & Chief Allied Health Officer

Project Team

Role Name Title Project Lead Helen Clark Regional Director Respiratory

Therapy, Patient Transport and EMS Liaison

Team Member Paul Brewer Chief Operating Officer – Nutrition and Food Services

Team Member Janet Clark Regional Director Communication Disorders

Team Member Mary Lessing–Turner Regional Director Physiotherapy, Director Patient Care Rehab/Geri HSC

Team Member Marlene Stern Regional Director Occupational Therapy, Discipline Director HSC

Team Member Laury Jasper Patient Care Team Manager/Rehab. Geri Program, Physio. Professional Lead SOGH

Team Member Fiona McIntyre Program Support Manager, Rehab. Services SBGH

Team Member Ray Racette President and CEO VGH

Team Member Shelley Irvine–Day Regional Manager LTC and Manager Communication Disorders DLC

Team Member Sandra Loewen Regional Director Social Work

Team Member Jason Marchand Chief Human Resources Officer VGH

Project Manager Susan Gerlach

initiative 6 allied health project 6.1 allied health

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