The Allied Health Worklife Survey

The Allied Health Worklife Survey Final Report Prepared by The Allied Health Worklife Survey Working Group of the Allied Health Leadership Council February 5, 2003

Table of Contents Acknowledgements... 2 Executive Summary and Recommendations... 3 Part One: Introduction... 7 Background... 7 Role of the Allied Health Leadership Council... 7 Goals of the Allied Health Worklife Survey... 7 Who Are the Allied Health Practitioners?... 8 Part Two: The Allied Health Worklife Survey: Survey Methodology... 10 Development of the Allied Health Worklife Survey... 10 Distribution of the Allied Health Worklife Survey... 11 Survey Analysis... 11 Sample Characteristics... 11 Part Three: Key Findings for All Allied Health Practitioners... 12 Survey Characteristics of All Allied Health Practitioners... 12 Work Life Satisfaction of All Allied Health Practitioners... 16 Key Priorities of Allied Health Practitioners... 19 Part Four: Key Findings for Allied Health Practitioners by Professional Group... 20 Survey Characteristics by Professional Group... 20 Work Life Satisfaction of Allied Health Practitioners by Professional Group... 34 Key Priorities of Allied Health Practitioners by Professional Group... 59 Part Five: Additional Information Provided by Allied Health Practitioners... 60 Part Six: Recommendations... 62 Conclusion... 64 Appendix A - Copy of Survey Sent to Allied Health Practitioners... 65 Appendix B - Organisations and Groups to which Surveys Were Submitted... 71 Appendix C - Responses to Survey - Survey Characteristics of All Respondents... 73 Appendix D - Responses to Survey - Survey Characteristics by Group... 89 Allied Health Worklife Survey Final Analysis 1

Acknowledgements The completion of this report has been made possible with the support and assistance of many people. The Allied Health Worklife Survey Working Group would like to acknowledge and thank: The Winnipeg Regional Health Authority, specifically, Réal Cloutier, Chief Operating Officer and WRHA Vice President, Long Term Care, for supporting the carrying out of the survey The Allied Health practitioners of the Winnipeg Regional Health Authority who took the time to complete and return the Allied Health Worklife Survey The Population Health and Service Analysis Unit of the WRHA which assisted and advised in survey design and analysis, specifically Jan Trumble Waddell, Val Austin-Wiebe and Debbie Taillefer The Allied Health Worklife Survey Working Group: Janet Bjornson, Kelly Lukaszewski Gayle Restall Erik Aasland who conducted the analysis and drafted the final report Allied Health Worklife Survey Final Analysis 2

Executive Summary and Recommendations Executive Summary Late in 2001, as part of its ongoing commitment to Allied Health practitioners, the Winnipeg Regional Health Authority, through the Allied Health Leadership Council, undertook an assessment of the quality of their working lives. Part of this process involved knowing the extent to which Allied Health practitioners were satisfied with their working lives. To do this, the Allied Health Leadership Council undertook to develop and administer a survey whose goal was to measure Allied Health practitioners satisfaction with their working lives. To accomplish this, the Allied Health Leadership Council created the Allied Health Worklife Survey Working Group. The Working Group developed and administered the Allied Health Worklife Survey for distribution to Allied Health practitioners throughout the region. A total of 2537 surveys were distributed to site coordinators in each workplace in which Allied Health practitioners were employed. The site coordinators distributed 2352 surveys of which 1551 were returned for a response rate of 66 per cent. The breakdown of completed and returned surveys, by discipline, include: Audiologists 6 Cardiology Technologists 27 Cardiovascular Technologists 1 Clinical Dietitians 84 EEG Technologists 4 Human Ecologists 4 Laboratory Technologists 235 Nuclear Medicine Technologists 27 Occupational Therapists 170 Orthopaedic Technologists 12 Orthotists 2 Perfusionists 2 Pharmacists 96 Physiotherapists 197 Radiology Technologists 130 Recreation Therapists 83 Respiratory Therapists 114 Social Workers 159 Speech Language Pathologists 43 Spiritual Care Workers 42 Ultrasound Technologists 26 Others 66 Not identified 21 The Allied Health Worklife Survey Working Group provided an analysis of the survey results of all 1551 Allied Health practitioners from which several workplace issues were identified. As well, the Allied Health Worklife Survey Working Group provided a similar analysis of 13 Allied Health disciplines grouped into 10 professional groups, representing 1370, or 88%, of the 1551 Allied Health Worklife Survey Final Analysis 3

respondents. They include the following professional groups and the number of responses received from each one: Audiology and Speech Language Pathology 49 Clinical Dietetics 84 Diagnostic Imaging 1 183 Laboratory Medicine Technology 235 Occupational Therapy 170 Pharmacy 96 Physiotherapy 197 Respiratory Therapy 114 Recreation Therapy 83 Social Work 159 Other Allied Health professions make up the remaining 181 survey respondents. These 181 practitioners (who belong to more than 10 other Allied Health disciplines) were not placed into groups to be analysed, as the numbers and responses rates for these professions were too small to ensure respondent confidentiality. Their views and comments are addressed in the analysis provided for all 1551 AHPs in Part 3 of this report. For all AHPs, whether as a whole or by professional group, the report shows that there are numerous issues in need of further examination. While impossible to list each one, they tend to centre on six principal concerns, namely: workforce shortages excessive workloads the lack of continuing education opportunities the lack of career laddering opportunities the inadequacy of workplaces, including problems with facilities and equipment compensation issues The identification of these and other concerns takes place throughout this report. Several recommendations have been put forward for implementation consideration by the WRHA. Allied Health Worklife Survey Recommendations The report identifies the following recommendations: 1. To better understand the Allied Health workforce in the region, it is recommended that Winnipeg Regional Health Authority undertake an annual survey to collect data on the size, composition, and site of work and other characteristics of the Allied Health workforce. 2. As heavy workloads are identified as a key issue for Allied Health practitioners, it is recommended that Directors of Allied Health Disciplines with site managers develop plans to address this problem. These plans should include: 1 The diagnostic-imaging group is comprised of three disciplines: radiology technology, nuclearmedicine technology and ultrasound technology. Allied Health Worklife Survey Final Analysis 4

Understanding the causes of workload pressures Comparisons of workload levels between sites and with other jurisdictions Development of work simplification processes Addressing the need for support staff Addressing workforce shortages Addressing staffing levels Assessing the need and feasibility of establishing regional float pools to provide support to sites 3. The establishment of relief budgets for Allied Health practitioners should be a priority for the sites and region. 4. As the percentage of part-time staff in most Allied Health disciplines is fairly high, additional study is required to determine reasons for this. Regional Directors of Allied Health Disciplines should engage Allied Health leaders and staff in discussion of work requirements and preferences and balance the need to increase full-time positions with staff preferences for full and part time work in recommending solutions. 5. The need to increase continuing education opportunities has been identified as a priority for Allied Health practitioners. The recently established Allied Health Education Fund is one step to begin to address this concern. Additional dialogue is required with Allied Health practitioners to better understand educational needs related to professional development, management training, computer training. The region and sites should then develop and implement a comprehensive Continuing Education Strategy for Allied Health Practitioners. 6. As opportunities for career advancement for Allied Health practitioners are extremely limited, it is recommended a Task Force for the Development of Career Advancement Opportunities for Allied Health Practitioners be appointed immediately. It should be comprised of representatives from Human Resources, CEOs, Regional Program Teams, Allied Health Leadership Council and Allied Health practitioners in the region. The Task Force should deliver a report with recommendations to the WRHA Vice President in charge of Allied Health within six months. 7. It is recommended that the WRHA and the sites employing Allied Health practitioners implement strategies and actions to increase valuing of Allied Health practitioners. This should include mechanisms to ensure Allied Health practitioners have a voice within the organisation, opportunities to participate meaningfully in decision making, and implementation of rewards and recognition programs targeted at Allied Health workers. 8. The WRHA sites and programs need to develop an implementation plan to improve workspace and tools to enable and support Allied Health practitioners to carry out their day to day responsibilities. Safety and security concerns should be given priority. 9. To address the lack of equipment and the existence of outdated and malfunctioning equipment, an increased annual budget allocation specifically for Allied Health equipment should be established by the region. Requests for Allied Health equipment should be channelled to that Fund and allocated through the Regional Directors of Allied Health Disciplines. 10. It is recommended that the WRHA, in collaboration with sites, implement standards, processes and training that will facilitate excellence in management that will promote effective multidisciplinary teams. Allied Health Worklife Survey Final Analysis 5

11. It is recommended that the WRHA develop and implement a communication plan to clarify issues and processes related to unionisation. 12. It is recommended that the WRHA conduct an evaluation of equity in compensation of Allied Health practitioners and implement an action plan to address inequities. 13. It is recommended that the Vice President in charge of Allied Health report back to the Allied Health workforce on a quarterly basis about the outcomes that have occurred as a result of the feedback that Allied Health practitioners provided through this survey. Report Distribution 14. It is recommended that the full report be distributed to the following groups: WRHA Vice Presidents and CEO Allied Health Leadership Council CEOs of Hospitals and Long Term Care Centres WRHA Human Resources Council Health Care Unions with Allied Health membership Manitoba Health 15. It is recommended an executive summary of the report be distributed more widely throughout the region to Allied Health site managers and professional leaders, Program Directors, Community and Long Term Care Directors, facility senior managers, etc. 16. It is recommended the Allied Health Worklife Survey Report be placed on the WRHA Web site for those who wish to access the complete report. Action on Findings 17. It is recommended the Allied Health Leadership Council develop an implementation plan to address the issues and recommendations in the report and report on progress with its implementation to WRHA Senior Management through the Vice President and Chief Allied Health Officer. Allied Health Worklife Survey Final Analysis 6

Part One Introduction Background Late in 2001, as part of its ongoing commitment to Allied Health practitioners (AHPs), the Allied Health Leadership Council, on behalf of the Winnipeg Regional Health Authority (WRHA), embarked upon a process to better understand the quality of their working lives. This process involved understanding the extent to which AHPs are satisfied with their working lives and work towards making improvements. To ascertain just how satisfied AHPs are with their working lives, the Allied Health Leadership Council developed the Allied Health Worklife Survey in which all AHPs were asked to participate. The Role of the Allied Health Leadership Council The role of the Allied Health Leadership Council is to provide collaborative leadership for the enhancement of professional Allied Health services within the Winnipeg Regional Health Authority 2 The Allied Health Leadership Council composed of Allied Health directors of clinical programs, professional advisory committee chairs, regional directors of Allied Health programs, and community representatives was given the task of overseeing the development and administration of the Allied Health Worklife Survey. To accomplish this, the Allied Health Leadership Council created a working group, which comprised three members: Janet Bjornson, Kelly Lukaszewski and Gayle Restall. In preparing the survey, the working group consulted a number of other surveys on working life and enlisted the assistance of Debbie Taillefer of the Population Health and Health System Analysis Portfolio. From the Allied Health Worklife Survey, information regarding the extent to which AHPs feel satisfied with their working lives was garnered. Based on the responses, the survey also provided a good indication of the key priorities identified by AHPs. The Goals of the Allied Health Worklife Survey The Allied Health Worklife Survey has five central goals, namely: to measure AHPs perception of working life satisfaction to identify the issues most important to AHPs in the WRHA to identify additional information on the Allied Health workforce to inform the WRHA, Manitoba Health and relevant committees to make improvements in the working lives of AHPs to identify key issues that the Allied Health Leadership Council should work on over the next two to three years The information and recommendations provided in the following pages represent the views of the AHPs who responded to the Allied Health Worklife Survey. 2 Allied Health Leadership Council, AHLC Information Manual, 1 October 2002. Allied Health Worklife Survey Final Analysis 7

Who Are the Allied Health Practitioners? The Allied Health Leadership Council has developed a working list of health professions considered to be Allied Health disciplines. The list defines Allied Health disciplines as those professions whose practitioners fall into the professional/technical category and who require a degree or certificate to practise. 3 As a result of the working nature of the list, the exact number of AHPs employed by the WRHA and its funded facilities is currently unknown. As a result, only an approximation of the number of AHPs is possible, which puts the number of AHPs who belong to the 25 different Allied Health disciplines between 2,500 and 3,000 as of September 2002. At the same time, approximately 27,000 people work for the WRHA and its funded facilities. Therefore, as a percentage of the total number of people employed by the WRHA and its funded facilities, between 9% and 11% are AHPs. Seven of the 25 Allied Health disciplines are regulated by a regulatory or licensing body and are governed by legislation. These disciplines have a legislative responsibility to self regulate. They are also required to be registered or licensed in order to practise. The 7 regulated Allied Health disciplines include: Audiologists Clinical Dietitians Occupational Therapists Pharmacists Physiotherapists Respiratory Therapists Speech Language Pathologists The 18 non-regulated Allied Health disciplines include: Cardiology Technologists Cardiovascular Technologists Child Life Therapists EEG Technologists Human Ecologists Laboratory Technologists Music Therapists Nuclear Medicine Technologists Orthopaedic Technologists Orthotists Perfusionists Prosthetists Psychometrist Radiology Technologists Recreation Therapists Social Workers Spiritual Care Workers Ultrasound Technologists Allied Health Leadership Council, AHLC Information Manual. 26 November 2001. Allied Health Worklife Survey Final Analysis 8

To ensure clarity, therefore, the term Allied Health practitioner refers to all of the approximate 3,000 health practitioners who belong to all 25 Allied Health disciplines contained in the Allied Health Leadership Council working list of Allied Health disciplines. Allied Health Worklife Survey Final Analysis 9

Part Two - The Allied Health Worklife Survey: Survey Methodology Development of Survey The Allied Health Worklife Survey Working Group drafted the Allied Health Worklife Survey based on its knowledge of issues within Allied Health. Other surveys regarding working life previously consulted by the WRHA include: the 2001 Rehabilitation Services Worklife Survey the 2001 Health Sciences Centre s Staff Satisfaction Survey, and the 2000 Nurses Worklife Survey of the Nursing Worklife Task Force. Two other surveys from external sources were also consulted for applicable questions, namely: the 2001 London Health Sciences Centre s Work Employee Survey, and the 2001 Survey of Hamilton Health Science Centre Staff Feedback on the survey design and questions was provided by Debbie Taillefer of the Population Health and Health System Analysis Portfolio. The Allied Health Worklife Survey itself is included in Appendix A of this report. It consists of four parts. Part A was concerned with gathering demographic information on AHPs, including, but not limited to, age, gender, discipline, and the settings in which they practise their profession. Part B dealt with gathering respondent information on systems and infrastructure support, professional practice and quality of care, workload, working life, and compensation and benefits. Part C was concerned with gathering information on what the key priorities for AHPs are, asking them to rank in terms of importance a number of potential priorities. Respondents were also given the opportunity to provide three additional priorities should the ones provided not reflect the priorities deemed key by them. The Allied Health Worklife Survey finished with Part D, which asked AHPs to provide further suggestions that could make their workplaces more supportive. Pilot Testing of the Allied Health Worklife Survey Once completed, the survey was distributed to all AHPs at Seven Oakes Hospital through their Professional Advisory Committee chairs and professional leads. The survey was folded and placed into an unmarked envelope. Participants were asked to complete the survey; place it back in the envelope; seal it; and return it to their professional leaders. The following feedback was received from respondents based on the pilot test at Seven Oakes Hospital: Regarding the demographic questions, respondents were concerned that they could be identified Respondents indicated that they would have preferred a range of possible responses, using a Likert scale 4 4 Questions that ask respondents to categorise a statement by indicating whether they strongly disagree, disagree, are undecided or neutral, agree or strongly agree with the statement are referred to as Likertscale questions. Allied Health Worklife Survey Final Analysis 10

Following discussions with the survey adviser in the Community Health Assessment Unit, no changes were made to the Allied Health Worklife Survey. Distribution of Survey Self-administered surveys were distributed to all AHPs in the WRHA. To ensure as broad a distribution as possible, copies of the Allied Health Worklife Survey were sent by the Regional Director of Allied Health and Long Term Care to all organisations in which Allied Health practitioners were known and suspected to be employed. Within the organisation, a site coordinator, such as a Professional Advisory Committee chairperson was selected to distribute the Allied Health Worklife Survey to all AHPs. Once distributed and completed, the surveys were then collected and returned by the site coordinator to the Regional Director of Allied Health and Long Term Care for the data to be entered into Microsoft Access database program. Appendix B lists in detail the organisations and groups to which the Allied Health Worklife Survey was distributed. Survey Analysis Survey analysis was provided by the Community Health Assessment Unit of the WRHA. General demographic data on AHPs provided in Part A of the survey were analysed to provide an indication of the composition of all 1551 survey respondents. Responses to Parts B, C and D were analysed to provide an indication of the extent to which all 1551 AHPs who responded to the survey are satisfied with their working lives. In addition to providing an analysis of all 1551 respondents, an analysis of 13 Allied Health disciplines, categorised into 10 different professional groups, was undertaken. This fulfilled the Allied Health Leadership Council s request that large groups be analysed separately for comparative purposes. Sample Characteristics A total of 2537 surveys were sent to site coordinators for further distribution to AHPs employed in their respective sites. As of 30 September 2002, 1551 of 2352 surveys distributed by its coordinators were returned for an overall response rate of 66 per cent. Allied Health Worklife Survey Final Analysis 11

Part Three - Key Findings for All Allied Health Practitioners The following section of this report has three principal goals, namely: to provide an indication of the composition of the 1551 AHPs who participated in the Allied Health Worklife Survey by examining the background information they provided about themselves to identify and examine the level of satisfaction AHPs have for a number of important working-life and workplace issues in order to understand just how satisfied they are with their working lives to examine what AHPs have identified as key issues, which they feel need to be addressed if there is to be an improvement in the extent to which they are satisfied with their working lives Survey Characteristics Comprehensive data on all the responses to the Allied Health Worklife Survey can be found in Appendix C of this report. The following section is a summary of the background information AHPs provided about themselves in Part A of the survey. Broken down into ten parts, it provides a summary of the composition of the AHPs who completed the Allied Health Worklife Survey in terms of: Age Gender Group Practice Setting Type of Work Performed Program Employment Status Years of Experience Supervisor Status Shift Work Age Distribution of Respondents Respondents were asked to provide an indication of their age by choosing from six possible age groups. The mean age of respondents was calculated and is between 31 to 45 years of age, with the median age group being 41 to 45 years of age. At 44%, nearly half of all AHPs are 40 years of age or younger. Thirty-eight per cent are 41 to 50 years of age, while 17% are 51 years of age or older. Of the 17% of AHPs 51 years of age or older, 6% are older than 56 years of age, which would seem to indicate that the Allied Health workforce will not experience large numbers of potential retirements in the near future. Allied Health Worklife Survey Final Analysis 12

Gender Distribution of Respondents When asked to identify their gender, 73% of respondents indicated that they were female and 15% indicated that they were male. Perhaps to ensure greater confidentiality, 13% per cent of respondents chose not to respond to the question. It is clear that the majority of AHPs are women, which is likely the result of professions that have traditionally been dominated by women. However, the distribution of women and men varies between Allied Health groups, which can be found in Part Four of this report. Seventy-three per cent of all AHPs surveyed are women Discipline To get a good understanding of the Allied Health disciplines to which AHPs belong, respondents were given 23 Allied Health disciplines from which to chose. Based on the responses, the ten largest disciplines are: Laboratory Technologists, 15% Physiotherapists, 13% Occupational Therapists, 11% Social Workers, 10% Radiology Technologists, 8% Respiratory Therapists, 7% Pharmacists, 6% Clinical Dietitians, 5% Recreation Therapists, 5% Speech Language Pathologists, 3% To account for any Allied Health disciplines not identified in the survey question, respondents were given the option of choosing a twenty-fourth response labelled other. Four per cent of respondents selected other. Practice Setting Respondents spend the majority of their time working in seven different practice settings, which break down as follows: Hospital-Tertiary, 47% Hospital-Community, 25% Long Term Care Facility, 10% Community (Community Site & Community Health Clinic), 8% Personal Care Home, 5% Multiple Hospitals, 1% Hospital and Community, 1% Seventy-two per cent of all AHPs surveyed work in a hospital Allied Health Worklife Survey Final Analysis 13

A small number of respondents, however, selected other and include such locales as a client s home or a school. At 72% of respondents, it is clear that most AHPs spend the majority of their time working in a hospital. Type of Work At 87%, the vast majority of AHPs who responded to the survey spend most of their time performing direct service type of work. The remaining AHPs spend their time performing types of work related to management, education, and professional lead. As well, close to one half of all respondents indicated that they were in a position where a secondary type of work is performed, including types of work related to education, direct service, professional lead, management, and research. When asked whether or not their job descriptions require the incumbent to have a background in their specific disciplines, the vast majority of respondents, 86%, replied that they do. Ten per cent of respondents indicated that job descriptions do not require someone from the specific discipline, while 4% of respondents chose not to answer the question. Program The Allied Health Worklife Survey s question on program provided an indication of respondents perception of alignment with the program management model in place in the WRHA. Respondents were asked to indicate the program in which they work the majority of their time, having been given 22 different programs from which to chose. They were also given the option of selecting other should they be part of a different program, which, if chosen, respondents were then required to fill in on a blank line the program in which they work. While Appendix C provides a breakdown of all the programs in which the respondents work, the ten largest programs by response include: Other, 22% Rehabilitation/Geriatrics, 17% Laboratory Medicine, 15% Diagnostic Imaging, 11% Child Health, 5% Pharmacy, 5% Surgery, 4% Critical Care, 4% Internal Medicine, 2% Family Medicine, 2% Twenty-two per cent of respondents chose other as their response. This is important as it shows that almost one-quarter of AHPs surveyed were unable to select the program in which they spend the majority of their time. That 22% of respondents may not see themselves as aligned to one program is indicative of the challenges related to placing AHPs within the program management structure. Allied Health Worklife Survey Final Analysis 14

Employment Status Sixty-two per cent of AHPs surveyed are engaged in full-time work, while 36% are engaged in varying degrees of part-time work. Of the 36% of respondents who work part time, 15% work between 0.1 and 0.5 EFT, while the other 21% work between 0.6 and 0.9 EFT. About 2% of respondents identified themselves as casual workers, while less than 1% chose not to respond to the question. Thirty-six per cent of all AHPs surveyed work part time Years of Experience To better understand their levels of experience, AHPs were asked to indicate their years of experience in three different areas: their respective groups, the Winnipeg region, and their current positions. For the most part, AHPs have a good deal of experience in their disciplines, with almost 80% of them having more than five years, including 19% with more than 25 years. This is noteworthy as it indicates that one in five respondents has a significant amount of professional experience, which is valuable to AHPs with less experience (20% of respondents have five or fewer years of experience). Within the Winnipeg Region, just over 27% of respondents have more than 21 years of experience, with 27% of respondents having five or fewer years of experience. Within in their current positions, just over 12% of respondents have more than 21 years of experience, while at 49%, a significant percentage of respondents have five or fewer years of experience. These percentages are reflective of the significant restructuring that has taken place within sites over the last five years, which has resulted in changes to positions. Supervisor When asked whether their supervisors were of the same discipline, 71% of all respondents indicated that their supervisors are of the same group, while 27% indicated that they are of a different discipline. Two per cent of respondents did not answer the question. Shift Work The shifts that AHPs work vary to a large extent. Thirty-three per cent of respondents are required to work evenings and 15% are required to work nights. Just over one-half of all AHPs are required to work weekends. Based on the large number of respondents that work in hospitals, this is not unusual. Twenty-one per cent of AHPs are also required to be on call. When asked whether the number of shifts they are expected to work is reasonable, 92% of AHPs indicated that they are satisfied with the number of shifts they are required to work. Allied Health Worklife Survey Final Analysis 15

Measuring Work Life Satisfaction of Allied Health Practitioners: Are They Satisfied? While the previous section provided some insight into the composition of the Allied Health workforce, the following section provides an analysis of Part B, the largest section of the Allied Health Worklife Survey. The goal of this part of the survey was to obtain some indication of just how satisfied AHPs are with the quality of their working lives. To do this, AHPs were asked to answer 24 questions regarding several aspects of their working lives, namely: Thirty-eight per systems/infrastructure support professional practice/quality of care workload work life compensation/benefits cent of all AHPs surveyed do not have adequate workspace Systems/Infrastructure Support For the most part, AHPs are provided with the necessary systems and infrastructure support to carry out their work, but a substantial number of them are not. Twenty-five per cent of AHPs responded that they do not have the equipment they need to do their Nine out of ten jobs. Moreover, when asked if they had adequate tools (telephone, computer, e-mail, voice mail, etc.) to do their jobs, 28% of them AHPs surveyed responded that they did not. In terms of the environments in which they spend both their work, 38% of respondents indicated that they did not have adequate workspace to do their jobs, while 17% of respondents do not feel safe own time and work and secure in the workplace. time engaged in From these responses, it is clear that a significant number of AHPs are experiencing difficulties in carrying out their work, be it from a lack of equipment or tools necessary to carry out their jobs to the four out of ten AHPs whose work space is inadequate. Also significant is the realisation that one in five AHPs does not feel his or her work environment is safe or secure. continuing professional development Professional Practice/Quality of Care In terms of their practices, nine out of ten AHPs are able to obtain the necessary patient or client information they need to carry out their work. Nine out of ten AHPs also Only half of all spend their own time, as well as work time, engaging in continuing professional development, which is indicative of their motivation to AHPs surveyed feel remain current in their jobs and maintain skills to provide quality of that they have care. sufficient time and In terms of support in the workplace to participate in or conduct tools to support research, only six out of ten AHPs find that it exists. When it comes to the ability of AHPs to support the clinical training of students at their clinical training of places of work, only five out of ten AHPs feel that they have sufficient students time and tools to support such training. Allied Health Worklife Survey Final Analysis 16

As for the quality of care, three out of ten AHPs are not satisfied with the quality of care that they provide to their patients and clients. When asked why they are not satisfied, the following reasons were provided: workloads are too heavy, 23% lack of time, 20% lack of staff, 18% lack of adequate equipment or current equipment is outdated, 11% lack of support from administration/management, 10% they work in an outdated facility or in a facility that is too small, 4% patient or client waiting lists are too long, 3% Many AHPs cite high workloads first and a lack of time second as the two principal reasons for their dissatisfaction with the quality of care they provide to their patients or clients. Workload Survey results for workload show that 37% of AHPs cannot adequately handle the work assigned to them. Forty-one per cent of AHPs report having no coverage when they are sick, suggesting the absence of relief backfill when they are sick or on holidays. When asked about the adequacy of the support staff in place, 42% of AHPs indicated that support, such as clerical and non-clerical staff, is inadequate. Worklife The responses to the questions regarding the quality of AHPs working lives are telling, providing both positive and negative results. On the positive side, 85% of AHPs are satisfied in their work, which indicates that they are generally happy with the work they perform. That 89% of respondents indicated that they feel respected by their colleagues for their contributions to patient or client care undoubtedly contributes to this. Moreover, at 99%, an overwhelming number of AHPs feel that they make positive contributions to their areas of responsibility. Overall, AHPs seem to be quite satisfied in their work; respected by colleagues for their contributions; and feel that they make positive contributions to their areas of responsibility. When considering the ways in which respondents interact with their organisations, however, the situation is less positive. For example, 26% of respondents feel that they do not have opportunities to participate in decisions that affect their work areas. As for changes and new developments within their organisations, just over 30% of AHPs are not informed of changes or new developments. The survey also shows that almost one-third of AHPs feel that their disciplines are not valued and respected by the organisations for which they work. Twenty-six per cent of all AHPs surveyed do not feel that they have opportunities to participate in decisions that affect their work areas Thirty-seven per cent of responddents cannot adequately handle their workloads Eighty-five per cent of all respondents are satisfied in their work Almost one-third of AHPs feel their disciplines are not valued and respected by their managers Only 27% of respondents felt there were sufficient advancement opportunities Allied Health Worklife Survey Final Analysis 17

Of all the questions about working life, the question regarding opportunities for advancement provided perhaps the most distressing result. Asked whether or not AHPs felt there were sufficient opportunities for advancement within the WRHA, only a mere 27% of respondents felt that there were sufficient opportunities. This indicates that nearly threequarters of AHPs feel that they cannot move up within the WRHA. The perception of such limited opportunities for advancement is Less than onehalf of all AHPs undoubtedly leaving some AHPs disillusioned, possibly leading to numerous recruitment and retention issues. surveyed are When asked about their satisfaction with the program management satisfied with their models in place in their organisations, less than one-half of respondents were satisfied. While several reasons likely exist for this, program management model one could be the inability of many AHPs to determine to which of the current programs they belong or aligned. While it was also noted earlier that 26% of respondents do not feel that they have opportunities to participate in decisions that affect their work areas, at 46%, an even greater number of AHPs feel that the groups to which they belong are not involved in the decisions made by their organisations. So while involvement in decisions regarding work area is important, involvement in decisions regarding the organisation as whole is perhaps more important as such decisions have an impact on several aspects of working life. It is important, therefore, that AHPs have input into the decisions that affect their organisations. Only half of all AHPs, however, feel that this is happens. Compensation/Benefits As for remuneration, seven out of ten AHPs indicated that their pay is Nearly half of all not appropriate to their job responsibilities. This is compounded by the fact that nearly half of all AHPs routinely work overtime to manage their AHPs surveyed workloads. However, the survey did not ask respondents to indicate routinely work whether or not they are paid or unpaid for overtime work. Undoubtedly contributing to these feelings of inappropriate pay is the perception of overtime to handle AHPs that they could earn more money in the private sector for the their workloads work they perform. That numerous AHPs feel overworked and underpaid, while at the same time knowing that they could earn more in the private sector, has the potential to make the recruitment and retention of AHPs difficult. Allied Health Worklife Survey Final Analysis 18

Identifying the Needs of Allied Health Practitioners: What Do They See as Key Priorities? In Part C of the Allied Health Worklife Survey, respondents were asked to rank in order of importance what they considered to be the top three priorities for them. Respondents were also given the option to add as many as three additional priorities of their own in the event that the given priorities were different from what they considered a priority. Of all the priorities indicated, respondents indicated that the need to address workforce shortages in Allied Health groups was the most important. This was followed by the need to: address workload levels of staff increase the number of Continuing Education opportunities create more opportunities for advancement establish an Allied Health Recruitment and Retention Fund address inconsistencies in standards across the Region implement mechanisms for rewards and recognition of staff, and provide better support of student training Allied Health Worklife Survey Final Analysis 19

Part Four Key Findings by Professional Group Based on the descriptive statistics in Appendix C, this part of the report will analyse AHPs by the discipline groups to which they belong in order to understand the extent to which they are satisfied with their working lives. The 10 Allied Health discipline groups to be examined include: Audiology and Speech Language Pathology (AUD & SLP = 49) 5 Clinical Dietetics (CD = 84) Diagnostic Imaging (DI = 183) 6 Laboratory Technology (LT = 235) Occupational Therapy (OT = 170) Pharmacy (PH = 96) Physiotherapy (PT = 197) Respiratory Therapy (RT = 114) Recreation Therapy (REC = 83) Social Work (SW = 159) The numbers in parentheses indicate the number AHPs from each group who completed the Allied Health Worklife Survey (as well as the acronyms used throughout this report, particularly in the charts and tables). Combined, the 10 Allied Health groups account for 1370, or 88%, of the 1551 survey participants. Age Distribution of Respondents Percentage of respondents by age group Age AUD & SLP (n=49) CD (n=84) DI (n=183) LT (n=235) OT (n=170) PH (n=96) PT (n=197) RT (n=114) REC (n=83) SW (n=159) < 30 22 33 14 3 32 21 22 11 22 21 31 to 40 51 25 29 20 35 30 27 28 31 19 41 to 45 12 18 27 25 12 21 15 29 20 21 46 to 50 10 8 13 24 12 14 16 21 10 19 51 to 55 2 11 12 19 4 11 14 7 8 11 > 56 2 5 2 8 4 3 4 2 7 7 Not given - - 3-1 - 3 2 1 1 Total % 100 100 100 100 100 100 100 100 100 100 - AUD & SLP = Audiology and Speech Language Pathology - PH = Pharmacy - CD = Clinical Dietetics - PT = Physiotherapy - DI = Diagnostic Imaging - RT = Respiratory Therapy - LT = Laboratory Technology - REC = Recreation Therapy - OT = Occupational Therapy - SW = Social Work 5 Audiologists and speech language pathologists have been grouped together for the purpose of this analysis because their respective group sizes were too small to do an analysis and because they belong to the same regulatory body. 6 Radiology technologists, ultrasound technologists and nuclear medicine technologists have been grouped together into one group entitled diagnostic imaging for the purpose of this analysis as all three professions belong to the Diagnostic Imaging Program. Allied Health Worklife Survey Final Analysis 20

The table above provides a breakdown by age groups of the AHPs who comprise the 10 Allied Health groups under examination. It shows that the majority of the 1370 AHPs who comprise them tend to be under 46 years of age, with the exception of laboratory technologists who are more evenly distributed between the six ages groups. One notable exception to this is the less than 30 age group, which makes up only 3% of the laboratory technologists who responded to the survey. Unlike the remaining groups, it would seem that little hiring of laboratory technologists has taken place over the past five years. Also of note is how few AHPs are more than 50 years of age. This seems to indicate that the professions which make up these groups will not experience high numbers of potential retirements: a phenomenon that is expected to occur in both the private and public sectors over the next ten years, as the baby-boomer generation exits the labour force. However, it could also indicate that people are moving out of their professions at younger ages. Gender Distribution of Respondents Gender distribution of respondents by professional group 100% 80% 2 19 11 11 8 10 15 10 14 60% 40% 90 87 70 78 80 65 76 52 78 75 Not Given Women Men 20% 0% 8 AUD & SLP (n=49) CD (n=84) DI (n=183) 13 19 11 LT (n=235) 9 27 Professional Profile 14 33 12 11 OT (n=170) PH (n=96) PT (n=197) RT (n=114) REC (n=83) SW (n=159) - AUD & SLP = Audiology and Speech Language Pathology - PH = Pharmacy - CD = Clinical Dietetics - PT = Physiotherapy - DI = Diagnostic Imaging - RT = Respiratory Therapy - LT = Laboratory Technology - REC = Recreation Therapy - OT = Occupational Therapy - SW = Social Work Although some individuals chose not to identify their gender, the chart above clearly shows that respondents in the ten groups are mostly women, which mirrors the gender composition of all 1551 respondents as a whole. The only notable exceptions are pharmacists and respiratory therapists who report higher numbers of men, at 27% and 33% of respondents respectively. Allied Health Worklife Survey Final Analysis 21

Practice Setting Distribution of respondents by practice setting Practice Settings AUD & SLP (n=49) CD (n=84) DI (n=183) LT (n=235) OT (n=170) PH (n=96) PT (n=197) RT (n=114) REC (n=83) SW (n=159) Hospital Tertiary 53 33 54 75 37 54 48 59 7 27 Hospital Community 16 22 33 21 29 28 31 29 7 24 Community - 8 4-10 2 5 3 13 23 Long Term Care Facility 21 25 6 3 12 9 10 8 24 11 Personal Care Home 4 7 - - 4 1 1-42 13 Multiple Hospitals 2-1 - - 1 - - - - Hospital & Community - - - - - 1 1-1 1 Other - 4 1 1 7 2 3 1 3 - No Response 4 1 1-1 2 1-3 1 Total % 100 100 100 100 100 100 100 100 100 100 - AUD & SLP = Audiology and Speech Language Pathology - PH = Pharmacy - CD = Clinical Dietetics - PT = Physiotherapy - DI = Diagnostic Imaging - RT = Respiratory Therapy - LT = Laboratory Technology - REC = Recreation Therapy - OT = Occupational Therapy - SW = Social Work For AHPs as a whole, 72% indicated that they work in a hospital. When the ten groups were examined, laboratory technologists were highest at 96% of respondents who work in a hospital. Diagnostic imaging technologists were also higher at 88% of respondents. In contrast, only 15% of recreational therapists work in hospitals, while 66% work in long term care facilities and personal care homes. Social work is the group whose practitioners are most evenly split between different practice settings, with 51% working in hospitals and 49% in other practice settings. Type of Work Please Indicate the Type of Work Where You Spend the Majority of Your Time Work Type AUD & SLP (n=49) CD (n=84) DI (n=183) LT (n=235) OT (n=170) PH (n=96) PT (n=197) RT (n=114) REC (n=83) SW (n=159) Direct Service 94 85 90 87 94 80 93 87 82 89 Education - 10 2-2 - 1 5-1 Management 4 6 3 4 1 11 4 4 13 4 Prof. Lead 2-3 6 2 5 2 4 4 4 Research - - - - 1 2 - - - - Other - - 1 1 - - - - 1 1 No response - - 1 2 1 1 - - - - Total % 100 100 100 100 100 100 100 100 100 100 Allied Health Worklife Survey Final Analysis 22

As is the case with AHPs as a whole, AHPs in the 10 groups spend a significant majority of their time engaged in direct service work. The table above shows that the groups whose practitioners report direct service as the most common type of work are audiology and speech language pathology and occupational therapy, at 94% respectively. The numbers of AHPs in who perform work in positions of management, research, or education are very small. If your position involves more than one type of work, please indicate secondary type of work Work Type AUD & SLP (n=20) CD (n=42) DI (n=68) LT (n=82) OT (n=51) PH (n=39) PT (n=59) RT (n=64) REC (n=25) SW (n=66) Direct Service 30 12 40 48 29 21 27 41 60 26 Education 50 57 31 16 33 49 42 42 8 41 Management - 5 13 9 22 3 8-12 11 Prof. Lead 15 24 4 17 12 23 17 8 12 15 Research 5-3 10 4 3 4 9-2 Other - 2 9 1-3 2-8 6 Total % 100 100 100 100 100 100 100 100 100 100 - AUD & SLP = Audiology and Speech Language Pathology - PH = Pharmacy - CD = Clinical Dietetics - PT = Physiotherapy - DI = Diagnostic Imaging - RT = Respiratory Therapy - LT = Laboratory Technology - REC = Recreation Therapy - OT = Occupational Therapy - SW = Social Work The types of secondary work vary significantly depending upon group. Notable, however, are the significant numbers of AHPs involved in direct service, education, and professional lead work. Allied Health Worklife Survey Final Analysis 23

Does the position description for the job you are currently holding require someone from your specific allied health group? 100% 80% 60% 40% 8 8 11 18 11 8 11 9 2 1 1 4 1 4 4 2 90 91 90 87 88 88 85 88 11 12 77 8 9 83 No Response No Yes 20% 0% AUD & SLP (n=49) CD (n=84) DI (n=183) LT (n=235) OT (n=170) PH (n=96) PT (n=197) Professional Profile RT (n=114) REC (n=83) SW (n=159) When asked whether or not there is a requirement that the jobs they perform be filled by someone from within the same profession, the majority of respondents in each group indicated that such a requirement exists. The chart above indicates that only a small number of the positions which make up the 10 groups do not require applicants to be from within the group. Program Please indicate the program in which you work the majority of your shifts Program AUD & SLP (n=49) CD (n=84) DI (n=183) LT (n=235) OT (n=170) PH (n=96) PT (n=197) RT (n=114) REC (n=83) Anaesthesia - - - - - - - 3 - Child and Adolescent - 1 - - 5 - - - 2 5 Mental Health Child Health 35 2 1-6 2 8 5-6 Critical Care - 2 - - - 6 2 37-1 Community Mental Health - - - - 1-1 - - 1 Community Services for - - - - 1 - - - 18 Seniors Diagnostic Imaging - - 90-1 - - - - Dialysis - 8 - - - - 1 - - Emergency - 2 1 1-1 3-1 Family Medicine 2 7 - - 2 1 4-2 Home Care - - - 5-1 2-7 Internal Medicine 2 2 - - 4-4 1-3 Laboratory - - 1 95 - - - - - - SW (n=159) Allied Health Worklife Survey Final Analysis 24

Medicine Mental Health - - - - 7 2 - - 2 8 Oncology 2 1 - - - - - - - 3 Pharmacy - - - - - 71 - - - - Primary Care - 1 - - 1-1 2 1 - Psychogeriatrics - - - - 1 - - - 1 3 Public Health - - - - - - - - - 1 Rehab/Geriatrics 37 30 - - 39 3 39 6 30 19 Surgery 6 7 1-6 - 14-1 3 Women s Health 4 1 - - - 1 - - 8 Other 16 33 5 3 20 15 25 41 42 30 No response - - 1 - - - 1 1 1 1 Total % 100 100 100 100 100 100 100 100 100 100 AHPs were asked to identify the program in which they spend the majority of their shifts, which is summarised in the above table. The programs of diagnostic imaging, laboratory medicine and pharmacy are, understandably, primarily single-discipline programs. However, in other disciplines, such as occupational therapy, physiotherapy, clinical dietetics and social work, AHPs were distributed amongst many programs. Significant numbers of AHPs selected other as the category, indicating that several respondents were unable to place themselves into one of the existing 22 programs. This is likely due to the small numbers of AHPs within a single discipline at many sites and the differing structures from site to site. Employment Status Employment status by group 100 80 60 40 20 59 41 45 55 68 69 32 31 4951 77 23 59 41 67 33 56 44 70 30 Full-Time Part-Time 0 AUD & SLP (n=49) CD (n=84) DI (n=183) LT (n=235) OT (n=170) PH (n=96) PT (n=197) Professional Profile RT (n=114) REC (n=83) SW (n=159) - AUD & SLP = Audiology and Speech Language Pathology - PH = Pharmacy - CD = Clinical Dietetics - PT = Physiotherapy - DI = Diagnostic Imaging - RT = Respiratory Therapy - LT = Laboratory Technology - REC = Recreation Therapy - OT = Occupational Therapy - SW = Social Work Allied Health Worklife Survey Final Analysis 25