Table 3.

Barriers and facilitators to successful implementation of assistant roles

	Barriers and facilitators	Stage of CF
Organizational
Timing	Implementation of roles was not well timed with training organization (PA) The OTAP role was introduced at the same time as new services were being developed (OTAP)	Stage 1: incorporates project planning and project management elements around time lines/time frames and key dates for implementation
Overall strategy	An overall strategy/approach was not identified prior to the implementation (PA, SPA and OTAP)	Stage 1: assists staff to plan the change management process
Recruitment	Targeted recruitment strategy was key to success of the role (SPA and PA) Managers suggested succession planning for OTAP staff through targeted recruiting in non-health area	Stage 7: Competency based role descriptors are written that can then be used for recruitment process.
Organizational and team culture	The implementation of the PA role involved managing the cultures of two different organizations (training organization and the health service). The culture of the organization was perceived as supportive to the introduction of the new role (SPA). An innovative and flexible working environment enhanced the implementation of the OTAP role.	Stage 1: works with staff to identify key contextual factors that may or may not facilitate the implementation process, including discussion around local, state wide and national barriers and drivers
Classification of roles/pay	Delay in Industrial classification of new roles led to a delay in recruiting, paying and providing initial training for the PA. Split industrial classification led to two tiered industrial relations system (PA and SPA).	Stage 1: includes identification of facilitators and barriers and also discussion and planning around the targeted grade the new role will be. Stage 7: facilitates identification of key areas for sustainability e.g. need for negotiation at a higher level for new roles to be created.
Resourcing	Protected time to allow staff to perform all stages of implementation (including planning and engagement). Lack of this led to high workload levels and lack of engagement of all stakeholders	Stage 1: incorporates project identification of what resources will be required of and provided by the organization to support the implementation process. Stage 6: plans training resources.
Attributes
Of the assistant	Personal traits of the assistant: specifically, maturity, flexibility, adaptability, fits well into the team; should know their own boundaries and capabilities and not exceed these boundaries; well-developed insight with regard to their skill set and role boundaries	Stages 1, 3 and 4: facilitation of what attributes are required of the assistant. These attributes are then written into role descriptions (stage 1). Every competency requires an understanding of the specific skills and attributes a worker needs to perform their role competently (stage 4).
Of the team	Managers and the team needed to be innovative and flexible while remaining committed to clinical governance. Team members needed to embrace ‘modern ways of working’ and be willing to try new things	Stage 1: incorporates engagement of staff, nominating champions and leaders and project planning (such as how to manage staff, how to assess willingness for change, developing a strategy to drive change) Stages 2–6: involvement of staff in these stages helps to identify and reinforce team attributes that will drive change
Skills	A clinical educator role was seen as essential in providing supervision and guidance to all staff including the PA. The SPA role was facilitated by a leader with formal training experience who was able to break down the role into discrete competencies, and develop competencies for the role where none existed previously. Lack of previous experience working with an assistant can make staff uncomfortable “letting go” of their work	Stage 1: includes project planning, which involves identifying trainers. Also awareness raising identifies champions for change. Stage 5: aids planning around supporting systems such as supervisors. Stage 6: Includes training trainers and developing links with training providers
Overall strategic direction, nationally, locally and professionally	At a national strategic level, Health Workforce Australia (HWA) established several broad policy directions around the introduction of new roles, including assistant roles. The relatively small numbers of people accessing the PA training precluded investment in and further development of training packages for the PA and OTAP. The podiatry and speech pathology professional associations had developed scope of practice documents, but no competency frameworks.	Stage 1: pre-awareness includes identification of supporting bodies/resources; links planning with professional/government strategic directions Stage 6: includes identification of local training bodies and facilitates engagement with them
Relationships
Training organization	Specialized skills required for podiatry training meant unique requirements that could not easily be met within the training organization resources. A strong, and consultative relationship with the training organization was identified as key to the SPA success. The OTs had minimal understanding of the training organization and the specific training undertaken by the OTAPs	Stage 1: engagement with all key stakeholders, including the training organization. Links also with identifying contextual facilitators and barriers. Stage 7 sustaining: links with higher education institutions are encouraged to develop bespoke training packages for individuals and organizations
Other stakeholders/ service providers	The enrolled nurses who undertook the role prior to the introduction of the podiatry assistant role were not consulted in the implementation process. IMPACT = > nurses expressed that they felt ‘a bit used’ and were disappointed that they would be ceasing the role