9 Strategies to Manage Stealth Rationing and Bureaucracy Creep in Allied Health Services

The allied health workforce model is often historic, tokenistic, and unrealistic when it comes to addressing growing population needs. Consequently, the capacity of services—i.e., the number and type of services that can be delivered within existing resources—is rarely defined but consistently under-resourced.

As we explored in our article on stealth rationing in allied health services, the lack of explicit planning models stretches both services and practitioners well beyond available resources, leading to burnout and reduced service effectiveness.

While workforce shortages are not unique to allied health, these professions often lack the mandated staffing ratios seen in nursing and the political leverage of medical professions to achieve minimum standards.

 

1. Have a Clear Service Capacity and Value Proposition

Allied health services often attempt to be everything to everyone, given their broad roles across health, social, and community sectors. This makes it difficult to set boundaries, which often results in service over-extension.

To address this, define a clear value proposition for your service. This includes:

• Identifying the patient groups you are best equipped to serve.
• Establishing clear goals for patient outcomes.
• Setting time frames for achieving these outcomes.

For example, a physiotherapy service might focus specifically on reducing waitlists for post-operative rehabilitation within six weeks. By narrowing the focus, it becomes easier to manage demand and allocate resources effectively.

 

2. Call Rationing What It Is

Stealth rationing happens gradually, akin to the “boiling frog” analogy: services and staff gradually adjust to increased demand and reduced capacity until burnout becomes inevitable. To counter this, it’s essential to:

• Acknowledge when service capacity is being exceeded.
• Have open discussions with your team about workload limits.
• Identify early warning signs, such as longer patient wait times, decreased staff morale, or increased errors.

Encourage staff to speak up when they notice rationing creeping in and document changes to capacity and demand. This provides evidence for requesting additional resources and helps you manage expectations.

 

3. Protect Yourself

Leaders set the tone for work-life balance. I once knew a health service manager who made it a point to leave work at 5 PM, symbolically establishing healthy boundaries. This not only protected her own well-being but also set an example for her team.

To protect yourself:

• Establish clear personal boundaries that align with your paid workload.
• Prioritise self-care by recognising when demands are unreasonable and addressing them promptly.
• Delegate tasks when possible, and push back against expectations that exceed your role’s scope.

By doing so, you maintain your own capacity, setting a standard for sustainable work practices within your organisation.

 

4. Protect Your Staff

Your staff are your most valuable resource, so it’s vital to support them with:

• Adequate training and supervision, enabling them to perform their roles safely and effectively.
• Safe workload parameters, ensuring they have time for patient care without compromising safety or quality.
• Sufficient equipment and resources to perform their roles effectively.

This may involve adjusting workloads, restructuring roles, or advocating for additional resources. Keeping your staff safe and supported ensures they remain productive, retainable, and engaged.

5. Ringfence Resources

Administrative tasks like report writing, assessments, and documentation often consume more time than necessary. To optimise this, consider:

• Tracking time spent on non-clinical tasks to identify inefficiencies.
• Using templates for documentation, reports, and referrals to reduce time spent.
• Implementing digital solutions like dictation software for faster note-taking.

Create clear boundaries around administrative time. For example, set aside specific blocks in your schedule to complete these tasks. Adopting the 60-30-10 time management rule can help: allocate 60% of your day to high-value tasks, 30% to medium-priority tasks, and 10% to lower-value tasks.

 

6. Prioritise Highest-Risk, Highest-Need Patients

If demand exceeds capacity, prioritise patients based on risk and need. This means:

• Developing clear triage criteria to guide decision-making.
• Involving staff and patients in the prioritisation process to ensure transparency.
• Reviewing patient pathways regularly to identify areas where resources can be redirected.

During the COVID-19 pandemic, many health services had to reallocate resources toward the highest-risk patients, setting a precedent for adaptive workforce planning. Use similar strategies to manage day-to-day service demand.

 

7. Use Staff to Their Full Scope of Practice

To maximise resources, ensure staff are working at the top of their scope:

• Review role descriptions regularly to ensure alignment with skills and competencies.
• Implement frameworks like the Victorian Credentialing, Competency, and Capability Framework or the Calderdale Framework to identify where staff can expand their roles.
• Reallocate tasks that don’t require clinical expertise to other team members, freeing up clinicians for high-value care.

For instance, instead of involving senior clinicians in recruitment panels, use their expertise in clinical decision-making and patient care.

 

8. Delegate Effectively

Allied health professionals often struggle to delegate tasks, but effective delegation is critical when resources are limited.

• Identify roles that can be safely delegated and those that require clinical expertise.
• Use workload planning models to determine optimal task distribution.
• Encourage flexibility, allowing different allied health professionals to share overlapping tasks.

For example, a physiotherapist could delegate initial patient assessments to a trained assistant, enabling more time for complex cases.

 

9. Maximise Impact with Available Resources

In resource-constrained environments, services often focus on urgent rather than high-value care. To counter this:

• Clearly define your service’s purpose, goals, and target population.
• Evaluate the value of services provided, prioritising those that prevent admission or reduce the need for higher levels of care.
• Regularly review resource allocation, ensuring it aligns with strategic goals and the highest impact on patient outcomes.

For instance, focus occupational therapists on home-based assessments that prevent hospital admissions rather than low-priority discharge planning.

 

Conclusion

The growing demand and limited resources for allied health services call for strategic workload management. Proactive planning and resource allocation are crucial to achieving the greatest outcomes with the resources available. This discussion aims to foster further development of effective tools and principles for allied health workforce management, supporting both patient outcomes and professional sustainability.

 

The Allied Health Academy hosts a number of communities of practice on its platform catering to the full spectrum of allied health disciplines and professions, including allied health assistants and advanced clinical practitioners. For more information about The Allied Health Academy platform, contact us today.