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9 Open Discussion On each of the 2 days of the workshop, the final session allowed workshop organizers, presenters, and participants to comment on the day’s proceedings. This chapter captures many of those comments as a way of revisiting the major themes discussed at the workshop. Comments made by organizers and presenters are attributed to the person who made that comment. A final section compiles comments made by other workshop participants, who are not identified. Many of these comments take the form of recommended actions, but these recommendations should in all cases be seen as those made by in- dividuals at the workshop, not as recommendations from the Institute of Medicine or from the workshop participants as a whole. DATA COLLECTION AND ANALYSIS • Allied health needs to articulate the value it adds to the health care system in terms of outcomes, which requires the collection and analysis of data (Fraher). • Allied health needs to demonstrate that the collection of more data can better inform workforce planning and allocation of resources in the states (Chapman). • Developing a minimum dataset is vital for organizations that edu- cate, license, and employ allied health professionals. Professional associations, licensure bodies, educational institutions, and other organizations all need to help build a strong data system (Fraher). 69
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70 ALLIED HEALTH WORKFORCE AND SERVICES • The reestablishment of the Forum on Allied Health Data could bring together many groups to generate needed data (O’Daniel). • An allied health research institute could focus on, among other things, the relationship between allied health education and patient- level health outcomes (Chapman). EDUCATION AND TRAINING • Better high school preparation, outreach to students, and articula- tion agreements among educational institutions can improve the creation of and movement up career ladders within and among allied health professions (Chapman). • A core set of skills conferred by allied health education and train- ing programs could give people the background to move up career ladders (Swift). • Allied health personnel can be trained in innovative as well as traditional practice settings. Learning about case management, care coordination, patient navigation, and other innovative prac- tice models can be very valuable for future allied health workers (Fraher). • Allied health students, like medical students, increasingly will need to have soft skills that enable them to interact and communicate smoothly and professionally with each other and with patients in new team-based health care environments (Donini-Lenhoff). • Young people are using new technologies to learn and communi- cate differently, yet these technologies have not been incorporated into education or practice (Salsberg). • Accreditation of programs needs to be much tougher to ensure that education and training programs are up to date and relevant. Though standards exist for accreditation, no mandate exists for ac- creditation to be certified, and oversight of accreditation is lacking (Swift). • Accreditation also needs to ensure that programs can evolve so people receive the training that employers need (Swift). • Data are required to demonstrate that the balance between certifi- cation and flexibility is based on evidence and not on impressions or interest group pressure (Salsberg). • The development of for-profit educational institutions is challenging the not-for-profit sector to become quicker and better (Salsberg). • A study is needed to look at the barriers to diversity in the allied health professions and the roles of educational and professional organizations in increasing diversity (Fraher).
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71 OPEN DISCUSSION • The case for diversity rests not just on who is available to fill jobs but on better quality of care, better outcomes, economic opportu- nity, and job growth (Chapman). PRACTICE ISSUES • The balancing of flexibility with quality assurance standards and accreditation will be a continued challenge (Salsberg). • Allied health professionals need to be at the table with doctors and nurses in making decisions about health care delivery (Swift). • Allied health workers may need to be separated into a much smaller number of categories based on the nature of their relationship to the delivery of care, from those who are responsible for patient health to those who provide support services (Salsberg). • Practice variations from state to state offer valuable opportu- nities for comparative effectiveness research. If one state gives prescribing privileges to psychologists and another does not, out- comes can be compared across those two states to learn what role workforce factors may play in patient care and quality outcomes (Donini-Lenhoff). • The uniform processes being developed in some states to assess changes in scope of practice could be implemented much more widely (Salsberg). • The distribution of allied health workers is an issue in many parts of the country and needs to be studied. Programs to change the distribution of other health workers should encompass allied health workers (Fraher). • Allied health can be a leader in health care innovations, such as new models of team-based care, and emphasizing that point can be a uniting force across the allied health professions (Chapman). THE FUTURE OF ALLIED HEALTH • The contribution of the allied health professions has much more recognition and visibility than in 1989 when the National Research Council last looked at the issue. Allied health has changed sub- stantially over the past 2 decades. It has grown much larger, and educational requirements have increased as health care has grown in scope and complexity (Chapman). • The allied health professions need to educate administrators, pay- ors, and other groups about the value of what they do and the opportunities they can offer to do even more (Donini-Lenhoff).
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72 ALLIED HEALTH WORKFORCE AND SERVICES • Despite its varied representation, allied health needs to speak with a unified voice if it is to address crosscutting issues and influence health care policy (Chapman). • Assessing the health care needs of the population would be a valu- able way to establish the need for allied health services (Fraher). • Decisions about the future of allied health will not be made in Washington, DC, but by the many thousands of individuals and organizations at the state and local levels and in the professions (Salsberg). • The current time of change is an ideal opportunity to rethink what allied health is and what it can do differently. OTHER INDIVIDUAL COMMENTS • A careful analysis of the knowledge and abilities of different allied health occupations would likely reveal enormous overlap. Having such information could allow organizations to make hiring deci- sions based on what they need done regardless of a person’s title or credentials. • Defining the roles and responsibilities of licensed health science professionals could help make them accountable for self-regulation and for overseeing workforce issues. Such definitions also could allow for the specification of career paths into the health science professions. • Complementary or alternative medicine needs to be considered in any discussion of allied health since Americans are spending bil- lions of dollars on these forms of care every year. • Real-time data are needed so young people being trained in allied health will be in a better position to secure jobs. Without such in- formation, there may be a backlash at the state and federal levels as people who have been trained cannot find jobs. • The use of unlicensed medical assistants will likely continue to grow as care moves into the community and reimbursement rates go down. • Students and prospective students need to know about the roles and responsibilities of health care workers, including allied health workers, to have realistic expectations about future careers.