JCPSLP Vol 20 No 2 July 2018

Entrepreneurship in speech-language pathology

The role of speech-language pathology professional identity in response to workforce redesign Rachael O’Brien, Rebecca Mitchell, and Nicole Byrne

The introduction of assistants in speech- language pathology is a workforce change that includes modification of the roles and responsibilities of speech-language pathologists (SLPs). Resistance to working with assistants is prevalent, and there has been little research into the perceived impact of working with assistants on SLPs’ professional identity. This paper explores SLPs’ perceptions of their professional identity in response to working with assistants. Semi-structured interviews were conducted with 20 SLPs in New South Wales, Australia. Findings indicate that working with assistants may be perceived as a potential threat to the SLP professional identity as a result of challenge to the values and distinctiveness of the professional group. Participants’ sense of professional identity was impacted by the real or perceived threat presented by the introduction of assistants. perceptions of significant workforce redesign will contribute to understanding the future speech-language pathology profession. Introduction Changes in health care workforces encompass modifications to the roles and responsibilities of health care professionals (Bach, Kessler, & Heron, 2007). This includes the introduction of assistant roles which are designed to enhance efficiency within overstretched health systems with finite resources. An assistant in allied health (hereafter “assistant”) is a vocationally trained person whose role is to support the work of tertiary trained allied health professionals, with either a single- or multi-disciplinary focus. The work undertaken by assistants in speech- language pathology can be clinical or non-clinical (Lizarondo, Kumar, Hyde, & Skidmore, 2010) and they may be employed in all settings in which speech-language pathologists (SLPs) work, including both adult and paediatric settings, across a full range of practice areas. Consideration of professional identity construction and how it can shape

Speech Pathology Australia recognises the value of the assistants working within the profession (Speech Pathology Australia, 2016b), but clearly states that assistants are to be considered as having a supplementary role, and never as a replacement for a fully qualified SLP. Speech Pathology Australia further specifies tasks which are the responsibility of SLPs only and are unsuitable for delegation, including assessment, differential diagnosis, clinical problem-solving and therapy planning (Speech Pathology Australia, 2014, 2016a). Current literature suggests that reforms involving assistants may drive a perception that professional roles are at risk and professional expertise undervalued (Nancarrow & Borthwick, 2005; O’Brien, Byrne, Mitchell, & Ferguson, 2013). This constitutes a challenge to professional identity. Professional identity is defined as “the relatively stable and enduring constellation of attitudes, beliefs, motives, and experiences in terms of which people define themselves in a professional role” (Ibarra & Barbulescu, 2010, p. 764). Threats to professional identity have been known to result in behaviour that aims to defend the professional role or leads to professionals exiting organisations. This is particularly likely when the new identity required as a result of the change is inconsistent with the pre-existing professional identity (Schilling, Werr, Gand, & Sardas, 2012). O’Brien and colleagues (2013) provided an initial discussion on the perception of professional identity threat and SLP willingness or otherwise to work with assistants. This current paper extends on this critical issue in relation to professional identity and workforce change in speech- language pathology. Professional identity formation The formation of a professional identity occurs when a person relates to and identifies with a specific professional group with distinct knowledge, attitudes, values and belief systems (Hudson, 2002). Professional identity can determine an individual’s perspective, attitude and behaviour relevant to the work context (Adams, Hean, Sturgis, & Macleod Clark, 2006). Professional identity helps individuals compare and differentiate themselves from others in the workplace (Turner, Hogg, Oakes, Reicher, & Wetherell, 1987), contributes to perceptions of relative status of groups and professions, and impacts on interprofessional interactions. SLPs’ professional identities are shaped by their expectations and experience of the professional group (Mackey, 2007) including training, qualifications and socialisation. They also encompass

THIS ARTICLE HAS BEEN PEER- REVIEWED KEYWORDS ASSISTANTS PERCEPTIONS PROFESSIONAL IDENTITY SPEECH PATHOLOGY WORKFORCE REDESIGN

Rachael O’Brien (top), Rebecca Mitchell (centre), and Nicole Byrne

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JCPSLP Volume 20, Number 2 2018

Journal of Clinical Practice in Speech-Language Pathology