JCPSLP Vol 20 No 2 July 2018

you just can’t. You’re basically not following the evidence base just due to the restrictions that you’ve got in the workforce” (Participant #11). Notwithstanding challenges in implementing evidence- based practice, participant accounts strongly indicated that their sense of professional identity came from being able to implement best practice and achieving clinical outcomes for clients. These reports contributed to the SLP identity of an organised and strategic professional, skilled in clinical prioritisation and time management. Client focus and advocacy Participants discussed client focus and advocacy as key components of the SLP professional identity, particularly in relation to vulnerable clients. They noted attempts to increase self-efficacy and service access for clients, as well as their responsibility for advocating for appropriate access to other services, in addition to assessment, therapy, clinical management and outcomes. One participant stated, “We really try and focus on that collaboration… It’s like, ‘what do you want to work on? I’ll support you to do it’” (Participant #11). Theme 2: Professional identity threats Analysis suggested that the introduction of assistants was perceived as a potential threat, in theory and/or practice, to the professional identity of SLPs. Threats were particularly aligned with clinical autonomy, client focus and advocacy. Threat to professionalism The introduction of assistants, perceived as being pursuant to economic efficiencies, was interpreted as degradation of the professional role by deskilling the professionalworkforce and devaluing established roles. The following quote highlights this sentiment, “De-skilling … And, not just de-skilling but losing … recognition for the role, the speech pathology role” (Participant #16). Some participants held reservations regarding assistants’ ability to provide an appropriate level of clinical care required to maintain outcomes for clients. This was based on the belief that assistants lack appropriate knowledge and training to undertake such tasks. The introduction of assistants was presented by some participants as providing a cheaper, less effective and less professional method of service provision, “They don’t have that training. They’re not a speech pathologist; they’re not the person who’s actually qualified…” (Participant # 20). Some participants saw merit in the idea of assistants working with clients where intervention requires no significant modification, again highlighting the perception of difference between the skills and knowledge of the SLP and assistant: It would have to be something within some fairly limited constraints about what somebody who doesn’t have the benefit of a four-year speech path degree could handle... that doesn’t really require novel thought, doesn’t really require a whole lot of active modification. (Participant #9) Being a SLP was a defining category referring largely to qualifications and expected skill sets, quality management and outcomes, and professional behaviour. Recognition of the distinct and unique professional role of an SLP was an important factor raised by participants. One participant stated: “we’ve fought for so long to be recognised as equals of physios and things like that and then to say well, someone else could do my job, that sort of could be a little

bit demeaning” (Participant #10). Another shared concern regarding the abilities of individuals in an assistant role, “Because they’re not a speech pathologist, they don’t have a degree” (Participant # 14). Threat to clinical autonomy and critical thinking Participants perceived that management decisions regarding resourcing of speech pathology services devalued both clients and the evidence base to which clinicians are committed. Professional values were framed in terms of the ability to demonstrate consumer focus and achieve clinical outcomes. One participant questioned, “Are we getting good outcomes for the patient? You know you’d have to really look at that” (Participant #5) , while another reiterated “You’d just want to make sure that you maintain the standards of care” (Participant #6). The participants portrayed the profession as having high standards and client-centred values distinctive from other professional and vocational groups, a defining characteristic that participants indicated may be compromised with the introduction of assistants. Threat to client focus and advocacy Delegating clinical tasks to assistants was seen by some participants as decreasing the individualised treatment that most participants valued. For example, delegating clinical tasks to assistants may cause the SLP to have less contact with clients, resulting in poor clinical relationships, as follows: will it increase the efficacy of what’s going on or will it just mean that people that wouldn’t have received a service then get a service because they’ve only got mild problems - rather than a home program they get to see an aide. (Participant #1) I guess speech paths will be able to sit in a room and do a whole lot of stats now, when I think what it should be doing is allowing us to do more specialised intervention, assessment. (Participant #9) Perceptions of poorer clinical relationships with clients were connected to perceptions of decreased consumer focus and the ability to be consumer focused was perceived by participants as being pivotal in ensuring maintenance of high standards of care and client satisfaction with speech-language pathology services. Discussion This paper demonstrates the presence of a strong professional identity for the SLPs involved in the study. Findings show that workforce redesign can impact professional identity and lead to the emergence of professional identity threat. This paper highlights the importance of professional identity in the success, or otherwise, of a planned workforce redesign (Haslam, 2014). Professional identity Our data suggest that SLP professional identity reflects professionalism, client focus and clinical autonomy. Client focus is consistent with findings of O’Brien, Mitchell, and Byrne (2017) who found that consumer focus was a core value for SLPs, and a moderating factor influencing perceptions of the introduction of assistants. This finding was reflected in discussion of standards of care, outcomes, advocacy, and the profession’s ethical values. Participants identified the importance of positive professional relationships with clients in achieving clinical outcomes, given the client-centred nature of the profession. The

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JCPSLP Volume 20, Number 2 2018

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