The insights of allied health professionals transitioning from a matrix structure to a centralized profession-based structure within a public hospital setting

Abstract To manage the challenges associated with increasing costs and demand for healthcare, administrators often propose a re-structure of the workforce to gain more efficiencies. However, this can have detrimental impacts on professions such as allied health if the uniqueness of this workforce is not taken into consideration before, during and after re-structuring. In the dynamic setting of public hospital bed-based services, allied health is highly complex, consisting of diverse professionals (e.g., audiology, physiotherapy, occupational therapy, podiatry, pharmacy, dietetics, social work, and speech pathology), each requiring different technical expertise, training pathways, professional governance, and accountability. This case study evaluates the outcomes of a re-structure of allied health professionals working in bed-based services who transitioned from a matrix to a centralized structure of service delivery. Qualitative data were collected in a survey across three years to gain the perceptions from allied health staff about the impacts of the new structure. The results demonstrated that a centralized profession-based structure with single points of accountability was superior to a matrix structure in this context. The benefits identified included improved governance, administration efficiencies and cost-savings gained by having the budget and professional management aligned. This resulted in improved workforce planning and flexibility that delivered care to patients based on clinical priority. Further benefits included professional skills training pathways and succession planning across clinical specialties which enhanced career opportunities, all of which improved wellbeing and morale. These findings add to the sparse research pertaining to the components (structural, human and systems) to consider when incorporating allied health professionals in a proposed organizational design and the contingencies they require to operate successfully within certain contexts.