By Miller, Thomas W Gallicchio, Vincent S
Allied health professionals in all disciplines must be visionary as they address education, training, and health care delivery in the next decade. Examined herein are forces of change in education, training, health care, the recognition of essential leadership styles, and the paradigm shifts facing the allied health profession in the health care arena. Some visionary directions are offered for allied health professionals to consider as health policy and clinical agendas emerge toward the year 2020. J Allied Health 2007; 36:236-240. ALLIED HEALTH PROFESSIONALS are experiencing shifts that education, technology, the economy, and society are driving as we enter the new millennium.1 Allied health professionals should have a vision for the health care marketplace over the next 20 years and see it with clarity. In doing so, allied health professionals must consider (1) the effects of technology and automation on research and health care delivery; (2) the important influences of political, economic, and social change; (3) the progress made to develop and understand more clearly professional needs of health care personnel; and (4) the changes in population demographics in the United States that will have a direct impact on the first three points.
The advent of telemetry, technology, and other new mediums of communication, which aid in both obtaining and analyzing information, provides new challenges to health care professionals.2 The impact of the Human Genome Project will continue to uncover discoveries toward improving our understanding of the molecular mechanisms in preventing, diagnosing, and treating human diseases.3 Emerging paradigms provide an organizational focus that will shift from single-site initiatives to networks of health care services bonded and partnered by Web-oriented technology and integrated delivery systems.4,5 These changes force health care professionals to explore and examine the way in which the providers deliver services in the emerging paradigms of a health promotion and disease prevention delivery network for the future.
What Are the 21st Century Driving Forces for Allied Health?
The new millennium brings the potential for an integrated clinical, research, and educational collaborative environment that must consider economic, demographic, environmental, social, epidemiological, political, and technological change.6,7 The focus of this collaborative environment must address the critical elements of globalization, empowerment, technology, and leadership in the health care arena today.
Globalization is a historical process, the result of human innovation and technological advances. It refers to the increasing integration of economies around the world, particularly through collaboration and partnering. The world is rapidly changing, and globalization is helping to establish common social, economic, and political agreements between countries, as evidenced by the 1993 Maastricht Agreement that established the European Union and the 1994 North American Free Trade Agreement by the United States, Canada, and Mexico.8 These agreements provide the content and rationale for government involvement in enhancing educational opportunities and removing barriers that heretofore have limited the flow of students, educators, professionals, and practices across borders. Globalization refers to the movement of people (labor) and knowledge (technology) across international borders. There are broader cultural, political, and environmental dimensions of globalization, but for the allied health professions it refers to a holistic perspective, the ability to bridge disciplinary, technological, and cultural gaps and to become global in our learning and problem solving in health care. To date, globalization in the health care professions has yet to be fully addressed because of the barriers in place that relate, in many instances, to issues such as the competitive nature of our health-related disciplines, a hierarchy reflected by a vertical rather than horizontal model, and credentialing and licensure variation by discipline, state, and/or nation. The global mobility of health care professionals is at present limited because international education and training standards are yet to be determined, as well as who has jurisdiction to purpose, implement, and/or monitor international standards; however, discussions and importantly dialogue have been initiated by a number of allied health professional bodies to address these issues. For example, the American Society of Clinical Pathology Board of Registry and the National Accrediting Agency for Clinical Laboratory Sciences have both recognized the shifting global demands placed on the laboratory profession by the widespread use of advanced laboratory-based technologies and the current workforce shortage of qualified laboratory personnel.21 The American Society of Clinical Pathology Board of Registry has created a Global Task Force Committee consisting of qualified laboratory-based practitioners and educators to articulate what are the emerging issues that need to be addressed to more effectively deal with these global concerns. Partnership with the International Federation of Biomedical Laboratory Science is also seen as a first step in this arena as a way to move forward to address the global issues pertaining to the international practice of the laboratory profession.21 No doubt other health care disciplines will soon articulate a similar agenda.
Importantly, some of the barriers that have limited international mobilization are now being addressed for the first time, and governments have recognized that these barriers need to be overcome if true globalization of the health care professions is to become a reality. Development of a shared vision with administrators, consumers, competitors, and providers will be the critical factor for the success of our allied health professions over the next decade.9 Disciplines, individual allied health professionals, and organizations will need to focus more on serving the public and the community good, with greater emphasis on health promotion and disease prevention strategies. Mastering change for health care professionals will be essential for success. “Systems thinking” will surpass linear thinking.10″12 This has the potential of leading to a more integrated understanding of the problems and their solutions in the allied health professions.
Accelerated change and increasing complexity require an “empowered allied health workforce.”13 Empowerment may be defined as self-direction, allowing health care professionals to take responsibility and authority for decisions that affect them. Empowerment permits speed in decision making, allows practitioners to collaborate and partner more freely, and promotes the cultivation of creativity, quality, safety, and a true liberation of the human spirit. Empowerment requires a new administrative leadership paradigm for 21st century health care.
Trofino9 and Miller10 suggest that two forms of leadership are needed for our health care system. (1) Transactional leadership is leadership in which relationships among allied health professionals are based on an exchange for some resource valued by them. To the allied health professional, interaction between administrators and clinicians is usually episodic, short lived, and limited to the exchange transaction. (2) Transformational leadership is more potent and complex and occurs when one or more allied health professionals engage with others in a collaborative environment in which clinicians and administrators raise one another to higher levels of commitment and dedication, motivation, and productivity. Through this transforming process, the motives of the leader and followers become identical. This relationship transforms both parties by raising the level of human conduct and ethical aspiration of both health administrators and clinicians to a new level.
Technology is another major element.14,15 Technology offers the advantages of access, speed, and flexibility and serves as a major mode of accelerating learning, building information capacity and global knowledge. The world is indeed getting flat. As technology has embraced the digital field, the true reflection and impact of this technology are now being realized. Any piece of health care information, whether it is an X-ray, computed tomographic scan, laboratory record, telehealth component, or patient’s history, if it can be digitalized, it can be transmitted across space and time. Implementation of such a system to aid in the diagnosis and prognosis of an individual patient’s health care is already in place in many parts of the world. User-friendly access pathways and clinical models of health care such as interdisciplinary collaboration will be of primary importance to ensure easy access to information systems for the global population.3
The multiskilled allied health professional is a person with 2020 vision! Highly technical competencies, along with content expertise, cultural competence, and having a global perspective, will permit multiskilled allied health professionals to address complex systems analysis in an indigenous user-friendly manner.
Education in the allied health professions must reassess and reformulate its curriculum for the needs and requirements of health care in the 21st century. Emerging clinical and administrative models of differentiated practice have begun to identify the cadre of expert specialists needed to provide educational services in the future. New alliances with many disciplines, including science, health care, business, industry, and global educational initiatives, will be forged. These empowered “knowledge specialists” will use current technology to provide clinical services through nontraditional models and use school districts as a primary model for providing health promotion, prevention, and universal health care in a disease prevention education-oriented marketplace. Finally, there is a shift from a traditional model of health care delivery that uses new technology involving telehealth and telemedicine to a broad spectrum of consumers in business, medicine, health care, schools, and the world community through distance learning technology.16,17
What Are the Paradigm Shifts for the Allied Health Professions?
There are numerous emerging shifts in education and training in allied health, models of health care delivery, technology and information systems, accountability, financial incentives, prevention and wellness, and use of human resources. These shifts will force us to explore and examine the way in which the practitioner delivers and provides services to the global network of health care consumers.9,10,16 Economic strategies will likely see shifts driven by capitation and contracts for providers and with financial incentives for consumers in maximizing cost-effectiveness of health care services (Table 1).
In shifting to a new paradigm, accountability will also see major shifts. Controls against duplication of effort and liability for incompetence must be developed through integrated networks of accountability at both the local and national levels. Accreditation will provide, as it currently does, monitors to assess improved markers for health care delivery. Likewise, networks of prevention- oriented programs, organizations and government programs that promote disease prevention, will impact delivery of services.
Allied health professionals have already witnessed a variety of changes in the information technology paradigms.14 The advent and use of advanced computers and information systems, work stations, and integrated communication systems involve worldwide networks of accessibility. Databases and data warehouses, along with hypertext formats with linked information structures, are clearly seen as a part of the emerging information technology models over the next two decades. These will replace the organized sets of documents, data files, local network accessibility, and separate applications health administrators utilize in traditional models of disseminating evidence-based health care decision making.17
Stephen Covey et al.18 have has provided the allied health professions with a series of important issues in preparing for the year 2020. The professional with 2020 vision needs to be a person with the following characteristics. The first is self-awareness, which is the capacity to stand apart from one’s losses and examine one’s thinking, motives, and history to understand oneself. Self- awareness makes it possible for allied health professionals to become aware of our development and recognition as health care providers to the world community. Michael Hammer and Steven Stanton, in their book The Reengineering Revolution, make the point that all change will bring some loss and will require grieving. Covey challenges us to understand the internal guidance system, that self- awareness and development of conscience that allows us to sense and understand ourselves within new models of health care delivery. The extent to which we engage this force is the extent to which we prepare ourselves for change and adaptation in both delivery of health administration and the educating of the whole person-the health promotion and disease prevention component.
The third endowment that Covey discusses is that of independent wealth, which focuses on one’s understanding of what competencies and skills each brings to the world table of health competencies and the ability as scientists to act in our best interest as well as in the best interest of others. While recognizing that multicultural, environmental, and genetic factors may affect the way in which individuals take action, we must recognize that these influences do not have to limit us in our quest for relevant application of science. Together with self-awareness and conscience, health care professionals must be able to obtain responsibility for new models of intervention and move toward a “vision” for change in the health and well-being of a global population.
The final of the human endowments discussed by Covey et al.18 involves creative imagination, which is the power to envision the direction for which we are responsible as both persons and professionals. As allied health professionals, it is this endowment that enables us to see ourselves as well as our colleagues differently and from a new perspective. As health administrators who examine the changing components of our profession, we recognize that both the insights and the vision of all those who have contributed to the profession are recognized and appreciated for the evolving dynamic model of scientific understanding and the contribution that health administrators have made to society and to the world for the new millennium.
Allied health professionals with 2020 vision must consider a number of important factors for the first two decades of the 21st century.
* Enhanced public education will emerge designed to educate the public about the value of prevention and health promotion. Programs will utilize multimedia and telehealth approaches in providing consumers with accurate and understandable information. Strategies for health administrators and practitioners in educating the public and marketing services will be an essential part of the public education program.
* Allied health professionals will require a cutting-edge understanding of the international marketplace academically, educationally, economically, socially, culturally, ethically, and politically.
* Allied health professionals must embrace a holistic perspective and bridge the multicultural similarities and differences we have come to realize among the various countries and cultures of the world.19
* Allied health researchers will engage with empowered groups of educators, practitioners, and consumers and will facilitate rather than direct changes and new directions in health care delivery.
* Quality control testing and evaluation will be replaced by a complex analysis system and networks that will analyze how learning styles, consumers, and genetic factors influence behavioral markers that result in decision making and compliance with health promotion and disease prevention.
* The use of clinical monitors will aid in assessing both physical and psychological markers for a spectrum of disorders served by the allied health professions. Much like the pacemaker and blood glucose monitors, these microbackpacks will assist in regulating physical and psychological stability for consumers in need of this technology. This level of intervention has already appeared in certain areas of the world.
* Allied health professionals will by necessity be multiskilled information specialists serving new alliances of clinicians, researchers, and educators for health care delivery.
* Scientists, clinicians, and administrators in allied health will realize new paradigms of service provision that will include algorithms and pathways of care mediated by genetic factors, technology, and new interventions for health care delivery.
* Dissemination of prevention research findings will occur through classic courses at all levels of education. Education will be offered in grade schools, high schools, and universities through new technology with specialized distance learning technologies. This will feature the world’s most competent educators, scientists, researchers, and professional practitioners in health care, all sharing in the educational process to improve the instructional paradigms of allied health education.
* Allied health prevention specialists will have aligned with scientists to develop new models of testing that integrate biochemical, genetic, and psychological markers into standard clinical profiles.
* World consciousness will grow to ask for an ethical and moral conscience with respect to worldwide provision of health promotion and disease prevention.
* Barriers and borders that currently limit the transnationalization of allied health education and professional practice will yield more international exchanges of education through distance education and coursework offered to create an international body of professionals who will be free to live, work, and practice their clinical skills internationally.
* The Human Genome Project,20 genetic mapping, testing, and genetic diagnostics will lead allied health professionals to improved identification of highly “at-risk” individuals for selective interventions that will be accomplished through genetic therapeutics.
* Prevention education programs for health and wellness will be successful in producing convenient and schoolbased “health super centers” that feature health food, exercise, medical screening and care, health counseling, vitamin counseling, and health promotion and disease prevention education that will improve quality of life and manage various medical conditions.
* Educational curricula will become more standardized across university training sites, thus allowing for the accrediting of educational training and practice over a wider area than is currently practiced. This will be done to encompass as large a geographic area as necessary that would be not necessarily be limited by countries. Larger geographic demarcations are likely, such as the European Union as an example. This will allow education and clinical standards to be implemented to reach the largest target population possible. This strategy is already taking shape in Europe. The Treaty of Bologna has allowed all of the educational institutions within the European Union the opportunity to establish a single set of guidelines to govern all instruction and curricula of the educational programs within the European Union member states by 2010. The impact of this unique initiative to further promote educational unity with the European Union will not only further promote globalization but will also place pressure on the United States to move in this direction. This may be an absolute if the United States is to maintain its technological edge in education and clinical practice of its educational programs in general and its health care programs specifically. * New alliances in prevention education, law, and science will emerge with health administrators, practitioners, and consumers as significant partners in health care and reform efforts. Lifelong education, the SMART Medical Home, and information awareness with a “health promotion” emphasis become the critical ingredients in improving quality-of-life issues for all age levels and the members of the world community.
These visionary concepts provide areas in which the allied health community can begin to address changes likely to occur during the first quarter of the 21st century. The issues confronting allied health professionals today are increasingly complex and varied in content. In the domains of academics, research, industry, and health care, health care professionals with 2020 vision represent an enormous wealth of talent and energy, competency and capability, cost-effective models of health care in practice, science, research, and service. The effects of technology and automation; the influence of global, social, economic, and political changes; and our role and responsibilities as health care professionals have been explored. Allied health professionals with 2020 vision must have clarity of vision for the future and the competency to adapt to forces of change for the benefit of science and practice for the world’s consumers of competency-based health care.
The authors thank Robert F. Kraus, MD, Scott Hasson, EdD, Mike Zito, FT, David Tiberio, PhD, Tom Holcomb, EdD, Jeanine Adams, EdD, OTL, Katherine Hegedus, RN, DSN, Lane J. Veltkamp, MSW, Joseph Smey, EdD, and colleagues in the Allied Health Professions, Alpha Eta, and the North American Consortium of Nursing and Allied Health for support and assistance, as well as graduate students Kathy Long, PA- C, Bruce Elliott, PT, Cheryl Marzenac, OT-L, Michelle Moder, MS, RD, Janet Saier, MS, Kate Bassouda, BS, Tag Heister, MLS, and Jill Livingston, MLS, for their assistance in the preparation of this manuscript.
1. Web-based Education Commission: The power of the Internet for learning: moving from promise to practice. Washington, DC: Webbased Education Commission to the President and the Congress of the United States; 2000. Available at: http://interact.hpcnet.org/ webcommission/index.htm.
2. VandenBos GR, Williams S: The Internet versus the telephone: what is telehealth, anyway? Prof Psychol Res Proct 2000; 31:490- 492.
3. U.S. Department of Commerce: A nation online: how Americans are expanding their use of the Internet. Washington, DC: U.S. Department of Commerce; February 2002. Available at: www.ntia.doc.gov/ntiahome/dn/index.html.
4. Wood J, Miller TW, Hargrove S: Telehealth applications in clinical supervision for psychology. Prof Psychol Res Pract 2005; 36:173-179.
5. Hilty D, Marks S, Urness D, et al: Clinical and educational telepsychiatry applications: a review. Can J Psychiatry 2004; 49:12- 23.
6. U.S. Department of Public Health: Healthy People 2000. Available at: http://HealthyPeople.gov. Accessed Feb 7, 2006.
7. U.S. Department of Public Health: Healthy People 2010. Available at: http://HealthyPeople.gov. Accessed Feb 7, 2006.
8. Maastricht Agreement. Int Compar Law Q 1994; 42(2):213-237.
9. Trofino J: Transformational leadership in health care. Nun Manage 1996; 26:42-47.
10. Miller TW: The psychologist with 2020 vision. Consult Psychol J Pract Res 1998; 50:25-35.
11. Miller TW, Ryan M, York C: Utilizing algorithms and pathways of cate in allied health practice. Internet ] Allied Health Sci Pract 2005; 3(2):l-8. Available at: http://ijahsp.nova.edu/articles/ vol3num2/
12. Miller TW, Suchinisky R, Kraus RF, Leukfeld C: Clinical algorithms and critical pathways in health care. ] Contemp Psychother 1997; 27(4):119-123.
13. DeLeon P, Crimmins D, Wolf A: Afterword: the 21st century has arrived. Psychother Theory Res Pract Training 2003; 40:164-169.
14. Miller TW, Jarrin O: Telemedicine applications for ADHD in underserved populations. In: Columbus F (ed). Progress in Attention DeficitlHyperactivity Disorder Research. New York, NY: Nova Science Press; 2005.
15. Miller TW, Miller JM, Burton D, et al: Telehealth: a model for clinical supervisions in allied health. Internet ] Allied Health Sci Pract 2003; 1(2):1-12.
16. Shetet JL: Five trends shaping future labor force. Hosp Health Networks 2003; 67:30-31,35.
17. Lenhart A: The ever-shifting Internet population: a new look at Internet access and the digital divide. Washington, DC: The Pew Internet and Ametican Life Project; 2003. Available at: www.pewinternet.org/ reports/toc.asp?Report=88.
18. Covey SR, Merrill AR, Merrill RR: First Things First. New York: Simon and Schuster; 1994.
19. Miller TW, Elliott B, Long K, et al: Telehealth home applications for adults with developmental disabilities. Telemedicine e-Health 2006; 12:57-65.
20. Mrzek D: The new genetic paradigm: application to prevention intervention research. Presented at: annual convention of the Society for Prevention Research; June 24-27, 1999; New Orleans, LA.
21. Global Task Force Report: Reshaping pathology and laboratory medicine for a flat world. Pathology Today 2006; 3(6): 1. Available at http://www.ascp.org/aboutus/newsroom/pdf/Nov_06_Web.pdf.
Thomas W. Miller, PhD, ABPP
Vincent S. Gallicchio, PhD, MT(ASCP), CLS(NCA)
Dr. Miller is Professor, College of Medicine, University of Kentucky, Lexington, KY; and Dr. Gallicchio is Associate Vice Ptesident for Research and Economic Development, Director of the Office of Sponsored Programs, and Professor of Biological Sciences and Public Health Sciences, Clemson University, Clemson, SC.
Received February 22, 2006; revision accepted August 29, 2006.
Address correspondence and reprint requests to: Thomas W. Millet, PhD, ABPP, College of Medicine, University of Kentucky, 3470 Blazer Parkway, Lexington, KY 40509-1810. Email [email protected]
Copyright Association of Schools of Allied Health Professions Winter 2007
(c) 2007 Journal of Allied Health. Provided by ProQuest Information and Learning. All rights Reserved.