Table 4 Themes and representative quotes (with type of AHA position)

Underutilisation of AHAs due to:

• Limited understanding of the scope of the AHA role or knowledge of AHA tasks.

“It appears that there is clarity required (consistency) around what is ‘in scope’ for a Social Work Assistant (SWA) role - this requires significant further discussion and input from all team members” (Full (standard) Scope: Metropolitan, Discipline-specific, Hospital)

• Limited time for AHA training and skill development

“Some of the duties require more training - so are not being performed yet, but may be in future” (Full (standard) Scope: Regional, Multidiscplnary, Hospital)

• Unwillingness of AHP to delegate to AHA

“AHP withheld some tasks perceived to be inappropriate for AHA. Training in supervision and delegation to assistants would be helpful”. (Advanced scope: Rural, Multi-disciplinary, Community)

• Insufficient analysis of AHP role to determine tasks that could be safely delegated.

“Needs further definition of the task requirement and some structure around delegation of ‘when’ [it is] appropriate for the OTA to be delegated this task “. (Advanced Scope: Metropolitan, Discipline-specific, Hospital)

• Insufficient confidence/or skills on part of the AHP to delegate effectively.

“AHP are not satisfied that the AHA has had enough exposure/experience to complete this task yet without supervision” (Full (standard) scope: Remote, Multi-disciplinary, Hospital).

• Lack of an established relationship or confidence in the AHA

“Some duties have been performed … but since the current OT has begun [these tasks] have been ceased either due to AHA feeling they didn’t have sufficient competency or OT feeling it wasn’t in the AHA’s scope”. (Full (standard) scope: Regional, Multi-disciplinary, Hospital)

Advanced level exists in practice – some AHAs are working independently with relatively complex patients.

“[The advanced AHA ] Identifies and conducts quality improvement activities…with guidance and prompting from supervising AHP, simple ideas can be initiated into improvements in processes ” (Advanced scope: Metropolitan, Discipline-specific, Hospital)

Contextualised role descriptions more accurately reflect duties than generic role descriptions

“Physio is OK, OT and SP not to full scope. Duties statement needs revising and rewording. Difficulties with having a multi-disciplinary role. Maybe discipline-specific would work better”. (Full (standard) scope: Metropolitan, Multi-disciplinary, Hospital)

‘On the job’ training, as part of a formal qualification or not, is the most appropriate and accessible form of training

“[The] AHP reported a high level of training and supervision was required and provided to support skill/task development [in the AHA]” (Advanced scope: Regional, Discipline-specific, Hospital)

Relatively few of the evaluated AHA roles had a formal training plan in place

“[There was] limited training provision for AHA due to the isolated location and no structured training plan”. (Full (standard) scope: Remote, Multi-disciplinary, Hospital)

Certificate IV was insufficient training for advanced scope roles

“Cert IV not enough for advanced role - needs higher level training”. (Advanced scope: Regional, Multi-disciplinary, Community)

AHAs reported the amount of formal supervision from AHPs was inadequate

“[AHA] reported … formal supervision has predominately centred around the Cert IV training and achievement of competencies which [she] felt was not adequate to continue her professional growth” (Full (standard) scope: Discipline-specific, Metropolitan, Hospital)

It takes 6 months for AHAs to reach effective skill level. Longer for trainees and advanced scope roles.

“[The AHA took] a long time to train (more than 6 months). Informal training process was ad-hoc. More formal supervision would be of benefit. AHP’s confidence in AHA [is] low” (Full (standard) scope: Metropolitan, Discipline-Specific, Hospital)