From a solo practitioner providing home visiting physiotherapy services for people with a neurological injury, Steve Woollard APAM spent more than a decade building up his practice in Melbourne to around 35 people.

Steve didn’t know it at the time, but when the NDIS was rolled out in 2016 his practice was perfectly positioned to hit the ground running.

After starting NeuroRehab at Home (later to become the NeuroRehab Allied Health Network (NRAHN)) in 2005, Steve and his team had experience of working with compensable clients through Victoria’s Transport Accident Commission and with publicly funded clients as part of the Victorian Slow to Recover Program.

This mix of treating both publicly funded and compensable clients coincided with an expansion of multidisciplinary services at NRAHN to include exercise physiology, occupational therapy, speech pathology and psychology.

‘So when the NDIS came to Melbourne, our systems were ready for the change in the public funding of services for people with a disability,’ Steve says.

‘We were already a fee-for- service provider that was ready to accept NDIS clients—and we were really responsive.

'We’d developed a really good team; the business grew very rapidly once the NDIS started to kick in.

'Over the last six years we’ve gone from around 40 people to now having more than 200 people in the organisation.’

Steve Woollard

Demand for services from NDIS participants through NRAHN has been high from the start, so much so that there are often waitlists of participants wanting service provision.

At times the demand has been so high that the waitlists at NRAHN have been at capacity.

As the director of NRAHN, Steve says employing new graduates and early career physiotherapists to help the organisation meet that demand has been an important part of the business growth strategy.

‘Our organisation now caters to about 5000 people, and the majority of them have an NDIS plan because they have some form of permanent disability that will be ongoing.

'We’re working towards providing our clients with more ability and function,’ Steve says.

‘So there is a lot of support that is needed for junior workers to come into the NDIS sphere. And we look after our people really well.’

NeuroRehab Allied Health Network’s head of clinical services, physiotherapist Teekay Harbidge APAM says physiotherapy services are among the highest in demand at NRAHN.

The organisation employs around 35 physiotherapists—and that number is steadily growing.

Each year there is a specific number of new graduate and early career physiotherapists taken in at NRAHN so as to match the provision of learning resources available to them as each embarks on their career pathway.

‘With our new graduates and early career practitioners, we invest a lot in training.

'From the time of onboarding we ensure that they’re well supported.

'We find them a peer support buddy, which is similar to a mentoring program where the buddy provides coaching, guidance and motivation.

‘We also have a very detailed supervision structure for our new graduate and early career clinicians.

'It starts off with one hour per week for the first three months, in addition to that peer support buddy who is with them for four months initially.

'Then it goes into an hour a fortnight, with the addition of that peer support as required. After seven months, it becomes one hour per month.

‘We also run a program called the Nest, where we detail various topics around working in the NDIS space.

Teekay Harbidge

'We provide training in terms of investing in their professional development and we have an open-ended budget so that they can undertake courses that are really relevant to their case load,’ she says.

‘We run in-house PD courses specifically for the physiotherapy department.

'We have a program called the early career tutorial, in which an experienced physiotherapist will provide training on a specific topic and go in-depth.

'Those topics might include spasticity assessment and management, clinical reasoning and motor learning, neuroplasticity, and Pilates training and assessment—which might be covered at university, but not in depth. We also have hands-on training in order to broaden their skill set.’

 Teekay, who graduated in the Netherlands and came to Australia for her second-year physiotherapy work placement and stayed, says the multi- layered approach when welcoming new graduates and early career clinicians to NRAHN also includes having them shadow more senior practitioners.

Although some might think this a time-intensive endeavour, Teekay says the pay-off is in having the skills gap minimised in new graduates and early career clinicians.

Steve says there is also a big focus on case allocation with new graduates and early career clinicians at NRAHN.

The organisation’s allocation managers carefully evaluate the incoming referrals and match them to a particular skill set, ensuring that new graduate and early career clinicians are working within their scope.

‘We’re certainly not an organisation that gets a referral and passes it to anyone.

'It requires tailoring of a case load to ensure that the right therapist with the appropriate level of skill set is matched with the client to ensure that the client is provided with the level of care that is suited to their needs.

'This means that new grads are not allocated complex cases’, Steve says.

‘We then slowly, progressively, increase their complexity with the type of client they take on.

'They may start with a basic case load and take on perhaps one more complex one, which is overseen by a supervisor and in which there is more communication 
about and management of, to ensure they’re on the right track.

'Or they might organise a joint session with their supervisor to see that particular client, to make sure that they are on the right track and that they and the client are progressing.’

In the first year with the NRAHN, new graduates and early career clinicians join career planning meetings held at the three, six and 12-month intervals.

Teekay says the meetings provide the opportunity to focus on goals, celebrate successes and give feedback as to what is going well, as well as outline areas
for growth and improvement.

The meetings also help set expectations and goals for the coming months ahead and identify training needs to match the team members’ areas of interest and expertise.

Teekay says NRAHN also invests in its managers so they then have the capability and capacity to help develop new graduate and early career clinicians as the latter take on work with clients who have more complex needs.

‘The managers are an integral part of our team as they are instrumental in directly developing and shaping our young clinicians, which makes a difference,’ she says.

This goes hand-in-hand with a carefully curated culture, which last year saw NRAHN named as the 20th best workplace in the Australia, Steve adds.

‘With us it’s about fully caring for our clients and also fully caring for our team members.

Young NDIS client Jayden rides his trike to get in some exercise. Photo: Everyday Independence.

'That means we are looking out for their professional development, it’s why we have a really strong, big budget for professional development, and we make sure that our people are always learning.

‘They’re always supported by their supervisors and the team leaders.

'By ensuring their growth is at the centre of our mind, that’s also helping with staff retention, which is so important because there is such demand for NDIS work.’

The fully mobile model

As a fully mobile practice operating in northern New South Wales, Community Therapy has a unique model of care for the onboarding and training of new graduates who join their team.

Director Scott Lynch APAM says supporting junior therapists starts with an extensive buddying and shadowing period where the new graduate will go out on the road with a more experienced practitioner to see how they run their day-to-day case load.

‘It’s important that they see how our clinicians schedule their days and manage their tasks across the mobile phone, laptop and all the different pieces of software that we use to make community service provision possible,’ Scott says.

‘There is quite a lot of complexity with community services as opposed to being in a private practice or hospital.

'You’re a clinic on wheels, so there are lots of moving parts.’

Scott founded Community Therapy five years ago after discovering his passion for working with older adults in residential aged care while on the team at a private practice.

Reaching meaningful goals and really enjoying chronic disease management inspired him to want to work more with patients with complex conditions, disabilities and those with multiple comorbidities as well.

Then, he says, there was a natural transition to also supporting younger adults and middle-aged adults living with disabilities.

Scott Lynch

He branched out alone and began working predominantly in residential aged care facilities and with older Australians in the community—around the same time as the NDIS was being rolled out across the country and there were changes through community aged care reform.

‘Both of those were very much on brand with our main focus at Community Therapy.

'We started doing a lot of community support for older adults and people living with disabilities, and that remains our mission and vision of supporting older adults and people living with disabilities with allied health services,’ Scott says.

‘We operate across our local area health districts of the Central Coast and the Hunter New England.

'Over the past five years we’ve grown to be a multidisciplinary allied health service; we’re not a clinic as such because we’re fully mobile.’

Community Therapy’s team of 90 employees supports NDIS participants with physiotherapy, dietetic, occupational therapy, exercise physiology, massage therapy, speech pathology and therapy assistant services.

Adults living with a disability form the majority of clients, particularly those with physical disabilities, although Scott says the organisation has progressively expanded support to people living with psychosocial disabilities.

‘One of the important parts about supporting people who have funding through the NDIS is really understanding your suitability to support them.

'So we look to understand the scope of practice and suitability to support our team members, ranging from new graduates all the way up through to seniors,’ Scott says.

‘That means evaluating who each team member is best-placed to support or what support they may need to expand their scope of practice and skills.

'This has direct impacts on client results and evidence-based practice of what you can deliver and it has large ramifications across culture and retention of your team.’

New team members and new graduates who join the organisation are well supported through what Scott says is a graded approach to case management.

‘We are making sure that we progressively increase therapists’ case loads, especially with respect to complex NDIS assessments early on. 

'If somebody hasn’t worked in the NDIS before, there are a lot of things that people won’t be used to. For example, there is a lot of terminology involved.

'There are a lot of different NDIS acronyms, the ins and outs of NDIS plans and service agreements to start learning.

'Other stakeholders in the NDIS, such as support coordinators, local area coordinators or planners, will expect that you know this,’ Scott says.

 ‘Even those who have been working in the sector for many years… it’s rare to have a very broad understanding of all the moving parts.

'Being a part of an experienced NDIS team is really important for new grads so that they have that support to navigate the scheme.’

Scott says as well as having a clear onboarding checklist of steps for new graduates, Community Therapy has a robust library of different instructional videos, tutorials and handbooks for access by new graduates and early career physiotherapists.

These can be accessed at any stage of their career progression, he says.

‘I think an important part of workplace wellbeing when NDIS is part of someone’s case load is making sure there is clear support and systems in place and to support people through new learnings.

‘It is also important to have realistic expectations of KPIs if that’s the way your team is functioning.

'As a team, we are not KPI-focused and I know that is unusual.

'Instead we are more clinical outcome-focused. We have found that therapists like to be busy helping people and that tracking and reporting billable hours KPIs to the team did not work for us.

‘Instead, we continue to improve our systems and foster a positive workplace culture focused on wellbeing and clinical excellence.’

Multi-faceted support structure 

Clinical supervision is a thing of the past at Everyday Independence, which actively manages more than 10,000 NDIS participants and is one of the largest NDIS providers in Australia.

Physiotherapist Ingrid Cole, the Managing Director of People at Everyday Independence, says new graduates and early career physiotherapists who join Everyday Independence are immersed in a world-leading social model that delivers real change in the community.

‘Our vision at Everyday Independence is for all Australians to engage in everyday life as valued members of their community.

'To deliver on this vision we actively recruit passionate practitioners committed to changing the game for our participants.

'We provide team members with an enriching learning environment that offers the best support and guidance to master their skills and deliver life-changing outcomes.

‘Our mentoring and coaching is a multi-faceted support structure that includes an eight-week induction program delivered face-to-face and online, a
12-month new graduate program and weekly therapy mentoring.

'New graduates also have immediate online access to a senior clinician.'

Ingrid says each of the cross-functional support structures is fit for purpose; however, each has a common goal of keeping new graduates and early career team members learning, growing and developing. 

Everyone employed at Everyday Independence has a growth plan and is part of a working alliance that includes all team members at all levels of the business, she says.

Ingrid Cole

‘We broke up clinical supervision into two main areas: mentoring, so that’s on-the-ground training to support people going out with each appointment, and coaching.

‘Coaching is different because it’s grounded in the understanding that the team member knows the answer and enables them to dial the coaching up or down as needed to build their skills and confidence as a therapist,’ Ingrid says.

‘Our induction program also focuses on what they need to become a great disability practitioner and creates an understanding of our organisation’s culture and values.

‘Along with our everyday therapy mentoring, we have senior clinicians available each morning for our grads to connect with.

'They can be out in the field or writing a report and they can tap into a senior clinician as needed.

'What we have learned is that graduates need more discipline-specific mentoring than two, three or four hours.’

With more than 700 team members, of which around 500 are allied health professionals, the business employs around 60 physiotherapists at any given time, Ingrid says.

A decision was made early on at Everyday Independence to divert as many of the administrative tasks away from clinicians as possible to free them up to focus on their clinical work and professional requirements.

This also provides the more senior clinicians with time to mentor and coach the next generation coming through; between 15 and 20 graduate physiotherapists are employed at Everyday Independence each year.

Ingrid says the learning model for grads is the 70, 20, 10 model—70 per cent on the job, 20 per cent social and community learning, and 10 per cent formal learning.

‘Formal learning can include reading journals, professional development, that sort of thing.

'We find that getting the 70 per cent right is where their confidence really increases because they’re out and about seeing and doing,’ Ingrid says.

'This year, Everyday Independence has also introduced Communities of Practice, where all new graduate physiotherapists come together as a group for scenario-based learning.

Ingrid says it is also one of the ways the business helps to harness the talents of its high-achieving team members, of which physiotherapists are a huge part.

‘We do find our physiotherapists progress their careers into leadership probably faster than any other discipline,’ Ingrid says.

‘The needs and goals of NDIS participants, as well as access to the services they require, are at the heart of the work we do at Everyday Independence.

'Working collaboratively through an interdisciplinary approach, new graduates and early career physios are encouraged to put the participant first from the outset.

‘The goals are the person’s; the physiotherapists and all the other professionals feed into that, as opposed to a person having physiotherapy goals, occupational therapy goals and speech therapy goals,’ Ingrid says.

‘The person with the disability is the expert and the therapist is a coach or facilitator.

'The reason the grads do that so well is that they are open to learning and they integrate into that interdisciplinary team.

‘This is what a future fit practitioner is and it is an exciting time to learn and be a physiotherapist at Everyday Independence.’