It Takes a Community to Make an Expert: Exploring Professional Expertise Amongst Allied Health Professionals

Abstract

This thesis explores the nature of professional expertise amongst allied health practitioners in New Zealand. Particularly focusing on highly-experienced allied health (therapy) practitioners, it identifies elements of expertise that are valued within workforce communities and that are exemplified by a collection of practitioners. The thesis offers a multidiscipline and multidimensional study of expertise and develops new understandings of highly-experienced allied health professionals and their relationships with work. Speech-language therapy is the initial practice context which later expands to include dietetics, physiotherapy, occupational therapy and other therapeutic professions. Participants were mostly female and did not identify as Māori or Pacific peoples. First, an analysis of online survey data from speech-language therapists captures aspects of expertise that they value highly. The survey identifies a set of themes that characterise experts within the speech-language therapy community. Second, a narrative review of the literature focuses on professional confidence as a key factor in expert performance for allied health professionals. The review discusses both internal and external factors that influence the development and maintenance of professional confidence and identifies current limitations of knowledge beyond the first few years of practice after qualifying. Third, a typology of allied health practitioners’ work orientation is constructed. Analysis of interview data from practitioners across more than six therapy professions suggested four conceptual types along two dimensions. The diversity of work orientation and its relationship to the development and maintenance of expert performance is discussed. Fourth, a mixed method study explores critical incident narratives that highly-experienced practitioners told about their work. Affirming, challenging and otherwise transformative incidents form a backdrop to detailed narrative study that highlights the practitioners’ search for meaning and the role that meaning plays in the development and expression of expert performance. From these four investigations, findings are brought together to inform what it might take to become known as an expert AHP. The findings highlight the value of experts and the roles they can play in their professional communities. A set of recommendations for practitioners and stakeholders including colleagues, managers and supervisors is identified. Overall, the thesis indicates that professional confidence and expertise are intrinsically linked and can be explicitly developed, through knowledge sharing, reflective practices and narrative reframing. Each professional community has an essential role in developing and encouraging experts to emerge. The significance of professional expertise is highlighted throughout the thesis, as are the possible causes and consequences of a shortage of professional experts.