BARRIERS AND FACILITATORS TO EFFECTIVE IMPLEMENTATION OF THE ESTABLISHED CLINICAL SPECIALITIES IN NIGERIA

Background: Improving the quality delivery of physiotherapy (PT) interventions to patients has been linked to advanced clinical skills and knowledge; advanced clinical reasoning and judgement of the PT clinicians. Hence, the need for physiotherapists to develop and demonstrate higher levels of knowledge and clinical specialisation competencies as supported by the World Physiotherapy Congress.  Available evidence suggests improved patient outcome when exposed to speciality focused care than generalised physiotherapy care.

Purpose: The training need assessment was carried out with the committee of heads of physiotherapy departments in Nigeria during their annual conference/ AGM  in 2019. The focus is on effective implementation of the established clinical specialties for quality delivery of physiotherapy interventions to patients. In addition to the training needs assessment, this study examines barriers and facilitators to effective implementation of the established clinical specialities in Nigeria.

Methods: This is a cross-sectional study. It is both descriptive and exploratory in nature. Structured questionnaires were distributed to heads of physiotherapy departments (n=30) at their annual national workshop/conference in 2019.  A convenience method of distribution was utilized. Data was collected on demographics, knowledge of clinical specialities, number of trained PT specialists and availability of specialist units. Qualitative data were collected using structured self-reported questions on perceived facilitators and barriers to effective implementation of the established clinical specialities. Descriptive statistical analysis and thematic framework analysis were applied to the data.

Results: Barriers to effective implementation include – staff shortage, lack of funding for specialist training, limited space, institutional politics and lack of personal motivation. The facilitators include management support, postgraduate training, adequate staffing, interprofessional collaboration and good clinical practice. The findings led to a capability building training on implementation and improvement science. Participants (100%) reported increased knowledge of implementation science.

Conclusion(s): The study demonstrates the need for capability building training on implementation theories, tools and methods for physiotherapists. Designing a specialised training for physiotherapists increased the impact of the training. The feedback from the capability building training shows an improved understanding on how to embark on collaboration, advocacy for funding and management support for effective implementation. Building leadership capabilities for clinical leads including physiotherapists is one of the ways to improve quality of care delivery in health care facilities. 

Implications: For educational institutions: There is a need to include policy development, implementation and improvement science in physiotherapy education curriculum at post graduate level.
For practitioners: Continuous professional development training is a necessity for physiotherapists to improve their leadership capability and practice.

Funding, acknowledgements: None

Keywords: Clinical specialities, Implementation science, Leadership capability

Topic: Professional issues: business skills, leadership, advocacy & change management

Did this work require ethics approval? No

Institution: The organisers approved the survey distribution.

Committee: None

Reason: No experiment or clinical intervention intended at any stage. Participants voluntarily participated in the training.