This study aimed to explore how the current use of delegation is informed by the culture within the clinical setting as well as views, attitudes about and experiences of delegation among physiotherapists, physiotherapy support workers, physiotherapy managers and patients.
A focused ethnographic study was conducted in the musculoskeletal outpatient physiotherapy services of two NHS (National Health Service) Trusts, in the United Kingdom . This included two weeks of participant observations and semi-structured interviews with physiotherapists, physiotherapy managers and support workers. In total, 19 patient interviews and 23 clinician interviews were conducted. Data analysis was informed by Roper and Shapira's framework.
Eight main themes emerged from the data: reasons for delegating tasks to support workers, delegation process, facilitators of delegation, barriers of delegation, how to improve delegation practice, patients’ awareness about clinical roles, patient’s experience about treated by a physiotherapy support worker and patients’ preferences. Patients who were treated by a support worker reported that they were not always aware that the treating healthcare professional was not a physiotherapist. Clinicians who delegated clinical activity to support workers, either did not explain clearly to patients that they would be referred to a support worker or when they did, patients did not retain the information. Patients reported that overall, they were satisfied with the treatment they received from the support workers and that seeing the same clinician, waiting times for the first follow up treatment, number and frequency of follow up treatments and mode of treatment were all felt to be characteristics of a good physiotherapy service. Physiotherapists highlighted that they had no undergraduate or any formal training on delegating clinical tasks to support workers. Clinicians’ perceptions and attitudes towards delegation, lack of a competency framework and appropriate training for physiotherapists and support workers, long waiting lists to see the support workers and not having the appropriate facilities were described as delegation barriers. On the other hand, having a clear and thorough delegation process, including a safety net to identify patients who need to be reassessed by the physiotherapist, defining the role of support workers, good communication and team working, having the appropriate skill mix in the physiotherapy team and appropriate training for physiotherapists and support workers were reported as facilitators of delegation.
The findings highlighted the importance of providing a clear explanation to patients about whether they are being treated by a support worker or physiotherapist. Having a clear and thorough delegation process and appropriate training for both physiotherapists and support workers were viewed as essential in facilitating the delegation of clinical tasks to support workers.
The results have informed the design of a discrete choice experiment to elicit patients’ preferences about the use of delegation to physiotherapy support workers within musculoskeletal physiotherapy services and they will contribute to the development of “best practice” recommendations to guide physiotherapists in delegating clinical work to physiotherapy support workers.
delegation
skill mix
