E. Farquhar1, A. Moran2, D. Schmidt3
1Wagga Wagga Base Hospital, Murrumbidgee Local Health District, Physiotherapy, Wagga Wagga, Australia, 2Albury Wodonga Health, Department of Rural Health, Albury, Australia, 3Health Education and Training Institute, Rural Research, Bega, Australia
Background: Longstanding gaps in physiotherapy service delivery exist in rural areas across Australia. There is a lack of appropriate physiotherapy business models and strategies to get services where they are needed. In response to this, a large public rural health organisation contracted a private physiotherapy business to implement a public-private partnership to provide physiotherapy services to hospital inpatients, aged care facility residents and outpatients in four outer regional Australian towns. Treatment rooms were provided by the health organisation for the private physiotherapists to see clients.
Purpose: This study investigated the success of a rural private-public partnership model of service delivery. This study explored how stakeholders defined success and examined if the model was successful according to stakeholder definitions. Barriers and enablers (mechanisms) to success were identified and linked to stakeholder defined success measures.
Methods: A qualitative study was conducted using a Constructive Inquiry design. Participants were purposively recruited, via email invitation and telephone follow up. Participants comprised managers and clinicians from the rural public health organisation and the private physiotherapy business involved in setting up or working within, or alongside the partnership. Semi structured interviews were undertaken with all participants. Data were transcribed verbatim and analysed using Framework Analysis. Program Logic was used to synthesise all information.
Results: Individual interviews were conducted with 5 staff from each partnering organisation, including managers and clinicians (total n=10). Two main themes and three sub themes were identified. All participants described the model as being successful. Elements of success included improved access to local services and satisfied stakeholders. Three mechanisms that led to successful implementation of the service delivery model were identified. The first mechanism was the provision of human and multiple other resources, which included the workforce model and the use of multiple resources for the partnership. The second mechanism was stakeholder engagement, which included having motivated stakeholders and consistent stakeholders. The third mechanism was streamlined processes, which included the content of the contract and referral schedule, streamlined administration processes for contracting and accounting, having processes for managing private therapists in a public setting as well as processes for communication.
Conclusion(s): This study demonstrates that an innovative physiotherapy public-private partnership model of service delivery can be a successful way to improve access to physiotherapy services in rural areas. Achieving success is contingent on mechanisms such as those identified in this study.
Implications: Public-private partnerships have potential to address service gaps in hospital, residential aged care and primary care in rural areas. Public-private partnerships may provide yet another solution to improving access to healthcare and through this the health, wellbeing and quality of life of rural people. The mechanisms described to successfully implement the model should be considered when setting up similar partnerships in rural physiotherapy.
Funding, acknowledgements: This research was supported by the New South Wales Health Education and Training Institute’s Rural Research Capacity Building Program.
Keywords: rural, contracting, workforce
Topic: Service delivery/emerging roles
Did this work require ethics approval? Yes
Institution: Murrumbidgee Local Health District
Committee: Greater Western Human Research Ethics Committee
Ethics number: HREC Reference No. LNR/17/GWAHS/41 (GWAHS 2017-033)
All authors, affiliations and abstracts have been published as submitted.
