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Jenkins F.1,2
1Cardiff and Vale University Health Board, Executive, Cardiff, United Kingdom, 2JJ Consulting Healthcare Ltd, England and Wales, United Kingdom
Background: Patient outcomes and experience are influenced by the way physiotherapists are organised and managed. A changing health reform agenda has frequently challenged management arrangements for physiotherapy. Impacts are documented for medicine and nursing but much less so for the United Kingdom's third largest profession, physiotherapy. This PhD study contributes to the management evidence-base for physiotherapy.
Purpose: A PhD study to evaluate the impact of health service reforms on physiotherapy analysing the resulting management structures in England and Wales and the impact of different models of management structure and their impact on patient care, staff development and manager's roles.To provide evidence for other physiotherapists and managers when faced with organisational re-structuring.
Methods: An observational mixed methods research design, including a narrative literature review; questionnaire census survey; semi-structured interviews; physiotherapy narrative history; and a normative evaluation of physiotherapy management structures.
Results: Health service reforms had impacted on the structure of physiotherapy management impacting on patient care and the organisation of physiotherapists. The main changes to physiotherapists roles were changes in employing organisation and the structures within them. The type of structure influenced the governance arrangements, the potential for staff development, access to specialist physiotherapists and ultimately the quality of care to patients. The introduction of competing providers in England differed from the system in Wales. A preference for professionally-led models of organisation was widely reported.
Conclusion(s): Most physiotherapists were managed within cross-allied health profession (AHP) structures. Devolved and fragmented structures were increasingly emerging but physiotherapists reported a preference for professionally-led structures which gave improved patient outcomes and experience. The contribution of physiotherapists to patient care were acknowledged in professionally-led structures with professionally-led governance structures being favoured. Physiotherapy managers ranked the AHP Directorate model the highest, and the fragmented structure the lowest. The AHP professions will need to consider merging together to maximise their combined contribution to patient care, or risk the disadvantages of being fragmented and devolved.
Implications: An understanding of the roles, responsibilities and functions required to effectively manage a physiotherapy service to provide good patient experience, as well as the merits of different management structures will enable the profession to influence its management arrangements when faced with organisational restructuring. To improve patient care physiotherapists would do well to consider being organised with other AHPs to give critical mass and strengthened governance.
Funding acknowledgements: Thanks to Cardiff and Vale UHB for funding this PhD
Topic: Professional issues
Ethics approval: NISCHR Research Permissions Coordinating Process
Research Governance Global Governance Review granted approval, ethical approval was not required (IRAS 89355).
All authors, affiliations and abstracts have been published as submitted.
