Management Symposium 2007 – WCPT Vancouver
Abstract
Management Symposium, led by Robert Jones.
Changes in health care are driven by several factors: financial, political, economic and social. Consumer changes, with increasing life expectancy, the increasing number of people with long term illnesses, widespread access to health information and increasing demand for both quality and quantity of health care has required health strategists to re-evaluate the organisation and structure of health care services worldwide. In response to the increasingly competitive and demanding health environment, physiotherapy managers have frequently been required to consider what might be the “best” organisational structures for their services, in order to manage effective clinical service provision and improve patient outcomes within resource constraints.
Structural changes have caused concerns for physiotherapy services. These have related to service fragmentation into small teams often managed by directorates, divisions or general managers. The individual issues included; fears that staff would not get the professional support needed and professional standards would drop, difficulties with recruiting and retaining staff, lack of career progression and the Head of Service being accountable for professional standards without authority.
The introduction of relatively decentralised management units based largely on medical speciality groupings has often been perceived by physiotherapists as a need to “make them fit” with a desire for neat organisational boxes on organisational charts. Management arrangements for physiotherapists are not uniform. In some places a single Head of Service manages each of the Allied Health Professions as individual entities. In others they are managed in a variety of different groupings, for example in directorate structures, combined AHP groups or matrix management models.
Despite the recognised contribution to patient care, research into physiotherapy management has been limited. The AHPs have lacked influence in comparison with medical and nursing colleagues in the larger policy process of structural reforms at national, regional and local levels throughout the world. Thus, the potential for strategic influence has been fragmented and diluted. Organisational structures for AHP services appear to have “swung” between full devolution to localities and centralisation to AHP directorates, without full consideration for the impact of these decisions on patient care and the many factors affecting clinical governance.
Implications/conclusions
The importance of organisational structures cannot be ignored. They establish the context for many aspects of healthcare; commissioning, patient flows, cross-organisational boundary working, information management, communication processes, clinical governance and the management of risk.
Management structures should be defined after the functions of a service are determined. Organisational structure directly influences the provision of patient care, affecting both staffing and service issues.
Robert Jones |
Fiona Jenkins |
Rosalie Boyce |
Janice Mueller |
