Preventing cutbacks and expanding care: advocating for physio services

The Report: August 2006 vol.27 num.4

by LAURA BUSHEIKIN

e all know that physiotherapists help heal peoples bodies. But forthis to happen effectively, the medical decision-making bodies needsome rehab as well, says Scott Brolin, Professional Practice Chief ofPhysiotherapy at Royal Columbian Hospital.

Brolins focus is on the big picture; on looking athow hospital administrations work, how decisionsare made, and how this impacts the patient.

Brolins very first position involved changing hospital systems. In 2002, he was fresh out of university, having earned a BScPT from Curtin University in Perth, Australia. Soon after returning to Canada, he was hired to lead a new program called PEARS (Prevention, Early Activation, and Return-to-workSafety) at Royal Columbian Hospital. This program was a joint initiative between the employer and various unions in the workplace. As program leader, Brolin worked throughout the hospital to improve prevention and response to workplace injury.

When the position of professional practice chief, responsible for all physiotherapy activities in the hospital, came up two years later, he relished the opportunity to advocate for physiotherapy services throughout the hospital.

-My own personal focus is on human health resource planning," he says. -How does one decide what kind of human resources you need for a particular service? When you look at different physio departments across Canada, most staffing decisions are based on what was done in the past, for instance, one physiotherapist for 30 beds. But our health care system is changing rapidly ... its very different than only five years ago." Decision-making around caseloads and other key issues needs to change as well, he says.

Brolins interests led him to become active in the Physiotherapists Association of British Columbia(PABC), where he chairs the public practice advisory committee. He is also a member of the legislative committee of the College of Physical Therapists of BC. It was as the result of a PABC survey that Brolin realized physiotherapists wanted the tools and resources to be able to advocate for their services.

-One way to do that is to understand how to make a business case in language that our decision-makers can understand, because most of the decision-makers are not physios." To that end, Brolintaught a course for the PABC entitled -Making aBusiness Case for Publicly Funded Physiotherapy Services.

"A key element in making a case for services is data, says Brolin.

-Data collection among physios in BC is variable at best. Some sites are not collecting any data whatsoever. With no data, its very hard to make abusiness case to show you are being effective," hesays.

Of course, the data must be the right kind.

-Dont waste time collecting data that isnt doing anything for us,"advises Brolin. -Instead, describe things we are not able to do becauseof the workload. Talk about the percentage of patients that we cantsee because there are not enough physios to handle the caseload," saysBrolin.

Current practices for workload measurement are outmoded, he says. -The Workload Measurement System described by the Canadian Institute of Health Information is actually only work measurement. It just describes what we do with our time. But our patients expect the right service from theright person at the right time. Unless we can measure our ability to meet these expectations we arent measuring workload.

"As an example of an effective way to collect anduse data, he describes a pilot work load model from his workplace.

-One of our senior therapists took a select group of patients: total hip and knee replacement patients.She looked not at how many physios they need basedon a historical level, but on what outcomes patients need and how to achieve that. She chose a list of outcomes that are specific to physio treatment. Then she tracked the time it took to achieve each of those outcomes and compared it to pathway length and length of stay.

-The results showed that with our current level of staffing we were able to achieve all our rehab goals within similar timelines to the pathway, eventhough the length of stay was longer than the pathway. This demonstrates that staffing levels seem to be adequate to what we hope to achieve, and that the longer stay is due to other inefficiencies in the system.

-So should the axe start to swing again, - he says,-we now have true data to say that with current levels of staffing we are able to achieve these desired outcomes, and with less we run the danger of not being able to do so.

"Its this kind of research and solid information that will give physiotherapists a better chance of convincing decision-makers to maintain their programs.

-Physiotherapy has in the past got less attention than, say, doctors and nurses. Were still not on a level playing field, but it is improving. That will depend on how well physios defend their services tothe public," says Brolin.

-This is not exclusive to physiotherapy," he adds.-The way forward for all of us as health care professionals is figuring out the value of our services and demonstrating that through patient outcomes.The decision-makers want to see a focus on keeping patients as healthy as possible in a way that will keep costs under control.

"With people like Brolin taking leadership on theseissues, there is cause to be optimistic.