P hysio th e ra p y, S e p te m b e r 1982, vol 38, n o 3 59 EDITORIAL EVALUATION OF PHYSIOTHERAPY D u ri ng 1981 the pr of es sio n o f p h y si o t h e r a p y was eval uat ed bv a t ea m of experts fro m the C o m m i s s io n for A d m i n is tr a t io n . A det ai led list o f criteria t o b e ev alu ate d was s u b m itt e d to the N . E . C . for c o m m e n t. T h e tea m interviewed and obs er ved p hy si o t h er a p i st s at selected hospit als a nd e du ca tio na l institutions. T h e re p o rt o f this tea m to the Co m m is s io n for A d m i n i s t r a t i o n is eagerly aw ai te d as it will p ro b a bl y have far re ach ing effects on the salaries a n d career st ru c tu re o f p h y si o th er a pi st s, as well as on the futu re dev elo pm ent o f the profession. The A c t io n C o m m i t te e (see R e p o r t on its activities) is co nc e rn ed a b o u t the image o f the p hy si o t h e r a p y profession after a c o m m u n i c a t i o n s au dit d o n e by a pu bl ic relations c o m p a n y . Th ey wish to impr ove the image o f p h y s io th er a p y ^ind have identified several target g r o u p s for this exercise. These tw o issues are closely re lated a n d it may be a wort hwh il e exercise to use the research findings o f H S O R U (H eal th Services O r g a n i s a t i o n Re se arc h Un it) at Brunei University in o r d e r to clarify so m e o f the issues a n d to identify similar p r o b l e m s in S o u t h Africa. Ki nst on el al. (1981) d ef ine d w o r k as decisions a n d responsibility within an o r g a n is a t i o n a n d identified five s tr a ta that c o u ld ap ply to ph y si o t h e r a p y practice. These are: pr esc ri be d o u t p u t ( s t r a tu m I): sit ua ti on al respo nse (II); sys tem atic service pr ovi sio n (III): c o m pr e he ns iv e service pr ovi sion (IV); a n d c o m p re h en s iv e field co verage (V). Sensitivity, skill, j u d g m e n t a n d ethics m ay be required at each level, whilst w o rk at a n y level may affect w o rk at ot he r levels. M os t clinical ph y si o t h e r a p y pr actice, i.e. eval uat io n, p l a n n i n g a n d im pl e m e n t in g t r e a tm e n t, oc cu rs at s t r a tu m II. In this way. w'ork to be d o n e can be m at c h ed to or g a n is at i o n a n d a sensible hi era rch y, with in teraction between the different levels o f wo rk , can be established. This in tu rn leads to a ra tio na le for car eer de vel opm ent . Re sponsibility a n d a u t h o r i t y f or each s t r a tu m can be defined a n d w o r k to be d o n e can be o r d e r e d in terms o f complexity. W o r k st ra ta are a descriptive f r a m e w o r k , b u t do not reflect W'ork being d o n e by individuals, n o r their pe rsonal influence or effectiveness. Th ey indic ate socially defined e x p e c t a t i o n s a n d ac c ou nt a b ili ty , with discrete grades of Responsibility. T h u s a post w ou ld be g r a d e d a c c o r d in g to the wo rk to be d o ne , whilst the per son in the post will have the a b il i ty / c a p a c i t y to wo rk at that specific level. Such a system will assist de ci si o n - m ak i n g a nd w o r k f lo w by indic atin g where decisions o u g h t to be ta k e n a n d at whos e a uth or it y. In a fu r t h e r article. 0 v r e t v e i t el al. (1982) exam in e the o r g a n i s a t i o n a l p r o b l e m s o f h i g h l e v e l c l i n i c a l ph ysi ot her ap ist s. It was felt th at there was lack of r e co g ni tio n o f the skills a n d expertise o f sen io r clinicians, whilst p r o m o t i o n wa s a c h i e v e d by m o v i n g i n t o a d m i n i s t r a t i o n , tea ch in g or even by e mi gr ati on . T he d e ve lo p m en t o f clinical specialties may have p ro vi de d a te m p o r a r y a nd p a r tia l solu tio n, b u t di d not necessarily raise the level o f wo rk , o r the res po nsi bility an d au th o r i t y . It was also felt that the gr a de Se ni or I (U. K.) was am bi g u o u sl y defined a n d di d no t specify the a m o u n t o f a d m i n i s t r a t i o n , tea chi ng o r research to be included. A u t h o r i t y a n d a c c o u nt a b ili ty were also p r o bl em at ic a l as there was not alw'ays the one s t r a t u m distanc e whi ch ensures a w o r k a b l e m a n a g e r - s u b o r d i n a t e r e l a t i o n s h i p . Cl in ic al a u t o n o m y revolved a r o u n d interpr of es sio nal a n d in tra pr of es sio nal re lat io ns h ip issues. Decisions a b o u t type, freque nc y, pr iority a n d te r m i n a t io n o f t r e a tm e n t ha d no clear guidelines as to res ponsibility a n d p r o b l em s were usually resolved on a pe rsonal basis. S o m e p hy si o t h er a p i st s felt th at inf or ma l a r r a n g e m e n t s gave t h em m or e fr eed o m , whilst o th er s felt that u n a m b i g u o u s a n d a g re e d guidelines w ou ld give them a u th o r i t a t iv e profes sion al su pp o rt . Do e s this a p p ly to the p h y s i o t h e r a p y pro fessio n in So u th Africa? D o we have clear guidelines for levels o f wo rk , r e s p o n s i b i l i t y , a u t h o r i t y a n d a c c o u n t a b i l i t y ? I f the profession is to have a n y fu tu re d e v el o pm en t it is essential that we all have so m e an swers to so m e o f these questions. References Ki n sto n , W.. 0 v r e t v e i t , J. a n d T eag er, D. P. G. (1981) Levels of w o r k in p hy si o t h er a p y , P h ysio lh e r 67. 236-239. 0 v r e tv e it , J, Kins to n, W. a n d R i ch a r d so n , J. (1982). O r g a n is at io n al p r o b l e m s o f high level clinical p h y s i o t h e r a ­ pists. P hysiolher. 68, 10-12. Contents - Inhoud R e s p ira to ry P h y s io th e ra p y in P a e d ia tric s — L. M. D avids .............................................................. 60 H ip A d d u c to r M u s c le Release in th e T re a tm e n t of C h ild re n w ith C e re b ra l P alsy — B. T ra u b and C. P itc h fo rd ................................... 62 Stress and the P re d is p o s itio n to S p o rt In ju rie s H. H. S c h o m e r .......................................................... 64 H o w to a p p ly C a rd io p u lm o n a ry R e s u s c ita tio n . 66 W ould you m an ag e w ith o u t y o u r S o c ie ty — S. H. Irw in -C a rru th e rs ........................................... 67 The H is to ry of the L e c tu re rs ’ G ro u p o f the S. A.S.P. 69 R e port on the A c tiv itie s o f the A c tio n C o m m itte e 70 IX In te rn a tio n a l C o n g re ss o f W C P T — X C o u n c il M e e tin g W C P T ................................... 71 A p p a ra tu s ...................................................................... 73 B oo k R eview s .............................................................. 73 V aca ncies ...................................................................... 75 R ep ro du ce d by S ab in et G at ew ay u nd er li ce nc e gr an te d by th e P ub lis he r (d at ed 2 01 3. )