Physiotherapy, Ju n e 1982, vol 38, no 2 27 EDITORIAL RESEARCH INTO PHYSIOTHERAPY Physiotherapists in this country have become more aware of their responsibility for organisation of the services to the public (patient care and education) as well as o f the image they project to the public and their colleagues in the health care professions. This has resulted in setting up courses in management and marketing o f physiotherapy. At present an investigation by a PR firm is being undertaken to clarify some of these issues an d to give guidelines for further action or study. A series of articles in Physiotherapy highlights aspects of Physiotherapy Organisation being investigated by the Health Services Organisation Research Unit ( HS ORU ) at Brunei University, Uxbridge, Middlesex. The research method used is to investigate an organisational problem or a symptom of such a problem in collaboration with the client presenting the problem. The clicnt is in control as regards confidentiality and pacc, but is also motivated and has detailed knowledge of the situation UOvretveit et a i 19 8 1). Organisation o f physiotherapy services affects patient care and the profession itself, and most problems such as high staff turnover and resource constraints can be improved by changing the organisational design. Once the problem and related issues are clarified, organisational solutions can be created. The advantages and disadvantages, as well as the possibility of implementing such solutions, are then examined. This can form a resource for others with the same or similar problems. HSORU was involved in analysing the distribution of responsibility, such as superior-subordinate relationships, appointment of staff, allocation of resources, assigning work and appraising quality of work from 1966- 1969. At that time the consultant-therapist relationship was a prescribing one, which involved determining priorities of scrvice, but not assigning work to a specific therapist or direct judgement on such work. From 19 7 1-1974. professional growth led to full professional status and moved to self-management. Three main issues, namely the role of consultants in physical medicine, the work of hospital and grou p superintendents and the relationship between administrators and senior therapists, were investigated by HSORU. Various conflicts were highlighted. Since 1974 the expected level o f professional work (patient treatment), different levels of work and weights of responsibility were clarified and an organisational structure to reflect this was developed. Three work strata, namely helpers and students, basic professional work (three grades) and managerial work (some superintendents) were identified and a fourth stratum for possibly District Therapists was suggested. The organisational f relationship between doctors and therapists was formulated and questioned prescription in view of new treatments, increased skill and higher standard o f education of therapists. A new concept was needed to allow consultants overall responsibility for patient treatment and therapists responsibility for self­ management. Early in 1980 the whole profession became involved and “ high level” organisational problems investigated led to organisa­ tional changes a nd a so un d base for the development o f the profession. A second article describing physiotherapists as bureaucrats (Kinston and Ovretveit, 1981) defines terms to be used in describi ng p h y s i o t h e r a p y o r g a n is a t i o n . T h e role o f a physiotherapist is described in terms o f expectations. In private practice the role is more individual, since the therapist’s skills are made available directly to the public a nd he makes his own decisions. In public service the role is also an office, created by another person, and the individual view a n d official view o f the role may be mismatched. It was felt this role should be defined so as to balance the needs of patients, ot her health professionals, the profession an d individual therapists. Bureaucracy could be defined as a large-scale, complex organisation and therapists working in public service are thus bureaucrats. Bureaucracy can facilitate o r o b st r u c t function and this influences patient treatment, which in this instance is an expression o f bureaucratic function. Health Authorities could be responsive to guidance from the profession, who should be responsible for organisational problems unique to it. It is difficult to describe work an d work responsibilities in organisation, rather than activities or tasks, but organisational structure should be based on work to be done. A great problem could be the elevation o f status over work, which leads to preoccupation with career progression — prestige, rights, privileges, rank and pay — resultingin structures which prevent, inhibit, discourage or interfere with work, rather than a structure which facilitates functioning in the role with increased efficiency and effectiveness. Rather, education should recruit people of the right calibre, create realistic expectations and furnish appropriate training. The authors conclude that informal organisation is often a precursor of, and depends on, a substructure o f formal organisation. However, it is better that matters such as division of work, work content of roles, au thority for decisions, relationships between different levels, accountability, pay, niles and procedures (clinical a u to nom y) are defined an d made public. The structure should be realistic, with acceptable limits, so that power can be channelled constructively. References Kinston, W. an d Ovretveit, J. (1981). The physiotherapist as a bureaucrat. Physiother. 67, 168-170. 0vretveit, J, Tolliday, H. and Kinston. W. (1981). Research into the organisation of physiotherapy. Physioiher., 67, 1 10- 113. C o n t e n t s - In h o u d The Effects of Chest Physiotherapy and Tracheo­ bronchial Suctioning on tc P 0 2 in M echanically Ventilated Newborn Infants — P. Gounden .. 28 Responses of Superficial and Deep Blood Vessels to C ooling — G. Mitchell, J. Enslin, M. Mastrolonardo, B. Shunn and A. Stewart ....................................................... 31 The Measurement of Pain — A Brief Review — C. A. Liggins ......................................................... 34 Synopsis of Physiotherapy in Owamboland Nami­ bia (South West Africa) — G. Sobel ................ 37 The Vertical W heeler — P. E. W akefield ............ 40 A M obilising Technique fo r the Symphysis Pubis — R. M itchell ............................................................... 43 Research Proceedings of a Meeting of the Natal Coastal Branch of the South African Society of Physiotherapy held on 15 M arch 1982 ............ 43 The Report of the 10th Meeting of the National C ommittee of Representatives held on Saturday 20 March 1982 in Johannesburg ...................... 47 Book Reviews ............................................................ 50 Vacancies ................................................................... 51 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. )