JUNE 1980 P H Y S I O T H E R A P Y 35 MANAGEMENT OF A PHYSIOTHERAPY DEPARTMENT C A R O L C O R N E L L , D ip. Physio. (Cape Town)* ABSTRACT The concept o f scientific m anagem ent is considered. T he fu n ctio n s o f m anagem ent are defined and discussed with particular reference to the m anagem ent o f a physio­ therapy departm ent. Qualities w hich are required in a supervisor are exam ined and the necessity fo r the d eve­ lopm ent o f m anagem ent skills is stressed. T h e shortage o f fo rm a lly trained physiotherapy m anagers is noted and possible solutions to rem edy this problem are suggested. M anaging a physiotherapy dep artm en t can be exciting _ ^ n d challenging b u t how m any physiotherapists have the ■Secessary skills to do full justice to the position? T rad i­ t i o n a l l y medical an d param edical services are headed by m em bers o f their p articu lar professions. U sually these d epartm ent heads have h a d n o fo rm al m anagerial train ­ ing and w hile experience is valuable, it should be an adjunct to and n o t a replacem ent fo r m anagem ent know ­ how. H ospitals a n d their com ponent departm ents need skilled adm inistrative an d clinical supervision to ensure an efficient health care service. T herefore it is essential th a t m anagerial skill should be as much p a rt o f a phy- siotherapist-in-charge’s job as clinical skill. T his article is geared tow ards th e physiotherapist w orking f o r a Provincial o r G overnm ent au th o rity o r o th er large co rp o ratio n ra th e r th an fo r som eone w ho is self-em ployed. H ow ever, the basic principles o f m anage­ m ent discussed are applicable to any situation. Scientific m anagem ent — a term now in general use — is a fairly new discipline b u t has developed rapidly th ro u g h o u t the m o d em industrial w orld in recent years. O u r ever m o re com plex environm ent m akes dem ands on us which can only be solved by th e developm ent o f new skills. T hese skills are applicable to all fields o f hum an endeavour from household m anagem ent to th e running o f a physiotherapy departm ent. A definition o f m anagem ent is no t easy b u t th e fo l­ lowing is a good w orking definition: T h e process by • Private Practitioner; form erly Principal P h y sio th era­pist, D ay H o sp itals O rganisation, Bellville.Received 30 A pril 1980. OPSOM M ING D ie konsep van w etenskaplike bestuur w ord oorweeg. D ie fu n ksies van bestuur m e t spesiale verw ysing n a die bestuur van ’n fisioterapie-departem ent w ord gedefinieer en bespreek. E ienskappe nodig vir toesighouers w ord ondersoek en die behoefte vir die ontw ikkeling van bestuursvaardighede w ord beklem toon. D aar word gelet op die teko rt aan fo rm ele opleiding van fisioterapie- bestuurders en m o o n tlike oplossings hiervoor w ord voorgestel. w hich th e senior staff o f any g ro u p directs actions to ­ wards a com m on goal. Im plicit in this definition is the understanding th at m anagers them selves seldom carry ou t the activities; ra th e r they delegate duties to and supervise th eir efficient discharge by o th e r people. F U N C T IO N S OF M A N A G E M E N T I t m u st be stressed th a t m anagem ent is an integrated concept and it is difficult to divide it into separate fu n c­ tions. H ow ever, it is a useful exercise to undertake if m erely to try and underline th e full scope o f th e discipline. Joseph L. M assie (1971) defines th e follow ing seven functions o f m anagem ent: D ecision m aking — th e process by w hich a course o f action is consciously chosen fro m available a lte rn a ­ tives f o r th e p u rp o se o f achieving a desired result. O rganizing — the process by w hich th e structure and allocation o f jobs is determ ined. S ta ffin g — th e process by w hich m anagers select, train, p ro m o te an d retire subordinates. P lanning — th e process by w hich a m anager antici­ pates th e fu tu re an d discovers alternative courses o f action open to him. C ontrolling — the process th a t m easures current p e r­ fo rm an ce and guides it tow ards som e predeterm ined goal. C om m unicating — th e process by w hich ideas are transm itted to others f o r th e purpose o f effecting a desired result. D irecting — th e process by w hich actual perform ance of subordinates is guided tow ards com m on goals. O n reading th e ab o v e list, two things com e to m ind. Contents Management of a Physiotherapy Department ... 35 Preliminary Thoughts on Auditing ........................... ...38 Practice M a n a g e m e n t.................................................... ...43 National Committee of R e p re s e n ta tiv e s ................... ...45 Correspondence ............................................ 51, 52, 53 Classified — Vacancies .................................... 55, 56 2 — Inhoud Obituary ........................................................................56 South African Assoc, of Occup. Therapy Congr. ... 57 Proceedings of Eighth International Congress ... 57 W orld Confederation fo r Physical Therapy ........... ...57 Training Centres in the Republic of S.A......................58 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. ) 36 Firstly, m ost o f th e points could be described as com- m onsense b u t th e consistent application o f so-called com m onsense is rare. Secondly, m any of th e functions overlap; fo r exam ple, staff m otivation w ould com bine th e functions o f directing and staffing, thus re-em pha- sizing th e integrated n a tu re o f th e process. Since m anagem ent has been defined and dissected, w h at o f th e characteristics o f th e good m anager? R o b ert K atz (1955) sum s these u p in th e follow ing points: T h e good m an ag e r requires: Technical skills, i.e. proficiency in p erform ing an activity in th e correct m an n er w ith the ap p ro p riate tech- 1̂1 um an relationship skills — the skill o f co-operating w ith others, . . C onceptual ability — th e ability to see individual m atters as they relate to th e overall picture. H aving outlined th e scope o f m anagem ent, let us now consider how this relates to som e practical points co n ­ cerning the supervision o f a physiotherapy departm ent. A s m entioned above, it is well nigh im possible to sepa­ ra te th e various functions o f m anagem ent so th ere will b e som e overlap. D ecision and P olicy Making Physiotherapy departm ents, in com m on w ith .other hospital departm ents, usually hav e to w ork within the constraints o f overall hospital policy (a policy being a guideline fo r decision-m aking). T h e first thing a head of d ep artm en t m ust do is to becom e th o ro u g h ly fam iliar w ith this policy so th a t th e aim s o f th e d epartm ent m ay mesh sm oothly w ith those o f th e hospital. I t is o ften useful to gain th e ea r o f a helpful adm inistrative officer w ho can explain th e finer details and iron out m isunderstandings. . D ecision-m aking is a w hole subject on its own. h o r th e purposes o f this article, suffice to say th a t decisions m ay be m ad e by individuals, by fo rm al com m ittees o r by inform al groups and n o one m ethod is rig h t all the time, time. Organizing O ne o f the m o st im p o rtan t facets o f organizing is the careful draw ing u p o f job descriptions, th e benefits of w hich are num erous. T h e com pilation o f a job descrip­ tion fo r each m em ber o f staff requires careful planning b u t it does supply a y ardstick by w hich th e perform ance o f th e dep artm en t and th e individual concerned m ay be judged. T h e jo b description is a concise sum m ary o f the duties an d responsibilities o f th e p articu lar job an d it serves as a useful com m unication tool and problem - solving device as, should problem s arise, it provides a fram ew ork w ithin w hich a solution can b e found. T h e m em bers o f staff should be actively involved in com ­ piling th e description. N o t only are they th e people fill­ ing the jobs b u t this ap proach also gives them th e op­ p o rtu n ity to co n trib u te tow ards th e m anagem ent o f the deparm ent w hich, in tu rn , engenders a feeling o f belong­ ing an d participation. T h e m em bers o f staff know w hat will be req u ired o f . them an d they to o h av e som ething concrete b y w hich to assess th eir own progress. R em em ­ ber, how ever, th a t an y situation involving people is dy n a­ m ic and n o t static and re g u la r updating o f th e job description m ay b e necessary. Planning, Staffing, Controlling, Directing T h e cu rren t physiotherapy staff shortages and the lim itation o f th e executive pow ers o f th e supervisor in m any institutions does curtail m anagem ent function. T his fact notw ithstanding, because m anagem ent m ust p lan fo r b o th the present an d th e fu tu re, th e follow ing points should be bo rn e in m ind an d im plem ented w here possible. Besides clinical notes, records o f all aspects of de­ p artm en tal function a re vital. On these facts an d figures will hinge th e response from th e hospital adm inistrators to requests fo r additional staff, building alterations, new equipm ent an d im proved conditions o f service. F u tu re plan n in g is im possible w ithout access to such records. In addition, hospital adm inistration does dem and, from tim e to tim e, inform ation to justify aspects o f the de­ p a rtm e n t’s function on an econom ic basis. E qually im ­ p o rtan t, th e supervisor m ust know how to present this in fo rm atio n in w ell-m otivated an d succinct m em oranda. W here possible, direct involvem ent in th e plan n in g of an y new d ep artm en t is essential. R egretfully all too fre ­ quently th e supervisor w ho should be consulted reg ard ­ ing the building requirem ents is only b ro u g h t in a t a late stage. W here such an o p p o rtu n ity does present itself, careful consideration m u st be given to the m any factors involved, such as th e type of service required, equip-^ m en t needed, th e dem ands w hich m ay be m ad e by popu lation grow th an d m any other factors w hich go beyond, the scope of this article. C onsultation w ith o th er physio­ th erap y supervisors in the area o r fu rth er afield, if necessary, is a useful m eans o f gaining additional inform ation. T h e provision o f an adequate staff to cope w ith the w orkload m ust be ensured. O n-going evaluation of the function o f th e d epartm ent an d the dem ands m ade on it m u st b e carried o u t on a reg u lar basis. O n the basis of these findings, th e service m ust accordingly be pruned o r extended. I t is a w aste o f professional skill to h a v e tasks car­ rie d o u t by qualified staff w hich could be done satisfac­ to rily by unskilled staff. Provision should be m ade for th e allocation o f such supportive personnel to the staff establishm ent, th eir ro le being to m aintain th e p roduc­ tivity o f th e physiotherapy staff at an optim um level. O’N eill (1976) states th a t as a general rule, in th e general hospital departm ents investigated f o r their report, w here there was a staff o f three o r m ore, approxim ately one th ird o f th e staff was non-physiotherapist. W h ere a physiotherapist is sole-in-charge, th e ap p o in t­ m ent o f an aide/receptionist to th e d epartm ent is essen­ tial if productivity is n o t to suffer. A ll too often this is th e very situation w here a physiotherapist is assured that, if help is needed, she need only ask a nurse aide o r po rter. Inevitably, this unspecified help is n o t readily av ailable when required. T he resu lt is tension betwe^j personnel and valuable p atien t treatm en t tim e is lost. ■ D elegation o f duties an d responsibility by the super­ visor is essential fo r th e sm ooth running o f th e bigger departm ent. M arcus (1966) in his article on com m on failings of supervisors describes th e “seven deadly sins” , one o f which is: “Playing everything close to the chest. K eep everything to yourself. D o n ’t tell anybody an y ­ thing . . . Ju st be uncom m unicative” . T h e resu lt is usually inefficiency and an u n h ap p y departm ent. P a rt o f th e process of control is provision fo r evalu­ atio n o f staff perform ance, p articu larly o f th e new staff m em ber. T he staff need to know clearly w h at is ex­ pected of them ; this is provided by the job descrip­ tio n previously discussed. Satisfactory w ork should be given recognition and p o o r w ork should b e construc­ tively criticised. A specially designed evaluation form should be used. Communication C om m unication provides the link betw een all o th er functions. T h e types of com m unication in an organisa­ tio n can be described as vertical, flowing back and forth betw een m anagers and subordinates; horizontal, w here staff on sam e level co-ordinate activities w ithout refer- JUNIE 1980F I S I O T E R A P I E 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. ) JUNE 1980 P H Y S I O T H E R A P Y 37 ence to their superior; inform al, e.g. th e “grapevine” . Effective com m unication is regular com m unication. T he supervisor m u st relay inform ation from th e d e p a rt­ m ent to th e h ospital adm inistration and m ust in turn relay relevant inform ation back to th e departm ent. Sys­ tems m ust be set u p w ithin th e d epartm ent to encourage a flow o f inform ation betw een staff, and to anticipate an d solve problem s. Im p o rta n t m atters should be w ritten; w ritten requests deserve w ritten replies. O ral messages m ay be in o rd er a t times but th e m ore levels they have to go through, th e m ore ro o m th ere is fo r error. C onflict is an inherent p a rt o f m anagem ent and may be handled by (1) dom ination, (2) com prom ise, o r (3) integration. Integration w ould seem to be the m ost suc­ cessful approach. T o achieve it, differences m ust be b ro u g h t into the open, all parties concerned join in th e discussion and together a position acceptable to all and to th eir w ork­ i n g relationships is chosen. M T o encourage com m unication within the physiotherapy ™ tablishm ent, re g u la r staff m eetings are a m ust. These gatherings serve both as an oppo rtu n ity fo r clinical teaching and fo r adm inistrative discussion and instruc­ tion, ' A fu rth e r practical p o in t in this field: never tak e it fo r granted th a t o th er hospital personnel know either the w hereabouts of th e staff a t any given tim e o r the details o f the d ep artm en t’s w orking hours. T his is particularly pertinent fo r the busy supervisor o r th e physiotherapist in the sole-in-charge situation. A lways en su re th a t any variation in th e ro u tin e physiotherapy service offered, an d hence expected by o th er departm ents, is docum ented an d circulated to relevant sections. D o n o t fo rg et to notify th e p h ysiotherapy staff o f changes as well. M any physiotherapy jobs entail a great deal o f m obility during the day. I t is th erefo re essential th a t a receptionist be available a t all times to process enquiries, thereby facili­ tating the sm ooth run n in g o f th e departm ent. A useful ro u tin e fo r the supervisor is to organize a set period daily w hen staff queries can b e d ealt w ith on a personal basis. N o th in g alienates b o th o th er h o s­ pital staff and th e physiotherapists themselves m ore quickly than th e constantly elusive and ap p aren tly too busy supervisor. A t th e clinical level, good com m unication m ust be m aintained between the p h y sio th erap y d epartm ent and Koth er departm ents of th e hospital. By m eans o f con- ltation w ith relevant dep artm en t heads, th e role w hich e physiotherapists are expected to fulfil m ust be clearly defined. E ach p hysiotherapist should b e encouraged to p articip ate fully in th e health team activities o f their section. A ttendance a t clinical meetings and w ard rounds provides good o p portunities fo r th e physiotherapist to learn and to contribute. I t should also be stressed to staff th a t they must, as a m atter o f routine, rep o rt back to the doctors regarding patients’ treatm ent progress. This is som ething which is often neglected. As m entioned briefly, u n d er planning, it is advisable fo r a supervisor to keep in contact w ith heads o f o th er physiotherapy departm ents. I t provides a n opportunity to share knowledge, get advice and discuss com m on problem s when th e need arises. N o t least, good ra p p o rt m u st b e fostered betw een th e staff and th eir patients an d extended to th e p a tie n t’s fam d y if they are available fo r consultation. A s the physiotherapist is so often in a counselling situation, it is advisable fo r special attention to be given to this field during training sessions. The Supervisor i ^ ! U S-UpT iso r i s .,in fact a leader an d th e type o f leadership chosen will set th e to n e fo r th e departm ent. T h e dictatorial approach — “d o it o r else” is to be avoided as is th e paternilistic type o f lead e r w ho does everything personally, thereby m aking th e ir staff reliant on them . TTie leader should develop th e dem ocratic a p ­ p roach, w here he/she depends n o t only o n h is/h er own abilities b u t actively encourage his/her subordinates to accept responsibility and p articip ate in decision-m aking a n d planning. By these m eans b o th personal grow th and th e developm ent of m anagerial ability is e n ­ couraged. This ap proach builds up a co-operative atti­ tude an d job satisfaction am ongst the g ro u p tow ards the job. T h e supervisor needs to be people-conscious; perso n ­ nel m anagem ent is a vital p a rt o f th e jo b . A n open- minded, outw ard-looking ap proach should be developed and an y tendency tow ards a rig id attitu d e should be checked. T h e staff hav e the rig h t to expect a firm yet fair and considerate approach. If th e supervisor does n o t know som ething, o r has m ade a mistake, it should b e adm itted since n o b o d y will be fooled b y an attem pt to hide th e fact. C ontinuous education is essential and attendance o f all staff at post-graduate courses sho u ld be b o th expected a n d actively prom oted. T h e supervisor should be a m em ber o f the p ro fes­ sional society and take a n active role in its activities and encourage staff to d o the sam e. W h en applying fo r such a p o st, th e prospective super­ visor should realise th a t m anagerial skills, if n o t yet acquired, will have to b e developed. T his will enable them to cope w ith th e com plexities o f adm inistration and thereby ensure efficient and effective p atien t care. A lso to be b o rn e in m ind is th a t the ap p o in tee to such a p o st w ill be required to represent th e profession to the adm inistration. Such a challenge should be m et w ith enthusiasm . CONCLUSION V a rio u s aspects o f m anagem ent and th e ir application to physiotherapy have been considered. T h e need fo r such skills in to d ay ’s environm ent has also been dis­ cussed. H ow ever, w here can th e physiotherapist get form al m anagerial training? A t present, no n e o f the physiotherapy training centres offers such a course. P er­ haps it is w orth considering th e in tro d u ctio n a t u n d er­ graduate level o f a course in basic m anagem ent which could then serve as a fo u n d atio n fo r the practical ex­ perience gained later, w hile w orking. V arious branches o f th e South A frican Society o f P hysiotherapy have organized lectures touching on aspects o f m anagem ent an d this is to b e encouraged. T h ere is a g reat deal o f literatu re available on th e subject and articles have been published specifically on physiotherapy m anagem ent by some overseas physiotherapy journals. T h e m anagerial process is a com plex social activity and th e idea th a t m anagem ent is som ething related to business an d n o t to a professional ro le m u st be refuted. M anagem ent supplies a fram ew ork fo r th e efficient and consistent run n in g o f an y organization, be it large o r sm all, professional o r non-professional. References 1. K atz, R o b e rt L. (1955). Skills o f an effective adm ini­ strator. H arvard Business R eview , Jan-F eb 33 - 42. 2. M arcus, E dw ard E. (1966). T h e physical therapist in supervision. P hys. Ther. 46, 391-394. 3. M assie, Joseph L. (1971). E ssentials o f M anagem ent, 2nd E d. E nglew ood Cliffs N .J. Prentice H all. 4. O ’N iell, M ichaela T. (1976). Physiotherapist caseload standards. Physiother. Can. 28, 95-98. 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. ) 38 Bibiliography Feitelberg, Sam uel B. (1966). Basic considerations o f a jo b description. Phys. Ther. 46, 383-386. 386. Lister, M arilyn J. (1966). P erform ance evaluation o f the new staff mem ber. Phys. Ther. 46, 387-390. 387-390. JUNIE 1980 R ochelle, D o n n a (1966). H ow to answ er questions. Phys. Ther. 46, 428. T odd, J. W . (1977). T h e use o f hospitals. 6 Analyses. Update, A pril, 935-938. K enly, Judith D. (1972). A supervisor’s view of staff evaluation. S. Af r. J. Physiother. 28, 2-4. W hitfield, A. G. (1978). C hair a com m ittee. Br. M ed. J. 2, 936-937. F I S I O T E R A P I E PRELIMINARY THOUGHTS ON AUDITING T H E EFFIC IEN C Y OF A PHYSIOTHERAPY SERVICE USING A COMPUTER PROGRAMME M. J. R U N N A L L S , Dip. Physio., C .T.P. (Cape Town)* A B S T R A C T T h e initiation o f a docum entation audit o f the efficiency o f physiotherapy services provided in a large general teaching hospital is discussed. R esults and trends o f behaviour as analysed by com puter program m es are show n. I N T R O D U C T I O N T h e T ygerberg H ospital is n o t only a large general teaching hospital b u t also p a r t of a large provincial hospital (state controlled) organisation. Thus, because of its very size (1 750 beds) and the hierarchy in the m anagerial system th ere will naturally be certain in trin ­ sic problem s. T o be confident th a t there is an adequate physiotherapy service in both out-patient departm ent an d w ards is n o t easy. I t is also well nigh im possible fo r the senior physiotherapy staff to keep track of all th a t occurs. T h e fact th a t a ju n io r o r even a senior m em ber o f staff, is unhappy, o r perhaps in adequate as regards their w ork p o ten tial and capacity can go u n ­ noticed. I t is also difficult to defend th e departm ent against ju s t o r unjust criticism from higher authorities, th e m edical profession, nursing profession, o ther allied health services an d peers unless its effectiveness (the case) can be substantiated very clearly. F urth erm ore, it should be rem em bered th a t litigation w ill inevitably become m ore prevalent an d substantiative evidence again will be essential to defend th e case. M E T H O D W ith these p roblem s in m ind a docum entation audit has been instituted based on th e w ork o f K h an and H ow royd (1976) w ho posed th e follow ing questions: 1. Is an acceptable stan d ard o f care being provided? 2. Does th e present stan d ard o f care show any im ­ provem ent over previous years? 3. Is the staff com petent? 4. Is full use of resources being m ade? A uditing o f docum entation becomes a way o f assess­ ing th e efficiency o f th e departm ent. F u lly realizing that this is purely a “docum entation” au d it it can, however, b e regarded as a relevant an d reasonable m easurem ent o f efficiency o f th e services provided. Such an au d it can * Senior L ectu rer and H ead o f D ep artm en t of Physio­ therapy, U niversity of Stellenbosch and T ygerberg H ospital. Received 30 A pril 1980. O P S O M M IN G D ie instelling van ’n dokum entasie-oudit van die doel- treffendheid van fisioterapie-dienste wat in ’n groot op- leidingshospitaal voorsien word, w ord bespreek. R esul- tate e n gedragspatrone soos deur rekenaar-program me ontleed, w ord aangedui. be evolved around two focal points, and the Problem O riented M edical R ecord approach propagated by W eed (1968, 1971). T h e tw o focal p oints are: 1. T h e physiotherapist viz. the m easurem ent o f p ro ­ fessional com petency and 2. th e system viz. the identification o f problem s which lim it th e system and thus th e com petency of the physiotherapist. W ith regard to the physiotherapist th ere a re fo u r characteristics o f professional com petency which can be analysed: 1. C om pleteness: A re all the data fully re c o rd e d ' A re all th e problem s identified? A re there plans pertaining to all the problem s? 2 R eliability: A re the data accurate? A re all the d ata kept up to date? A re all the plans instituted? Is there evidence th a t th e latest treatm ent m o d ali­ ties are being im plem ented? ^ 3. S ound analytical sense: Is there evidence th a t tq d ata obtained are used to solve th e problem s? 1_ the plan th a t has been developed relevant to the d ata? D oes the plan tak e cognisance, o f th e latest treatm ent techniques? A re all the plans realistic? 4. Efficiency: A re the problem s solved within a rea­ sonable am ount of time? A re alternative treatm ent m ethods im plem ented when necessary and as soon as possible? A docum entation audit th a t w ould fulfil all th e above- m entioned factors w ith certain m easurable criteria had to be established. F o r this p u rpose au d it form s fo r long­ term patients (hospitalization o f m ore th an 14 days) and an d short-term patients (hospitalization of less th an 14 days) w ere evolved. T hese form s were draw n up so th a t th e results could be com puterized an d w ere based on th e form proposed by K h an and H ow royd (1976). (Figs. 1 an d 2): A sh o rt com puter p ro g ram m e was w ritten to calculate th e percentages fo r each sub-section o f the au d it form . T hese percentages w ere then used fo r fur- there analyses. By m eans of th e B M D P 9D program m e of the B M D program m e package a m onthly analysis of efficiency was possible. F u rth e r com puter program m es w ere set up to show th e trends of behaviour in the v arious sub-sections o f the established criteria fo r effi­ ciency as well as to establish auditor bias. 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. )