P H I L O S O P H I C A L R E F L E C T I O N M e r g in g P h y s i o t h e r a p y a n d O c c u p a t io n a l T h e r a p y T r a i n i n g : A Pa r a d i g m S h if t A B S T R A C T : This p a p e r is based on Stephen C o v e y ’s w ork “The 7 H abits o f H ighly E ffective P e o p le ”, w hich is only one p h ilo so p h ica l approach a im ed at em p ow ering p eo p le to achieve d esired goals. It is therefore not a research article, neith er d oes it sug gest that C o v e y ’s p h ilo so p h y a lone w ill lead to success, b u t rather, it is in tended to o ffer a p a ra d igm we n eed to consider a n d w ork w ithin w hen applying any o f the m a n ag em en t theories to the jo in t training o f occup a tio n al therapy a n d p h ysio th era p y students. N a tura lly such a p h ilo so p h ica l p a ra digm ca nn o t sta n d a lone in the p ra c tic a l im p lem entation o f a merger, h ow ever a discu ssion o f the m a n ag em en t theories a n d their strategies are b eyon d the scop e o f this paper. Therefore, while the ideas sh a red here are the p ro d u cts o f a p erso n a l an d p ro fessio n al conviction, a nd n eed to be read w ithin this context, it m ay be w orthw hile to co nsid er the p o ssible long-term im plica tio ns to the training a nd d evelop m en t o f p ro fessio n als in the rehabilitation sciences. K E Y W O R D S : M ERG E, P H YSIO TH ERAPY, O C C U PATIO N AL THERAPY, R E H A B IL IT A T IO N M ERG E. M'KUMBUZI VRP (BSc Honours Physiotherapy, UZ)'; EALES G (PhD)2 1 Registered MSc Physiotherapy student, Department of Physiotherapy, University of the W itw atersrand. Department of Physiotherapy, University of the W itw atersrand. INTRODUCTION Structural change is everyw here - in public and private sector organizations. Forteza & N eilson (1999), looking at the past decade o f globalization, and looking into the future propose that to succeed there are three key disciplines that organizations need to look into: 1. The design o f organizational structure 2. T he m anagem ent processes for allo cating resources and 3. The com pany’s culture, values and behaviour. B ut m ore im portantly is the need to attend to all three elem ents o f struc ture, process and people simultaneously. U niversities are not exem pted from this change. In particular the restructuring CORRESPONDENCE TO: VRP M ’kum buzi U niversity o f W itwatersrand Faculty o f Health Sciences 7 York Road, Parktown 2193, South Africa. Tel: +27 11 488-3450/2 Cell: 27 83 2440-780 Fax: +27 11 488-3210 Em ail: vyvpiw ai2000@ hotm ail.com taking place in m any tertiary institutions in South A frica is a reality that may bring together the training program m es o f m any health courses. Further, the m ultidisciplinary training prom oted in p rim ary health care fav o u rs such restructuring. D riven by political, social, econo m ic and tech n o lo g ical forces, and “com plicated by the challenge o f cro ss-cu ltu ral o p eratio n s, reg u lato ry schemes, tastes and resentm ents based on nationality” (Forteza and Neilson, 1999), the trend is towards mergers into fewer, more influential and cost-effec- tive university faculties and departm ents. One area that has potential for a successful and m eaningful merger, that is in terd iscip lin ary train ing w ith o u t any one losing the uniqueness o f the professional aspects, is the training of physiotherapists and occupational the rapists. In Zim babw e the training o f these two professions was m erged at the inception o f the d ep artm en t largely because o f lim ited hum an resources. Therefore much cooperation had to exist betw een the two professions. On the o th er hand the School o f H ealth Professions and R ehabilitation Sciences at the U niversity o f Southam pton (UK) offers three undergraduate courses in physiotherapy, occupational therapy and podiatry, and a m asters program m e in rehabilitation and research. It is their submission that the strength o f the school lies in the m ultidisciplinary collaboration existing in the research program m es at a postgraduate level (U niversity o f Southam pton Postgraduate Prospectus, 2000). Supervision is provided within the school and jo in t supervision with other departm ents can be arranged. The m asters in rehabilitation and research is also a fea tu re at the U n iv e rsity o f Indianapolis in the State o f Indiana. Yet still, O bafem i Awolwo U niversity - Ife, form erly the U niversity o f Ife (Nigeria) offers a B achelor o f M edical R ehabi litation degree w ith specialization in physiotherapy (BM R PT). This 5-year program m e includes in its curriculum aspects o f occupational therapy and speech therapy, with specific em phasis on physiotherapy dedicated to the last two years o f training. At the University o f the W itw atersrand (South Africa) however, physiotherapy and occupational therapy training developed and grew independently. W hile the two professions share com m on goals w ith respect to the philosophy o f rehabilitation, the processes and strategies are often different. These 3 2 SA J o u r n a l o f Physiotherapy 2001 V o l 57 No 3 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. ) mailto:vyvpiwai2000@hotmail.com differences are reflected in both teaching and clinical approaches, and may on the surface seem irreconcilable. This paper describes one paradigm to consider when adapting to change. W hile the structure o f university departm ents is an im portant consideration in the change process, it is beyond the scope o f this paper. S uffice to m ention that w hether clinical and academ ic depart ments function under a divisional head, faculty dean or the head o f a school of therapeutic sciences for instance may have sig n ific an t o rg anizational and functional implications. M erging into fewer, more influential and cost-effective university faculties and departments presents one way of effecting professional survival. The challenge for occupational therapy and physiotherapy academ ic interdependence is not only in defining the “training system, the plan ning system , the com m unication system, the budgeting system or the inform ation system ...” T here are already several system s to select from . R ather, the challenge is to trust the com petencies o f each profession, acknow ledge and adapt the strengths o f their system s and, to strengthen their weaknesses. A successful merger between occu pational therapy and physiotherapy is obviously the product o f a paradigm. The focus is not so much in setting up organizational procedure, but is in the definition o f character and the creation o f m eaningful relationships that enable interdependent interaction. Interdepen dence is a higher level o f function com pared to independence. SYNOPSIS AND BACKGROUND TO COVEY'S WORK The com m on thread in the model pre sented by Stephen Covey is the endeavour to optim ize the hum an potential. It is in the principles and values o f understanding, integrity, courage, confidence, empathy, coo p eratio n and hum an preservation through renewal strategies that hold the key to successful interdependence Stephen C ovey (1989) presented a model (The Seven Habits), which accord ing to him encapsulate the strategies that are used by highly effective persons. This paper applies these seven habits to forward a m ind set for a successful m erger o f o ccup ational therapy and physiotherapy academ ic departm ents. The prem ise o f this model is that the best way to accom plish increased productivity from both a personal and business perspective is through enhancing the human resource (Covey, 1989). The fundam entals leading to this success are enshrined in the ‘character eth ic’. These include living with fairness, integrity, honesty and hum an dignity. Anthony Robbins, author o f Unlimited Power (1997) describes these as the principles that give us the security to adapt to change, and the w isdom and the pow er to take advantage o f the opportunities that change creates. T he seven habits are subdivided into three parts: • Personal Victory - this is the product o f the first three habits 1) being p ro activ e, 2) setting goals and 3) setting priorities. • Public Victory is the product o f habit 4) seeking a w in/win 5) seeking to understand and 6) seeking synergy • Sustainability - this is the function of the seventh habit, w hich is involved with renewing and re-energizing the individual. Habit 1: Proactivity Being proactive enables one to choose, but with this freedom is an accom pany ing responsibility for the choices made. In the case o f departm ental mergers, choices with regards to ways in which cost-cutting m easures can be im ple mented, rather than hoping to be spared from this exercise will constitute the first step. The obvious advantage o f such an initiative is the subsequent strategic planning to m anage the effects o f m erging academ ic departm ents and thus, exert more control over the direc tion they will take. C ircles o f in flu en ce and con cern . Circum stances that can be controlled at the local level constitute the circle o f influence, w hile circum stances deter mined, m odified or controlled by factors beyond local control constitute the circle o f concern. For instance selecting the departm ents to merge falls into the circle o f concern. This is becau se such a merger is as a result o f overall university and faculty vision and plans. M eanw hile the operational procedures o f the merged departm ents will fall into the circle o f influence because these are laid down and implem ented at a departm ental level. In m ost situ a tio n s the circle o f influence is smaller, but lies w ithin the circle o f concern. The challenge for m anaging a depart m ental merger is to enlarge the circle o f influence. This has the potential to close the gap between the circle o f influence and the circle o f concern thus increasing control over o n e ’s operations. Friedm an et al (1994) lists the m ajor organizational issues facing academ ic units as, “institutional influence, faculty developm ent, and role in m edical edu cation, research productivity, financial stability and clinical responsibilities” . Bundy (2000), in his graduation speech echoed m any o f th ese sen tim ents, and made special m ention o f the need to form collaborative partnerships at departm ental, com m unity and interna tional levels as well as within the private sector. Given such a plethora o f back ground issues, the circle o f concern for the ph y sio th erap y and o ccup ational therapy academ ic departm ents is com plex and daunting. H ow ever the ultimate concern is a university and faculty’s d ecisio n on the num ber and m ost ap p ro p riate d ep artm en ts to m erge, without com prom ising the quality focus with which departm ental objectives are achieved, and without further com pli cating the m ajor issues m entioned above. The circle o f influence has 3 parts to it: • D irect Control. This firstly involves a paradigm shift w here individuals ack n o w led g e that a m erger is inevitable. This inevitability is as a result o f political, social, economic and technological forces. Therefore, each staff m em ber needs to buy into the concept o f the need for change in order to realise a cut in departm ental running costs. Secondly staff m em bers need to set goals for themselves within the new m indset and thirdly, set priorities about how to achieve the goal. T hese first three steps when SA J o u r n a l o f Physiotherapy 2001 V o l 57 No 3 3 3 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. ) acco m p lish ed co n stitu te “perso n al victory” (Covey, 1989). An exam ple m ight be the goal o f increasing the research output in a given time period. T he p rio ritie s m ay be to firstly reorientate teaching m ethodologies to increase problem (student) based learning and in so doing free more time for research; secondly to undertake m ore clinical responsibilities and use experiences gained here as a source o f research data, and thirdly to identify potential partnerships for research. • Indirect Control involves problem - solving by changing our methods o f influence. Covey (1989) identified over 30 methods o f hum an influence ranging from em pathy to persuasion and confrontation. In the case o f a physiotherapy and occupational the rapy merger, proactive behaviour in the circle o f influence w ould largely involve m eetings with staff from the tw o d ep artm en ts and in flu en cin g them to see the m erger as m utually beneficial. This can be done on several fronts, such as inform al one on one staff contacts, form al departm ental m eetings and through healthy debates between students from the different departm ents. This process if achieved successfully is described as “Public victory”(Covey, 1989). • “No Control” factors exist in the proactive stage. An exam ple might be the greater num ber o f applicants and intake for physiotherapy leading to a “pow er in num bers” situation of physiotherapy over occupational therapy. In such an event all staff and students need to find ways to culti vate and exercise maturity, wisdom, integrity and courage. C h an gin g even one fa c to r in the circle o f influence changes the equation and thus has the potential to change the m agnitude and quality o f the final outcom e. Habit 2: Seeing the End - Goal Setting. Setting goals is based upon the precept that all things are created twice (Covey, 1989). First in the m ind - as a plan or blueprint, then, the physical im plem en tation. W hen the m ental planning has been carried out well, one is able to a) m axim ize the output, b) anticipate problem s and obstacles, and c) to thus seek possible solutions and probable alternatives in advance. The extent to which we understand the principle o f two creations we act within and enlarge the borders o f the circle o f influence. If on the other hand we act at variance with this principle and take charge only o f the second and physical im plem entation we in actual fact dim inish the potential o f the result or output. Thus if for exam ple, the im m ediate concern is to cut costs, one m ust have a m ental picture o f how this can be achieved before it is put to work. This includes the realization that cutting costs does not change the goals and objectives o f the existence o f the physiotherapy departm ent in the university. The overall goal rem ains for the physiotherapy and occupational therapy training school to see itself within the context o f the desti nation o f its graduandi i.e. professionals functioning in the health care system. Physiotherapy and occupational therapy have much to contribute to healthcare. The professions thus need to position them selves ideally in order to be active participants o f future resolutions to cur rent and future problem s and challenges. QUALITY ASSURANCE AS A GOAL At this point, som e attention needs to be devoted to the “total quality m ovem ent”. Q uality assurance is driven by custom er dem ands, financial burdens and profes sional dem and for quality. An added pressure em anates from the em ergence and gro w th o f a ltern ativ e branches o f healthcare and in particular the alter native therapies w hose com petencies are derivatives o f the traditional occupa tional therapy and physiotherapy tech niques. Q uality assurance (QA) includes all the processes and sub-processes of planning for quality, the developm ent of objectives for quality, setting stan dards, actively com m unicating standards, developing indicators, setting thresholds, collecting data to m onitor com pliance to standards and app ly in g so lutions to im prove, (Reerink, 1999). Quality A ssu ran ce and co st cu ttin g are not m utually exclusive, thus merging depart m ents in a structured way is consistent and in harm ony with quality assurance. The im m ediate and obvious goal for the p h y sio th erap y and occu p atio n al therapy academ ic d ep artm en ts is to design excellent training program m es which even when merged strengthen the unique contributions o f either p ro fession. The salient features o f the ideal train ing p ro g ram m e sho uld in the authors’ opinion include: • High quality - the graduating thera pist should be o f an exceptionally high com petence in clinical practice as well as research and adm inistrative endeavours. • A p p ro p riaten ess - the graduating therapist should be able to m eet the needs o f his im m ediate environm ent but m ust also be able to function in any environm ent. R estructuring efforts w hich look m ore to producing “world class” graduates to standardize c u rric u la and ach iev e eco n o m ies o f scale tend to neglect national and cultural preferences, and m ay not realize or m eet local needs. • A ccessib ility - g e o g rap h ical and cultural • A ffordability - for the state, individual and those financing tertiary education • Com prehensiveness - the program m e should encom pass the four pillars o f healthcare, which are preventive, prom otive, therapeutic and rehabilita tive interventions. • Fields o f practice - curricula design should equip and generate sufficient in terest to m o tiv ate therap ists to participate in all clinical specialties • Scope o f Practice- curricula should be su fficien tly d iv erse to enable m arket absorption even into non- clinical organizations • S ervice cu ltu re - the pro gram m e should provide opportunities for stu dent therapists to develop the hum ane characteristics o f a w illingness to serve, com passion and a culture of integrity. All these rem ain critical co n sid e rations and should be on the agenda o f academ ic departm ents w hen planning for a merger, thus a m erger has to be engineered in such a way that it faci litates pro m otes and u p holds these features. 3 4 SA J o u r n a l o f P hysiotherapy 2001 V o l 57 No 3 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. ) ADVANTAGES OF MERGING The Edith Cowan University in Australia as early as 1996 tabled discussio ns for possible merger with the M urdoch University and others. Two reasons provided the stim ulus for this direction in the university’s developm ent: 1. To becom e a stro n g er and m ore com plim entary institution 2. To enhance its portfolio for national and international student admissions. W ith regards to physiotherapy and occu p atio n al therapy these reasons too are relevant. In addition the m ulti disciplinary approach to patient care in institutional and com m unity practice can be dev elo p ed at a train ing level. T he m u lti-d iscip lin a ry approach has the potential to m ake services more con venient and available to the patient. This is achieved by an increase in the quality o f care and by greater success in treatment outcom es. Indicators such as reduced duration o f therapy and attendance and thus, reduced cost to the funder o f health services as well as cost-effective use of resources by the health organization are and will becom e increasingly important for rehabilitation services managers. How do these benefits accrue to the university departm ent? 1. T he c re d ib ility o f the academ ic departm ent and its reputation as a centre o f excellence will grow. This could attract funding for university projects and program m es from the com munity. 2. Students attached to units practicing the m ulti-disciplinary approach are exposed to “best practice” situations during training. 3. The learning and experience gained through w orking with other health professionals will increase the cli nical expertise o f therapists, thereby generating a pool o f therapists for clin ical teachin g w ith the lateral thinking required in today’s health care arena. Emerging diseases, alternative thera pies and the advent o f m anaged health care requires universities to com m it them selves continuously to re-evaluat ing medical education. DISADVANTAGES OF MERGING T hese have been listed as: 1. Uncertainties and negotiations can harm the im age o f the faculty and departm ent, particularly if they are protracted 2. M ergers are disruptive 3. A greem ent is not certain 4. Political support from individuals, institutions and other stakeholders is not always forthcom ing even when agreem ent is reached. Edith Cowan University. Minutes o f the 47th reg. meeting o f the council. 1996. Thus, goal setting m ust take all this w ider sig n ific an ce o f ph y sio th erap y and occu p atio n al therapy academ ic departm ents’ m erger into account. It is not adequate to set goals and keep them to oneself. C ovey (1989) describes the goal setting process as one that needs to be principle centered. Part o f this process in practice includes the setting up o f a m ission statem ent, or as Friedm an (2000) prefers the strategic context o f your operations. This esta blishes the fram ew ork through which your individual and organizational goals are artic u lated . T he p ro cess, w hich may take anything from a few hours to m onths, requires professionals to reflect on their innerm ost values and to express their vision in a solid form (only written goals are real goals). The process itself is very important. It m ust o f necessity be the product o f the participation and contribution of all involved physiotherapy and occupational therapy staff members for it to em power, organize and com m it them to the mission statem ent (Covey, 1989). The m ission statem ent that is selected becom es the criterion by which the new departm ent m easures its own operations. In addition, it also becom es the yardstick by which outsiders m ea sure its relevance and value. Given that future students and society (patients) are the consum ers, the m ission statem ent should reflect and com m u nicate the excellence pursued by the departm ents. Finally the m ission statem ent is a constant. The value basis upon which it is form ed is not circu m stan tial but rather, when the correct principles have been applied they foster a culture to uphold the m ission statem ent even when the odds are unfavourable. Habit 3: Establishing Priorities - First Things First Setting priorities is one o f the m anage m ent functions. W ithin the context o f an occupational therapy and physiotherapy merger, priorities are set on two levels. Firstly on an individual, personal and professional level, and secondly, at a departm ental level. U niversities are generally m andated to teach, conduct research and contribute to society through com m unity service. Com m unity service includes contribu tion to the direction in which develop m ent o f the profession will take. Faculty and departm ental plans are founded around these m andates. Knowing the purpose for the existence and operations o f the physiotherapy and occupational therapy departm ents on a daily, weekly and annual basis is para m ount to setting priorities. To know this requires good time m anagem ent. A tim e m an ag em en t m atrix (Covey, 1989) is intended to assist in deciding w here the greatest proportion o f your time should be spent for effective operations. THE TIME MANAGEMENT MATRIX - ACCORDING TO STEPHEN COVEY (See Fig 1) T he co n seq u en ces o f sp ending too m uch time in the “urgent and im portant” block are crisis m anagem ent, stress and burnout. The activities in the “not im portant” row do not make significant contributions to m eeting organizational goals (Covey, 1989), further staff may feel their jo b is im possible as they “feel the territory is too wide.... making them both p ro fessio n a lly in effectiv e and personally unhappy” (Forteza et al, 1999). Essentially then, occupational therapy and physiotherapy activities prior to, during and after the m erger should be concentrated in the “im portant but not urg ent” . O ne o f the m ain activities here is relationship building. Deckm yn (1999), in an analysis o f know ledge m anagem ent concludes that failure is as a result o f an overem phasis on tech nology. The secret she says may be in the prom otion o f hum an interaction, not SA J o u r n a l o f P hysiotherapy 2001 V o l 57 No 3 3 5 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. ) Figure 1: The Time Management Matrix - According to Stephen Covey U R G E N T N O T U R G E N T IM P O R T A N T 1. C ris e s , p r e s s in g p r o b le m s , d e a d lin e d r iv e n p ro je c ts 2. Prevention, relationship building, recognizing new opportunities, planning, recreation N O T IM P O R T A N T 3. In te r r u p tio n s , s o m e c a lls , s o m e m a il, s o m e re p o rts , s o m e m e e tin g s , p r o x im a te p r e s s in g m a tte rs a n d p o p u la r a c tiv itie s 4. T r iv ia , b u s y w o r k , s o m e m a il, s o m e p h o n e c a lls . T im e w a s te rs a n d p le a s a n t a c tiv itie s S o u rc e : C o v e y , S .R "T h e 7 h a b it s o f h ig h l y e ffe c tiv e p e o p le - P o w e r f u l le s s o n s in p e r s o n a l c h a n g e " p g ! 5 1 . technological interfacing. The need for relationship building where two or more parties com e together is im portant if trust and a spirit o f genuine cooperation are to be cultured. Encouraging healthy and constructive discussion and debate, as well as m aking provisions to develop skills and strengthen w eaknesses can achieve this. From a p ra ctical p o in t o f view “ im p o rtan t b u t not u rg en t” requires e x ten siv e p re p aratio n o f and for m eetings betw een occupational therapy and p h y siotherap y dep artm en ts. The agendas should have significant bias to positive and constructive principle centered item s e.g. issues related to shared teaching, jo in t com m unity pro jects, research partnerships and student welfare. The consequence o f focusing on “im portant but not urgent” activities is to decrease the relative tim e spent in “im portant and u rgen t” and “not im portant and urgent”, i.e. the urgent and stress causing activities. O ne o f the principle functions o f the academ ic departm ent is to impart know ledge. It follow s then that the m ajor “im portant not urgent” activities will occur around defining and review ing the curricu lum . D ifficu lties will be encountered in defining that which is core because o f rapidly changing m edical education. A ccess to advanced technology, in creasin g the body o f know ledge and the speed o f accessing new inform ation will be im portant acti vities. C urriculum review is intended to shed that w hich is no longer relevant and to increase the em phasis on evidence based teaching. For exam ple, the role o f som e electrotherapy m odalities in p h y sio th erap y is being increasingly challenged and may be an area needing careful review, especially as physiothera pists are more often than not reluctant to shed course content. The tim e matrix does not allow for “crossing the bridge when you com e to it”, it clearly spells out a planning process to preem pt crises and unprecedented decisions. Som e o f the challenging issues need ing to be resolved and planned for will include: • A dequate provision for student cli nical practice - this will b ecom e increasingly difficult if OT and PT clinical areas are to be taught concur rently, as well as with anticipated increases in student intake, • P rio ritizin g research and teaching schedules, while teaching may be th eo retically and tra d itio n ally the principal function o f the university, research output is a critical consider ation for academ ic prom otion and professional survival, and • Calculation and provision o f optim al student/staff ratios for the teaching o f the different com ponents o f the PT and O T curricula. “Im portant but not urgent” activities are thus com m itted to strategic planning. T heir nature requires not only efficiency with regards to m eeting a deadline by w hich the m erger m ust be com plete but also, to allow sufficient tim e to ensure that all staff m embers are “on board the ship” thus “subordinating schedules to people” (Covey, 1989). The University o f Edith Cow an - A ustralia in its early deliberations for m erging with other universities estim ated a tim e fram e o f one year at adm inistration level while faculties, divisions and schools were given up to 3 years to im plem ent the mergers. However, ensuring that staff are supportive in an inform ed m anner requires sound know ledge m anagem ent practices. K n o w ledge m anagem ent refers “to the ability to create and trans fer as m uch o f the right know ledge as possible in the best m ethod possible in order to have a positive im pact...thus enabling the organization and individual to learn and adapt. “(Friedm an, 2000), dem onstrates the im m ediate and cascading gains that can be m ade in perform ance levels when all staff buy into the concept - (see Fig 2) P ro active behaviour, setting goals and setting priorities are active processes that all individuals and the separate departm ents m ust undertake. H ow ever in preparation for the com ing together o f the two departm ents either party will need to keep in m ind the p ossib le concerns o f both occupational therapy and p h ysiotherap y. T his paves the way for identifying core principles and values from which a w orking platform is developed. Habit 4: Seeking to Understand At face value this habit may appear to be the g re a te st ch allen g e fo r m erging departm ents. However, when the habits leading to personal victory have been accom plished with maturity and integrity, the process to public victory should follow with relative ease. In seeking to understand, it is necessary to overcom e the following: • Preoccupation with o n es’ own profes sion • Inferiority and superiority com plexes • Insecurity w hich is indicative o f the fear o f change (o f the unknown) • Identifying com m on ground • A ck n o w led g in g and resp ectin g unique differences and practices. T he first step to und erstan d in g involves generating a know ledge base. A t tim es o b tain in g in fo rm atio n and understanding can occur simultaneously. 3 6 SA J o u r n a l o f P hysiothera py 2001 V o l 57 No 3 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. ) Figure 2: Knowledge Management Accelerates Performance in Three Ways. Accelerated Transformation G etting everyo n e Im proving Getting additional up to speed faster breakthroughs, faster faster • A c c e le r a t i n g th e le a r n in g c u rv e - in v o lv e s g e tt in g in d iv id u a ls u p to s p e e d fa s te r. D e c k m y n ( 1 9 9 9 ) o ffe r s th a t " i f y o u w a n t to c h a n g e p e o p le 's b e h a v io u r , c h a n g e th e in c e n tiv e p r o g r a m " . • Im p r o v in g fa s te r - in v o lv e s in c r e a s in g th e r a te w it h w h ic h g a in s a r e m a d e in a g iv e n a r e a e .g . re s e a r c h o u tp u t. • A c c e le r a te d tr a n s fo r m a tio n - in v o lv e s h o w th e k n o w le d g e - b a s e d s o lu tio n w ill a c c e le ra te th e p a c e o f in c re a s e d le v e l o f im p a c t, it is m o r e d if f ic u lt to q u a lif y b u t th e b e n e fit o f d o in g so w ill h e lp set p r o p e r e x p e c ta tio n s o n c e th e e f f o r t h a s b e g u n . ( E x tra c te d fr o m M a r k F r ie d m a n 2 0 0 0 : w w w . e m e r g e n c e c o n s u lt in g .c o m ) The forum s in which greater under standing can be enhanced are many. Some will be less threatening and less confrontational and should be the pre ferred choice. One approach that has proved effective in m any com panies in the USA is to set up so-called com m unities o f practice, w hich allow w ork ers to share know ledge on a particular topic (D eckm yn, 1999). W hen seeking to understand, use o f academ ic and clinical staff contacts and m eetings, pro fessio n al association m eetings as well as professional publications should be made. W hile inform ation technology can provide the infrastructure to help groups com m unicate Skip M cDonald, vice president o f know ledge m anage ment at Align Solutions Corp. in Dallas say s the m ain goal is to en ab le person- to-person com m unication. “If this com m unication happens in a public forum, such as a threaded discussion, that is an added advantage” (Deckm yn, 1999). The spread o f opportunity for discus sion presupposes the need to understand the total context o f occupational therapy and physiotherapy practice, education, continuing education, professional devel opm ent issues, research priorities and future orientation. Seeking to understand therefore goes beyond the im m ediate environs o f the academ ic departm ents and should make use of the expertise and advice from colleagues not directly involved in academia. Finally, one should seek to under stand first rather than to be understood. H ence attentive listening is needed, and when this is done with a genuine desire to understand m any insecu rities, potential conflicts and biased perceptions fall away. C ovey (1989), describes the process o f seeking to be u n d erstood as a 3-pronged approach: 1. Ethos - this represents the credibility o f character and the trust and faith it inspires in others and is a function o f integrity and com petence. 2. Pathos - relates to the em otional alignm ent portrayed with respect to other p eople’s views in relation to ones own. 3. Logos - relates to the logical reasoning of ones m otivation. W hile m ost p eo p le head straight for the logical reasoning in trying to forward their argum ent (Covey, 1989), there is a need to c o n sid er the ethical and em otional backgrounds of individuals. Should these backgrounds m anifest as insecurities they have the potential to negate the logical reasoning (logos paradigm ) and frustrate merger efforts. Thus, in pursuit of the next habit (win/win), m uch sensitivity needs to be invested at the negotiating table for the foundation o f a cooperative and sup portive environm ent in w hich to conduct the traditional m issions o f teaching, research and com m unity service. This will require som e hom ew ork on the pow er dynam ics, “baby or pet” projects and special experiences and com peten cies of staff in the respective departments. Deckm yn (1999), also observes that staff w ho have contributed a lot to the departm ent are rew arded with high visibility, i.e. is not to say the rem aining staff have no part to play but, incentives m ay be needed to ju m p start their perform ance. Habit 5: Seeking a W in /W in . A win/win is defined as achieving a balance between courage and confidence (Covey, 1989). It is a fram e of mind and heart that constantly seeks mutual benefit in all hum an interactions. It therefore requires a spirit of cooperation rather than com petition. With respect to a physiotherapy and occupational therapy m erger it requires know ledge o f the strengths and w eak nesses of both parties. The strength of the occu p atio n al therap y cu rricu lu m seem s to stem from their capabilities in co m m u n ity -b ased teach in g . T he grow ing influence o f the public health m ovem ent, Prim ary H ealth C are and health sector reform to decentralized system s m akes co m m u n ity - based teaching extrem ely relevant. Also, core to occupational therapy is the psychoso cial co m p o n en t o f their curriculum . E ales (2000), recognizes the need for SA J o u r n a l o f P hysiothera py 2001 V o l 57 No 3 3 7 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. ) http://www.emergenceconsulting.com Figure 3: Domains of Learning K n o w le d g e S k ills P ro fe s s io n a l Q u a lit ie s ( W h a t y o u m u s t k n o w ) ( W h a t y o u m u s t d o ) ( W h a t y o u m u s t b e lik e ) A d a p t e d f r o m : U n iv e r s ity o f th e W it w a t e r s r a n d , D e p t, o f O c c u p a t io n a l T h e r a p y 4 th Y e a r - 2 0 0 0 , p g . 16. physiotherapists to “pay m ore attention” to psychosocial aspects o f disease in a m ulticultural society, such as that found in South Africa. In my experience phy siotherapists very often pay lip service to this dim ension o f patient need. For exam ple the social history form s an im portant part o f the initial physiothe rapy assessm ent, but very often therapy co n ce n tra tes on the bio m ech an ical aspects o f the patients problem , and biom echanical indicators are used to discharge the patient. I believe in many instances p h y sio th erap ists w ould do well to direct interventions more towards functional and occupational goals. On the oth er hand p h y siotherap y has grown and enjoys greater public patronage than occupational therapy, is recognized more by other health service providers and org anizations such as doctors and medical aids respectively. One o f the reasons for this characteristic is the dom inance o f physiotherapy in acute curative services, and the biom edi cal approach o f physiotherapy practice. F inally the m erger m ust address issues relating to alternative sources of funding and efficient use o f hum an and m aterial resources to obtain cost-effec tiv en ess o f the com bin ed academ ic departm ents. Indicators grouped under four broad categories will dem onstrate a win/win situation for occupational therapy and physiotherapy: • G rowth and m aintenance o f student intake capacity by both occupational therapy and physiotherapy • An increased quality graduate output e.g. high aggregate marks, market absorption, and therapists who are able to d e liv e r the services they prom ise to. • G reater quantitative and qualitative research cap ac ity and o u tp u t by both occupational therapy and physio therapy • G reater quantitative and qualitative co m m u n ity service cap ac ity and contribution. A com posite indicator can be derived from the above, and used to define the academ ic excellence profile ascribed to m erged academ ic departm ents. As the goal is cost-effectivity, gains dem onstrated by these indicators will need to be w eighed against input costs. H abit 6 attem pts to suggest practical m easures that can be im plem ented to achieve these gains. Habit 6: Seeking Synergy Synergism recognizes that the whole is greater than the sum o f its parts. In o th er w ords how do you add one and one to get three (1 + 1=3)? Further, synergy values differences and uses it to “catalyze creativity, and com e up with a better product”(Covey, 1989). Any strategy is futile if it is not pursued in a spirit o f cooperation, partnership and com plem ent: 1. Sharing o f space - for lectures, practi c a l , meetings and professional con tinuing health education venues 2. Shared resources e.g. library m aterial, teaching equipm ent such as projec tors, video cam era and clinical or therapeutic equipm ent and appliances such as standing fram es and mobility aids. 3. Shared teaching o f courses com m on to both the occupational therapy and physiotherapy curriculum . There are areas that are com m on to occupational therapy and physiotherapy. The model below presents a method o f identifying com m on ground. (See Fig 3) The know ledge base would for exam ple include such courses as com m unity health, research m ethodology, biostatis tics and kinesiology and biom echanics. Clinical m anagem ent o f conditions such as stroke, injuries, burns, and cerebral palsy whose m anagem ent by both occupational therapists and physio therapists is often duplication could constitute the skill com ponent. Professional quality courses could include medical ethics, com m unication within healthcare, adm inistration, busi ness operations and m anagem ent. 4. Joint research and publications 5. Joint com m unity service 6. S hared ad m in istra tiv e duties e.g. course and year coordination. SUSTAINABILITY. Habit 7: Renewal Strategies - "Sharpening the saw " Finally, in order to succeed in depart m ental m erg er th rough use o f the paradigm outlined above, the welfare o f staff m em bers m ust be attended to. In so doing, the hum an resource is optim ized and the character ethic is strengthened, (Covey, 1989). Renewal activities can be defined in four broad categories - physical, mental, social/em otional and spiritual. T hese enable therapists firstly, to continue to achieve the organizational goals and secondly to be able to continue navi gating through the rapidly changing socio-econom ic, political and healthcare arena. 1. Physical - physical renewal focuses on c re atin g the c o rre c t physical fram ew ork for optim al function o f the hum an body. This includes a good diet, rest and exercise. From an organizational perspective a m ajor responsibility to staff m em bers is to ensure adequate rest and breaks. The departm ent m ust adhere to fair policy on annual, m aternity and sick leave. 2. M ental - the process o f continuous im provem ent is the hallm ark o f the “total quality m ovem ent” (Reerink, 1999). The m erged academ ic depart m ent has the responsibility to provide o p p o rtu n ities fo r co n tin u in g e d u cation in the area o f physiotherapy, o ccu p atio n al th erap y and related research and adm inistrative duties. W orkshops, courses and conferences can be organized join tly with the 3 8 SA J o u r n a l o f Physiotherapy 2001 V o l 57 No 3 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. ) pro fessional associations. Funding for international and regional atten dance needs to be planned for. This key area should be built in to an orga nizational objective from the outset. W hile som e o f the mental renewal a ctiv itie s such as research and publication may overlap with regular w ork responsibilities, this area should c o n sid er in dividual interests and preferences to a greater extent. Further, departm ental heads need to provide opportunity and create an ambience fo r intellectual d isco u rse betw een staff members rem oved from regular work responsibility and obligation. An area that will need due conside ration will be the added skills and com petencies required in adm inistering a more com plex departm ental structure. 3. Social/E m otional. Social and em o tional needs o f sta ff need to be catered for. R egular tim e o ff and not extending w orking hours on a daily basis m ay seem overly sim plistic considerations. In essence tim e spent with fam ily or away from the work place has a direct and positive effect on m aintain ing sta ff balance and w ork output capacity. F urther, opportun ities fo r staff to socialize ou tsid e the w orkplace and develop a better understanding and appre ciation o f colleagues as well as a support system in the w ork place are important considerations in staff welfare issues. U ltim ately, the quality o f work will testify to the spirit with which it is done. T his reflects the atm osphere in the w orkplace and the culture that is nurtured. 4. Spiritual - A lthough this part is often an intensely private experience, it is extrem ely important, as “...it draws upon the sources that inspire and uplift... and tie us to the timeless truths o f hum anity” (Covey, 1989). People exercise their spiritual health differently. Som e fin d spiritual renewal in religion, others in music and yet still others in their relation ship with nature. To com e full circle, it follows then that if org an izatio n al o b jectiv es are derived from principles and core values, the organization needs to respect the source o f these values. With regards to physiotherapy and occupational therapy education, practice and research, there can be no room for isolating or scorning individual sources o f spiritual health. M any o f these renewal strategies can be negated or potentated by the leader. C ovey (1989), recom m ends a stew ard ship type o f leadership. Even in an academic departm ent where the levels o f qualification, experience and expertise o f staff may be fairly equal, a hierarchy o f who is in charge is necessary, for the simple reason that no one can m ake a decision w ithout a clear chain o f com m and. A lack o f lead ersh ip creates problem s not only o f poor organizational responsiveness but also o f poor staff m orale, (Forteza et al, 1999). Further The Edith Cowan University emphasizes that a substantive leader is necessary to harness early com m itm ent and unity. CONCLUSION There is no doubt that we are living in a tim e o f rapid political, social, econom ic and technological change. This change requires us to find ways to adapt struc ture; methods and system s in order to ensure our professional survival. It m ay ap p ea r that d ep artm en tal m erger challenges the conventions of professional autonomy. Quite so, as it has been the case that each professional group has had in addition to a separate training, a separate hierarchy above it. The literature indicates that this tradi tional structure only “tends to com pound the professional isolation and ‘tribalism ’ o f each group” (R olfe & Jackson, 2000) - which I am sure my colleagues will agree is quite evident in physiotherapy and occupational therapy clinical and academ ic departm ent boardroom s and corrid ors! ACKNOWLEDGEMENTS: The authors would like to thank Helen Farmer (Occupational therapist) and Aimee Stewart (Physiotherapist) fo r their interest and encouraging ideas in shaping the writing o f this paper. REFERENCES. B u n d y C . 2 0 0 0 . 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