The frequency of publication of guidelines is increasing. To make informed choices in the health care system, physical therapists should understand how guidelines are developed. The GRADE approach has been adopted by national and international organizations that produce guidelines relevant to physical therapist practice. Understanding the GRADE approach will enable physical therapists to make informed clinical choices.

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Evidence that supports the explicit need to develop leadership skills at all levels of clinical practice is prevalent 1–8; yet intentional development of “self-leadership” within healthcare, and particularly within physical therapy, remains slow, fragmented, and inconsistent. Delineation and standardization of the definition of leadership and the approach to develop leadership skills in individuals practicing within healthcare continues to be debated producing several key dilemmas. Moreover, there is a lingering misperception that developing leadership capacity is reserved for physical therapists who assume positional or formal roles as “leaders” within communities, healthcare organizations, practices, or teams. This misperception focuses leadership development on “leading others,” rather than “leading self”. Similarly, challenges exist between balancing the leadership development needs of the leader as a positional role and the act of “leading” as physical therapists practice and engage within all levels of care and within different communities – as individuals and within teams. This tension further complicates when and how best to prepare physical therapists to meet this essential skill set in clinical practice. The purpose of this perspective is to describe non-positional self-leadership and its importance to physical therapy practice, to propose common or contemporary leadership-related terminology, and to suggest a framework for leadership development. Through accomplishing these purposes, readers may be encouraged to change and adopt recommendations.

Introduction. Leadership is linked to patient experience and quality of care. Some health care professions have identified leadership competencies to guide curriculum design. Yet, the physical therapy profession lacks explicit leadership competencies for the point-of-care professional. The academic community is inconsistent including leadership development within Doctor of Physical Therapy entry-level education or residency/fellowship training. This project aimed to fill this knowledge gap and inform the conversation on leadership competencies essential for new graduate physical therapists while clarifying whether expectations differ for those physical therapists with additional experience who do not hold formal leadership positions. Subjects. Delphi panel of physical therapists with content expertise in leadership Methods. A collated document of leadership competencies was circulated electronically to the Delphi panelists for 2 rounds of structured review. Each panelist rated each competency for level of importance for new graduate physical therapists and the more experienced physical therapists. Consensus threshold was set priori at 0.80. Results. The Delphi panel consisted of 14 content experts. Ten completed 2 rounds of review. Of the 76 potential leadership competencies, 37 were deemed as “very important” and 1 as “somewhat” important for all physical therapists regardless of years postlicensure. Three were “not important” for new graduate physical therapists. Consensus was not reached on 35 leadership competencies. Conclusions. Identification of leadership competencies for physical therapists is essential for role identity and to impact quality of care and the overall patient experience in physical therapy. Results of this paper provide a foundation for discussions on the adoption of a set of leadership competencies within the profession to guide leadership development within curricula for entry-level and professional development activities.

Background and Purpose. “Leadership at all levels” has been identified as one of the 12 critical issues facing organizations around the world. The American Physical Therapy Association Vision calls physical therapists “to lead” efforts to transform society. Leadership competencies essential for practice recently have been identified. These competencies illustrate how physical therapists independent of professional role and position can support achievement of the Quadruple Aim. The profession has taken steps to prepare physical therapists with clinical competencies to practice as movement system experts; however, like many health professions, education has struggled to keep pace with professional formation and leadership skills that shape role identity. More emphasis needs to be placed on developing skills needed to lead, advocate, and influence change. The purpose of this position article was to expand conversation on leadership and propose an evidence-based framework, which can be used to build competence throughout entry-level curricula. This framework can bring the profession one step closer to adopting leadership as an essential domain of competency and providing the missing link to bridge the gap in achievement of the Vision. Position and Rationale. Leadership should be recognized as an obligation of all physical therapists and developing leadership an obligation of education, as it is critical to our evolving role identity. Adoption of a leadership competency framework informed by competencies will help assure graduates exhibit leadership skills to challenge current practices and advocate for transformation of the health care system. The team explored established leadership frameworks to evaluate “fit” of the 57 leadership competencies. Although frameworks offered valuable perspectives, none sufficiently “fit” the evidence to support widespread adoption. This led us to design a Leadership Competency Framework for Physical Therapists (LCF-PT) to categorize, enhance utility, and clarify interpretation of these competencies. Discussion and Conclusion. The LCF-PT organizes 57 competencies into 3 tiers and 11 thematic clusters that can further advance our role as movement system experts and build a more robust role identity consistent with a doctoral profession. Without a framework, DPT education programs will likely remain fragmented, unintentional, and inconsistent in the development of leadership competencies in Doctor of Physical Therapy graduates. Future research needs to validate the LCF-PT by stakeholders to confirm the framework is sufficiently robust to guide leadership development at all levels. This framework also can support eventual benchmarking of best practices in education in the future. To move forward as practitioners of choice and to ensure our voices are heard, all physical therapists must acknowledge that “to lead” at all levels is critical to role identity, achievement of the Quadruple Aim and the Vision to transform society by improving the human experience. This clarity will move us closer to “dreaming the not-so-impossible dream,” challenge current practices, implement evidence, and advocate for transformation of the health care system.