Describing the Value of Physical Therapy in a Complex System Using the Socio-Ecological Model

Abstract

A system is a collection of entities (ie, widgets, molecules, people, businesses) that interact in such a way that their resulting collective behavior is not immediately apparent by viewing the collected items separately. Hospital-based health care meets the definition of a system, but further specification is helpful to describe the value of components in the system. Complexity science offers a chance to reconceptualize our understanding of health care to an environment of connected parts operating together and adapting on the basis of inputs and outputs. The purpose of this conceptual article is to apply complexity science principles to acute care physical therapy in order to provide perspective on the value of the physical therapist in the hospital environment and on the contextual factors that influence the profession's value. We present a model, the Socio-Ecological Model for Acute Care, and apply this model to physical therapy in order to describe the interrelated factors influencing the profession's value to individual patients, to the hospital units on which they practice, to the hospital system as a whole, and how they contribute to policy discussions. Yet, this value is difficult to distinguish due to the multifarious inputs into the system. Providing a clear description of the value of physical therapy in hospital settings is essential in our current health care environment that is increasingly cost-conscious. We provide perspective for clinicians and health care leaders while suggesting needs for future research.

Creating Value Together: A Triad of Clinicians, Administrators, and Researchers

“…The recent, landmark report “The Economic Value of Physical Therapy in The United States” found an average net monetary benefit of physical therapy services for 8 different diagnoses, ranging from $2144 to $13 981 per episode of care 6. While these are important findings, it is discouraging that our entire body of evidence can only produce this level of extrinsic value for 8 diagnoses, and with no particular mention to acute care—not for a lack of want, but rather a lack of indisputable evidence due to the tremendous difficulty deducing the direct influence of acute physical therapy in complex adaptive systems like hospitals 7…”

“…Integrating physical therapy's knowledgebase with areas like population health, health services, and workforce research has potential to translate our innate understanding of our profession's value to others. Collaborative research efforts outside the clinical spectrum can yield outcomes that show the macroeconomic value of acute care physical therapy and provide metrics that matter to patients and decision-makers 7. Allies in other domains of research are not a luxury, they are a necessity.…”

“…6 While these are important findings, it is discouraging that our entire body of evidence can only produce this level of extrinsic value for 8 diagnoses, and with no particular mention to acute care-not for a lack of want, but rather a lack of indisputable evidence due to the tremendous difficulty deducing the direct influence of acute physical therapy in complex adaptive systems like hospitals. 7 Defining the value of physical therapy intervention to a dollar figure seems taboo to many physical therapists, who joined the field for nonmonetary reasons. However, monetary value is a ubiquitous outcome measure everyone (ie, policymakers, clinicians, patients) understands and is undeniably important for all stakeholders.…”

“…Collaborative research efforts outside the clinical spectrum can yield outcomes that show the macroeconomic value of acute care physical therapy and provide metrics that matter to patients and decision-makers. 7 Allies in other domains of research are not a luxury, they are a necessity.…”