Principles to guide sustainable implementation of extended-scope-of-practice physiotherapy workforce redesign initiatives in Australia: stakeholder perspectives, barriers, supports, and incentives

Abstract

Sustainable implementation of new workforce redesign initiatives requires strategies that minimize barriers and optimize supports. Such strategies could be provided by a set of guiding principles. A broad understanding of the concerns of all the key stakeholder groups is required before effective strategies and initiatives are developed. Many new workforce redesign initiatives are not underpinned by prior planning, and this threatens their uptake and sustainability. This study reports on a cross-sectional qualitative study that sought the perspectives of representatives of key stakeholders in a new workforce redesign initiative (extended-scope-of-practice physiotherapy) in one Australian tertiary hospital. The key stakeholder groups were those that had been involved in some way in the development, management, training, funding, and/or delivery of the initiative. Data were collected using semistructured questions, answered individually by interview or in writing. Responses were themed collaboratively, using descriptive analysis. Key identified themes comprised: the importance of service marketing; proactively addressing barriers; using readily understood nomenclature; demonstrating service quality and safety, monitoring adverse events, measuring health and cost outcomes; legislative issues; registration; promoting viable career pathways; developing, accrediting, and delivering a curriculum supporting physiotherapists to work outside of the usual scope; and progression from “a good idea” to established service. Health care facilities planning to implement new workforce initiatives that extend scope of usual practice should consider these issues before instigating workforce/model of care changes.

Advanced musculoskeletal physiotherapy: Barriers and enablers to multi‐site implementation

“…A qualitative investigation of a number of different health professionals involved in one Australian hospital AMP service made recommendations for guiding the sustainable extended scope of physiotherapy practice implementation. These were proactively addressing credibility, marketing, concerns, quality and safety, outcomes, training, recruitment and support (Morris et al, ). In a mixed‐methods study examining satisfaction in multicentre Irish advanced musculoskeletal physiotherapists, relationships with medical teams and educational opportunities were primary themes (O'Mahony & Blake, ).…”

Advanced Physiotherapy Practice: A qualitative study on the potential challenges and barriers to implementation in Ghana

“…In the United Kingdom, a formal support and engagement of the employer is required before a physiotherapist may undertake advanced level of training programs, such as injection therapy (Chartered Society of Physiotherapy, 2016b). A study examining the views of stakeholders in Australia (Lizarondo et al, 2016;Morris et al, 2014) also identified management support as one of the key challenges and areas requiring improvement in extending health-care practitioner's scope of practice. Robarts et al (2008) also highlighted how support from management has aided in establishing advanced practitioner roles, by developing Central Intake and Assessment Clinics for total joint arthroplasty patients in Ontario, Canada.…”

“…The roles performed by advanced practitioners include performing assessments and triage in orthopedic outpatient clinics, prescribing controlled medications, working in accident and emergency departments, providing injection therapy, requesting and interpreting laboratory tests, and ordering magnetic resonance imaging and computed tomography scans (McClellan, Cramp, Powell, and Benger, 2010). APP roles have resulted in reduced patient waiting times, reduced direct and indirect hospital and patient costs, and freeing up consultant time, which have resulted in greater patient and consultant satisfaction (Kersten et al, 2007;McPherson et al, 2006;Morris et al, 2014). While implementation of APP roles in developed nations has resulted in such health-care system improvements, the value of introducing similar models of care in developing nations remains unknown.…”

Erweiterte Rollenfunktionen der Physiotherapie im Akutkrankenhaus – Umfrage unter Physiotherapeuten der Ostschweiz

“…Derzeit gibt es weder einen global definierten Bildungsweg für die Ausübung von ER noch eine global anerkannte Definition [15]. Der Bildungsgrad wurde jedoch als wichtiger Förderfaktor für die Ausübung von ER erkannt [16] und ist in nationalen Berufsverbänden der Physiotherapie im Vernehmlassungsprozess [6]. Ausweitungen der Kompetenzen sind auch in der Physiotherapie in der Schweiz zu beobachten.…”