Priorities of Hybrid Clinician-Managers: A Qualitative Study of How Managers Balance Clinical Quality Among Competing Responsibilities

Abstract

Objective Oversight of clinical quality is only one of physical therapy managers’ multiple responsibilities. With the move to value-based care, organizations need sound management to navigate this evolving reimbursement landscape. Previous research has not explored how competing priorities impact physical therapy managers’ oversight of clinical quality. The purpose of this study was to create a preliminary model of the competing priorities, motivations, and responsibilities of managers while overseeing clinical quality. Methods This qualitative study utilized the Rapid Qualitative Inquiry method. A purposive sample of 40 physical therapy managers and corporate leaders was recruited. A research team performed semistructured interviews and observations in outpatient practices. The team utilized a grounded theory-based immersion/crystallization analysis approach. Identified themes delineated the competing priorities and workflows these managers utilize in their administrative duties. Results Six primary themes were identified that illustrate how managers (1) balance managerial and professional priorities; (2) are susceptible to stakeholder influences; (3) experience internal conflict; (4) struggle to measure and define quality objectively; (5) are influenced by the culture and structure of their respective organizations; and (6) have professional needs apart from the needs of their clinics. Conclusion Generally, managers’ focus on clinical quality is notably less comprehensive than their focus on clinical operations. Additionally, the complex role of hybrid clinician-manager leaves limited time beyond direct patient care for administrative duties. Managers in organizations that hold them accountable to quality-based metrics have more systematic clinical quality oversight processes. Impact This study gives physical therapy organizations a framework of factors that can be influenced to better facilitate managers’ effective oversight of clinical quality. Organizations offering support for those managerial responsibilities will be well positioned to thrive in the new fee-for-value care structure.

Physical therapists’ professional role identity in the clinician to leader transition

“…In a study of Australian physiotherapy managers, Glendinning (1987) found only 5% of their time was spent as spokesperson and 7% in the figurehead role. In a more contemporary study, Hoekstra et al (2021) noted hybrid PT clinician-managers felt a sense of personal responsibility to patients and staff. The findings of increased accountability are consistent with Hoekstra et al ’s (2021) findings, likely due to the more contemporary nature of Hoekstra et al ’s (2021) study.…”

“…Participants in this study also redefined success in their new roles. The hybrid PT clinician-managers studied by Hoekstra et al (2021) struggled to redefine measures of success, inferring quality based on operational metrics. Physical therapists in this study defined success at the team level through objective measures of patient satisfaction, outcomes and successful discharge planning.…”

“…In a study of Australian physiotherapy managers, Glendinning (1987) found only 5% of their time was spent as spokesperson and 7% in the figurehead role. In a more contemporary study, Hoekstra et al (2021) Establishing a new professional identity left participants inhabiting two worlds, clinical and leadership. Prior research from other health-care professions cites this phenomenon as a source of role conflict and new leader ineffectiveness (Masoumi, 2019;Sofritti, 2020;Wikstrom and Dellve, 2009).…”

“…Participants were accepted as long as patient care responsibilities did not exceed 60% of their defined job duties. Many first-time leaders in PT continue to work at high levels of patient care (Hoekstra et al , 2021).…”