The changing landscape of professional practice in podiatry, lessons to be learned from other professions about the barriers to change – a narrative review

Abstract

Background The delivery of healthcare is changing and aligned with this, the podiatry profession continues to change with evidence informed practice and extending roles. As change is now a constant, this gives clinicians the opportunity to take ownership to drive that change forward. In some cases, practitioners and their teams have done so, where others have been reluctant to embrace change. It is not clear to what extent good practice is being shared, whether interventions to bring about change have been successful, or what barriers exist that have prevented change from occurring. The aim of this article is to explore the barriers to changing professional practice and what lessons podiatry can learn from other health care professions. Main body A literature search was carried out which informed a narrative review of the findings. Eligible papers had to (1) examine the barriers to change strategies, (2) explore knowledge, attitudes and roles during change interventions, (3) explore how the patients/service users contribute to the change process (4) include studies from predominantly primary care in developed countries. Ninety-two papers were included in the final review. Four papers included change interventions involving podiatrists. The barriers influencing change were synthesised into three themes (1) the organisational context, (2) the awareness, knowledge and attitudes of the professional, (3) the patient as a service user and consumer. Conclusions Minimal evidence exists about the barriers to changing professional practice in podiatry. However, there is substantial literature on barriers and implementation strategies aimed at changing professional practices in other health professions. Change in practice is often resisted at an organisational, professional or service user level. The limited literature about change in podiatry, a rapidly changing healthcare workforce and the wide range of contexts that podiatrists work, highlights the need to improve the ways in which podiatrists can share successful attempts to change practice.

Exploring the use of musculoskeletal ultrasound imaging by podiatrists: an international survey

“…With appropriate governance, there is potential for a new model of podiatric practice to emerge in which a holistic approach using technology to enhance diagnosis and management of musculoskeletal conditions or pathologies also facilitates patient education, engagement and empowerment [20–22]. The findings from our survey indicated common benefits of podiatrists using MSUS in their practice including improved access, reduced waiting times for appointments, improved patient journeys through tighter, more focused management plans.…”

Becoming a Podiatrist: an exploration of the practices and processes which underpin the acquisition of a professional identity

“…The shift from core podiatry to the utilisation of more advanced skills has already seen the implementation of podiatric surgery and independent prescribing (9,10). In addition, the profession has established a position in the centre of a wider foot health workforce whereby core requirements can now be delegated more readily to assistant grades (11). These shifts are not without challenge in terms of the boundaries with other professional groups (12) however, the movement has been towards establishing an identity of practice that extends beyond the foot whilst retaining the commonality of the COP (7).…”

The biopsychosocial‐digital continuum of foot orthosis practice and research: the VALUATOR model

“…Value is also affected by the changing and complex needs and expectations among different age populations. These factors affect outcomes and should therefore affect practice [26]. For example, athletes often set high (or unrealistic) expectations on how they will perform in competition, based on past results, competitors and coaching.…”

“…For example, for what purpose or clinical endpoint are orthoses useful, how does cost and quality of the orthoses matter, and how do the nature and model of services that deliver orthoses impact outcomes [16][17][18][19]. Efficacy of foot orthoses has been subject to protracted debate and a number of factors associated with variable efficacy have been proposed [11,19] including: i) the evolution of orthoses materials and associated technologies [20][21][22][23], ii) application by a wide range of practitioners [24,25]; poor knowledge transfer between research and practice [26][27][28]; and increasing interest by consumers and other purchasers and dispensing by unqualified vendors [11].…”