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REP 1 - The warm up

Chantal Lauzon, PT & Melissa Anderson, PT

Physiotherapists (PT), Physical Rehabilitation Therapists (PRT) and Physiotherapist Assistants (PTA) are faced with difficult decisions every day. CPA wants to increase awareness and provide tools so that you know what to do if you are faced with ethical dilemmas. 

By learning more about the issues and discussing how to address them, we hope to empower you to protect your professional reputation.

 

What is #30reps? 

From March 1-30, 2017, we'll share a post a day about fraud, abuse and waste to help you work your ethical muscle.  These blog posts will explore issues that can affect your professional reputation. Some brave members have come forward to anonymously share their stories in order to help bring awareness to these issues. 

Other entries come from provincial regulators, your liability insurer, and others wanting to share their voice. The month will culminate with a tweet chat where we hear from you and brainstorm how we can continue to protect our professional reputation.  

Let's talk about these professional issues and get the conversation started.

The Business Dictionary defines reputational risk as “the risk that a company will lose potential business because its character or quality has been called into question.” 

The current health care environment is influenced by educated and connected consumers.  

Word of mouth is being eclipsed by online reviews.  

Headlines about insurance fraud, abuse and waste also threaten the reputation of the profession. 

The effectiveness of CPA’s advocacy for the role of physiotherapy can be decreased by a few instances of poor judgment, lack of integrity or insurance fraud.  

The bad behaviours of a few people can negatively impact all members.  

 

Reputational risk may affect individual members directly:

  • Patients may choose a different clinic or a different profession for their health care needs

  • Potential for patient complaints to the regulator

  • Rejected insurance claims lead to increased member use of liability insurance to defend billing practices

  • Funding for access to physiotherapy may be reduced by government and health system administrators  

  • Decreased job satisfaction and employee engagement

  • Stress of reporting colleagues for fraud or abuse

 

Bad behaviour may affect the profession:

  • By decreasing the effectiveness of advocacy efforts

  • By harming the positive reputation that physiotherapy currently enjoys

  • By potentially creating lower standards of care if there are no consequences for fraud, abuse, or waste

  • By negatively impacting collaboration with other health professions 

 

Regulation, accreditation and licensing can all contribute to oversight of the profession.  However; clinicians themselves are accountable to their patients, their colleagues, and their profession.  

By enhancing awareness of reputational risk and how to mitigate it, each and every PT, PRT and PTA can help to be a part of the solution.

 

So what’s next?

  • Spread the word! This #30reps isn't just for CPA members; please share with your colleagues

  • Join the conversation by reading and responding to each of the #30reps

  • Mark your calendar for the March 31st tweet chat from 12-1 EST

  • Share the reps that mean the most to you (using the hashtag #30reps) on social media or within your networks

  • Talk about issues with your colleagues and employers

  • Learn more by checking out resources at the end of each blog post

  • Refer to your provincial standards of practice 

  • Reach out for help as needed (from colleagues, supervisor, employer, regulatory body, insurer or legal counsel, professional association)

 

What do you think?

  1. Does the physiotherapy profession have a reputation problem? 

  2. How do you promote your positive reputation as a PT, PRT and PTA? 

  3. What do you hope to learn about throughout the month?

 

Written by: Chantal Lauzon, PT & Melissa Anderson, PT

 

#30REPS 2017 is brought to you by

 

 

 

Read more 30 REPS

Comments

Great initiative. Looking forward to the 30reps. 

Patrick Lalonde, PT (FCAMPT)

 

 

1. Does the physiotherapy profession have a reputation problem? 

No

  1. 2. How do you promote your positive reputation as a PT, PRT and PTA? 
  2.  Patient-focused quality care
  3. keeping cost-effectiveness to the health system in mind
  4. evidence-based practice
  5. Show respect towards the other professions.
  6. Be involved/contribute back to the community. 
  7.  
  8. What do you hope to learn about throughout the month?

No expectations.... 

 

 

 

 

Merci Patrick! Thank you for your well-thought out comments. Glad to see that you are on board. 

1. I think some doctors are not fully aware of our role & therefore often give physios a bad rep.

Good food for thought.  Do you have any suggestions for increasing knowledge of our role with physicians?

Melissa

@CPA_Melissa

2. Educating people about what are purpose & role is helps promote a positive reputation 

We agree. That's why we have a public website: physiocanhelp.ca  

@CPA_Chantal

Most PT clinics seem to have a good reputation and work in a safe and ethical manner. One thing that concerns me is we do hear about ethical concerns about some clinics in the area-yet they seem to be able to reamin open for years and years. I'm not certain that the profession, and the professional organizations (CPA/OPA/CPO), "police" these rougue clinics appropriately.

We agree that the vast majority of PT clinics are professional, safe and ethical.  As a self-regulating profession, it is the responsibility of physiotherapists to call each other out, and to report unethical practices to the appropriate provincial college.  It is not the role of the association to 'police' clinics, we are using #30reps as an education and awareness campaign.

 

Melissa

@CPA_Melissa

I think it is important that we as members of the profession are vigilant in protecting our reputation and preventing fraud.  The popular media stories about fraud particularly in the MVC sector are certainly concerning and raise the public's concern about the trustworthiness of health care providers (including physiotherapists) in that arena.  What often seems lacking in the discussion about new FSCO clinic licences (in Ontario) and clinic regulation is facts about the number of fraud cases involving registered physiotherapist.  I hope over the course of the month the CPA the membership can bring some actual numbers to the discussion.  Are we talking about a few bad apples in PT or a whole bushel full?

Great points. That was our first question too... Didn't realise how hard it would be to quantify the problem. What we were able to determine is that there is a problem and there is evidence of complaints to regulators in most jurisdictions. However, we realize that there is under reporting of these issues. It takes courage to report a colleague, an employer, or a competitor for bad behaviour. 

@CPA_Chantal

One bad apple can ruin the whole bushel, especially in the age of social media!

Good communication with other professionals and family members with consent.

Use of evidence-based quality care which produces good results.

Good communication and evidence based care are certainly some of the building blocks for ethical and professional practice! 

I don't think as a profession we have a reputation problem with the public as from what I've found they don't seem to have much awareness about what we do/ our role in the first place. Within the profession I think there's some Physiotherapists that garner poor reputations more in private practice than anything (e.g. Physiotherapy mill / shake and bake type Physiotherapists) that continue to practice and see umpteen number of people/ hour. Unfortunately I believe these type of clinics affect the public and health sectors view of what Physiotherapy is as they see such a volume of people. I've had talks with physicians and medical students who are hesitant to send people to some Physiotherapy clinics as they are totally passive in their interventions, neglecting education and exercise and not actively engaging the patient, trying to help them meet their movement targets/ goals. I don't know how we can make these places/ people more accountable or combat that negative view other than to continue to be vocal about what we can do well and have these discussions between us and the public. 

 

 

Thank you for your input. We agree that seeing, as you say, “umpteen number of people/ hour” is not quality care and may greatly harm the reputation of our profession from the view of the public, referral sources, etc. When patient volume increases beyond a quality threshold, we need have the confidence, for the sake of our reputation, to speak up. One way to increase accountability is through the collection of patient-reported outcome measures (PROMs). The collection of PROMs through, for example, FOTO’s electronic outcome measures system can demonstrate the effectiveness of physiotherapy interventions. If effectiveness takes a nosedive after, for example, a private practice clinic decides to increase patient volume from 4 to 5 patients per hour, the physiotherapist could show their manager that patient outcomes suffered as a consequence. If patient outcomes suffer due to volume, the reputation of that business may suffer as a result, and hopefully the caseload would be reduced after an open conversation with the clinic manager. Physiotherapists should speak up about excessive volume. Thanks again for your input!

 

Kerry

@CPA_Kerry

 

I think PTs have a good reputation. Sometimes we are said to be "expensive" but often that is when the person is not looking ahead at the preventative and effective benefit we provide.

I promote my positive reputation by being transparent to my clients, to other health care providers I deal with and any lawyers or insurance adjustors that I need to be contact with.  I take the time to assess, treat and clinically reason well and provide education along they way.  If something I have assessed is out of my scope of practice or I am not comofrtable with it, I refer the client for further diagnostic imaging or to another provider.

I hope to learn about innovative ways PTs are practicing and how they advocating for themselves in their practice.

 

Excellent! Transparency is key to managing expectations. Thank you for your comments.

@CPA_Chantal

  1. Does the physiotherapy profession have a reputation problem? -As a whole no, in private practice there is fraud happening, which harms our reputation. In terms of patient experience, our reputation is that we give a bunch of exercises, or we give them "pain"
  2. How do you promote your positive reputation as a PT, PRT and PTA? -Professional presentation while volunteering or representing OPA/PT. Constant education to patients
  3. What do you hope to learn about throughout the month? -specifically how the CPA/OPA is preventing fraud, what if any protocols are there in place, how much communication is there between CPA and the large insurance companies.

 

In our work preparing this series, we learned that physiotherapy generally enjoys a positive reputation with insurers and the public.  We are also aware that physiotherapy, along with massage therapy and chiropractic care, are on insurer's radar, as the frequency and costs of these claims are increasing. This was discussed in a recent news article https://www.thestar.com/business/personal_finance/2015/04/13/the-rise-of... .

We need to ensure that we are maintaining our positive reputation. and the best way to do that is to talk about issues and look for strategies to mitigate any risks. By far the best way is to put the needs of our clients ahead of our own.

Melissa

@CPA_Melissa

I believe that there is a continually growing awareness of physiotherapy and the scope of practice that our profession encompasses.  We generally have a great reputation; however, it is not hard to find a patient with a story about a bad experience with physiotherapy.  Unfortunately, it seems the negative messages seem to perculate through the populace alot faster, and with larger impact than the positive ones.  I believe that we need to continue to use our positive stories and highlight our innovative practitioners that are providing excellent, evidence based care to their clients.  These stories are also very easy to find... we just don't share enough of them.  I think that as a group we are getting better with our advocacy efforts and our reputation is improving as a result.  I promote PT on a daily basis within my clinical world by working to practice professionally and to provide evidence informed treatment to my clients.  As a volunteer I am actively working to help promote the profession on both a provinical and national level with government and other stakeholder groups. I am looking forward to sharing ideas about this important aspect of our professional lives and have no expectations... just interest in learning. 

 

Cheers

Wendy 

 

 

 

 

Thank you for your comments Wendy. In the current media climate, we are well aware that negative stories "trump" the positive ones. As a profession, we need to take note of what is occuring and our education and awareness campaign is attempting to do that.

We will be using the three colours of a stop light to highlight the topics in the #30reps series. Green indicating what to strive for; yellow indicating to proceed with caution and be aware of potential pitfalls; and red for behaviours that should be stopped or reported. 

We hope to hear more from you as topics are posted. 

@CPA_Chantal

 

  1. Does the physiotherapy profession have a reputation problem?   No. But I agree most people don't know the full scope of our practice...eg. just identifying with traditional outpatient practice. 

  2. How do you promote your positive reputation as a PT, PRT and PTA? As a PT having been in public, private, acute, rehab, community, LTC and pallaitive practice -- I focus on integration and collaborative with EVERYONE I meet.  In short I try and add clincial, interpersonal and professonal value where ever I go.  Its a personal challenge of mine over 25 years.  How can I create a win-win. 

  3. What do you hope to learn about throughout the month?  What other PTs are experiencing, pros and cons across country.

 

Thanks for joining the conversation!  Win-win solutions and collaboration are great ways to increase our reputation.

@CPA_Melissa

I do believe there are still some physiotherapists out there that give the profession a bad reputation. Unfortunately there are still some practitioners that practice in a very hands off/passive way. I often have patients describe their experience with physio as 'heat and machines'. However, I do believe this is changing and our profession as a whole has mostly progressed passed this exclusive type of treatment.

Sad but true. I had to argue with my personal trainer who thinks that PTs do not know how to teach people how to perform exercises. I have hope for the future and feel we are heading in the right direction in that regard.

@CPA_Chantal

 

Every profession has good and not-so-good practitioners. When I talk to my patients/clients, I find that the biggest issue is a lack of sufficient communication. Having been treated somewhere, they were not given enough education that could be preventive and that adequately explains to the client the causative factors. And I also agree with a lot of comments here about many people being unaware of the role of Physiotherapy, Physicians often being among them.But those who do experience Physiotherapy, then carry with them a good opinion of the profession.

We need to all be providing #QualityPT to each and every patient. 

https://physiotherapy.ca/blog/patients-dont-expect-good-physiotherapy-anymore

CPA is continuing to work on our #QualityPT campaign to inform members about what that entails. Effective communication is part of providing patient-centred care.

What recourse do physiotherapists have when a local doctor tells you to your face that even though you provide excellent, efficient treatment to patients (including them) they are unable to refer patients your way unless you rent space from them in their building????? This is the type of "practice" that erodes our Brand or reputation as you call it. My patients are referred by a few doctors but mostly they show up wanting to be 'fixed up' just like their friend, family member or colleague as a result of treatment at my clinic.  Often they are not even looking for physiotherapy, just assessment and treatment that has results.  I think we have to keep listening to our patients and not find excuses when they don't get better but keep thinking and searching for ways to improve our own skills.  We should strive to succeed with less focus on immediate income and more attention to actual results we are making with our patients. Remember that each patient leaving your office is a potential walking billboard.  It is not your employer that is responsible for what message is on that board, it is you the physiotherapist.

 

Great comments!

From your description of the scenario, I would guess that the physician is not being compliant with the CMA's code of ethics (https://www.cma.ca/Assets/assets-library/document/en/PD04-06-e.pdf#searc...) or their policy on professionalism (https://www.cma.ca/Assets/assets-library/document/en/advocacy/CMA_med_pr...).

I appreciate your comment about patients being a walking builboard for your services.  It is true that word of mouth referrals are very valuable to your physiotherapy business.

As you say, listening to your patients is one way to ensure you are providing quality care.  Another would be to utilize an electronic outcome measurement system, which would allow you to compare your patients with patients in the database, to help set realistic goals and expectations of treatment.

Thanks for taking the time to add your voice to this conversation!

@CPA_Melissa

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