JUNE 1980 PHYSIOTHERAPY
MANAGEMENT OF A PHYSIOTHERAPY DEPARTMENT
CAROL CORN ELL, Dip. Physio. (Cape Town)*
ABSTRACT
The concept o f scientific m anagement is considered.
The functions o f management are defined and discussed
with particular reference to the m anagement o f a physio­
therapy department. Qualities which are required in a
supervisor are exam ined and the necessity fo r the deve­
lopm ent o f m anagement skills is stressed. The shortage
o f form ally trained physiotherapy managers is noted
and possible solutions to remedy this problem are
suggested.
M anaging a physiotherapy departm ent can be exciting
_ ^ n d challenging but how m any physiotherapists have the
■Secessary skills to do full justice to the position? T radi­
t i o n a l l y medical and param edical services are headed by
members of their particular professions. U sually these
departm ent heads have had no form al managerial train­
ing and while experience is valuable, it should be an
adjunct to and not a replacement for managem ent know­
how. Hospitals and their com ponent departm ents need
skilled administrative and clinical supervision to ensure
an efficient health care service. Therefore it is essential
that managerial skill should be as much p art of a phy-
siotherapist-in-charge’s job as clinical skill.
This article is geared towards the physiotherapist
working fo r a Provincial or G overnm ent authority or
other large corporation rather than fo r som eone who is
self-employed. However, the basic principles of m anage­
m ent discussed are applicable to any situation.
Scientific m anagem ent — a term now in general use —
Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2013.)
is a fairly new discipline but has developed rapidly
throughout the m odem industrial world in recent years.
O ur ever m ore complex environm ent makes demands on
us which can only be solved by the development o f new
skills. These skills are applicable to all fields of hum an
endeavour from household m anagement to the running
of a physiotherapy department.
A definition of m anagem ent is not easy but the fol­
lowing is a good working definition: T he process by
Private Practitioner; form erly Principal Physiothera­
• pist, D ay H ospitals O rganisation, Bellville.
Received 30 A pril 1980.
Contents — Inhoud
Management of a Physiotherapy Department ... 35
Preliminary Thoughts on Auditing ........................... ...38
Practice M a n a g e m e n t.................................................... ...43
National Committee of R e p re se n ta tive s................... ...45
Correspondence ............................................ 51, 52, 53
Classified — Vacancies .................................... 55, 56
2
35
OPSOMMING
Die konsep van wetenskaplike bestuur w ord oorweeg.
Die funksies van bestuur m et spesiale verwysing na die
bestuur van ’n fisioterapie-departement w ord gedefinieer
en bespreek. Eienskappe nodig vir toesighouers word
ondersoek en die behoefte vir die ontw ikkeling van
bestuursvaardighede word beklemtoon. Daar word gelet
op die tekort aan form ele opleiding van fisioterapie-
bestuurders en m oontlike oplossings hiervoor word
voorgestel.
which the senior staff o f any group directs actions to­
wards a common goal. Im plicit in this definition is the
understanding that managers themselves seldom carry
out the activities; rather they delegate duties to and
supervise their efficient discharge by other people.
FUNCTIONS OF M ANAGEM ENT
It m ust be stressed th at managem ent is an integrated
concept and it is difficult to divide it into separate func­
tions. However, it is a useful exercise to undertake
if m erely to try and underline the full scope o f the
discipline. Joseph L. Massie (1971) defines the following
seven functions of management:
Decision m aking — the process by which a course
of action is consciously chosen from available alterna­
tives fo r the purpose of achieving a desired result.
Organizing — the process by which the structure and
allocation of jobs is determined.
Staffing — the process by which managers select,
train, prom ote and retire subordinates.
Planning — the process by which a m anager antici­
pates the future and discovers alternative courses of
action open to him.
Controlling — the process th at measures current per­
form ance and guides it towards some predeterm ined
goal.
C om m unicating — the process by which ideas are
transm itted to others fo r the purpose o f effecting a
desired result.
Directing — the process by which actual perform ance
of subordinates is guided towards common goals.
On reading th e above list, two things com e to mind.
Obituary ........................................................................56
South African Assoc, of Occup. Therapy Congr. ... 57
Proceedings of Eighth International Congress ... 57
W orld Confederation for Physical Therapy ........... ...57
Training Centres in the Republic of S.A......................58
 FISIOTERAPIE
36
Firstly, most of the points could be described as com-
monsense but the consistent application o f so-called
commonsense is rare. Secondly, many of the functions
overlap; for example, staff m otivation w ould combine
the functions of directing and staffing, thus re-empha-
sizing the integrated nature of the process.
Since m anagem ent has been defined and dissected,
w hat o f the characteristics of the good manager? R obert
K atz (1955) sums these up in the following points:
T he good m anager requires:
Technical skills, i.e. proficiency in perform ing an
activity in the correct m anner with the appropriate tech-
^11uman relationship skills — the skill of co-operating
with others, . .
Conceptual ability — the ability to see individual
m atters as they relate to the overall picture.
H aving outlined the scope of management, let us now
consider how this relates to som e practical points con­
cerning the supervision of a physiotherapy department.
A s m entioned above, it is well nigh im possible to sepa­
rate the various functions o f m anagem ent so there will
be some overlap.
Decision and Policy Making
Physiotherapy departm ents, in comm on with .other
hospital departm ents, usually have to w ork within the
constraints of overall hospital policy (a policy being a
guideline fo r decision-making). T he first thing a head of
departm ent m ust do is to become thoroughly fam iliar
with this policy so that the aims o f the departm ent
may mesh sm oothly with those o f the hospital. It is
often useful to gain the ear o f a helpful administrative
officer who can explain the finer details and iron out
misunderstandings. . the allocation o f such supportive personnel to the staff
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Decision-making is a whole subject on its own. h o r
the purposes of this article, suffice to say th at decisions
m ay be m ade by individuals, by form al committees or by
inform al groups and no one m ethod is right all the time,
time.
Organizing
One of the m ost im portant facets o f organizing is the
careful drawing up of job descriptions, the benefits of
which are num erous. T he compilation o f a job descrip­
tion for each mem ber of staff requires careful planning
but it does supply a yardstick by which the perform ance
of the departm ent and the individual concerned m ay be
judged. T he job description is a concise sum m ary of the
duties and responsibilities of the particular job and it
serves as a useful com m unication tool and problem-
solving device as, should problem s arise, it provides a
fram ew ork w ithin w hich a solution can be found. The
members of staff should be actively involved in com­
piling the description. N o t only are they the people fill­
ing the jobs but this approach also gives them the op­
portunity to contribute tow ards the m anagem ent o f the
deparm ent which, in turn, engenders a feeling o f belong­
ing and participation. T h e members of staff know what
will be required o f . them and they to o have something
concrete by which to assess their own progress. Remem­
ber, however, th at any situation involving people is dyna­
mic and not static and regular updating of the job
description m ay be necessary.
Planning, Staffing, Controlling, Directing
T he current physiotherapy staff shortages and the
limitation of the executive powers o f the supervisor in
many institutions does curtail m anagem ent function.
This fact notwithstanding, because m anagem ent must
plan for both the present and the future, the following
JUNIE 1980
points should be borne in mind and implemented w here
possible.
Besides clinical notes, records of all aspects of de­
partm ental function are vital. On these facts and figures
will hinge the response from the hospital adm inistrators
to requests for additional staff, building alterations, new
equipm ent and improved conditions of service. Future
planning is impossible w ithout access to such records. In
addition, hospital adm inistration does demand, from
tim e to time, inform ation to justify aspects of the de­
partm ent’s function on an economic basis. Equally im ­
portant, the supervisor must know how to present this
inform ation in well-motivated and succinct m em oranda.
W here possible, direct involvem ent in the planning of
any new departm ent is essential. Regretfully all too fre­
quently the supervisor who should be consulted regard­
ing the building requirem ents is only brought in at a late
stage. W here such an opportunity does present itself,
careful consideration m ust be given to the m any factors
involved, such as the type of service required, equip-^
m ent needed, the demands which m ay be m ade by popu
lation growth and m any other factors which go beyond,
the scope of this article. C onsultation with other physio­
therapy supervisors in the area o r further afield, if
necessary, is a useful m eans o f gaining additional
inform ation.
The provision of an adequate staff to cope with the
w orkload m ust be ensured. On-going evaluation of the
function of the departm ent and the demands made on it
m ust be carried ou t on a regular basis. On the basis of
these findings, the service must accordingly be pruned
o r extended.
It is a waste of professional skill to have tasks car­
ried o u t by qualified staff which could be done satisfac­
torily by unskilled staff. Provision should be m ade for
establishment, their role being to m aintain the produc­
tivity of the physiotherapy staff at an optimum level.
O’Neill (1976) states th at as a general rule, in the general
hospital departm ents investigated fo r their report, where
there was a staff of three or m ore, approxim ately one
third o f the staff was non-physiotherapist.
W here a physiotherapist is sole-in-charge, the appoint­
m ent o f an aide/receptionist to the departm ent is essen­
tial if productivity is n o t to suffer. All too often this is
the very situation w here a physiotherapist is assured
that, if help is needed, she need only ask a nurse aide or
porter. Inevitably, this unspecified help is not readily
available when required. The result is tension betwe^j
personnel and valuable patient treatm ent time is lost. ■
D elegation of duties and responsibility by the super­
visor is essential for the smooth running of the bigger
departm ent. Marcus (1966) in his article on common
failings of supervisors describes the “seven deadly sins” ,
one o f which is: “Playing everything close to the chest.
K eep everything to yourself. D on’t tell anybody any­
thing . . . Just be uncomm unicative” . The result is
usually inefficiency and an unhappy department.
P art o f the process of control is provision for evalu­
ation o f staff perform ance, particularly of the new staff
mem ber. The staff need to know clearly w hat is ex­
pected of them; this is provided by the job descrip­
tion previously discussed. Satisfactory w ork should be
given recognition and poor work should be construc­
tively criticised. A specially designed evaluation form
should be used.
Communication
Com m unication provides the link between all other
functions. The types of com m unication in an organisa­
tion can be described as vertical, flowing back and forth
between managers and subordinates; horizontal, where
staff on sam e level co-ordinate activities w ithout refer-
 JUNE 1980 PHYSIOTHERAPY
ence to their superior; informal, e.g. the “grapevine”.
Effective com m unication is regular communication.
The supervisor m ust relay inform ation from the depart­
m ent to the hospital adm inistration and m ust in turn
relay relevant inform ation back to the departm ent. Sys­
tems m ust be set up within the departm ent to encourage
a flow of inform ation between staff, and to anticipate
and solve problems. Im portant m atters should be
written; written requests deserve written replies. Oral
messages m ay be in order at times but the m ore levels
they have to go through, the m ore room there is for
error.
Conflict is an inherent p art of m anagem ent and may
be handled by (1) domination, (2) compromise, or (3)
integration. Integration would seem to be the m ost suc­
cessful approach.
To achieve it, differences must be brought into the
open, all parties concerned join in the discussion and
together a position acceptable to all and to their w ork­
i n g relationships is chosen.
M To encourage communication within the physiotherapy
™ tablishment, regular staff meetings are a must. These
gatherings serve both as an opportunity fo r clinical
teaching and for administrative discussion and instruc­
tion, ' T he supervisor should be a m em ber o f the profes­
A further practical point in this field: never take it
for granted that other hospital personnel know either the
w hereabouts of the staff at any given tim e or the details
of the departm ent’s working hours. This is particularly
pertinent for the busy supervisor o r the physiotherapist
in the sole-in-charge situation. Always ensure th a t any
variation in the routine physiotherapy service offered,
and hence expected by other departments, is documented
and circulated to relevant sections. D o n o t forget to
notify the physiotherapy staff of changes as well. Many
physiotherapy jobs entail a great deal o f mobility during
Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2013.)
the day. It is therefore essential that a receptionist be
available at all times to process enquiries, thereby facili­
tating the smooth running o f the department.
A useful routine for the supervisor is to organize
a set period daily when staff queries can be dealt with
on a personal basis. N othing alienates both other hos­
pital staff and the physiotherapists themselves more
quickly than the constantly elusive and apparently too
busy supervisor.
A t the clinical level, good comm unication must be
m aintained between the physiotherapy departm ent and
other departm ents of the hospital. By m eans of con-
K
ltation with relevant departm ent heads, the role which
e physiotherapists are expected to fulfil m ust be clearly
defined. Each physiotherapist should be encouraged to
participate fully in the health team activities o f their
section. A ttendance a t clinical meetings and w ard rounds
provides good opportunities for the physiotherapist to
learn and to contribute. It should also be stressed to staff
that they must, as a m atter of routine, report back to the
doctors regarding patients’ treatm ent progress. This is
something which is often neglected.
As mentioned briefly, under planning, it is advisable
for a supervisor to keep in contact with heads o f other
physiotherapy departments. It provides an opportunity
to share knowledge, get advice and discuss common
problems when the need arises.
N o t least, good rapport m ust be fostered between the
staff and their patients and extended to the patient’s
fam dy if they are available for consultation. As the
physiotherapist is so often in a counselling situation, it
is advisable for special attention to be given to this field
during training sessions.
The Supervisor
i ^ ! U S-UpT isor is .,in fact a leader and the type o f
leadership chosen will set th e tone for the department.
37
The dictatorial approach — “do it or else” is to be
avoided as is the paternilistic type of leader w ho does
everything personally, thereby m aking their staff reliant
on them . TTie leader should develop the democratic a p ­
proach, w here he/she depends n o t only on his/her own
abilities but actively encourage his/her subordinates to
accept responsibility and participate in decision-making
and planning. By these m eans b o th personal grow th
and the developm ent of m anagerial ability is en­
couraged. This approach builds up a co-operative atti­
tude and job satisfaction am ongst the group towards the
job.
T he supervisor needs to be people-conscious; person­
nel m anagem ent is a vital p art o f the job. An open-
minded, outw ard-looking approach should be developed
and any tendency towards a rigid attitude should be
checked. The staff have the right to expect a firm yet
fair and considerate approach. If the supervisor does
n o t know something, o r has m ade a mistake, it should
be adm itted since nobody will be fooled b y an attem pt
to hide the fact.
Continuous education is essential and attendance o f all
staff at post-graduate courses should be both expected
and actively prom oted.
sional society and take an active role in its activities
and encourage staff to do the same.
W hen applying for such a post, the prospective super­
visor should realise th at m anagerial skills, if not yet
acquired, will have to b e developed. This will enable
them to cope with th e complexities o f adm inistration
and thereby ensure efficient and effective patient care.
Also to be borne in m ind is th at the appointee to such
a post will be required to represent the profession to the
administration. Such a challenge should be m et with
enthusiasm.
CONCLUSION
V arious aspects of m anagem ent and their application
to physiotherapy have been considered. T he need fo r
such skills in today’s environm ent has also been dis­
cussed. However, w here can th e physiotherapist get
form al managerial training? A t present, none o f the
physiotherapy training centres offers such a course. P er­
haps it is w orth considering the introduction a t under­
graduate level o f a course in basic managem ent which
could then serve as a foundation fo r the practical ex­
perience gained later, while working. V arious branches
of the South A frican Society o f Physiotherapy have
organized lectures touching on aspects o f managem ent
and this is to be encouraged. T here is a great deal of
literature available on the subject and articles have been
published specifically on physiotherapy m anagem ent by
some overseas physiotherapy journals.
The m anagerial process is a complex social activity
and the idea th at m anagem ent is som ething related to
business and not to a professional role m ust be refuted.
M anagem ent supplies a fram ew ork fo r the efficient and
consistent running of any organization, be it large or
small, professional or non-professional.
References
1. K atz, R o b ert L. (1955). Skills o f an effective admini­
strator. Harvard Business Review , Jan-Feb 33 - 42.
2. M arcus, Edw ard E. (1966). T he physical therapist in
supervision. Phys. Ther. 46, 391-394.
3. Massie, Joseph L. (1971). Essentials o f M anagem ent,
2nd Ed. Englewood Cliffs N .J. Prentice Hall.
4. O’Niell, M ichaela T. (1976). Physiotherapist caseload
standards. Physiother. Can. 28, 95-98.
 38 FISIOTERAPIE
Bibiliography
Feitelberg, Samuel B. (1966). Basic considerations of a
job description. Phys. Ther. 46 , 383-386.
386.
Lister, M arilyn J. (1966). Perform ance evaluation of the
new staff member. Phys. Ther. 46, 387-390.
387-390.
PRELIMINARY THOUGHTS ON AUDITING THE EFFICIENCY OF A
PHYSIOTHERAPY SERVICE USING A COMPUTER PROGRAMME
M. J. RU N N A LLS, Dip. Physio., C.T.P. (Cape Town)*
ABSTR AC T
The initiation o f a docum entation audit o f the efficiency
o f physiotherapy services provided in a large general
teaching hospital is discussed. Results and trends of
behaviour as analysed by com puter programmes are
shown.
IN T R O D U C T IO N
The Tygerberg H ospital is not only a large general
teaching hospital but also p a rt of a large provincial
hospital (state controlled) organisation. Thus, because
of its very size (1 750 beds) and the hierarchy in the
managerial system there will naturally be certain intrin­
Reproduced by Sabinet Gateway under licence granted by the Publisher (dated 2013.)
sic problem s. To be confident th at there is an adequate
physiotherapy service in both out-patient departm ent
and wards is not easy. It is also well nigh impossible
fo r the senior physiotherapy staff to keep track of all
th at occurs. T he fact th a t a junior or even a senior
mem ber of staff, is unhappy, or perhaps inadequate as
regards their work potential and capacity can go u n ­
noticed. It is also difficult to defend the departm ent
against just or unjust criticism from higher authorities,
the medical profession, nursing profession, other allied
health services and peers unless its effectiveness (the
case) can be substantiated very clearly. Furtherm ore,
it should be rem em bered th at litigation will inevitably
become m ore prevalent and substantiative evidence again
will be essential to defend the case.
M ETHOD
W ith these problem s in m ind a docum entation audit
has been instituted based on the w ork o f K han and
Howroyd (1976) w ho posed th e following questions:
1. Is an acceptable standard of care being provided?
2. Does the present standard of care show any im­
provem ent over previous years?
3. Is the staff competent?
4. Is full use of resources being made?
Auditing of docum entation becomes a way o f assess­
ing the efficiency of the department. F ully realizing that
this is purely a “docum entation” audit it can, however,
be regarded as a relevant and reasonable measurement
of efficiency of the services provided. Such an audit can
* Senior L ecturer and Head of D epartm ent of Physio­
therapy, University of Stellenbosch and Tygerberg
Hospital.
Received 30 A pril 1980.
JUNIE 1980
Rochelle, D onna (1966). How to answer questions. Phys.
Ther. 46 , 428.
T odd, J. W . (1977). The use of hospitals. 6 Analyses.
Update, April, 935-938.
Kenly, Judith D. (1972). A supervisor’s view of staff
evaluation. S. Afr. J. Physiother. 28, 2-4.
Whitfield, A. G. (1978). Chair a committee. Br. Med. J.
2 , 936-937.
O P S O M M IN G
Die instelling van ’n dokum entasie-oudit van die doel-
treffendheid van fisioterapie-dienste wat in ’n groot op-
leidingshospitaal voorsien word, word bespreek. Resul-
tate en gedragspatrone soos deur rekenaar-programme
ontleed, word aangedui.
be evolved around two focal points, and the Problem
O riented Medical R ecord approach propagated by Weed
(1968, 1971). The two focal points are:
1. T he physiotherapist viz. the measurem ent of p ro ­
fessional competency and
2. the system viz. the identification of problem s which
limit the system and thus the competency of the
physiotherapist.
W ith regard to the physiotherapist there are four
characteristics of professional competency which can be
analysed:
1. Completeness: Are all the data fully recorded'
A re all the problems identified? Are there plans
pertaining to all the problems?
2 Reliability: A re the data accurate? Are all the
data kept up to date? Are all the plans instituted?
Is there evidence that the latest treatm ent m odali­
ties are being implemented? ^
3. Sound analytical sense: Is there evidence that tq
data obtained are used to solve the problems? 1_
the plan th at has been developed relevant to the
data? Does the plan take cognisance, of the latest
treatm ent techniques? A re all the plans realistic?
4. Efficiency: A re the problem s solved within a rea­
sonable am ount of time? A re alternative treatm ent
methods implemented when necessary and as soon
as possible?
A docum entation audit that would fulfil all the above-
m entioned factors with certain m easurable criteria had
to be established. F o r this purpose audit forms fo r long­
term patients (hospitalization of m ore than 14 days) and
and short-term patients (hospitalization of less than 14
days) were evolved. These forms were drawn up so
th at the results could be computerized and were based
on the form proposed by K han and H ow royd (1976).
(Figs. 1 and 2): A short com puter program m e was written
to calculate the percentages for each sub-section of the
audit form . These percentages were then used for fur-
there analyses. By means of the BM D P9D program m e
of the BM D program m e package a monthly analysis of
efficiency was possible. F u rth er com puter programmes
were set up to show the trends of behaviour in the
various sub-sections of the established criteria for effi­
ciency as well as to establish auditor bias.