Trends and Drivers of Change for Ontario's physiotherapists: Learnings from the This is PT Now project

Transcription

1 Trends and Drivers of Change for Ontario's physiotherapists: Learnings from the This is PT Now project Kathleen Norman, PT, PhD Webinar presentation to College of Physiotherapists of Ontario 2015 May

2 This is PT Now Who do PTs work with? How are PTs practice environments changing? What are the technology pressures and opportunities on PTs? College Object #10 To develop, establish, and maintain standards and programs to promote the ability of members to respond to changes in practice environments, advances in technology and other emerging issues. How are PTs patient care patterns changing? Regulated Health Professions Act, Schedule 2: Health Professions Procedural Code, 3(1), 10 (emphasis added)

3 Project design Interviews Trends Report Website representatives of organizations PTs in various sectors identifying 4 key areas of trends & drivers surveys aligned to 4 areas of trends & drivers, plus demographics Engagement & Data collection foresight research survey research

4 Foresight research foresight the ability to see what will or might happen in the future Purpose of a foresight project not to predict explicitly rather to consider what possible futures lie in store for a specific industry, sector, etc. present Traditional view: single future with a margin of error on forecasting Modified view: multiple futures are possible Futures images adapted from: Cuhls C. Journal of Forecasting 2003; 22: Foresight view: identifying a preferred future, and therefore the implications for what should be done at present

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6 Trends and Drivers of Change The Patient The Practice Technology The System Increasing Lifespan, Increasing Demand Focus on Wellness / Predict, Prevent and Promote Collaborative Care New Kind of Practice & Practitioner Technology Triage The Connected Practice New Models of Care More with Less

7 This is PT Now: Surveys The Patient The Practice Technology The System Demographics Patients / Clients you re seeing Who PTs work with: colleagues & teams Technology s influence on PTs practice Delivery of PT care & the influence of funding About you as a PT n=478 n=358 n=307 n=306 n=384

8 About you as a PT 61 years old or older 51 to 60 years old 41 to 50 years old FINDING: Mix of age and sex very typical of College membership as a whole. 31 to 40 years old 30 years old or younger male female

9 About you as a PT FINDING: Geographically very representative of College membership as a whole. 26% 48% 22% 9%

10 About you as a PT 4 or more employment sites/situations 3 employment sites/situations 2 employment sites/situations 1 employment site/situation no employment sites; not working as PT NOTE: Ontario may be quite different from other provinces in this respect. FINDING: About 40% have more than one employment site, almost exactly the same as for College membership as a whole Percentage of participants

11 What is your job/position title? physiotherapist

12 What is your job/position title? physiotherapist

13 Patients / clients seen Q Which body system is the main reason for your patients / clients to need physiotherapy? 90% NeuroMusculoSkeletal (n=125) a mix <10% NeuroMusculoSkeletal (n=134) (n=186) FINDING: Despite response options for Neurological, Cardiovascular-Pulmonary and Multi-function, very few participants reported a majority in any one category. 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Percentage of participants

14 Settings for patients/clients 90% Inpatients (n=71) 90% Outpatients (n=118) 90% Other locations (n=49) includes institutional living facilities, home care, schools, work locations Other participants: mixture (n=51) 0% 5% 10% 15% 20% 25% 30% 35% 40% 45% Percentage of participants

15 Patients / clients seen varying mixture of ages (n=156) mix of adults, including seniors (n=102) 80% seniors (n=89) 80% adults who are not seniors (n=65) 80% children and adolescents (n=32) 0% 5% 10% 15% 20% 25% 30% 35% 40% Percentage of participants

16 To develop, establish, and maintain standards and programs to promote the ability of members to respond to Changes In Practice Environments advances in technology and other emerging issues.

17 Colleagues & teams Q If you have a challenging clinical case, do you have at least one other PT? Yes, at least one other PT that works with me Yes, at least one other PT, but not at work site Sometimes other PT to ask, but not always available or not similar enough in practice area No other PTs to consult n/a, I don't interact with patients 0% 10% 20% 30% 40% 50% 60% 70% 80% Percentage of participants

18 Colleagues & teams Q If you have a challenging professional issue, do you have at least one other PT? I know which PT at my worksite I know which PT, but not at my worksite Sometimes other PT but not always available No other PTs at my work to consult 0% 10% 20% 30% 40% 50% 60% 70% 80% Percentage of participants

19 Perceptions of turnover Perceptions of turnover in PT positions very little to no turnover 31% n/a, unsure 16% workplace morale substantial turnover and instability 19% quality of patient care time spent mentoring new co-workers financial productivity some turnover, not excessive 34%

20 Perceptions of the effect of turnover High turnover has resulted in under-serviced clients Cutbacks to LTC and Retirement Homes has gravely affected PT work for seniors living in Ontario Positions left vacant after a staff departure, only filled after surgeon and patient complaints Positions temporarily empty due to maternity leave are left unfilled

21 Performance appraisal Q Who does your performance appraisal at primary workplace? 32% a PT If you have a challenging professional issue, do you have at least one other PT? n/a I know which PT at my worksite another regulated health professional 35% 21% I know which PT but not at my worksite no other PTs to consult 12% a non-regulated individual sometimes another PT but not always available

22 PT Professional support Not enough formal support from other physiotherapists Time does not allow for much collaboration with fellow PT's unless there is an urgent issue. There is little time for this and certainly no paid time. Peers and professional practice leads continue to provide ongoing feedback We are always available to each other [for] clinical and professional advice. CLINIC

23 Interprofessional collaboration Occupational Therapists Nurses or NPs Family doctors Orthopaedic surgeons Other physicians Physiatrists Dietitians Reg Massage Therapists Clinical Psychologists Kinesiologists Chiropractors % of respondents 58% 54% 34% 24% 32% 18% 35% 22% 16% 13% 9%

24 Referrals/reports to other professions Receiving / Sending referrals Receiving / Sending reports Occupational Therapists Nurses or NPs Family doctors Orthopaedic surgeons Other physicians Physiatrists Dietitians Reg Massage Therapists Clinical Psychologists Kinesiologists Chiropractors

25 More colleagues Social worker Speech-language pathologist Vendor of mobility equipment Respiratory therapist Recreation/leisure therapist Orthotist/prosthetist Teacher, Principal or other member of school staff Chiropodist/podiatrist frequent collaboration occasional referrals from or to members of this occupation Athletic therapist Naturopath / Naturopathic doctor Traditional Chinese Medicine practitioner Percentage of participants

26 Providing learning for students Students from PT programs (incl. IEPT learners from bridging) PTA/OTA students Students from other university-based health professional programs high school students Students from university kinesiology programs Students from college programs other than PTA/OTA 0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100% Percentage of participants

27 Impact of students* on income Personal income Worksite income 6.2% reported net gain 32% reported neutral 7.5% reported net gain 27% reported neutral * considering PT students/ learners only 3.3% reported net loss 3.6% reported net loss 58% n/a or don t know 61% n/a or don t know

28 Assigning tasks to support personnel Q To how many support personnel do you assign tasks in a typical month? across all employment sites Percentage of participants , n/a 1 2 to 3 4 to 6 7 to or more

29 Support personnel involvement across patient age (n=321) 80% children & adolescents 80% adults who are not seniors 80% seniors mix of younger & older adults MIX 16% 14% 12% 10% 8% 6% 4% 2% 0%

30 Support personnel involvement across settings (n=273) 18% 16% 14% 90% inpatients 90% outpatients 90% other locations Long-Term Care other participants: mixture 12% 10% SCHOOL 8% 6% 4% 2% 0%

31 Backgrounds of support personnel PTA/OTA (formal post-secondary program) Kinesiology (university degree) On-the-job training as regularly employed aides Internationally educated PT, not registered as PT here On-the-job training as occasional aides (e.g. high school students) Personal support worker (PSW) program Other non-university training program Other university program related to their role Fitness training program (personal trainer or related) Behavioural science technology program (community college) Other 0% 20% 40% 60% 80% 100%

32 Relationships & inputs to SP Participants asked to consider one SP to whom they assign tasks frequently 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% I am this person's employer. We are employees of same organization. We are employed by different organizations. Provide feedback to SP's manager. 62% Part of group responsible for SP performance evaluation. 11% Personally responsible for SP performance evaluation. 14% Minimal influence on SP's performance evaluation. 13% 0%

33 To develop, establish, and maintain standards and programs to promote the ability of members to respond to changes in practice environments, Advances in Technology and other emerging issues.

34 Technology: electronic records Creation of home exercise handouts or related Reports to other health care professionals/ health care organizations Records of patient attendance Internal records of fees and billing Records to insurer/funder about fees/ billing Assessment reports about patients Progress notes about patients electronic records electronic creation, official copy printed paper records n/a 0% 20% 40% 60% 80% 100%

35 Technology: electronic records Q What is your opinion of the software you use for? Time use / Workload statistics systems Electronic health record Scheduling systems Creation of home exercise or related Billing systems Number of responses Software is frustrating, clearly not designed with PT in mind Software is OK, but has some limitations The software is great! I can do exactly what I need to do.

36 Technology: electronic records Q Are certain tasks difficult with your technology? Having student under supervision sign entry and then you co-sign Integrating entries by multiple team members Having support personnel under your supervision make entries Recording specific types of information e.g., drawings, short forms, symbols Other challenges around reviewing, revising, retrieving records *&^#$@$***#!!! Number of respondents

37 Technology to gather patient data Q Do you use any technology(ies) to gather information from patients / clients when they are not at appointments? % Exercise tracking software/apps the patient / client fills in (daily/weekly log?) Applications that track biometric data from sensors worn by the patient/client Applications that prompt the patient / client to answer a question(naire) 2.3% 1.0% <1%

38 Availability pressure through tech Q Are you expected by your employer* to be available through technology for work tasks and communications when not at work? * If self-employed, do you put pressure on yourself? always most evenings and weekends routinely but not often in isolated instances never 0% 10% 20% 30% 40% 50% 60% 70%

39 Maintaining boundaries Q How much do you think communication technology and social media are increasingly making it challenging for you to maintain professional standards in relation to conflict of interest, interpersonal situations and professional boundaries? Percentage of Participants Not more challenging, just different or not answered Far more challenging

40 To develop, establish, and maintain standards and programs to promote the ability of members to respond to changes in practice environments, advances in technology, and Other Emerging Issues

41 Perceptions of patient treatment duration Q Each of your patients attends physiotherapy for how many visits? Q Do you think your patients typically attend fewer or more visits than 3-5 years ago? Many or all patients have 50+ visits 16% Many or all patients have visits 23% Many or all patients have 6-19 visits 51% Many or all patients have 1-5 visits 32% 50% 40% 30% 20% 10% 0% 10% 20% Percentage of participants

42 Whether patient care terminates early Q How often does it happen that a patient or client's course of PT care terminates sooner than you think is a good idea? often, many or most patients 21% sometimes / some patients 57% unsure or not answered 14% never 8%

43 Why patient care may terminate early The patient is discharged from the service (e.g., hospital inpatient) before the PT goals are met. The patient / client would benefit from more PT, but is not as urgent / critical as others who are waiting. In an inpatient setting, the facility needs to make the bed available for another patient. System flow pressures Constraints: funding / resources Patient/client/family reasons The patient / client cannot afford to continue and/or their insurance benefits are used up. The patient / client decides he/she doesn't want to continue treatment of any kind. There is a specific number of visits permitted by the contract / funding organization. The patient / client decides to seek a different profession. There is a lack of staff The resources patient to goes home continue or to a PT different care. place, and there aren't PT options available there. The family decides [not to] continue. Unknown Endorsement points (arbitrary scale)

44 Sources of concern for future Increasingly, patients' needs for PT are complicated by other factors (e.g., psycho-social, economic, etc). Increasingly, patients do not have adequate financial coverage for the treatment they require. My patients have more chronic problems or co-morbidities than they used to have. Increasingly, I am under pressure to discharge patients when they are still not well. My patients are sicker or more frail/fragile than they used to be. Increasingly, too much burden falls on families. My patients have higher expectations than they used to have. Patients increasingly treat their bodies as machines that can be "broken" then "repaired" as needed. Increasingly, patients have less support from family/friends. 0% 10% 20% 30% 40% 50% Percentage of maximal score

45 Pressures on funding & duration The CCAC are now demanding fewer visits and are reluctant to extend visits. Patients are much more complex but our number of visits and length of stay has decreased. There are NOT always good options to transition them to. WSIB's expectation for frequency of visits and length of stay has tightened up significantly over the past few years. The number of visits has drastically decreased due to the change in funding with the MOHLTC and Episode of care. It is becoming increasingly challenging to get patients through programs due to increases in complexity of their conditions. Rarely do I get to see a patient through to a satisfactory planned end. I often work for less than a typical professional wage to provide the kind of care I am happy to put my reputation on.

46 Sources of optimism for future Patients are more informed about their own health, and health matters in general, through media. Patients take more initiative about their health than they used to. My patients have higher expectations than they used to have. My patients increasingly want information about prevention and staying healthy. Increasingly, patients present to PT sooner when more can be done. Increasingly, patients' families (or other caregivers) are highly engaged. Increasingly, I have opportunities to do health promotion activities with/for patients. Increasingly, I can discharge patients, knowing there are appropriate resources for staying healthy. 0% 10% 20% 30% 40% 50% Percentage of maximal score

47 For more information: foresight research Acknowledgements Financial sponsorship: Trends Research & Website Build: Art & Science Digital Experience Design Queen s University Library QSpace Research Assistants: Juan Carlos Corpuz, PT, MScPT Brent Cunning, PT, MScPT Mary Jane O Donovan, PT, MEd, PhD candidate survey research Interviewees & Survey Participants: report forthcoming (and publications?) Contact information Kathleen.Norman@QueensU.ca

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