In Pursuit of Excellence
Monday November 23, 2009
Print This- Select Text Size:
advertisement
R. Scott Ward, PT, PhD, was treating a man in his 40s who had burns covering his arms and hands, but traditional range of motion exercises and tissue stretching was not improving the mobility in the patient’s left wrist. Undaunted, Ward was determined to overcome this problem. “We decided to look at the literature in search of other options,” says Ward, professor and chair of the department of physical therapy at the University of Utah, Salt Lake City. “After some reading, we decided to try an orthopedic technique by doing some specific joint mobilizations, and in this case, it worked.” Both Ward and his patient were thrilled with the result.
Ward’s determination to find a solution to the patient’s problem demonstrates something that is vital to excelling as a physical therapist: creative problem-solving skills. But problem-solving ability is just one component of what it means to practice with excellence. And although excellence is a term used commonly in healthcare as hospitals, rehab centers, and clinics tout the quality of their staff, the specifics of excellence can be difficult to define.
Defining Excellence
PTs and PTAs may disagree over exactly which characteristics best define excellence in physical therapy, primarily because there are so many aspects to consider. Some experts say that one of the most important qualities of a high-quality PT is someone who is a good diagnostician.
“An excellent PT has to be able to be creative and pull all the pieces together to diagnose the problem,” says James Shields, PT, DPT, OCS, flight commander and director of physical medicine at Wright-Patterson Air Force Base in Dayton, Ohio. “And being a good listener is critical to diagnosing a patient’s problem.”
In addition to having keen diagnostic skills, another mark of excellence in physical therapy is connected to outcomes. “Ultimately the mark of excellence is based on your outcomes, which [can be] hard to measure,” Shields says. “When the patient’s condition is resolved or the problem is relieved, that is a good outcome. Good clinicians will find a way to monitor their outcomes, and that is valuable.”
A critical part of achieving good outcomes relies on reading journals or other literature that provides the most up-to-date studies in the field. Even if Ward reads about a new finding or technique in a journal, he researches the new discovery in several journals before he changes his methods to ensure that there is evidence from multiple sources.
“If I graduated 15 years ago and am still practicing the same way I practiced 15 years ago, I know I am not pursuing excellence,” Shields agrees. “Reading literature and participating in continuing education courses are critical for staying current.”
An interest in research and the latest literature findings may even lead to the development of a new form of practice within a physical therapy department, says Nancy Goode, PT, DPT, MS, inpatient clinical director at Massachusetts General Hospital in Boston. As an example, at Goode’s hospital, one PT researched the area of vestibular rehabilitation in 1993 and several years later established a vestibular rehabilitation practice at the hospital that continues to expand today for patients who suffer from vestibular dysfunction.
Timeless Qualities
Another mark of excellence in a PT or PTA is a willingness to lead others, says Ward, who is also president of the American Physical Therapy Association. “Physical therapists who are excellent are those who find ways to lead, whether in practice or policy or regulations or politics,” he says. “This requires a willingness to work outside of the normal work hours, but it is hard to be truly excellent if you do not think about what you are doing outside of the traditional hours.”
However, leadership opportunities do not have to be exclusively related to physical therapy, Ward says. PTs and PTAs who volunteer in community organizations such as children’s sporting events or even reading at elementary schools are still representing the physical therapy field.
One of the benefits of leadership is teaching the next wave of PTs and PTAs, Goode says. “Excellent physical therapists are engaged in educating the next generation of practitioners through a variety of methods,” she says. “Clinicians who do this not only have the opportunity to pass on what they know, but also confirm for themselves that their rationale for their practice is sound.”
Goode has served as a clinical instructor for students who are training to be physical therapists. “Students are mentored in the clinic, which gives them the opportunity to apply their knowledge and gives them another dimension to what they have learned,” she says.
For Shields, mentoring other therapists is a critical part of his definition of excellence. “My door is open, and I am one of the therapists other PTs come to when they have clinical questions about a patient,” he says. “We go over the case and anything additional that might help them. They may even ask me to come in and treat the patient to learn.” Whether therapists are seasoned or new to the profession, keeping minds open to fresh perspectives and staying motivated to improve helps therapists grow as clinicians.
Pitfalls and Passions
Although the pursuit of excellence requires an inner drive, even the most motivated therapists may run into roadblocks.
“One of the biggest challenges is the issue of time when we have busy clinic schedules,” Ward says. “There are so many demands on time, and lots of patients who want to be seen. Part of being excellent is knowing how to balance all of that. Physical therapists who excel have to learn how to best balance the pressures of a good practice. It is someone who maintains excellence in the midst of busyness without compromising the quality of care.”
Another key to maintaining excellence is to nurture a passion to change, Shields says.
“One of the pitfalls is complacency,” he says. “If you lose the passion for improvement, someone will not be excellent.”
For Goode, the best way to nurture a passion for improvement is to foster a self-reflection on the quality of care you provide each day. “An excellent PT has an inner drive and curiosity,” she says. “It can be internally driven. An excellent PT thinks about their patients and what went well and what could be improved, and makes time for reflection. It may be on the commute home or in the shower, but that time is critical.” •
Heather Stringer is contributing writer for Today in PT.
Ward’s determination to find a solution to the patient’s problem demonstrates something that is vital to excelling as a physical therapist: creative problem-solving skills. But problem-solving ability is just one component of what it means to practice with excellence. And although excellence is a term used commonly in healthcare as hospitals, rehab centers, and clinics tout the quality of their staff, the specifics of excellence can be difficult to define.
Defining Excellence
PTs and PTAs may disagree over exactly which characteristics best define excellence in physical therapy, primarily because there are so many aspects to consider. Some experts say that one of the most important qualities of a high-quality PT is someone who is a good diagnostician.
“An excellent PT has to be able to be creative and pull all the pieces together to diagnose the problem,” says James Shields, PT, DPT, OCS, flight commander and director of physical medicine at Wright-Patterson Air Force Base in Dayton, Ohio. “And being a good listener is critical to diagnosing a patient’s problem.”
In addition to having keen diagnostic skills, another mark of excellence in physical therapy is connected to outcomes. “Ultimately the mark of excellence is based on your outcomes, which [can be] hard to measure,” Shields says. “When the patient’s condition is resolved or the problem is relieved, that is a good outcome. Good clinicians will find a way to monitor their outcomes, and that is valuable.”
A critical part of achieving good outcomes relies on reading journals or other literature that provides the most up-to-date studies in the field. Even if Ward reads about a new finding or technique in a journal, he researches the new discovery in several journals before he changes his methods to ensure that there is evidence from multiple sources.
“If I graduated 15 years ago and am still practicing the same way I practiced 15 years ago, I know I am not pursuing excellence,” Shields agrees. “Reading literature and participating in continuing education courses are critical for staying current.”
An interest in research and the latest literature findings may even lead to the development of a new form of practice within a physical therapy department, says Nancy Goode, PT, DPT, MS, inpatient clinical director at Massachusetts General Hospital in Boston. As an example, at Goode’s hospital, one PT researched the area of vestibular rehabilitation in 1993 and several years later established a vestibular rehabilitation practice at the hospital that continues to expand today for patients who suffer from vestibular dysfunction.
Timeless Qualities
Another mark of excellence in a PT or PTA is a willingness to lead others, says Ward, who is also president of the American Physical Therapy Association. “Physical therapists who are excellent are those who find ways to lead, whether in practice or policy or regulations or politics,” he says. “This requires a willingness to work outside of the normal work hours, but it is hard to be truly excellent if you do not think about what you are doing outside of the traditional hours.”
However, leadership opportunities do not have to be exclusively related to physical therapy, Ward says. PTs and PTAs who volunteer in community organizations such as children’s sporting events or even reading at elementary schools are still representing the physical therapy field.
One of the benefits of leadership is teaching the next wave of PTs and PTAs, Goode says. “Excellent physical therapists are engaged in educating the next generation of practitioners through a variety of methods,” she says. “Clinicians who do this not only have the opportunity to pass on what they know, but also confirm for themselves that their rationale for their practice is sound.”
Goode has served as a clinical instructor for students who are training to be physical therapists. “Students are mentored in the clinic, which gives them the opportunity to apply their knowledge and gives them another dimension to what they have learned,” she says.
For Shields, mentoring other therapists is a critical part of his definition of excellence. “My door is open, and I am one of the therapists other PTs come to when they have clinical questions about a patient,” he says. “We go over the case and anything additional that might help them. They may even ask me to come in and treat the patient to learn.” Whether therapists are seasoned or new to the profession, keeping minds open to fresh perspectives and staying motivated to improve helps therapists grow as clinicians.
Pitfalls and Passions
Although the pursuit of excellence requires an inner drive, even the most motivated therapists may run into roadblocks.
“One of the biggest challenges is the issue of time when we have busy clinic schedules,” Ward says. “There are so many demands on time, and lots of patients who want to be seen. Part of being excellent is knowing how to balance all of that. Physical therapists who excel have to learn how to best balance the pressures of a good practice. It is someone who maintains excellence in the midst of busyness without compromising the quality of care.”
Another key to maintaining excellence is to nurture a passion to change, Shields says.
“One of the pitfalls is complacency,” he says. “If you lose the passion for improvement, someone will not be excellent.”
For Goode, the best way to nurture a passion for improvement is to foster a self-reflection on the quality of care you provide each day. “An excellent PT has an inner drive and curiosity,” she says. “It can be internally driven. An excellent PT thinks about their patients and what went well and what could be improved, and makes time for reflection. It may be on the commute home or in the shower, but that time is critical.” •
Heather Stringer is contributing writer for Today in PT.
To comment, e-mail pteditor@gannetthg.com
Monday November 23, 2009