Wednesday, January 13, 2010

Liability Issues in Making the Best Use of Therapy Assistants

Recently, my organization started a comprehensive project to "enhance" the role of therapy assistants. My role, among many other participants, is to provide the acute care perspective. Knowing the staff as I do, I know that many PTs are resistant to idea of therapy assistants being utilized more. There concerns, among many, go beyond the usual concerns over fears that fewer PTs will be hired, that some PTs will be replace by assistants, etc... what really is a significant barrier to making better use of therapy assistants is a perception that doing so puts the professional at significantly more risk of lawsuits or loss of license to practice.

Recently I completed a literature review of what the liability risks are in collaborative practice and more specifically, the risk associated with a PT/therapy assistant relationship.

In general, the finding were comforting and what I expected. There is no significant increased risk to the PT as long as they are practicing professionally (I'll try to expand upon this more in a future blog).

A big challenge when we propose to "optimize" the role of the assistant is that we need to have an "ideal" to work towards. Despite my best efforts, I have yet to find any organization that feels they have defined or reached that ideal goal.

What I suggest is that we start with a few principles to guide both the professional staff and management. For the PT:

1. Only assign tasks to assistants that are competent to perform the task
2. If task is out of the scope of practice of the assistant, don't even consider assigning it
3. If make the decision to not assign a tasks, provide the rational for that decision
4. If the assistant is not competent, but the task is reasonably within their scope, implement a plan for the assistant to establish and maintain the competency.
5. Some tasks that could be assigned may, in some circumstances, be appropriately not assigned and still performed by the professional PT (for example, sometimes routine tasks that normally would be assigned to an assistant provide an opportunity to develop rapport with patients/clients and deal with difficult subjects, such as addressing issue of motivation or compliance to a treatment program).

For management, develop metrics that can allow comparisons between therapist. Identify and reward your good performers. Find opportunities to share the experience of exceptional staff with novice staff.

In my organization, I foresee it being very difficult to get some PT with decades of experience to assign more of their workload to assistants. New staffing allocation models will be resisted. But we must put a convincing case forward that changes are in the interest of patient care: improving outcomes, shortening length of stay, and improving staff morale. Don't focus on the dollars!


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