The content of most textbooks is perishable, but the tools of self-directness serve one well over time. Albert Bandura
Like the authors of many texts, I was driven by my professional experiences to write the first edition of this book. Particularly challenging in my broad range of clinical experiences as a physical therapist and department head, mixed with academic experiences as teacher and program director, were my managerial responsibilities. Equally challenging has been teaching management courses to physical therapy students. The management course is rarely considered the highlight of one's professional education. Sparking students' interest in the course is often an important first step.
I used the first edition of this text to teach a newly created management course and as a new text in a well-developed course. As expected, there were things that I thought should be improved in the format and organization of the text, and there were things that already needed to be updated because of the rapid changes in the healthcare policies and organizations in the United States. The need for a second edition was evident so that the content could be presented more effectively and clearly. A second edition is also an opportunity to bring the content up to date, and to provide new resources for accurate and relevant information for current managers and students of physical therapy management.
Since the first edition, some things have not changed. Many physical therapists continue to transition easily and successfully from clinical to managerial positions. More often than not, however, other physical therapists (and many students) seem to be willing to go to any means to avoid management because of their commitment and interest in direct patient care, or perhaps a fear of the unknown. The second edition continues to recognize that management responsibilities are complex, not for everyone, and remain important for clinicians to understand their work beyond the direct patient care they provide.
The second edition continues to provide an introduction to the physical therapist as manager for those whose career plans are to intentionally seek management positions in any healthcare setting. It also provides the reluctant manger or student an opportunity to view the broad range of possibilities for physical therapists as managers that they might not consider otherwise. As clinicians they will be better prepared to see work-related issues from the perspective of the boss or corporate demands.
This text is intended to serve as a springboard for the discussion of the physical therapist as manager across all healthcare settings rather than a “how-to” on management. Ideally, the text will provoke conflicting opinions and opposing views so that readers practice making important management decisions with no clear, black-and-white guidelines. The management activities are based on my real-life experiences in a wide variety of healthcare settings—either direct work experiences or discussions with other managers who have shared their experiences. Some of the actual decisions made in these situations had positive outcomes; others did not. Through discussions with others while working on these activities, readers have the opportunity to reflect on the decisions they would make in these situations from different perspectives. There are no hard and fast correct answers. The objective is to develop the ability the weigh the pros and cons of important decisions that impact the care of patients through the management of the work in physical therapy practices.
In addition to the management activities, in this edition, Web resources have been organized into lists at the ends of the chapters. These resources present the opportunities to add depth and breadth to topics during learning activities. They are also the tools for self-directed investigation and up-to-date information for learners after the course is completed so that their practices may remain current.
Although reorganized, the chapters in Section 1 of the second edition continue to lay the foundation for understanding the complexity of health-care organizations, the culture and business of healthcare, the role of managers and leaders in these organizations, and managerial challenges for the physical therapy profession. Selected contemporary healthcare issues are presented, which include workforce diversity, the culture of physical therapy, the leadership-management continuum, the Affordable Care Act, and reimbursement for payment for physical therapy services. Readers are asked to examine their current views on management as a career goal. Appendix 1 was added to present a brief history of theories of management, leadership, and organizations.
Each chapter in Section 2 addresses one of the core areas of responsibility of healthcare managers, which include vision, mission, goals; policies and procedures; marketing; staffing; patient care; fiscal; legal, ethical, and risk management; and communication. A simplified model for strategic planning is presented and employed throughout the text to develop managerial decision-making skills. For example, in one of the activities, students are asked: What should the team do? Consider: Where are they now? Where do they want to be? What do they have to work with? How will they get there? The activities in these chapters provide opportunities to explore each area of managerial responsibility in more depth. These chapters may stand alone with activities to apply concepts. The “Time-Out for …” activities in Section 2 chapters serve as the tools needed for the potential development of a business plan, feasibility study, or program proposal. To assist learners, new outlines for the preparation of these documents are found in Appendix 2.
Each chapter in Section 3 addresses management of physical therapy in a different setting—long-term care, outpatient centers, special education units in schools, home health agencies, and hospitals. The importance of the management of multidisciplinary rehabilitation units is addressed. Each chapter in Section 3 is divided into two parts. Part 1 addresses contemporary issues found in a particular setting. Part 2 identifies issues in each of the eight areas of managerial responsibility presented. At the end of each chapter are numerous activities that provide the opportunity to develop managerial decisions using a strategic planning tool to guide readers in their decision-making.
The style of the text is to present complex management concepts in a user-friendly, interactive format that reflects the real world of contemporary physical therapy practice through interesting activities. I would be pleased if these learning experiences lead to physical therapists who seek for themselves the latest and most important information about healthcare organizations, policies, and the responsibilities of managers. My hidden agenda is that the number of physical therapists who are eager to seek out management positions increases. It is important to their careers and it is important to our profession that we expand this aspect of professional practice. I hope that readers have the same wonderful career that I have had because I have been a manager.
Catherine G. Page, PT, MPH, PhD