Clinician’s Commentary on Chinn et al.

The authors of this article have captured the complexity and intersection of numerous key factors impacting physiotherapists’ perspectives on professional practice models: (1) support networks, (2) environments that support a community of practice, (3) support for professional development, (4) integration of professional practice leaders strategically within organizational design to enhance influence, and (5) balance professional practice accountabilities through integrated leadership roles.

With significant changes underway across the health sector, health care organizational structures will continue to evolve to enhance patient-centric care as a key principle. Many organizations should be recognized for their creative and strategic vision to evolve structures beyond true hospital boundaries through developing mergers and cross-sector partnerships to meet patient care needs more effectively. As our organizational structures become more complex, the importance of professional practice models to support clinicians in the intersections of practice, research, and education has never been more important.

How might these elements enhance practice and clinical care during a crisis in a global pandemic? These elements reflected the infrastructure required to support a magnitude of constant change to keep a health system stable to support patients when they most needed it.

At the time of this study, February to April 2020, Ontario, as well as many provinces across the country, were experiencing waves one to three of the COVID-19 pandemic, with future waves to follow. Adaptive models of care were required to address the crisis and support changes to the provision and prioritization of care as hospital admissions soared and most organizations experienced health human resource challenges.² Professional practice groups across the health system orchestrated these changes.

The lens of professional practice and profession-specific leadership was critical to review regulatory standards, policies, clinical practice guidelines, and team-based approaches to care to understand how best to prioritize and deliver care in the context of the pandemic. Support networks, communities of practice, and strategically aligned leaders were all enablers to ensure professions were supported to deliver the safest and best care possible in unprecedented circumstances, and for an unprecedented duration of time. With the volume and pace of change, distributed leadership roles and load sharing were highly effective in responding quickly to the ever-changing aspects of this crisis.

As our health care systems strives to stabilize, the triad of organizational change, pandemic recovery, and health human resources challenges have been a catalyst for many organizations to pause and re-focus on clinicians, specifically their wellness and burnout. High rates of clinician burnout have been attributed to poor patient outcomes, poor patient experiences, and higher risk of error.³ Evolving from the IHI Framework for Improving Joy in Work,⁴ key domains, including meaning and purpose, participatory management, camaraderie and team work, mirror similar constructs to the elements described in this article.

As several hospitals across Ontario implement new electronic patient records, the understanding of professional practice, scope of practice, and workflows is at the centre of these conversations. Structures allowing for individual profession expertise — close to the point of care and in leadership roles — to garner consensus of practice, inform workflows and design is critical to clinical transformational success.

While models may differ from one organization to the next, and support both our day-to-day care delivery, as well as respond to a crisis, organizations would be wise to reflect on their professional practice structures. Strategies aiming to include the key elements cited in this article can only foster stronger professions, maximize scope, interprofessional collaboration, the best of practice/education/research intersections, and, ultimately, the safest, most compassionate, and best of outcomes for patients.