Needed 100 Years Ago and Still Needed Now: Leadership Through Crisis and Recovery

This is the authors' abstract. We don't add key points for this paper.

Over 100 years ago, the emergence of the physical therapy profession originated within the societal events of the devastating needs of returning World War I soldiers and those who survived polio.1 As the profession approaches its centennial in the United States, we have yet to realize fully our potential as movement system experts who embrace an identity as essential providers on primary care teams. Individuals impacted by the COVID-19 pandemic will struggle to regain function caused by impairments of the musculoskeletal, neurological, cardiopulmonary, and immune systems. As movement experts who embrace the human movement system, physical therapists are ideally positioned to lead the development and implementation of evidence-based rehabilitation algorithms that guide health care practitioners in the acute and post-acute management of these individuals. As a profession, we have made significant gains in producing evidence to demonstrate our value. Academically, we have graduated physical therapists with clinical doctoral degrees for the past 25 years. There is strong external support for Doctors of Physical Therapy (DPTs) to be designated as essential health care providers as evidenced by statements from the Department of Homeland Security,2 the World Health Organization,3 state governments, and many health care organizations. So why do we not lead? Our profession needs leadership at all levels by physical therapists in all settings and practices. Despite evidence that patient care quality and safety improves when leadership knowledge, skills, and abilities (KSAs) are integrated into clinical practice,4 there remains a lack of clarity, emphasis, and integration in physical therapist education and practice on what it means “to lead.” The criticality of leading through crises is not uniformly and explicitly accepted by all physical therapists at the individual, organization, and systems levels. Health care professions such as medicine,5,6 pharmacy,7 public health,8 and nursing9 have developed expectations regarding leadership KSAs within the respective professions. Schools of medicine10,11 and nursing12,13 have created curricula integrating KSAs to produce competent practitioners in the application of leadership KSAs in daily decision making. Recently published evidence exists of specific leadership competencies needed by physical therapist graduates less than 1 year post licensure and for those at greater than 1 year post licensure.14 Post-professional leadership development opportunities have been available through the APTA and its components for over 15 years. Yet, even with the evidence from other disciplines and from within our own discipline, the foundational documents of education from entry-level15 through residency16 do not recognize leadership as a domain of competency essential in physical therapist practice. Unfortunately, ignorance and ineptitude17–18 of the evidence supporting the critical nature of leadership has contributed to our inability to overcome internal and external barriers regarding our identity and essential status. Without demonstration of leadership at all levels of practice, physical therapists will continue to struggle to effectively challenge the status quo, lead change, and advance evidence-based movement science and innovative collaborative models of care. Establishing physical therapists’ value as essential primary health care providers with unique movement system expertise requires all physical therapists to embody leadership competencies. This call to action challenges educators and clinicians to use existing leadership knowledge and emerging evidence to establish focused and systematic plans to develop and adopt such competencies as a first step to overcome ignorance and ineptitude.18 In the authors’ opinion, we believe opportunities for improvement exist in the arenas of education, clinical practice, organizations (systems) and communities, and public health. It is the authors’ hope that these preliminary recommendations will encourage conversation among and between educators and clinicians on the utility of leadership competencies through which physical therapists can influence diverse relationships within each sector. Recent events add a level of urgency to the acknowledgement of leadership as a domain of competency with consistent integration of leadership KSAs into DPT education. Evidence14,19,20 is available to successfully guide alignment of this complex concept in a stepwise and progressive manner across multiple points within entry-level education. Inserting a leadership domain of competency into foundational documents that influence entry-level15 and residency education16 would reframe the role identity of the physical therapist.21 Finally, an open discussion as well as evaluation and possible adoption of leadership frameworks20,22,23 within physical therapy and across health care disciplines would engage and unify the profession’s acceptance of leadership as a domain of competency essential in physical therapist practice. As highlighted by Pederseni et al24 and Kenney,25 physical therapists who demonstrate strong leadership skills are well poised to contribute to the survival rate of patients impacted by COVID-19 and can lead the recovery efforts of those rehabilitating from the virus. These authors suggest that physical therapists’ role expansion beyond discharge planning in the acute care setting may improve the overall quality of life of those recovering from the actual disease. Physical therapists are uniquely positioned to collect data sets needed to develop algorithms and evidence for best practice post intensive care stay and post infections.26 Besides supporting those directly impacted by the disease, physical therapists can use technology to support the mental health of those impacted by social isolation through creative exercise prescription designs that are adaptable and comply with social distancing and stay-at-home restrictions. Exercise, movement, and physical activity are recognized as key contributors to lessen the severity of illness from the COVID-19 virus.2 Practicing physical therapy today is much more complex than 1-on-1 patient interactions and requires skills in collaborative care, organizational awareness, organizational dynamics, and systems thinking, each identified as leadership KSAs for physical therapists at >1 year from licensure.14 Offering quality, patient-centered care encompasses consideration of positive patient experiences and requires health care professionals to explore development of meaningful relationships that contribute to or deter from the overall health of patients and communities. Systems thinkers ask critical questions that consider patient presentation, social determinants of health, and multiple competing factors between provider, complex health care, and patient support systems.27 This model of thinking requires constant questioning and energy on how to strategize, advocate, and change course based on data-driven quality metrics and decision making.28 Demonstration of leadership KSAs that encourage assertive communication and conflict negotiation to challenge current practices can result in positive changes that are in the best interest of patients and systems alike. Challenging the status quo while promoting innovation and empowerment at various organizational levels requires leadership KSAs exhibited with sensitivity to organizational cultures and subcultures. Doctors of physical therapy are fundamentally trained in critical thinking and have the skills to serve as system thinkers. Physical therapists in clinical environments should encourage application of such leadership KSAs to influence and effectively participate in critical health care provision decision making. Physical therapists have been involved in public health since 1915 with the polio epidemic. In the 1960s, the Committee on Professional Education published the expectations of leadership KSAs for physical therapists qualified for the public health arena.29 Dawson and Sims30 further explored the leadership competency of ethics orientation with their examination of physical therapists in the areas of priority setting, autonomy in relation to health promotion, and involvement in the political sphere. As highlighted by the perspective on post intensive care syndrome,26 physical therapists have an important role in the public health arena that is often overlooked: coordination of community resources and the advocacy for rehabilitation services. Activism within public health requires strong leadership KSAs (professional orientation, team orientation, initiative, and relationship building). Findings from Sebelski et al14 are congruent with this literature. The policy recommendations outlined in the Role of PT in Health Care Reform by the American Physical Therapy Association31 highlights the unique qualifications of physical therapists to impact public health and to lead campaigns to combat opioid addiction and promote exercise and physical activity in primary, secondary, and tertiary care of populations. More consistent integration and acknowledgement of the importance of leadership KSAs in DPT education can contribute to the promotion of physical therapists and our roles in public health. The current pandemic has given this profession an opportunity to transform physical therapists’ perceptions of leadership and embolden the profession to transform society. Increasing awareness of leadership competency gaps can be instrumental to rectify professional ignorance during recovery efforts post COVID-19 and beyond. Leadership competencies are critical for a strong role identity as essential health care team members who can support persons directly and indirectly affected by this pandemic. Preliminary suggestions have been made. The professional core documents, entry-level curricula, and post licensure professional development must evolve to fully integrate and prioritize leadership as an essential domain of competency expected of all physical therapists. Evidence exists related to leadership competencies needed by physical therapists. As noted by A.M. Jette,18 ignorance and ineptitude of evidence has left the profession struggling to move forward and transform society. Without change, our vision to transform society will remain only a distant aspiration. Intentional effort is required to re-prioritize from technical to non-technical competence, emphasize learning “to lead” in healthcare,32 and instead to “walk with the dreamers,” to overcome the unfortunate reality that physical therapists are “quietly competent”33 and generally unrecognized by many. Concept/idea/research design: C. Sebelski, B. Tschoepe, J. Green-Wilson, S. Zeigler, D. Clarke Writing: C. Sebelski, B. Tschoepe, S. Zeigler, D. Clarke Data collection: C. Sebelski, B. Tschoepe Data analysis: C. Sebelski, B. Tschoepe Project management: C. Sebelski Consultation (including review of manuscript before submitting): C. Sebelski, J. Green-Wilson The authors received no funding to support this study. The authors completed the ICMJE Form for Disclosure of Potential Conflicts of Interest and reported no conflicts of interest.