Good Practice: Collaborative Practice

Questions often arise about whether collaborative practice involves two physiotherapists providing services to the same client or collaboration between a physiotherapist and another health professional delivering care to the same client. Questions can relate to whether the two professionals can deliver care to the same client at the same time, the requirements if they choose to provide concurrent treatment, and issues of liability and apportioning of blame if the client were to experience an adverse event while receiving care from more than one health-care provider.

Collaboration in health-care delivery is a reality of multidisciplinary practice and team-based care common in many settings and sectors. The delivery of care by multidisciplinary teams is beneficial to patients, ensuring their access to the right team member at the right time and helps to make the health system more efficient by ensuring that the team member best equipped to deliver care is the one providing it. An example would be having a physiotherapist complete musculoskeletal examinations in primary care, capitalizing on our assessment skills and freeing up physicians to see clients requiring other services. Effective teamwork requires that team members know their roles and the roles and skills of their colleagues, understand the client’s goals, and communicate and collaborate effectively to help the patient achieve their goals.

That said, effective collaboration does not always involve clinicians working in formal multidisciplinary teams, and it is not always easy to build collaborative relationships with fellow physiotherapists or other health professions. However, as physiotherapists embrace client-centered care they also need to respect the client’s decisions regarding all aspects of their care, including the client’s decision to involve other professionals in their treatment program.

As stated in the Client-Centered Care Standard of Practice , a key expectation is that “the physiotherapist integrates a client-centered approach in all aspects of physiotherapy service delivery.”¹ This is achieved by ensuring that the physiotherapist “values the best interests of clients” and “involves clients in decision-making regarding their care, respecting their independence and right to refuse or withdraw from treatment at any time.”¹ At the very core of client-centered care is the understanding that it is the client who gets to decide who is and who is not on their health-care team.

It is the physiotherapist’s responsibility to act in the interest of the client when delivering services and to work with their fellow team members to help the client to achieve their goals.² Physiotherapists are also expected to participate “in concurrent treatment of the same condition when approaches are complementary, of benefit to clients, and an appropriate use of human/financial resources.”³ That doesn’t mean that physiotherapists will always agree to provide concurrent treatment, but it does mean that they should start from a place of trying to work collaboratively with those whom the client has chosen to have on their health-care team.

What’s required?

To engage in collaborative practice, the physiotherapist must:

• Ask about situations where the client is receiving or may be considering concurrent treatment.
• Gain the client’s consent and agreement to discuss and share information with the other health provider(s) involved.
• Discuss funding implications of concurrent treatment.
• Communicate with both the client and the other health-care providers effectively to ensure that care is integrated and optimized.
• Only participate in concurrent treatment when the approaches are complementary, of benefit to clients, and an appropriate use of human/financial resources.³

Physiotherapists are expected to discontinue concurrent treatment “when physiotherapy services represent a duplication of treatment.”³ However, there are situations that arise clinically in which the capacity of the public system to provide service does not match the care needs of the client. It is the College of Physiotherapists of Alberta’s perspective that in such situations the provision of concurrent treatment delivered by both publicly and privately funded physiotherapists does not represent duplicative treatment. In such situations, clients should not be prevented from purchasing additional private services, so long as services are coordinated, delivered effectively, and are consistent with the Standards of Practice.

To provide collaborative care safely and effectively, the health-care providers involved must establish strong, effective communication to ensure that care coordination occurs. This would include providing detailed information about treatment goals and methods. Communication should be appropriate for the situation and type of care the client is receiving, occur regularly, and be two-way (all participants in the relationship both providing and receiving information). When information sharing is not occurring regularly and effectively, both the patient and the providers involved are at risk. A lack of effective communication between health-care providers is one reason to refrain from concurrent treatment.

When engaged in concurrent treatment, physiotherapists must also “identify, document, communicate and manage the risks of concurrent treatment of the same condition,” and discontinue concurrent services if “the risks outweigh the benefits to clients.”³ There are myriad factors that would impact these risks and how blame could be distributed in the event that a client receiving concurrent treatment experienced an adverse event, including patient factors, the nature of the treatment provided, the time interval between care received from different health-care providers and the adverse event, and the nature of the communication between the client and their health-care providers and between the health-care providers involved.

The College of Physiotherapists of Alberta is not in a position to speculate on how blame would be apportioned in such an event, but if a physiotherapist is worrying about blame and liability, it’s worth considering why. Perhaps the physiotherapist is risk averse, or the concern may be a signal that the collaborative relationship is not as strong and effective as it should be. It may be a sign to invest more time and energy in strengthening the collaborative relationship with the other health provider or to discontinue the concurrent treatment. If a physiotherapist chooses to decline to provide concurrent treatment, the decision and rationale for the decision must be communicated to the client, and the discussion must be documented in the client’s record.³

Page updated: 03/01/2024