Republished: March 31, 2023
Updates: References to the legislation governing practice were updated to reflect legislative changes which came into effect on March 31, 2023.
Sometimes as we move forward, we have to leave things behind. There are many analogies, similes, and metaphors that relate to the retirement of someone or something. You can hit the end of the road, put things out to pasture or consign them to the scrap heap. The revised Standards of Practice have been circulated, and the January 2023 Good Practice article detailed the process used to update the Standards. Attentive readers will have noticed that there are a few Standards that are no longer included in the most recent draft standards.
The Standards highlighted in this article had quite a bit of overlap to the Code of Ethical Conduct or were a reiteration of the legislation, so important concepts are not getting lost, but the College is simplifying where the information is housed. Before stepping away from these Standards it would be best to highlight the important items to remember from each of them as we bid them farewell.
Client-Centered Care
I was not around for the inception of the original Standards of Practice so I can’t comment on what the group was discussing when they created this Standard, but I like to think they viewed client-centered care as an integral part of physiotherapy practice and having a Standard to reflect this key value was considered important. Client-centered care can be viewed as the basis upon which physiotherapy practice is delivered and is how physiotherapists learned to practice as students. Client-centered care does what its name indicates; it focuses care on the client and takes into account their lived experiences and goals of care.
The Standard’s expected outcome for patients was that:
“Clients can expect that they will be treated respectfully and their input will be valued, acknowledged, and integrated into all aspects of physiotherapy service delivery.”
A physiotherapist’s practice prioritizes the patient’s views and experiences into their decision making, which is why the Standard statement focused on a “client-centered approach”. However, in comparing the performance expectations of that Standard with the Code of Ethical Conduct we see the following:
| Client-Centered Care Standard | Code of Ethical Conduct |
|---|---|
|
Treats clients in a manner that recognizes and appreciates their autonomy, uniqueness, goals, and self-worth at all times. |
Demonstrate sensitivity toward individual clients, respecting and taking into consideration their unique rights, needs, beliefs, values, culture, goals, and environmental context. |
|
Values the best interests of clients. |
Work in partnership with clients to improve, support and/or sustain their health status and well-being. |
|
Involves clients in decision-making regarding their care, respecting their independence and right to refuse or withdraw from treatment at any time. |
Respect and support the autonomy of the client to participate in the management and decision-making relating their own health. |
|
Communicates with clients to facilitate their understanding of the care plan and how it addresses their goals, outlines the risks and benefits of services, and obtains informed consent. |
Communicate openly, honestly and respectfully with clients at all times. |
|
Monitors clients’ responses throughout service delivery, adjusting and modifying interventions/approaches as required, and obtaining ongoing informed consent. |
Respect the principles of informed consent including by explaining service options, risks, benefits, potential outcomes, possible consequences of refusing treatment or services, and by avoiding coercion. |
|
Treats all clients with compassion, respect, and dignity throughout the course of their care. |
Maintain professional boundaries that honour and respect the therapeutic relationship with clients. |
|
Terminates the therapeutic relationship with clients making appropriate arrangements for transfer of care or discontinuation of services. |
Provide an alternative treatment option through referral to another health-care provider/physiotherapist if the therapeutic relationship is compromised. |
As you can see from the above table there is significant overlap between the Standard and the Code of Ethical Conduct in terms of the principles and expectations for client-centered care which was recognized during the College’s discussions about this Standard.
Nearly all of the questions or complaints the College receives related to this Standard had to do with discharging patients or transitioning them to other practitioners when the therapeutic relationship was no longer positive. The data gathered and analyzed led to the creation of a new Duty of Care Standard which includes performance expectations that should help physiotherapists’ decision making when contemplating patient discharge. Client-centered care continues to be of importance as it is and will remain an essential element of physiotherapy practice which is reflected in the Code of Ethical Conduct.
Quality Improvement
Quality Improvement was another Standard that had significant overlap with the Code of Ethical Conduct as well as ties to the Evidence-Informed Standard of Practice. There was also discussion on whether it was within the role of a regulator to be involved in quality improvement as most often quality improvement falls into the purview and role of employers and the practice setting. Again, you can see the overlap below as we compare the Quality Improvement Performance Expectations with the Code of Ethical Conduct.
| Quality Improvement Standard | Code of Ethical Conduct |
|---|---|
|
Accesses and applies relevant information (e.g., patient outcomes, patient feedback) to improve client care and the delivery of physiotherapy services. |
Assess the quality and impact of their services regularly. |
|
Engages in continuous quality improvement processes that include the development, implementation, and evaluation of new or improved physiotherapy services to enhance client care as appropriate. |
Commit to lifelong learning and excellence in practice. Recognize the responsibility to share evidence-informed and clinical best practices in physiotherapy with each other and other health-care professionals. |
|
Supports the development of new evidence and best practices by participating in clinical research and program evaluation as appropriate. |
Contribute to the development of the profession through support of research, mentoring, and student supervision. |
Once again, the overlap creates unnecessary repetition. The updated Evidence-Informed Standard of Practice includes several performance expectations that focus on critically appraising evidence and incorporating that into practice. Regarding quality improvement, the physiotherapist “evaluating their practice in terms of client outcomes, and modifying approaches based on this self-reflective process” is the epitome of quality improvement and should be a performance expectation to prioritize in your practice.
Physiotherapists should not interpret the retirement of this Standard as a reduction in the importance of quality improvement. Like client-centered care, quality improvement is integral to physiotherapy practice and remains a priority in any physiotherapist’s practice. It is important to recognize that the ideals that were included in this Standard continue to live on in the Code of Ethical Conduct and the Evidence-Informed Standard of Practice.
Legislative Responsibilities
As the name suggests, the Legislative Responsibilities Standard was a reminder of the laws that govern practice and the responsibility physiotherapists have to be aware of the legislation that they abide by. Physiotherapy practice is governed by the Health Professions Act, the Physical Therapists Profession Regulation, the Health Professions Restricted Activity Regulation and College Bylaws. You can read more about the legislation that governs physiotherapy practice here.
Being a regulated health professional comes with many legislative requirements and responsibilities. The legislation that governs practice:
- Grants physiotherapists their protected title
- Establishes physiotherapy scope of practice, entry to practice and continuing competence requirements
- Establishes conduct processes and timelines
- Grants physiotherapists the ability to perform restricted activities
In order for physiotherapists to maintain their practice permit they also have to ensure that they follow continuing competency programs, register each year to practice, and meet the entry requirements when beginning practice in Alberta.
Since all of this is captured in law and those practicing physiotherapy in Alberta must abide by the law, the Standard of Practice was deemed redundant. Rather than being directed by the Standard, physiotherapists are directed by the law.
So, what are the take home messages from these changes?
- Re-read the Code of Ethical Conduct and reflect on some of the challenging decisions you have made so far in your career. Often times a disconnect between the client and the physiotherapist is the genesis for issues in a patient’s care or in the therapeutic relationship. The Code highlights a physiotherapist’s ethical obligations to the patient and prioritizes the patient’s input into their care. Keeping this notion at the forefront of your practice should enhance patient outcomes.
- Quality improvement is an integral part to being a competent physiotherapist. Quality improvement initiatives can include courses and gaining knowledge in areas of practice, but it is more than that. Its also about measuring your impact on patients within your practice and evaluating the results so that you can make informed changes to your practice that follow current evidence. The process culminates with the creation of better outcomes for your patients. Physiotherapists should focus on the performance expectations housed in both the Evidence-Informed Practice Standard but also the Code of Ethical Conduct to help guide their quality improvement initiatives.
- Understand the law that governs your practice. What does the legislation require you to do in your practice? The law goes further than a physiotherapist’s ethical responsibilities and carries risk if the physiotherapist does not comply with the legislation. It is each individual physiotherapist’s responsibility to know the legislation that pertains to their practice and to follow it. Take the time to educate yourself on the requirements set out by the province and by the College to protect the patients you treat and to maintain good standing as a physiotherapist in Alberta. Nobody wants to be the person that says “But I didn’t realize…” as they face a complaint or a legal infraction.
Footnote: Reference to the Government Organization Act was removed and replaced with Part 0.1 of the Health Professions Act and Health Professions Restricted Activity Regulation (Order in Council 049/2023, 050/2023).
Sean FitzGerald, PT, Practice Advisor
