Practising through complexity

2020 was a year of the unexpected. Physiotherapy staff found themselves thrown into the unfamiliar territory of a global pandemic.

This saw many redeployed into unfamiliar services, working unsociable hours and wearing layers of PPE. Physiotherapists had to stand down the services they normally run while planning for their restart without knowing what this would look like, or when it would happen.

All this while simultaneously managing their home lives and the challenges that came with a national lockdown.  

As we enter a new year, some will have thoughts of a ‘new start’ with fresh ideas and energy, however many of us will find we are continuing to practice through a time of complexity and uncertainty. 

In the professional advice service we have received enquiries covering a huge breadth of Covid-related topics from PPE, redeployment, loss of rehab space and services to digital resources and restarting services. We also continue to advise on the more day-to-day topics such as PLI, delegation, scope of practice and record keeping.

It is this that highlights the complexity of practising through a pandemic while dealing with the day-to-day. The new year is an ideal time to reflect on the past and move forward with new experiences and new tools in our pockets. 

Circle of influence

Physiotherapists like to be in control. We like to draw on experiences and knowledge to shape our clinical reasoning and help us make decisions that we are confident are right.

There is a temptation to wait for the right time to make decisions or implement change perfectly but, as we are all rapidly learning, that right time may never come.

In times of complexity we should be striving for progress rather than perfection.

Now is as good a time as any and we must accept that in challenging situations we can’t expect to have all the perfect solutions but we can take ownership of those things in our situation and our environment that we are able to control. 

But how do we know what we can control or influence and what we can’t?

The circle of influence [bit.ly/3qhQIkl] is a great tool for establishing this. It encourages you to look at all the things that concern you and helps establish that you have more power than you think over things that feel out of your control.

This can help you to take more responsibility for these elements of your practice. Identifying the things that you can’t control (like government policy or the weather) can help to put them to one side and encourage acceptance of parts of our working life that fall outside of the circle of influence instead of wasting time worrying and trying to change them. 

Cynefin framework

The best decisions are made by adapting your approach to changing circumstances. However, knowing which approach to use in a particular situation can be difficult, especially if it is one which we have not seen before, such as a pandemic. 

The Cynefin framework is a problem-solving tool that helps you make better decisions by assessing the situation you find yourself in. The tool provides five domains, defined by cause and effect relationships, that can help you to assess your situation more accurately and respond appropriately.

Resources available

So when practising in this ongoing complex environment, consider the circle of influence and complexity theory as tools to support you reviewing and continuing to improve the services you offer. Think about changes you have had to make that have worked well. Why not continue with them? Remember that anyone can lead and make changes and that they can be big or small. 

The CSP has many resources to support your decision-making so please keep referring to our website. You could also tap into the collective experience and expertise of your fellow members through iCSP.  

Case study

Hayley Williamson and her pulmonary rehabilitation (PR) team in Birmingham faced the familiar challenge of delivering group sessions during the pandemic.

With an increased understanding of their available resources and service user needs, they piloted a virtual PR service.

While challenging and at times frightening, keeping their team and patients involved throughout helped them develop, implement and evaluate the new service.

They found that ‘encouraging self-management and increasing patient confidence was essential for the service to minimise the likelihood of patients accessing secondary care’.

They also found that ‘the positive subjective feedback gained from patients was uplifting for staff and the objective outcome measures supported the clinical benefit of virtual PR’. You can read the full case study titled 'Trial of Virtual Pulmonary Rehabilitation during COVID-19 Pandemic' 

• Rachael Wadlow and Euan McComiskie are CSP professional advisers