Thesis (MBA)--Stellenbosch University, 2006. / ENGLISH ABSTRACT: South Africa's healthcare industry is at a crossroad as pressure in both the public and private sectors is increasing. The extent of change in the industry is overwhelming and it is seen as a very turbulent and unstable environment. Healthcare professionals must reconsider their position in the industry and adapt in this ever-changing environment. The physiotherapy profession forms a small part of the healthcare value chain, but it fulfils an important role in the healthcare system. Unfortunately the profession shows no clear direction and purpose. There also exists a mismatch between the current healthcare environment demands and the physiotherapy service delivery. If they do not adapt in this environment which is in turmoil and have a clear strategy for the way forward, they will be pushed out of the healthcare value chain and become obsolete. The aim of this research report was then to do an in depth analysis of the private healthcare industry in which physiotherapy is operating, to analyse the external physiotherapy industry and an internal analysis of the profession so as to construct a generic strategy for the physiotherapy profession in the private healthcare sector in South Africa. To achieve this aim, it was determined that qualitative, investigative research would be conducted. The research methodology used in this research report was a combination of primary and secondary research. Firstly, secondary research in the form of a literature review was conducted to provide a comprehensive insight into the provision of health care in South Africa. Thereafter, primary research was conducted through semi-structured, in-depth interviews with a purposive sample of physiotherapy industry experts to analyse the external physiotherapy Industry as well as the internal profession environment. Main findings include that the physiotherapy industry is becoming less attractive as competitive forces in the physiotherapy and private healthcare industry are moderate to strong. Deconstruction of the healthcare value chain in the private sector is increasing intra- and inter-professional competition. Government plays a major role in the attractiveness of the industry as they are restricting competitive and market forces and minimising profits through legislation. Medical schemes are trying to contain costs and managed healthcare is coming to the forefront. The physiotherapy market is stagnating and the clients' needs and requirements are changing. Opportunities that were identified we~e the expansion into new markets, involvement in other industries and broadening the scope of practice. Threats are mainly from governmental legislation and policies, vertical integration from the hospital and medical scheme industries and the threat of substitutes, especially alternative health. From the internal profession analysis a current strategy was identified and a strategic intent was formulated as the physiotherapy profession wants to be the preferred and relevant health care service provider in prevention, management and rehabilitation of potential and actual movement impairments of individuals. Strengths to help build this vision included their high regard and profile, quality training, increase in research and evidence and their whole service package. Weaknesses that must be overcome include poor business, managerial and marketing skills, limited role models and leaders and the high levels of intra-professional competition leading to the demise of the profession. Having completed the analysis, major strategic thrusts with a focussed differentiated approach for the profession could then be formulated: • Define physiotherapy and the scope of practice. • Reinstate physiotherapy in the healthcare system. • Develop leadership. • Cooperate within the profession. • Maintain professional autonomy. • Develop business skills. / AFRIKAANSE OPSOMMING: Gesondheidsprofessies moet hul posisie in die industrie herevalueer en aanpas in hierdie steeds wisselende omgewing. Die fisioterapie professie beslaan 'n klein deeltjie van die gesondheidsorg waardeketting, maar dit vervul 'n baie belangrike rol in die gesondheidsorg stelsel. Ongelukkig blyk dit asof die professie geen rigting en doeleindes het waarna dit beweeg en streef nie. Verder bestaan daar ook 'n wanbelyning tussen die huidige gesondheidsorg omgewingvereistes en die dienste wat fisioterapie verrig. Indien die fisioterapie professie nie aanpas in hierdie onstuimige omgewing nie en 'n duidelike strategie ontwikkel vir die toekoms nie, staan dit in gevaar om te verval uit die gesondheidsorg-waardeketting en te vergaan. Die doel van hierdie navorsingswerkstuk is dan om 'n in diepte analise te doen van die privaat gesondheidsorgindustrie waarin fisiolerapeute funksioneer, om die eksterne fisioterapie-industrie sowel as die interne professie te analiseer; ten einde 'n generiese strategie vir die fisiolerapie-professie in privaat gesondheid in Suid Afrika te ontwikkel. Om hierdie doelwitte te bereik is daar besluit om kwalitatiewe navorsing te doen. Die navorsingsmetodologie wat gebruik is bestaan uit 'n kombinasie van primere en sekondere navorsing. Sekondere navorsing is gedoen in die vorm van 'n literatuuroorsig om 'n omvattende oorsig te gee van die gesondheidsorg dienslewering in Suid Afrika. Daarna is primere navorsing gedoen in die vorm van gedeeltelike gestruktureerde, in diepte onderhoude met 'n doelbewuste steekproef van fisioterapie-kundiges om die eksterne omgewing en interne professie te evalueer. Hoof bevindings uit die analise is dat die fisioterapie-industrie se aantreklikheid besig is om te verminder as gevolg van gemiddelde tot sterk kompeterende kragte. Dekonstruksie van die gesondheidsorg-waardeketting in die privaatsektor lei tot verhoogde intra- en inter-professionele kompetisie. Die regering speel ook 'n groot rol in die aantreklikheid van die industrie en hulle beperk natuurlike kompetisie en markkragte en minimaliseer winste deur middel van wetgewing. Mediese fondse probeer kostes beperk en besturende gesondheidsorg begin ontluik. Die huidige fisioterapiemark is besig om te stagneer en kliente se behoeftes en vereistes is besig om te verander. Geleenthede wat geidentifiseer is sluit in die uitbreiding na nuwe markte, betrokkenheid by ander industrie; en die verbreding van fisioterapie se bestek van praktyk. Bedreigings bestaan hoofsaaklik vanaf regeringswetgewing en regulasies, vertikale integrasie van die hospitaal en mediese fonds industriee en die bedreiging van plaasvervangers, veral alternatiewe gesondheid. Vanaf die interne professie-analise is daar 'n huidige strategie geidentifiseer en 'n strategiese intensie kon geformuleer word. Hierdie intensie is dat die fisioterapieprofessie die gewenste en relevante gesondheidsorg diensverskaffer sal wees in die voorkoming, bestuur en rehabilitasie van potensiele en werklike bewegingsaantastings van individue. Sterkpunte in die professie wat hierdie intensie kan ondersteun, sluit in hul goeie profiel en agting, kwaliteit opleiding, toename in navorsing en hul volledige dienspakket. Swakpunte wat oorkom moet word is swak besigheids-, bestuur - en bemarkingsvaardighede, beperkte rolmodelle en leiers en die intra-professionele kompetisie wat die professie as 'n geheel ondermyn. Nadat die analise gedoen is kon daar hoof strategiese rigtings geformuleer word met 'n gefokusde differensiasie benadering: • Definieer fisioterapie en bestek van praktyk. • Hervestig fisioterapie in die gesondheidsorgstelsel. • Ontwikkel leierskap. • Samewerking in die professie. • Behou professionele outonomiteit. • Ontwikkel besigheidsvaardighede.

Thesis (MScFisio)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: Objective: To describe the baseline data of a surgical ICU in South Africa before the implementation of an evidence-based physiotherapy practice protocol. Design: Prospective cohort observational study Setting: Ten-bed closed surgical unit in a university affiliated tertiary hospital. Patients: All adult ICU admissions from 16 June - 30 September 2003. Measurements: The patient’s clinical data including demographic information, admission diagnosis, surgery classification and co-morbidities were recorded on admission to the unit. APACHE II score was calculated. The physiotherapy techniques, positions and functional activities used, the frequency and duration of physiotherapy treatment sessions, the provision of after-hours service and the diagnosis of pulmonary complications were also recorded daily. The time of mechanical ventilation was calculated and the number of re-intubations documented. The ICU length of stay or mortality was recorded. Results: 160 patients were admitted. Patients were 49 +/- 19.95 years of age. The mean APACHE II score was 12.3 +/ 7.19 and a 12.3% mortality was observed. Thirty seven percent of patients were admitted to the unit following elective surgery. Patients stayed in the unit for 5.94 +/- 6.55 days. Hypertension was the most frequent co-morbidity found in this cohort (42%), and 21% of patients tested, tested positive for HIV. Co-morbidities had no significant association with ICU LOS or mortality. Nine hundred and twenty seven physiotherapy records were obtained. Students were responsible for 39% (n=366) of treatment sessions, the unit therapist for 34% (n=311) and the on-call therapists for 27% (n=250). Despite routine daily physiotherapy for all patients in the unit, 39% (n=62) developed excessive secretions, 30% (n=48) of patients developed pneumonia and 27% (n=43) of patients were diagnosed with basal atelectasis. Nineteen patients (12%) died in the ICU. Patients spent a mean of 5.94 (SD 6.55) days in the unit. One hundred patients (63%) were ventilated. Almost a third of ventilated patients (31%) were intubated more than once. The patients spent a mean time of 3.8 days (SD 6.30) on the ventilator every time they were re-intubated. The development of pulmonary complications significantly increased the time on the ventilator and the LOS. Conclusions: This baseline study of a surgical ICU presents a picture of a unit providing care comparable to first world environments. The picture of the physiotherapy service provided in this unit is of a “traditional” service based neither on the available evidence regarding the prevention or management of pulmonary complications, nor on the incorporation of early rehabilitation into the management of mechanically ventilated adult patients in ICU. / AFRIKAANSE OPSOMMING: Doel: Om die basis lyn van ‘n chirurgiese intensiewe sorg eenheid in Suid Afrika te beskryf voor die implementering van ‘n bewysgesteunde fisioterapie protokol in die eenheid. Studie struktuur: Prospektiewe kohort observerende studie. Eenheid: Tien bed geslote eenheid in ‘n tertiêre opleidingshospitaal. Pasiënte: Alle volwasse pasiënte opgeneem in die eenheid tussen 16 Junie en 30 September 2003. Meetings: Demografiese data, diagnose met opname, chirurgie klassifikasie en ko-morbiditeite is aangeteken by opname. APACHE II is bereken. Die fisioterapie tegnieke, pasiënt posisies en funksionele aktiwiteite gebruik in behandelingssessies, die frekwensie en duur van behandelingssessies, die verskaffing van na-ure diens aan die eenheid asook die komplikasies gediagnoseer is daagliks aangeteken. Die tyd wat pasiënte geventileer is asook die aantal kere geher-intubeer is bereken. Die tydsduur van eenheid verblyf asook mortaliteit is aangeteken. Results: 160 pasiënte is opgeneem, met ‘n gemiddelde ouderdom van 49 +/- 19.95. Die gemiddelde APACHE II telling was 12.3 +/ 7.19 en die mortaliteit was 12.3%. Sewe en dertig persent van pasiënte is opgeneem na elektiewe chirurgie. Pasiënte bly in die eenheid gemiddeld vir 5.94 +/- 6.55 dae. Hipertensie was die mees algemene ko-morbiditeit (42%), en 21% van die pasiënte wat getoets is, het positief getoets vir HIV. Ko-morbiditeite het geen beduidende verband getoon met die tyd in die eenheid of mortaliteit nie. 927 Fisioterapie rekords is aangeteken. Studente was verantwoordelik vir 39% (n=366) van die behandelingssessies, die eenheid terapeut vir 34% (n=311) en die op-roep fisioterapeute vir 27% (n=250). Ten spyte van daaglikse roetine fisioterapie behandeling van alle pasiënte in die eenheid het 39% (n=62) oormatige sekresies ontwikkel, 30% (n=48) is met pneumonie gediagnoseer en 27% (n=43) met basale atelektase. Negentien pasiënte (12%) is dood in die eenheid. Die tydsduur van eenheid verblyf was 5.94 (SD 6.55) dae. Een honderd pasiënte (63%) is geventileer. Byna een derde (31%) van pasiënte is geher-intubeer. Met elke her-intubasie het die pasiënte gemiddeld 3.8 (SD 6.30) dae langer op die ventilator gebly. Pulmonale komplikasies het beide die tydsduur in die eenheid as op die ventilator betekenisvol verleng. Gevolgtrekkings: Hierdie basislyn studie beskryf ‘n eenheid waar pasiënte mediese sorg ontvang soortgelyk aan eerste wêreld lande. Die fisioterapeutiese diens wat gelewer word is egter nie gebasseer op die nuutste bewyse in die literatuur nie. Nog, in die voorkoming of in die behandeling van pulmonale komplikasies, nog in die vroëere inkorporasie van rehabilitasie in die hantering van volwasse pasiënte in ‘n intensiewe sorg eenheid.