New physiotherapy – 7 ways to change the world

I read something about critical theory this morning that made me think about a couple of recent posts on the future of physiotherapy.  In the piece, the author was taking critical theorists to task for attempting to ‘demystify’ the social world without proposing solutions.  People, she argued, want attractive alternatives and a sense that utopia, or at least the hope of a better life, might be possible.

This is a powerful argument that I don’t entirely agree with, but it did make me think about Roger Kerry’s recent blogpost ‘Physio will eat itself’, which followed my own question of whether we would disestablish physiotherapy as a profession if it were in the best interests of patients or the healthcare system as a whole (Link).

Critiquing the systems and structures, objects and subject positions that make up today’s healthcare system is a vital function of critically-minded health professionals, especially where those same structures and systems get in the way of meaningful and effective care.  But we should also think about how things might be ‘otherwise’, and open spaces for new ideas.

This doesn’t mean prescribing the solution, since the value of any idea depends on how and where it’s taken up, how it’s used and adapted, and how it’s perceived.  But there’s nothing wrong in greasing the wheels of change, if it can help.  So, following Nir Eyal’s adage that ‘People don’t want something truly new, they want the familiar done differently’ (Link), here are some ideas for ways we might all think physiotherapy ‘otherwise’:

1. Look to the margins: Look to people who are thinking and practicing at the very edges – or even beyond the boundaries – of convention. This means exploring the work of people who are taking risks: ‘bleeding-edge’ practitioners they are called in business.  Their ideas often fail, but when they succeed they are often groundbreaking.
2. By extension, this also means looking at practices that are not officially sanctioned or approved of by the mainstream. So don’t look to your professional bodies or even professional societies to be the source of your ideas.  Their role is to secure the present professional ideology, not to radically disrupt it.  Look instead to the people who may have ‘left’ the profession to explore life outside physiotherapy, but have then brought their ideas back in.
3. Look to the people doing the counterintuitive thing. To do this, you’ll obviously need to know what the intuitive and obvious thing is in much greater detail.  So study your profession: where it came from, what it does and doesn’t do, who it serves, who benefits, and who is marginalised.  Study where your professional boundaries currently are, and ask those classical critical questions: why is my way of doing/thinking things like this and not like that; what is holding these ideas and practices in place; what is not being done, said, thought?
4. Ask critical questions of people who claim to be innovating: is their idea just old wine in new bottles; what, if anything, are they subverting; what innovations are being promoted. Be ruthless here.  Deciding that Treatment A is more effective than Treatment B is not radical if your basic practice model and way of thinking stays the same.
5. Think about the different ways innovation can happen: try some new ideas, new practices, new practice locations, new clients, new definitions, new practice parameters, new connections…
6. Draw inspiration from those people who are creative by nature: designers, architects, authors, music producers, etc. Think big, and avoid the kinds of instrumental thinking that kills creativity.  Don’t sweat the small stuff.
7. Follow the principle that anything that opens space for new ideas is good, anything that closes space (rules, constraints, checks and balances, people’s negativity) is bad.

Physiotherapy needs real innovators right now.  We’re not given much help to be innovative in our training, because so much time is spent learning to follow rules and principles laid down by others, so we’re coming from a long way back.

As a profession, we’ve got to be much better at tolerating the weird, the uncomfortable and the incomprehensible, because it’s in these spaces that radical change is fermenting.  And who knows, today’s wacky could soon become tomorrow’s wonderful.