This is about Professional Autonomy (PA). In my opinion a vague, somewhat relevant concept that somehow impacts on the clinical effectiveness and future development of the physiotherapy profession. Much has been written about the topic, but it seems that some crucial principles have not been explored and clarified in sufficient depth. As a result it seems that our narrative about professional autonomy is incomplete.
In a series of articles/blogs, I will argue that delegated authority to control necessary resources and to be empowered and trusted to do so, precedes the state of being professionally autonomous (or having professional autonomy). In other words, PA (within the NHS context for example) is an outcome, a result of having been delegated the authority to control appropriate resources, including the resources to negotiate service contracts with the commissioners/purchasers of our services directly.
PA is the outcome of a range of organisational processes and arrangements, which are dynamic and variable in time. It is best understood as the outcome of inter-relational processes within each of the constituent organisations within a healthcare system.
Defining professional autonomy unilaterally and primarily in terms of its main elements (freedom to…, responsibility and self-regulation) seems deeply problematic because the concept is necessarily a negotiated and co-constructed one in the context of an organisation in which power-dynamics are affected by organisational and contextual pressures as well as the prevailing organisational “culture” and its priorities. The outcome of its co-construction depends on how the role of the physiotherapist is perceived and understood, inter-subjectively, by the power-dominant stakeholders in terms of its added value to the organisation, its clients, the wider community and society.
These things would be reflected in the amount and kind of authority and control explicitly delegated by the commissioner (along the relevant ‘chain of command’ involving team-leads service-managers etc) to the individual therapist.
I will also conclude that we should expand our professional lexicon to purposively use the vocabulary of disciplines such as economics and finance and to be able to express the ethos of patient centred care in terms of cost-effective treatment and the societal value of physiotherapy.