I have been thinking about all the changes that seem to have occurred in my career as a physical therapist and in the health care system as a whole. At Meridian Point Rehabilitation Hospital in Scottsdale, Arizona, we are involved in the exciting process of creating an interdisciplinary approach to pain and somatic dysfunction that integrates traditional and alternative disciplines like Rolfing. A song from my earlier years echoes “For the times, they are a’ changing….” I recall the general message of that song was to start treating people like the decent human beings that they are. The echo reverberates past the hopes of the “flower children” to the reality of business and the difficult process of integrating traditional and alternative therapies in a way that serves all concerned, patients, and practitioners alike.
Change is an inevitable part of life and it is not always easy to implement. One of the easiest ways to implement change, without too much resistance, is to include the people around you in the decision making processes while available options are being discussed. Many times I have been surprised at how the input of others changes the way I thought an interdisciplinary team ought to be constructed. Often, inclusion of numerous practitioners in discussion creates the necessary transition to real change. When I reflect upon the changes in my own professional arenas, one of the most vital components of accepting change is acknowledging the benefits and willingness to accept compromises for the good of all.
A wonderful incentive is opportunity. Opportunity is the potential to advance toward new ideas. It provides a context in which to grow. I have been fortunate because I work with a number of creative people, all of whom are united by the common goal of creating a humane and quality interdisciplinary approach to rehabilitation. It seems to me, it’s not so much how to get people to change for the positive, it’s whether or not people are willing to start to do it. Once they get on their own “yellow brick road”, it becomes their choice as to whether or not they want to continue on their own journey to Oz, sort of hang out in the poppy fields with the Tin Man, make a deal with the Wicked Old Witch of the West, or just party-out with the Munchkins. Now, how far down the road each person is willing to travel depends on how much effort they want to invest in changing themselves. I am sure we all know people that are so into transformation that they seem to live in Never Never Land where there aren’t any roads. They spend their life restructuring the basic terrain of the earth. They thrive on change and eat structure for lunch. There are those that gently keep tapping the tip of the shoulder of the road, just a bit too cautious that they are going to get hit or run over. From my experience, there is yet another group of people who consistently meander down the road. Sometimes they go off into the shoulders, and sometimes head straight down the middle with varied pace and yet, they always seem to be moving forward.
We call our interdisciplinary group the Team Managed Center’. It is a service program concept structured according to the three paradigms of practice (relaxation, corrective, and holistic). We are a partnership of likeminded professionals trained in a diverse array of traditional and alternative somatic therapies. We are dedicated to the team approach which integrates diverse skills and disciplines for the benefit of all patients who suffer from somatic dysfunction and all types of pain. The Team Managed Center has been originally implemented as the Team Managed Center for Pain Rehabilitation at Meridian Point Rehabilitation Hospital by mutual agreement between our contract agency and the hospital. The core team is comprised of three people: I am the Clinical Director and Team Coordinator and bring to the team my experience as a Board Certified Clinical Associate of the American Academy of Pain Management with an extensive background in neurofascial, structural, and integrative disciplines for all age groups; Jeffrey Maitland, Ph.D., a well known Rolfer and expert in soft tissue manipulation for pain, a Board Certified Diplomate of the American Academy of Pain Management who along with myself is an author, lecturer, and teacher on topics related to health and medical fields; and William F. Wong who is a Naturopathic Diplomat, a Certified Athletic Trainer and exercise kinesiologist. Jeff and I also work closely with pain management anesthesiologists in the Team Center often integrating fascial manipulation with pain blocks. The additional practitioners are all experienced and skilled in the specific areas of hands on techniques, advanced physical therapy with specialization in soft tissue mobilization/manual therapy, micro current electrotherapy and exercise therapy.
The protocols, techniques and strategies of all practitioners are combined in an integrated manner for the patients. We work with orthopedic and neurological dysfunctions in the early, middle and late phases. Following a team evaluation, we address the anatomy, functional movement, soft tissue system, and activities of daily living as they relate to the patient’s personal, professional, recreational and community contexts.
The plan of treatment is rendered and modified based upon the individual patient’s needs at a frequency of 2-4 times a week over an average of 2-4 months depending upon the diagnoses. We create time frames to allow the Rolfing method to be implemented, as well as adequate transition movement opportunities. Team Managed Center service program practitioners are supportive of patient directed results to improve functional mobility and general activity up to or under tolerable limits of pain perception. Community resources and private practitioners are suggested following discharge to empower the patient to function in the community, home, work and recreational areas. Simply stated, we wish to empower the patient to lead their lives as best they can according to their own desires and goals.
Our service program was implemented a year ago and we are in the process of fine tuning and assessing its progress in the medical context. Experience has required redefining our roles, responsibilities and our perceptions of ourselves within this integrated framework. The realization of how the opportunities within this work environment have changed all of our learning experiences is profound.
It has not been easy for the various disciplines which include Rolfers, Jin Shin, jujitsu practitioners, reflexologists, sports massage therapists, exercise kinesiologists, and alternative physical therapy practitioners to communicate with each other considering the various languages to which we are all accustomed. Finding a common language with which to relay our own discipline specific evaluation criteria and the protocols, techniques and strategies in the medical context has been a challenge. Creating insurance reports, progress notes and criteria validation for the medical system is an extraordinary challenge. We have found that as we progress on the road to transformation within the hospital, we are become more integrated as colleagues. This is often referred to as “belongingness”. Each of us wants our input, our existence, our presence to be at least heard, respected and hopefully honored. Having our presence and skill honored is closely tied to the level of honesty we each have about ourselves. Often we ask, “Are we trustworthy?” “Do we show fairness and sincerity in assessing the patient’s needs?” “Are we genuine in our interactions as adults?” There is also a sense of devotion that comes out in the work place when each individual is honest. This sense of devotion, which may be called loyalty, can be quite advantageous to future growth, profit and patient benefit. Devotion requires a commitment and commitments bring about further trust and mutual respect. Practitioners of the Team Managed Center are quite devoted to developing and expanding an interdisciplinary concept that recognizes the value of all skilled practitioners in alternative and allopathic realms.
Sometimes our pride in our egos assists us in working for recognition which can come in various ways: money, validation from traditional practitioners, insurance companies, improved public relations and obviously improved outcome results. Admittedly, the road can be quite rocky when dealing with a traditional medical administration. We must decide what we want from creating this interdisciplinary approach and when the symbols of recognition do come, the degree of sincerity in recognizing and blending in with the rules and attaining appropriate goals are extremely important. Acknowledging opportunity, the truth with which practitioners see themselves in their work environments, and how they are recognized by themselves and by others as they progress forward are also important and basic. In the Team Managed Center, we take the time to thank ourselves and our colleagues most sincerely. We communicate how much we appreciate the assistance and participation from our patients, each other and our personal support environment throughout the whole process of change. It is good thing for all involved.
The Team Managed Center service program is a collective effort. In a collective effort, each individual wants to be understood. We want other people to understand what we are saying though often times there is the hidden agenda of, “and I want you to agree with me”. Most fortunately, practitioners in the Team Managed Center do respect our individual differences in theory and practice. We have worked diligently to “agree to disagree” about philosophy theoretical considerations and practical applications; however, the bottom line is what is best for the patient at that particular moment. I am happy to state that on that point we always find resolution. Now, I am not recommending that we must agree with everyone or always change to other people’s point of view. But, our working environment provides a wonderful opportunity for each one of us to more deeply understand and appreciate the roles and benefits of other somatic therapies. We have all learned from each other in ways that have made us better practitioners in our own disciplines. We aim for the possibilities of dignity, respect, and fairness and, for the ultimate goal of quality patient care. In this possible place, a synergy exists.
A synergistic effect often occurs as we work together in a team effort. The total effects are greater than the sum of the individual efforts. Much is written about the basic tenants of synergistic team work. The components are basically respect, dignity, the right to be different, honesty, responsibility and, most importantly, that human beings are the greatest resource of any company or corporation. Everything that is done as a group tends to have far more productive result than things that are done individually. The tendency to fall into the crowd and feel like we don’t want to be noticed is thereby abated when there is true synergistic effort, for every individual is acknowledged.
I again reflect back on all the different work environments I have been fortunate to experience. Those individuals who are more responsive and willing to find resolution of difficulties through compromise are the ones who “walk what they talk.” They don’t have selective ethics or morals. They have basic constitutive principles that govern humane and quality therapeutic care. These principles make each individual responsible for allowing change and transformation to progress each and every work day. As an antidote to misunderstanding and failure, they value and promote honest communication among all practitioners in all contexts. I hope that as I continue down the “yellow brick road” towards that land of Oz, I remain aware of the mutual support that has been around me in my professional and personal life.
The Team Managed Center approach is unique in the pursuit of interdisciplinary protocols in the medical context and in its synergy of alternative and allopathic strategies, as well as in its emphasis to transition patients to available community resources. We are a highly experienced and skilled group of people who are committed to expanding the concept of integrated approaches in all health care fields and we offer our patients a quality intense, structured and beneficial program towards their own rehabilitation. “The times, they are a’ changing,” and my hope is that all somatic practitioners can learn and evolve from our co-operative efforts and become a vital human energy force that converts and transforms our history and learned experiences into new, more effective manifestations. Our team approach is committed to and capable of taking concise strategies of any discipline and allowing them to exist concurrently and equally with each other. We can respect, honor and own this wonderful potential for integrating diverse somatic therapies for the well-being of others, if we simply remember that we are all human, individually and collectively, venturing forward toward the expansion and transformation of ourselves and our unique professions within the health care system.