Monday, July 28, 2008

Evaluating Physical Therapists' Perception of Empowerment Using Kanter's Theory of Structural Power in Organizations

Evaluating Physical Therapists' Perception of Empowerment Using Kanter's Theory of Structural Power in Organizations

Patricia A Miller, Peggy Goddard and Heather K Spence Laschinger

PA Miller, PT, MHSc, is Assistant Clinical Professor, School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada. At the time of the study, she was Profession Leader, Physiotherapy, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada. Address all correspondence to Ms Miller at 5 Undercliffe Ave, Hamilton, Ontario, Canada L8P 3G9 (
P Goddard, MScN, RN, is Assistant Clinical Professor, School of Nursing, McMaster University. At the time of the study, she was Chief of Professional Practice and Chief Nursing Officer, Hamilton Health Sciences Corporation
HK Spence Laschinger, PhD, RN, is Associate Director, Research, and Professor, School of Nursing, University of Western Ontario, London, Ontario, Canada

Background and Purpose. Little is known about physical therapists' perceptions of empowerment. In this study, Kanter's theory of structural power in organizations was used to examine physical therapists' perceptions of empowerment in a large Canadian urban teaching hospital. Kanter's theory, which has been studied extensively in the nursing profession, proposes that power in organizations is derived from access to information, support, resources, opportunity, and proportions. Subjects and Methods. A convenience sample of physical therapists who had been working in the hospital longer than 3 months was used to determine the scores for the physical therapists' ratings of empowerment using the Conditions of Work Effectiveness Questionnaire. Results. Physical therapists' scores were similar to reported staff nurses' scores for access to support, information, resources, and opportunity (X=2.89, 2.91, 2.62, 3.25, respectively). Physical therapists' scores were higher than the majority of reported staff nurses' and nurse managers' scores for access to sources of informal and formal power structures (X=2.81 and 3.29, respectively). There was a relationship between the empowerment score and the physical therapists' global rating of empowerment. Unlike studies of nurses, there were no relationships when demographic attributes and empowerment scores were examined. Discussion and Conclusion. Evidence for the validity of Kanter's theory of empowerment was found. Kanter's theory can provide physical therapists and their managers with a useful framework for examining critical organizational factors (access to information, support, opportunity, and resources) that contribute to employees' perceptions of empowerment. A baseline measure for comparing future empowerment scores of this sample is available. Further work to examine the application of Kanter's theory to other samples of physical therapists appears to be warranted.

Key Words: Empowerment • Kanter's theory of structural power in organizations • Organizational restructuring • Program management

Wednesday, July 23, 2008

Staten Island firefighter accused of physical therapy scam

by Staten Island Advance
Monday July 21, 2008, 4:14 PM

From Bravest to busted?

A firefighter from Staten Island is accused of falsely claiming to be at physical therapy sessions and collecting approximately $7,500 in pay.

John Dimino, 45, a Prince's Bay resident, allegedly signed the Fire Department's command log on multiple occasions between August 2007 and February 2008 indicating he was leaving work to attend physical therapy sessions. The Department of Investigation says it found Dimino did not attend physical therapy on those occasions.

For most of his 18-year career, Dimino has been assigned to Engine 157 in Port Richmond. The alleged fraud happened at the Concord firehouse that houses Rescue Co. 5. Fire officials said that was most likely where he was performing light duty stemming from his injury.

Officials couldn't immediately say exactly how Dimino was injured or when, but said it was an on-duty injury.

He was charged today with third-degree grand larceny, first-degree falsifying business records and second-degree falsifying business records. The top charge of grand larceny carries a maximum penalty of seven years in prison if Dimino is convicted at trial.

The accused firefighter earns an annual salary of $68,470, according to officials.

His attorney, Rob Gallo, declined to discuss the case. Dimino fled from a photographer outside court today.

Therapists help Iraqi patients gain independence

by Staff Sgt. Don Branum
332nd Air Expeditionary Wing Public Affairs

7/23/2008 - JOINT BASE BALAD, Iraq -- An Iraqi man whose leg was shattered two months ago can walk again thanks in part to a team of physical and occupational therapists at Joint Base Balad's Air Force Theater Hospital.

Moqdad lay on a raised bed in the middle of the Occupational Therapy and Physical Therapy clinic July 22. Nearby, a pair of crutches leaned against a wall, waiting for the Iraqi Marketplace employee to use them for the first time since he left the hospital. He smiled and chatted with medical technicians as they wove bandages around the pins of a large metal brace -- known as an external fixator -- attached to his right ankle.

The physical therapists first saw Moqdad as an inpatient here, said Lt. Col. Lisa Smith, element chief of occupational and physical therapy for the 332nd Expeditionary Medical Operations Squadron here.

"We started therapy with him, trying to get him to walk again," said Colonel Smith, who is deployed from Wilford Hall Medical Center at Lackland Air Force Base, Texas. "That was the big challenge for us."

Moqdad was accidentally shot in the lower leg, splintering both his tibia and fibula, said Emad, an Iraqi translator and the eldest of Moqdad's six brothers. Air Force surgeons repaired what damage they could and attached the fixator to Moqdad's limb to help the bones heal properly. Then, they released him.

When the hospital discharges a patient, staff members determine what follow-up treatment the patient may need, Colonel Smith said. In Moqdad's case, the follow ups included regular visits to physical therapy.

The OT/PT clinic sees about 300 inpatients per month, nearly 90 percent of whom are Iraqi patients like Moqdad, Colonel Smith said. Physical therapists focus on treatment of spinal and extremity movement dysfunctions, while occupational therapists work primarily with patients' hands.

Colonel Smith's staff works closely with the Orthopedic Clinic, which installed Moqdad's fixator, so the orthopedic doctors can focus primarily on surgeries.

"Because this is a trauma hospital, we see a lot of patients who would ordinarily go straight to the Orthopedic Clinic," Colonel Smith said. The OT/PT clinic assumes many of the duties of an orthopedic clinic stateside, including screening patients and treating injuries that don't require surgery.

While patients at a hospital in the United States get continuing treatment and advice on how to modify their environment to accommodate their disabilities, patients here don't have that luxury, said Maj. James Ronyak, an occupational therapist deployed from the 88th Surgical Operations Squadron at Wright-Patterson AFB, Ohio.

"We don't see our patients on an extended basis like we would back in the United States," Major Ronyak said, "but as much as we can, we try to help them get back to full function."

The therapists do as much as they can while their patients are in the clinic. The physical therapy team pulled a set of horizontal bars next to the bed's edge for Moqdad and helped him stand on his uninjured left foot. As he hopped gingerly along the bars, Airmen eased him onto the waiting set of crutches.

Moqdad carefully navigated the room, with Colonel Smith following close behind to make sure he didn't fall backward. Finally, he made it back to his bed and lay down as Airmen took the crutches and examined his injured leg.

Once Moqdad leaves the clinic, however, his continued rehabilitation is up to him.
"Continuity of care is important," said Tech. Sgt. Dan Wilson, a physical medicine technician deployed here from the 75th Medical Operations Squadron at Hill AFB, Utah. "We can't go out to the community, so we have to make sure we're giving him the resources to take care of himself."

"We give them whatever they need when they leave the hospital, including illustrated exercises, translated into Arabic," Colonel Smith said. "We go over the exercises ad nauseam with the translators and patients and tell them how important it is to do it."

Most Iraqi patients are grateful for the treatment they receive from Air Force therapists, Colonel Smith said. Moqdad was no exception, as he frequently thanked the medical team in Arabic during his therapy.

Moqdad's family also appreciated the hospital's medical care, Emad said.

"They're the best," Emad said. "Moqdad's very lucky. This is the best hospital in Iraq."

How new Medicare legislation can help Physical Therapists

THERAPY CAPS. Medicare patients can spend no more $1,810 a year on speech and physical therapy and $1,810 on occupational therapy each year while recovering from an illness. But there are exceptions to these so-called "therapy caps."

If you’ve had a stroke and you need more therapy, for instance, Medicare has had a process for side-stepping the caps and getting extra services. That was due to expire at the beginning of this month.

The new legislation reinstates the exceptions process for speech, physical, and occupational therapy for another 18 months, making it possible for patients with serious illnesses to get needed help regaining essential functions.

PROTECTING SENIORS FROM MARKETING ABUSES. I wrote earlier this year about new regulations proposed by federal officials for private plans that operate under Medicare. Here’s a link to that post.

The new Medicare legislation requires the Centers for Medicare and Medicaid Services to make good on its promise and come out with new regulations for so-called Medicare Advantage plans this fall.

Among the practices that will be prohibited, according to the legislation: cold calling, door-to-door sales in apartment buildings and senior living facilities, sales pitches in doctors’ offices or at educational events, and cross-selling of non-health care products, according to materials from the chairman’s office of the Senate Finance Committee.