Personnel Management in Rehabilitation Practice

Original Editor - Wanda van Niekerk

Top Contributors - Wanda van Niekerk and Jess Bell  

Introduction

When starting or managing a rehabilitation practice, business owners need to make important personnel and human resources decisions. Effective recruitment and retention of qualified healthcare professionals is key to providing high-quality healthcare services, improving patient outcomes and supporting a healthier population. This page explores key considerations when employing personnel in rehabilitation practices, including recruitment processes, legal requirements and strategies for supporting employees.

Positive and Negative Aspects of Running a Business

Self-employed practitioners tend to report higher job satisfaction and enjoy the independence of owning a business. Owning your own business can mean more flexibility, freedom and better work-life balance. It can foster a greater sense of autonomy and overall personal, physical and financial satisfaction. However, there can be downsides to running a business, such as additional pressures, responsibilities, administrative and management tasks and roles. These tasks and deadlines increase work stress, as do other stressors, such as working long hours, fear of failure and the pressure to maintain your reputation as a clinician. There is also the possible lack of a “safety net” if the business is unsuccessful.

Deciding on a Business Structure

When starting a business, you need to decide if you want to form a business partnership or if you'll be a sole practitioner. Decisions have to be made on when and what additional staff are needed and how these staff members will be recruited, employed, managed and supported.

It is important to have a well-defined procedure or policy for staff recruitment and hiring. As a business owner, you must understand the legalities when hiring employees, especially in healthcare professions where registration with a professional body is required. In countries where continuous professional development (CPD) is required for registration, you need to verify that potential employees meet the necessary criteria and are currently registered.

As a business owner, you must understand and follow the employment laws of the country and the profession’s regulatory body before you employ someone.

Recruitment Process

Creating a Position

Always assess if a position is necessary by considering current and future business objectives. For new positions, it is important to evaluate sustainability and resource availability. For existing positions or roles, you need to determine if the position is still needed or if duties could be reassigned. A thorough job analysis informs the job description, creating a clear framework for the position. During the recruitment and retention process, employers should clearly define the desired attributes of potential candidates. This helps ensure that the best candidates are selected.

Job Advertisements

A job advertisement serves as a practical guide for employers and employees. It outlines the ideal candidate's expected responsibilities, skills, knowledge, behaviours, and preferred attributes. This enables potential employees to gauge if their qualifications match what the employer is looking for and understand the expectations and requirements of various positions.

McAleer et al. analysed the key attributes employers look for in early-career physiotherapists in 578 job advertisements. The attributes most requested were client focus (64.9%), communication / interpersonal skills (58.8%) and teamwork abilities (54.1%). Attributes such as empathy (4.2%), resilience (2.4%) and academic results (0.3%) were least requested. Location had an impact on desired attributes. In greater metropolitan and regional areas, client focus was an important attribute. In rural areas, passion and work ethic were emphasised. In small rural towns and remote communities, diverse attributes like self-motivation and career interest were key.

Employment and Contracts

Selection and Appointment Process

Once applications have closed, the selection process commences with the screening of applicants. Screening is carried out according to the position’s requirements - it can be done manually or with the aid of computer software.

Shortlisted candidates then proceed to the interview stage. Interviews should be structured and non-discriminatory. The purpose of the interview is to gather information and assess the candidate and their skills. It's essential to verify a rehabilitation candidate’s registration status during the interview.

It is advisable to use standardised templates within your procedures for job descriptions, interview schedules, and employment contracts. Once a successful candidate has been identified, they will be notified, and the employment offer can be presented and negotiated.

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Hiring on a Self-Employment Basis

Business owners often choose to hire clinicians on a self-employed basis. This is sometimes a matter of habit, but it can simplify administrative tasks, such as PAYE tax management. Business owners may also adopt this model because they believe it provides better financial protection for their business.

Being self-employed can also benefit clinicians, as it tends to offer greater flexibility (e.g. leave, hours). They may also be able to negotiate performance-based incentives, such as variable pay rates based on performance.

As a business owner, it is your responsibility to adhere to your country’s labour laws and the regulatory body of the profession regarding the hiring of self-employed or contract clinicians.

Employment Contracts

Employment contracts are necessary for every position in a business, whether they are an employee or a contract worker. A legally enforceable employment contract requires certain key elements, including:

• a mutual agreement between the parties who intend to be bound by specific terms
• a clear offer from one party and acceptance of the offer by the other party
• consideration (payment or compensation) exchanged for the promised performance of services
• specific terms detailing the position, responsibilities, compensation structure, work hours and termination conditions

It is best to have employment contracts in writing, rather than verbal contracts. Contracts should also be customised to the specific agreement rather than using a standardised version.

Staff Development and Support

As a business owner, it is important to support your staff so they can excel in their roles and continue growing as clinicians. Support can be offered through supervision and continuous professional development (CPD) activities. This may vary depending on the type of business or clinic that you operate. Support activities may include regular team meetings, formal shadowing and appraisals, or open-door policies with impromptu assistance when necessary.

There are also various options for CPD activities, including self-study by clinicians, subscriptions for online platforms and attending external CPD events, such as in-person lectures and courses. In smaller businesses, it is crucial to encourage staff to keep up with CPD activities or to organise activities within your business, as clinicians often feel isolated when working alone or in smaller practices.  

Professional development opportunities have a significant impact on staff retention in the rehabilitation workforce. They are also a key contributing factor to job satisfaction and feeling content in the workplace.

Supporting New Graduates

The transition from university to clinical practice can be challenging for new graduates. They have to contend with unfamiliar administrative tasks, a growing patient list, and more complex cases. Support in the workplace can positively impact their transition from university to clinical practice. Employers must be able to identify a new graduate's limitations and provide the necessary support to help them grow.

To help them transition into the workplace and enhance job satisfaction and engagement, employers can provide structured orientation and mentoring programmes. Areas for mentoring may include clinical and business knowledge and skills, autonomous practice as a clinician, and time management skills.

Additional strategies to assist with the transition for new graduates include allocating smaller caseloads to new employees, offering longer appointments, providing a salary in addition to a commission, mentoring new employees, assigning senior colleagues as mentors, and encouraging continued education.  

It has been found that newly appointed employees, especially new graduates, value “informal, non-judgemental accessible support from senior physiotherapists within their clinics and others within the organisation.” As a business owner, you have the responsibility to provide these opportunities for professional development, support mechanisms and networks to your employees. Furthermore, new graduates have a desire for informal education found through workplace relationships, interactions and initiatives. Clinical and practically relevant sessions provided by senior colleagues in an informal setting are highly valued and add to the clinical development, confidence and preparedness of newly qualified clinicians.

Employee Retention

Turnover intention - defined as the intention to stay or leave a business - is an early indicator of potential resignations from a business. The push-pull-stay theory is a useful framework to help understand the factors that can influence turnover intentions. Push factors push or drive employees to leave a workplace. Pull factors attract employees to opportunities elsewhere. Stay factors are factors that encourage or motivate employees to stay in a workplace. By recognising these different influences, it can be easier to predict and manage employee retention.

In rehabilitation professions, push and pull factors include:

• career development
• workload demands
• remuneration
• relationships with colleagues
• burnout
• personal reasons (e.g. commuting or work-life balance)

Stay factors include:

• autonomy as a clinician
• flexibility in work hours
• diversity of tasks
• positive work relationships with colleagues

Effective Retention Strategies

As an employer, it is important to consider retention strategies to ensure your business can continue to deliver high-quality healthcare services.

Professional growth strategies can have a positive impact on employee retention. Professional growth can be promoted by factors such as career progression, access to CPD, mentorship and peer supervision and addressing stressors in the workplace. Although CPD is a key factor, it can be challenging to maintain in certain fiscal climates. Low-cost alternatives such as communities of practice (both in person and online) also positively impact employee retention. Other learning experiences such as clinical discussions, mentorship and peer review are also impactful and employers should ensure these opportunities are available for their employees.

Employers can address workplace stressors through clinical wellness and resilience training sessions. Having organisational policies that protect a clinician’s time for non-clinical activities is also recommended. Often, rehabilitation practices that provide acute care offer extended service hours - this requires clinicians to work on weekends, in the evening or be on-call. Business owners should have supportive policies (such as having two consecutive days off after being on call) in place and implement self-rostering systems to improve clinician autonomy.

The following optional video discusses employee retention strategies in physiotherapy practices. It includes a range of topics, including understanding employee turnover, cultivating a strong company culture, compensation models, work-life balance, mentorship and creating career pathways.

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