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Rehabilitation Matters

About all rehabilitation

Generic capabilities

This section of the website covers the generic capabilities that all experienced healthcare professionals should have, emphasising the aspects that are pertinent to the practice of rehabilitation. These capabilities are complementary to the seven rehabilitation capabilities discussed in a separate section of the website, here. They are derived from, and very similar to, the generic capabilities required of all doctors as exemplified in the Rehabilitation Medicine curriculum (here). They were initially set out in a publication in 2020 (here). This page introduces the seven rehabilitation-focused generic capabilities, with a brief description. Details of each capability are given on separate pages. They can be seen in this Mind-Map here.

Table of Contents

Context

The primary feature of healthcare activities is their complexity. Indeed, healthcare services are among the most complex systems known. Almost all patient-related activities involve many people from many teams and different organisations, often spanning nearly all of society.

This organisational melange needs to be understood sufficiently to enable effective collaboration. It is only possible to work effectively within healthcare by understanding the professional, managerial, legal and ethical environments. This knowledge is minimal for someone starting in healthcare, but as soon as anyone progresses in any profession, they need to become familiar with their environment. Within such complex systems, quality is easily ignored, as it is no one’s responsibility; it should be everyone’s responsibility.

The second prominent feature of all healthcare services is that they depend absolutely upon teamwork and collaborative working, which, in turn, depends upon effective communication and an ability to establish and maintain good interpersonal relationships with a wide variety of people, including, but not limited to, patients and their families. This requires a broad understanding of many other people’s concerns, priorities, cultures, and environments.

Last, healthcare depends upon evidence and a skilled and knowledgeable workforce. All healthcare professionals need to help in education and research, to ensure this.

 

The seven generic capabilities

The capabilities outlined on this page derive from these characteristics of the healthcare system. They are also based on some evidence. The General Medical Council, and others, have investigated the nature and causes of complaints against doctors, other healthcare professionals, and the healthcare system in general. In part, the generic capabilities (high-level training outcomes) required of all doctors were based on these analyses. They are intended to reduce the frequency of poor patient experiences and complaints.

Capability 1: to work in healthcare and other systems.

This capability concerns identifying other necessary organisations and working within the complex network of systems that may be involved with any patient needing rehabilitation.

The capability in practice is that the rehabilitation professional is “able to identify and work collaboratively with all people and teams from Health, Social Services, and the many other organisations that a patient within a rehabilitation service may need.” It is important to note that the professional must be proactive in finding teams and organisations to help the patient. You can go to the page here.

This capability is more critical in rehabilitation than in most other health services. Three notable exceptions are psychiatry, paediatrics and geriatrics, where the range of problems needing to be resolved extends well outside health services. This is illustrated in some posts on this site: here and here.

Capability 2: to understand and adapt to societal contexts.

Health services are a part of Society, “the community of people living in a particular country or region and having shared customs, laws, and organisations.” [OED] and the rehabilitation professional must be aware of many socially-determined factors influencing choices and actions. These include national factors such as laws and ethical considerations and more local factors, especially personally-determined factors, often termed culture: “the ideas, customs, and social behaviour of a particular people or society.” [OED] The page can be visited here.

Thus, the capability in practice is that the rehabilitation professional is “able to identify the relevant legal, ethical, and cultural frameworks that appertain to a patient’s situation, to consider them when making decisions, and to adapt plans in the light of these factors.”

Though these factors are relevant throughout healthcare, they have a more significant influence and impact on rehabilitation because rehabilitation is always person-centred. In addition, in rehabilitation situations frequently pose difficult legal and ethical questions – which are not always recognised and acted on.

Capability 3: to maintain good communication with all parties

Rehabilitation is no different from all other areas of healthcare as far as the central importance of good communication is concerned, not only between the professional and the patient but between professionals. It is essential both in collecting data and in planning and delivering treatments.

The capability is that the rehabilitation professional is “able to establish and maintain effective communication with all patients, and their families, and with all other people, teams, and organisations involved with the patient’s rehabilitation.

Rehabilitation professionals face more significant problems in communication than most other healthcare professionals for several reasons. Many patients have issues that significantly alter their ability to communicate, such as diminished or absent ability to use language (aphasia), altered ability to speak clearly (dysarthria), reduced cognition, altered ability to pick up on non-verbal aspects of communication, and altered emotional state (to name a few). Families can be challenging to communicate with if they have radically different expectations, for example.

There is also a much more extensive range of other professionals and teams to communicate with, who may have very different knowledge and culture from a rehabilitation team.

Capability 4: to monitor and improve quality and safety

All healthcare services, and probably all teams and organisations, have increasing the safety and the quality of their service as a goal. Rehabilitation faces a specific challenge because, from the patient’s perspective, they are concerned about their overall service, not the standard of individual services. Even if all services were, individually, excellent, the patient might still suffer and experience poor quality through lack of collaboration and cooperation. Patients ‘fall through the gaps’.

The capability is that the rehabilitation professional is “able to monitor and improve the whole network of services involved with a patient, considering safety and quality of their service, each other service individually, and all inter-service transferring and/or sharing of responsibility.”

In other words, the professional has two additional responsibilities: ensuring that services interact and work together so that patients receive a safe, effective service and, if an example of risk or poor quality is identified within another service, drawing it to the attention of that service.

Capability 5: to understand and support research

Research is essential to service development and the setting and maintenance of service quality standards. An expert in rehabilitation needs to understand how to assess and interpret research to increase their expertise; they should also support it wherever possible to improve the quality of rehabilitation.

The capability is that the rehabilitation professional “is able to assess critically, and interpret clinically published research, is able to use findings in their clinical practice, and is able to encourage and support any research undertaken in their service.”

It is unrealistic to expect most healthcare professionals to be researching actively as leaders or significant contributors to a specific research project. On the other hand, research is a vital activity within healthcare services – witness the success of trials of treatments for Covid-19 – and all healthcare professionals need to use research to improve their practice. One way to better understand research is through involvement with researchers, discussing what they are doing and why. The best way to do this is to participate as a helper in research in the service.

More details are on this page. (here)

Capability 6: to teach and train others

All healthcare professionals have a responsibility to teach and train both students entering the profession and, with increasing experience, postgraduates. Rehabilitation differs from other areas of practice in being centred on multi-professional teams. Rehabilitation professionals, therefore, have an additional responsibility to teach other disciplines at undergraduate and, more importantly, at a post-graduate level about their work. They also need to teach and train all professionals about rehabilitation.

The capability is that the rehabilitation professional is “able to teach and to train both undergraduates and post-graduates, in two different spheres: about their own professional practice; and about rehabilitation as an activity.”

Much of this teaching is or should be part of day-to-day work within the team; some will be at team training and local teaching events, and a relatively small proportion will be at formally organised extensive group teaching or training events.

Capability 7: to maintain and use professional expertise

One of the fears felt by professionals entering or training in rehabilitation is that they will lose or not use their professional expertise (or, more simply, be afraid of loss of status); a concomitant risk is a failure to maintain and use their professional expertise. In reality, within a rehabilitation team, it is essential to have a high level of knowledge both to know when it is reasonable to adapt or alter the accepted assessment or treatment and to know when it is inappropriate to do so and to have evidence to support this.

The capability is that the rehabilitation professional is “able to maintain their professional expertise and to use it effectively within the context of a multi-professional team, contributing o team decisions and actions, adapting practice to the patient’s benefit.” The capability is expanded upon and can be seen on this page. (here)

The critical aspect of this capability is that the professional has sufficient and well-founded self-confidence that they can ‘wear their expertise lightly’, using it without difficulty and being complicated.

Summary

This page has introduced seven generic capabilities all healthcare professionals should have. It has focused on the aspects of these generic areas of knowledge and skill that will be relevant to professionals working as rehabilitation experts, usually in a team. The facets of generic expertise of particular importance to rehabilitation experts are unimportant to many other healthcare professionals. The succeeding pages expand on each capability. 

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