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Understanding power: A frontline perspective

In my work I see power all around me - in relation to the system I work in, the people I work with, and imbalances that I think need shifting.

Amy Frewin

I’ve been working as a community physiotherapist for three and a half years. I assess and treat older patients in their own homes – understanding their needs holistically and empowering patients to manage their health and well-being. I chose this area of physiotherapy because it’s meaningful, rewarding, and I get a greater idea of who my patients are as people.

In my work I see power all around me: in relation to the system I work in, the people I work with, and imbalances that I think need shifting. I think about these issues a lot, and am always learning. Based on my experiences, here are ten top tips for making power work better in health and care.

Learning about my power in the health and care system

Tip #1 - Senior managers and frontline staff need to talk to and learn from each other more

In my previous experiences, structural redesign of services usually involved senior managers communicating with the CCG and then staff responded to these changes. Recently, however, my perspective on this power has changed. I was asked to share my learning on what works and what doesn’t work, and have a voice in this discussion with senior management. This experience made me appreciate how much complexity there is in making decisions about health services. While the power should be vested in people who understand this complexity well, it’s important there is a communication flow with our senior managers so they can constantly learn from our experiences on the frontline too.

Tip #2 - Make sure targets do not undermine trust

The governance of our work often feels like a double-edged sword. It’s good to have targets but a significant part of our job is evidencing our work against these. I want to feel like I’m being trusted to use my professional judgement and do my job well rather than constantly having to prove what I’m doing. I completely understand that it’s necessary but can’t we be given some power to use our common sense sometimes?

Tip #3 – Support staff when demand outweighs capacity and integrate services better

Two situations make me feel especially powerless. First, when I’m reliant on other services and resources to provide care, but I cannot access these. Second, when we go through periods where the demand outweighs capacity and I feel stretched. I have to prioritise demand and revise my caseload, which makes me feel like I’m compromising on the standard of care I give. While I understand the pressure on resources in these times of austerity, I hope that managers and decision-makers can always bear this in mind.

Tip #4 - Look to the frontline for better ways of doing things

I recently wrote a new service proposal and implemented this. I found my peers were open to receiving the changes because I had suggested these. When the service redesign is led by frontline practitioners, it’s a powerful way to engage the wider workforce. We don’t get extra resource to implement new changes, so when the changes come from us, they’re more likely to be well received.

Learning about my power on the frontline

Tip #5 - Remember that our job is to empower patients to live their lives

Physiotherapy is very goal-orientated – our work is about enabling patients to achieve their own goal! For example, I recently started working with a lady who is newly registered blind with complex health conditions. Her goal is to be as independent as she can be. Although I treat her physical condition, I also help her practice using her telephone and TV remote. I’ve coached her to use an Amazon Echo, through her personal health budget, to keep on top of her multiple appointments with services. She now feels like she has regained some control over her life. Relationships are key - if someone has trust in you, then they’ll adopt your suggestions and they’ll feel comfortable to challenge you.

Tip #6 - Invest in relationships and bring a human touch to care

I have control over how much time I spend with patients to understand their needs holistically. There is scope for me to be human with patients, e.g. making them a cup of tea or hanging out laundry. This enables me to establish an equal relationship with patients in their own homes. The result is: I get a far better understanding of the patient’s needs and wishes, and the patient can trust me and be open with me. The lady mentioned above recognises me as her friend and this makes me feel proud - I’m using my power in the right way.

Tip #7 - Take responsibility and challenge poor behaviour

I can challenge the poor behaviour of my peers, patients and other services. In fact, when I witness this happening, I have a duty to escalate these concerns. Having responsibility for vulnerable patients means using my power to protect them. A large proportion of my patients are vulnerable adults; I escalate safeguarding concerns when those around them who should care for them behave in ways that undermine this. My responsibility is to ensure patients are safe in all aspects of their lives.

Shifting the power imbalances

Tip #8 - Include, listen, and respect!

It’s critical the voice of patients and frontline practitioners are considered when we make commissioning and service redesign decisions. Some people in health and care systems have more power than others; it’s important everyone is given an equal opportunity to have their voice considered and taken on board in a meaningful way. If everyone feels included, listened to and respected then power imbalances will shift.

Tip #9 - Integration means taking the time to get to know, and learn from, each other.

We need to understand what other organisations and practitioners are doing, and their skills and capacity, so we can forge relationships and deliver better care. Frontline practitioners need support around this, especially as the system wants us to work in an integrated way. I have the impression there is opportunity to utilise alternative resources and share elements of the work load once we understand each other’s services better, but information governance is a challenge. Getting integration right would empower staff to utilise their expertise when it’s necessary, increase job satisfaction, and improve patient experience.

Tip #10 - Help the general public to understand what they can expect

Patients don’t always understand what we do. This can cause a power struggle. For example, sometimes I make multiple referrals for patients, but other services have different waiting times and processes, and patients don’t know who to turn to. It’s frustrating for patients and their family to not know what is happening, and frustrating for me that I cannot do more to help, so makes us all feel powerless. Our health and care system should aspire to helping people feel in control. While we work on integrating our efforts, the general public needs better education about what services are available and what expectations they should have. Knowledge is power!

What do you think? I would love to hear your reflections, and suggestions for other top tips to make power work better, in the comments section below.

Amy Frewin has worked as a Community Physiotherapist for the last three years. This involves working with the ageing population primarily – for example those who have fallen or those who have long term conditions. She assesses and treats patients within their own homes, supports people discharged from the hospital and prevents hospital admissions through GP referrals.


Amy Frewin

Community Physiotherapist