SWOT Analysis of Physiotherapy Profession in Pakistan

 

Sana A¹, Rashid HN², Ilyas MN³, Danish H², Sheraz MA², Atif AB³*

¹Faculty of Health Sciences, University of Sargodha, Lahore Campus, Pakistan

²Riphah International University, Lahore Campus, Pakistan

³Faculty of Medicine, University of Sultan Zainal Abidin, Terengganu, Malaysia

 

ABSTRACT:

In the last five years, there is an abrupt increase in number of physiotherapy institutes all over the Pakistan. Where it has opened new doors for the graduates to attain jobs, it has also increased the number of enrolled students to an alarming level. The purpose of this study is to provide a broad vision analysis about strengths, weaknesses, opportunities and threats of physiotherapy profession by sharing experiences of qualified experienced physiotherapist as well as young physiotherapist for the betterment of physiotherapy profession in Pakistan. The overarching aim of this study was to assess the status of Physiotherapy profession in Pakistan. This is cross sectional observational survey in which 110 physiotherapist was taken from Punjab as sample by using non-probability purposive sampling technique. Study was divided into two phases (I and II). Phase-1 a qualitative interview was taken from (10) Experienced Physiotherapist who have been working more than 10 years. Phase-2 a quantitative questionnaire has designed from the interviews than filled by (100) Young Physiotherapist who have more than one-year experience. The SWOT analysis consists of 40 questions. It contained ten points for each category strength, weaknesses, opportunities, threats the result shows that there were three points for each category to which our respondent physiotherapists give strong response. By eliminating our threats and weaknesses we can utilizes strength sources for availing opportunitie. The conclusion of SWOT analysis concludes that main STRENGTH of physiotherapy profession is that level of education has increased in last decade, main WEAKNESS is low merit in private institutes, main OPPORTUNITY is research quality will be improved by foreign trained researcher working in Pakistan) & main THREAT is no professional council at national/international level.

 

 

 

INTRODUCTION:

By the end of war of independence on 14^th august 1947, Pakistan became a separate state on world map; at the time of independence, Pakistan inherited a health care delivery system that was inheritance of royal British era. During the initial phase (1947-1955) the rapid growth and socio-economic development appears to have a negative impact on health of people. As WHO study reveals that Pakistan having a good health care infrastructure but facing poor health indicators for minimizing their health relevant issue foreign assistance playing a critical role.

 

In 1956 as concerned with health care system, the school of physiotherapy was first established by Federal Government, Ministry of Health and Social Welfare with the assistance of WHO at Jinnah Postgraduate Medical Centre in Lahore.

 

Initially a 2-year diploma course was introduced which onwards converted into 2 years degree program later on upgraded into 3 years diploma. Afterwards in 1963 the program raised to BSc physiotherapy. In 1999 according to International faculties of physiotherapy, BSc Physiotherapy course promoted to 4 years BS Physiotherapy Degree Course. In accordance ‘VISION 2020 of APTA’, the 4 years BSPT Program upgraded to 5 years DPT (Doctor of Physiotherapy) Program in 2008 to meet the International standard.

 

Pakistan is land of opportunity this may be true in relation to development and growth of physical therapy profession. Our SWOT analysis emphasizes that there is substantial moment that exist in Pakistan to increase the practice of physiotherapy¹.Basically SWOT deals with examination of an organization’s internal strength and weaknesses, its opportunities for growth and improvement, and the threats the external environment presents to its survival ².

 

SWOT:

SWOT analysis is one of the essential techniques to examine the strength, weakness, opportunities and threats of an organization. SWOT analysis considered in other fields but has not considered in healthcare. For strategic planning, SWOT analysis is of primary importance based on experts’ panel. Expert’s opinion finalized because of facts and data extract from organizational performance, outcome measures, patient satisfaction level and utilization rates².

 

Definition:

SWOT is a tool that identifies what an organization can do and cannot do along with their prospective threats and opportunities

 

Steps in SWOT analysis:

SWOT analysis is decision-making method in which maintenance of an organization is design and updated with respect to external environment. Updated services and programs for gaining maximum performance of organization carry out this balance ^3].

 

Step I:

Efficiency of an organization can be measure by analyzing key data like funding source and current quality of medical technology.

 

Step II:

Surveys of organization provides informational data including internal and external factors of an organization that is classify into basic four categories strength, weakness, opportunities and threats ⁴.

 

Step III:

Expert’s panel of hospital design SWOT matrix for the analysis of individual business alternative.

 

Step IV:

To rule out the perfect alternative business, SWOT analysis integrated into decision- making mechanism.

 

Strengths:

SWOT analysis shows that strength is prevailing factor, which brings out extraordinary performances of an organization. Strength works on mutual understanding between employees and highly target quality enhancement to achieve the goal.

 

Weakness:

It minimizes quality of health care and elevates cost of healthcare. Poor communications, less efficient management, non-professional behavior in term of teamwork with other health care organizations leads to fall in healthcare organizational performance.

 

Opportunities:

It is simply maximum availability to an organization, which minimizes all the factors lowering quality of healthcare organization. Inter connection among healthcare organizations, by heavy financing for healthcare informatics, by developing clinical protocols in better way and increasing efficiency of personals are initiatives for the progress of healthcare organization. Satisfaction level of patient is also another opportunity for the means of improvement. Threats: Threats are downfall in the performance of an organization. Major factors in threats are more demands of unaffordable technology used for medical purposes, imbalanced economy, increasing pressure of uninsured population⁵.

 

Force Field Analysis:

duty of healthcare organization views to take action for the betterment of organization. Dominant areas were improving satisfactory level of customers, quality enhancement and variegation of healthcare personnel. Under SWOT analysis, Force Field Analysis focused on two forces namely helping forces and hindering forces. Helping forces drive an organization towards ambitions while hindering forces drive away from ambition. For the betterment of an organization, helping forces must overcome hindering forces so that the organization steps into brighter future. An organization can design some plans to step up the positive forces and lessen the negative forces after determine both of the forces⁶.

 

Effective Force Field also focuses on demands, objective, values and establishment of peculiar collaborator. In an organization, different personage plays role for both driving forces and retraining forces that is why it is essential apprehend personals, their perspectives, and proficiency of an organization. One more valuable key is to understand competitive personals to design a way of achieving goal. Kurt lewin view a new strategy that involvement of an organization towards betterment by enhancing positive standards and customize present standpoint.

 

Gap Analysis:

In addition, processed planning outcomes, SWOT analysis can be strengthen by gap analysis. Analysis shows there are indicative gaps in healthcare system as a result poor diagnose of patient’s situation and inaccurate methods of their look after. Gaps in healthcare comprises of shortcoming of knowledge, insufficiency of encouragement, lack of assets and unprogressive approach to information, which suppress teamwork. Robert Fleet croft with his coworkers used gap analysis as a standard for estimating healthcare quality. It is revealed that performance gaps break record of 25 percent as a result mortality rate was increased ⁷.

 

When the required demands by patients were not fulfilled gap of low healthcare created and this is due to poor conversation, lack of financial assets, deceptions and unavailability of expertise⁸. The performance gap can be minimized by providing full attention and primary care by physician before going to acute stage, improving quality of equipment required for proper checkup of patients⁹.

 

SWOT analysis is an initiative key point for the process of strategic planning. SWOT analysis considered expertise way of analysis of an organization performance. SWOT analysis majorly comprises of four factors as Strength, Weakness, Opportunities and Threats. These four factors may be affected by two forces namely as hindering forces and driving forces. In SWOT analysis, Gap analysis is another way to determine factors hindering in the betterment of organizational performance. It helps in removing major flaws in organization performance and increase quality and satisfaction level of personals and patients both.

 

LITERATURE REVIEW:

A qualitative research approach was conducted on SWOT analyses of physiotherapy profession in Kuwait reported 17 key informants and provided with a basis for strategic direction for the profession¹.

 

A social science method conducted on evaluating the quality of medical care indicates that by improving the assessment method the quality of health care can be increased¹⁰. A systematic research conducted on a participatory evaluation of the community based rehabilitation programme in North Central Vietnam in comparison of WHO model result reveals three out of five principle of WHO model have specific strength. The programme got benefit by considering positive aspect in years to come¹¹.

 

The results of study conducted on new skills for a new age that leads towards health concept in healthcare curricula indicates through SWOT analysis the shifting of traditional healthcare curricula to a more innovative public health oriented one is to be a success of profession¹². An electronic literature search was conducted on disability and rehab medicine in Pakistan concludes that there is 1000 physical therapist and 150 occupational therapist by increasing facilities and make accessible to all of them who need it .discrimination can be addressed¹³. The quantitative analyses of research in physical therapy conclude that physiotherapists must know about the available research method and clinical treatments¹⁴.

 

A SWOT analysis of new pattern of examination of Kerala University of health science concludes that it is successful way for making secure examination system in India ¹⁵. The evolution of doctorate of physical therapy is itself a sign of progression, many efforts are require for the establishment of physiotherapy profession ¹⁶. Creating a learning environment by using self-peer and co-assessment this study shows reflective competencies, which is ultimate requirement of every profession ¹⁷. The study conducted in Bangladesh for checking regulatory control of private higher educations that they are making education a business good rather than public good. The result of this study was by providing financial assistance to private universities they will focus on quality not only quantity of customers ¹⁸.

 

An international study shows that educational and professional issues of physical therapy exist among countries at modest level except for specialization, accreditation, and licensure¹⁹. Country Cooperation Strategy for WHO and Pakistan results shows that Pakistan is land of opportunity and by utilizing their source and managing health departments, it will maintain rank²⁰. Another study emphasizes on the training of faculty for development of medical education at national level²¹. Innovation in community physiotherapy reveals that experienced paramedics are gaining eminence due to their skillful work²². Higher education at international level indicates that it is not only a profit-gaining center but also gives benefit to public by polishing their practices²³.

 

Globalization and the universities this study shows the incoming impact of higher education growth on the nation²⁴. Physical therapy market overview indicates that 7% outpatient increases annually through 2018²⁵. Another study about the history of physiotherapy in Pakistan gives a lot of info about the growth of this profession along with the barriers^26,27. Qualification recognition issues of physical therapist explain whether qualified physiotherapist from one country equally applicable to other country system and services ²⁸. The study of Houben et al explains the use of SWOT analysis for strategic planning in medium and small industries²⁹. Today’s physical therapist reveals a vital role of physical therapy assistant under the supervision of physical therapist³⁰. History of physical therapy development in United States, by MOFAT ³¹.

 

 

MATERIALS AND METHODS:

A mix method study design was used.Phase-I was qualitative collection of data from the experienced leading physiotherapy professionals.Phase-II was quantitative collection of the data from the young emerging physiotherapy professionals working in Punjab and study was compiled at Riphah College of Rehabilitation Sciences Lahore.

 

Study was completed in 6 months after the approval of synopsis.Non-probability purposive sampling technique was used.

1.    Phase-I Judgmental/Purposive sampling

2.    Phase-II Convenient sampling

 

Phase-I:

Experienced physiotherapist working in Punjab.Phase-II, Young physiotherapist working in Punjab.In Phase-I, (10) Experienced Physiotherapist who have been working more than 10 years.Phase-II (100) Young Physiotherapist who have more than one year experience. For phase I, qualified physiotherapist having more than 10 years’ experience were considered.

 

Phase-II:

Young physiotherapist having experience of more than 1 year. Those Physiotherapists who were not working were excluded from study.Total 110 physiotherapists, who meet the selection criteria, were enrolled for the study. Informed consent was taken from physiotherapists stating about the safety of the study and their right to withdraw from the study at any time. Demographic details (name, age, sex,) were noted along with the necessary qualification details.

 

RESULTS:

In SWOT analysis of physiotherapy profession in Punjab, Pakistan, We had designed questionnaire by conducting interviews in 1^st phase of thesis. It contained ten points for each category strength, weaknesses, opportunities, threats. After analyzing our data we have concluded there were three points for each category to which our respondent physiotherapists give strong response i.e. S1 (Level of education has increased in physiotherapy profession in last decade (PP-DPT, T-DPT, M.PHIL, MS, PHD) 42.55 % (N=40) Physiotherapists have strongly agreed, 46.81 % (N=44) were agreed while 7.45 % (N=7) gives neutral response. S6 (Trend of privatization increases in physical therapy (increase in number of private institutes) 48.94 % (N=46) have strongly agreed, 39.36 % (N=37) were agreed, 7.45 % (N=7) were neutral.S9 (Increase in strength (number) of physiotherapy students) 43.62% (N=41) have strongly agreed, 36.17% (N=34) were agreed, 12.77% (N=12) were neutral. Three points for opportunities O1 (Research quality will be improved by foreign trained researcher working in Pakistan) 36.17 % (N=34) have strongly agreed, 43.62 % (N=41) were agreed, 13.83% (N=13) were neutral. O7 (increased communication skills while dealing with patients) 29.79% (N=28) have strongly agreed, 56.30 % (N=53) were agreed, 9.57% (N=9) were neutral. O8 (increased communication skills while dealing with Health care professionals) 35.11% (N=33) have strongly agreed, 51.06% (N=48) were agreed, 8.51% (N=8) were neutral. W1 (Low merit (50%) in private institutes for admission in physiotherapy) 70.21% (N=66) have strongly agreed, 18.09% (N=17) were agreed, 10.64% (N=10) were neutral.W2 (fall of standards in physiotherapy education) 51.61% (N=48) have strongly agreed, 34.41 % (N=32) were agreed, 11.83% (N=11) were neutral.W5 (untrained fresh graduates in teaching staff) 51.06% (N=48) have strongly agreed, 27.66% (N=26) were agreed, 14.89% (N=14) were neutral. W9 (Physiotherapists are running after the degrees rather than professional skills) 50.00% (N=47) have strongly agreed, 29.79% (N=28) were agreed, 15.96% (N=15) were neutral. T1 (Physiotherapy has no professional council at national/international level) 63.83% (N=60) have strongly agreed, 25.53% (N=24) were agreed, 10.64% (N=10) were neutral. T2 lack of recognition by medical and health care professional council PMDC 61.70% (N=58) have strongly agreed, 25.53% (N=24) were agreed, 10.64% (N=10) were neutral. T9 private institute make education a business68.09% (N=64) were strongly agreed, 23.40% (N=22) were agreed, 7.45% (N=7) were neutral.

 

DISCUSSION:

According to Cahalin et al. (2008),in many countries physiotherapy struggle for variety of issues in their regions, but the most common problems confronted to this field licensure, accreditation, altruism and clinical accountability¹⁹. In comparison of physiotherapy profession at functional level in Pakistan and worldwide community, there are remarkable variances at micro-level. There are nine major issues that is significantly relevant to Pakistan by dissolving that issues we can avail the opportunity and raise our strength and hinder our weaknesses and threats. For maintaining the worth of this field, SWOT is best step to find out the strategic ways to avail opportunities and minimizes our issues.

 

Development of national physiotherapy association into symbolic body:

Based on our collected data, Pakistan physical therapy association (PPTA) is under the process of development. It did not have firm roots as many of the physiotherapist even do not know about its existence. Klinger emphasizes on lifelong learning attitude based on professional organization by highlighting their website for India, Arab Emirates, and Iran all were getting opportunities by increasing research aids and annual conferences through physiotherapy association ¹. As one of the major threat to physiotherapy field is it has no professional council at national/international level and other major issue is lack of recognition by medical and health care professional council PMDC. All the problems can heard in a single voice that is professional association³², and leaders grows within our    community³³. To manage our health care policy it is important to make inter disciplinary efforts for maintenance of public reviews³⁴, for maintaining rank among the world of medical tourism Philippines are striving for accredited hospitals³⁵. The World confederation for Physical Therapy (WCPT) expressed their reviews, to support the movement of physiotherapists internationally and to consider their issues the organizations play a major role in companionship²⁸. Trend of privatization increases in physical therapy and Increase in strength (number) of physiotherapy students. Through the organization, scope of physiotherapy and clinical practice can openly challenge to interrupt false insights. As increase in number of physiotherapists, PPTA has developed rapidly to fulfill their member requirements. This study concludes that there is strategic need required to establish professional organization in Pakistan.

 

Educational competency:

Strong point of strength is Level of education has increased in physiotherapy profession in last decade (PP-DPT, T-DPT, M.PHIL, MS, PHD. The result of this study indicates there is foremost need of educational competency as one of the majorly highlighted weaknesses is Low merit (50%) in private institutes for admission in physiotherapy and second thing is fall of standards in physiotherapy education mentioning both points under same category requires attention. As concerned our history our social and political milestones proceeding in technology and changing needs have shaped the evolution of this profession³⁶. Continuous progression of the physiotherapy is highly concerned with standards of professional degree.as the physiotherapy field struggles a lot from just 2 months diploma to a 5 years authentic professional degree (DPT) for maintaining their decorum¹⁶. There is need to minimize such hurdles so the physiotherapy field in Pakistan maintain their quality of education and work proficiently at national and international level. Learning is considered a valuation driven³⁷ and it is used as a student learning tool by teachers¹⁵. Another weakness is untrained fresh graduates in teaching staff lowering our educational status whereas they can polish undergraduates by their updated knowledge to remarkable level, as concerned for trainer of health professionals, there could be a battle of interest in showing generosity and dodging malfeasance to students and society at same time³⁸. Another study that was conducted in India also focus on same issue of teachers training program and it resolved by training new teachers under the supervision of ‘Continuing Education’ scheme³⁹. Trained medical teachers have great impact on development of reflective      practitioners¹⁷, students get narrow determinative evaluation and summative assessment measures competence⁴⁰. It is therefore important to make secure examinations and training centers in Pakistan.

 

In Pakistan, private institutes make education a business the same situation confronted by Bangladesh as it is mentioned in one of its article by ¹⁸ that higher education sector consider education a business goods rather than public betterment. It concludes by managing finances through government aids and donor agencies it can supplement the expenses of private universities. Another study conducted by Hasan et al also give evidence that by improving marketing approach and making customer oriented packages the quality of education improves at private institutes⁴¹.

 

CONCLUSION:

The conclusion of SWOT analysis concludes that main STRENGHT of physiotherapy profession is that level of education has increased in last decade, main WEAKNESS is low merit in private institutes, main opportunity is research quality will be improved by foreign trained researcher working in Pakistan and main threat is no professional council at national/international level.

 

RECOMMENDATIONS:

·        More research work is required on this with equal ratio of male and female, with large sample size and population.

·        Separate work is required for clinical and educational SWOT analysis of physiotherapy profession n all over Pakistan.

·        SWOT should be conducted for each division of Pakistan

 

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Accepted on 20.01.2018        © RJPT All right reserved

Research J. Pharm. and Tech 2018; 11(10): 4553-4558.