Commentary

A Call for Clinical Autonomy

Properly supporting the journey of independence for complex rehab technology (CRT) clients involves many factors, one of the most important of which is empowering the Assistive Technology Professional (ATP) to make the best decisions regarding customized solutions for each individual client, according to their specific needs. At National Seating & Mobility (NSM), clinical autonomy is a non-negotiable order of business involving the confluence of client needs, technology and the ATP. As a leader in the industry, we must not interfere with the intersection of these three areas of responsibility in our quest to always put the client’s needs first.

Acknowledging ATPs as Trained Professionals

Several decades ago, rehabilitation technology suppliers came together to raise the standards of their profession and ensure a continuum of quality care for CRT consumers. The RESNA certification test was developed and is still the primary standard used by the industry to determine competence and professionalism.

NRRTS went on to establish ethical guidelines as well as additional standards related to the training, credentialing and continuing education requirements in the field of rehabilitation technology.

In support and acknowledgment of the standards, guidelines, and certification process, NSM respects our ATPs to make decisions on behalf of their clients.

“Clinical autonomy gives me the freedom to work as a part of the clinical team, including PTs, OTs, doctors, and caregivers, and provide recommendations without having to make a situation work within rigid parameters,” said Jacquie Ohanesian, NSM ATP. “NSM’s focus on clinical autonomy underscores the company’s first priority to keep the client healthy and gives me the ability to fully utilize my skills and training.”

Denise Harmon, an ATP with a career spanning more than 20 years, has spent years as an advocate for CRT professionals. Her journey began before titles or credentialing existed. She’s since taken every opportunity to educate others about the ATP profession and has served on the board and as president of NRRTS.

“We used NRRTS to raise funds to bring seed money to RESNA to develop the certification program for ATPs. This historical perspective makes me appreciate where we are now,” she said. “ATPs are not order takers, and at NSM, we are provided a platform to learn as much as possible about products and applications, and then given autonomy to provide the best products for the client.”

Technology Meets Client Needs

Manufacturers will continue to create products that vary in capabilities, opening doors to a myriad of potential solutions. ATPs bear the responsibility of integrating available technology with client needs.

“NSM’s stance on clinical autonomy means ATPs are not limited in making something work,” said Gerry Dickerson, NSM ATP and incoming NRRTS president. “Instead, we have the opportunity to provide a client with the right innovation. We have the flexibility to recommend the product that fits the client’s need as opposed to fitting the client with what you have in the back of the car. When you have that outlier client with unique needs, that is life changing for them.”

Marketshare Agreements Limit Solutions

Rigid marketshare agreements with manufacturers limit clinical choice. Our job is to improve the lives of our clients and give them the very best of what they need. At NSM, we do this by creating a culture and environment in which our ATPs have the unfettered ability to make the right decision for the client with no penalties.

“Clinical autonomy means freedom to focus on the most appropriate outcome for the client,” said Jeff Dettmann, NSM ATP. “Solutions should not be driven by cost of product or corporate agreements. One of the reasons I came to NSM after being in the industry 30 years was the ability to focus on the patient’s needs without limited product selection. It can be challenging to have a corporate accountant telling you that two products are the same when you know they are not. They have no clinical background or field trial experience.”

“If we operate only by profitability, our work becomes a commodity business, with cookie-cutter products,” Harmon said. “NSM teaches us about the manufacturers and manufacturing equivalents. As long as equipment is functional and easily adjustable, I can choose the best product to meet the client’s need. NSM takes the ATP and their business practice into account. Our compensation is not tied to specific product selections. NSM helps us understand categories while also giving us access to products that are efficient and productive.”
“There should never be a penalty to doing the right thing,” Dickerson added.

Overcoming Challenges

Although NSM fully supports clinical autonomy, there are some limitations for ATPs due to constraints outside the company’s control. Those constraints require creativity in delivering solutions to clients.

“Ten years ago the industry was different,” Ohanesian said. “Today there are many funding sources and policies; you have to keep ahead of the constantly changing rules. Every time I open my ‘tool box,’ I find a new set of tools to work with. The more I know the products, the better.”

Our ATPs agree that while NSM offers clinical autonomy, they are sometimes limited by policy. Knowing that many subsequent health issues can be solved by equipment is very important. NSM is working to support recommendations for client needs in spite of challenges in the funding process.

“NSM partners with us to help our clients find new avenues to cover costs when we introduce products that are needed, but may not be covered,” Ohanesian added.

Clinical Autonomy as a Best Practice

NSM’s culture is centered on the belief that we have a moral obligation to do everything in our power to efficiently, effectively and appropriately meet the needs of the client. Empowering our team of educated professionals to do the right thing on behalf of each client is the cornerstone of everything we do.

Our job, and the job of others in the industry, is to improve the lives of our clients. ATPs must be free to make the best decisions for their clients. Clinical autonomy as a best practice ensures a standard of responsibility and continuity of care for the individuals who need us.

One of my duties as CEO is to create an environment that attracts the best ATPs… and then to remove as many obstacles as possible so they all can do their jobs to the best of their ability. That includes giving ATPs clinical autonomy, and that’s what we’ll keep doing across NSM.

This article originally appeared in the February 2019 issue of Mobility Management.

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