APTA’s Proposed New Vision Statement

APTA just released a proposed new vision statement to be considered before the upcoming House of Delegates later this summer. More about the process can be read here, but in short, the proposed vision statement reads:

“The physical therapy profession will transform society by optimizing movement for all people of all ages to improve the human experience.”

I will confess that I’ve spent a total sum of maybe 5 minutes in forming an initial reaction, but initial reactions matter with big picture “who we are” statements to the public about where we see the profession of PT going in the next number of years. Unfortunately, my first glance led me to think that a better interpretation might be “we want to be all things to all people”, almost to the point that I no longer have a clue myself as to where PT fits into the broader health care system, much less other constituents who are far less familiar with who we are. I love the idea of dreaming big, but I guess I am at a loss for why we would define ourselves in such a broad manner that it’s impossible to get your hands around what it actually means. We all recognize health care is changing, but hospitals and clinics aren’t exactly going away anytime soon. Treating patients who are hurting and don’t view their problems in terms of  a “movement-related disorder” (much less physicians who have no idea what we mean when we say this) also isn’t going to change anytime soon. I do understand the rationale that Vision 2020 may have been too internally focused on the evolution of PT and certainly agree with revisiting vision statements from time to time. Nonetheless, I think we really miss the boat if we don’t continue to advocate our vision in more tangible terms using a language that is understood by the broader health care community. The notion of PTs being “practitioners of choice” and more importantly the ability of patients to “directly access” our services without a referral (perhaps one of the most fundamental keys to meaningful health care reform) as espoused in our current Vision 2020 are incredibly articulate, bold, and powerful words. More importantly, these phrases are tangible elements of a vision that lends itself to being evaluated (ie, have we gotten there yet?). “Optimizing movement” is far too nebulous, however idealistic and grand a vision it may be. The proposed statement would really benefit from some good back and forth discussion. What say you?

John

36 responses to “APTA’s Proposed New Vision Statement

  1. Selena Horner says:

    Better to have a vision that is easily understood, defined and measurable.

    What we really want is to see a 30-50% increase in patients self-referring for physical therapy services.

    What we really want to see is 50-75% referral rate to physical therapists for low back pain within the 1st 90 days after seeing a primary care physician (versus the measly 7% you guys found in your study).

  2. Jed Droge says:

    I have to agree with Selena. Let’s improve what we have now vs shooting the moon and saying we’ll take it all. Not that that’s bad, just not feasible for a profession like PT with lots of people don’t lots of things.

  3. Paul Gaspar says:

    Nice post. I agree that prospective patients and other health care practitioners will not understand APTA’s vision statement. I believe it adds confusion as to who we are and what we do. People largely understand what yoga, Pilates, chiropractic, and other modes of treatment/exercise/professions are. That understanding is a big part of getting a patient in the door for the first visit. Why would we not target the #1 reason why people would benefit from our services……back pain OR just pain? I regret to say that the confusion which would be caused by this vision statement would drive more patients into the arms of other health care disciplines. It is difficult enough to compete in today’s health care environment.

  4. Carl DeRosa says:

    I have to agree with John Childs’ comments in regards to the vision statement. First of all, I greatly appreciate the work of the Task Force and commend them on their distillation of the Vision Elements. Quality, collaboration, value, innovation, consumer-centricity, and access equity are, in my opinion, going to be the drivers of every aspect of a physical therapist’s future practice. The vision statement however seems entirely disconnected from the essential message of the vision elements. The elements of the vision are so clear, and use such well accepted and precise language, that the interpretation of the elements would be similar within our own community of physical therapists and more importantly, by nearly any external community of interest, including patients. I don’t think the same can be said with the current iteration of the vision statement. It would be difficult for this statement to stand-alone and result in it being interpreted in the same way to our internal and external constituents. We seem to be putting ourselves in a position where we need to put further definition and explanation around our chosen word of “movement.” Certainly there are some cases where the round peg of “improving movement” does fit nicely into a round clinical hole of movement dysfunction, but often times we have a square clinical hole that we are trying to force this round peg of “movement” in to. The term movement is a reach for enough aspects of current and proposed future directions of practice that we should give pause to making it the essence of a vision statement. Yes, we can whittle the square clinical pegs of wellness, or the square clinical pegs of pain for example, so they appear to be round, and then we can force them into a round hole of “movement dysfunction,” but the gyrations needed to create the illusion of the square pegs fitting into the round holes end up being understood by us alone. It is my belief that we can no longer afford to rely on internally crafted definitions at this critical juncture of health care trending because it impedes the development of meaningful collaborations, and puts those pushing forward our legislative and political trusts at a distinct disadvantage. I would suggest that the phrase “transform society” presents the same dilemma. The totality of our expertise is probably more closely aligned to optimizing physical health than the subset of movement dysfunction.

  5. Jerry Durham says:

    Hard to really comment when there is no context or definition of “What” a Vision Statement is supposed to achieve..

    John as the Author can you please define the context of a Vision Statement?…..also is the Vision Statement for the public or the profession?

    Thanks

  6. Jerry and all

    I have looked at visions from a practical standpoint – because if there is no practical application then why waste the time and money developing one. To me a vision is a picture of what your business or profession looks like when it is at its completion or optimal state. So it is a picture one can visualize of what they future state looks like. First of all very difficult to do in one sentence. Some say it has to be a short statement for memory sake – I say that is your Unique Selling Proposition (USP) or your motto. A vision is like a box top to a puzzle – seeing/reading it tells you if that is something that you want to be involved in. So does our professions vision create enough of a clear picture of what/who we aspire to be in terms we AND our stakeholders can envision. I think John’s point around vision 2020 are spot on – we could all clearly see what that means. This vision is way too vague or blurry – what does transform society mean?, how does movement do that? Only visual i get is the “We are the world” song with the singers swaying back and forth. We have a branding problem in that our stakeholders really don’t understand the value we bring. Our vision needs to communicate that value from our stakeholders perspective. A vision needs to move us – no “wow” factor in words – that happens in the visual created that then creates the emotional response.

    My comments are not meant to demean the work and those who have I am sure put a lot of effort into this. However our feedback and the stakeholders feedback is critical – Carl says it well – we have to not rely on internally crafted definitions. – Jeff

  7. John, thanks for the great insights. I would agree with many others in that I applaud the efforts of those who have proposed this vision. However, I am concerned that the efforts may have been misguided.

    You mentioned “Vision 2020 may have been too internally focused on the evolution of PT”. I would disagree. We need to get our own house in order first before we can ever “transform society”.

    The APTA continues to skirt the harsh realities of professional autonomy and direct access. We have 17 states in which a patient can freely, of their own choice, see a physical therapist for evaluation and treatment. We still have PTs debating the meaning of professional autonomy. How are we going to transform the world around us when patients can’t get in the door without a gatekeeper in some form or another? Will we just continue to seek permission to transform society?

    What intrigues me most is how this now takes the focus away from the slow (glacial) progress of Vision 2020, and puts it on some new shiny, sparkly future. Jeff, I would agree – visions of “We Are The World” …

    Allan

    1. Bill McGehee says:

      Thanks Dr. Childs for your commentary on the proposed new APTA vision language and for taking the time to engage on this issue. This is exactly what the task force was hoping would occur when the information on our work was posted on the APTA website . As chair of the Vision task force, I’d like to comment, provide some detail to “fill in the blanks” and hopefully answer some questions and will, no doubt, generate more.

      Let me first acknowledge what some others have already said and tell you the task force discussed, debated, and worked our way through all those points and many more in our work. That was one reason for the accompanying elements that are meant to add some more depth to our vision..much like the 6 pillars of Vision 2020 were meant to do.

      There were a couple of very broad themes that guided our work based on the information we collected early in the process and the charge we had from the House of Delegates 1). This vision should be “outward looking” and focused on our role in society and our obligation to meet society’s needs and 2). our role, particularly in the future, needs to expand beyond the mindset of just treating people who are having problems then discharging them—never to see them again until they have a serious problem and someone refers them back to us. Perhaps this is best captured in the phrase, “my physical therapist,” where people see John Childs, PT or Selena Horner, PT as their physical therapist and regularly see you to maintain a healthy, high quality of life so they are moving efficiently at their highest levels (whatever that means for them). Direct access at its best, I would suggest. Guided by these two themes, we also decided to aim high and be bold. I think getting someone to self refer to PT and capturing timely referrals for back pain and other musculoskeletal problems is as much about optimizing movement as helping Senator Mark Kirk learn to climb the 45 steps to enter the US capitol building.

      Here is some other information about vision statements that the task force considered in creating this proposal:

      Vision Drafting Guidance

      Vision statements typically accomplish two distinctive purposes:
      Statements of Identity—who we aspire to be. These can be more internally focused and recognize the important changes you need to make within your own profession, field or industry. These statements challenge you to aspire to be capable of making your best and most meaningful contribution to the future.
      Statements of Desired Outcome—what we aspire to change. These statements can be more externally focused and identify the important changes you will lead in the world. These statements can lead to benefits for the profession, field or industry; yet they are most powerful when the greater benefit accrues to society.

      Eight Tips on Vision Drafting
      Developed by Marsha Rhea, CAE, President of Signature i, LLC
      1. Dare to be bold, even at the risk of a near miss. A near miss still yields more progress than aiming low and playing it safe.
      2. Take all the time you need to do great things. A vision can take 10 years or more to achieve; manage expectations if you do set a target date.
      3. The more succinct the vision, the more memorable it will be. Too few words can fail to communicate; too many words and ideas just confuse people.
      4. Let your vision introduce and define you. Good visions are not borrowed from someone else’s clichés; say something distinctive about who you are and what you want to do that defines you.
      5. The clearer your priorities are, the more powerful the vision will be. Resist the temptation to be all things to all people; emphasize what’s most important and trust this will be sufficiently inclusive.
      6. Connect with the hearts and hopes of the followers and guide them to the future. Acknowledge the reality people face while envisioning what the future could hold.
      7. Speak to the public rather than sing to your choir. Jargon, insider language and concepts will mute your message; use language the public will understand.
      8. Take responsibility for your future. You are the main actors in this drama whether you say so explicitly or not; people must understand you expect to lead these changes.

      I would point you to the overview briefing from the task force, particularly Appendix B, at the Beyond Vision 2020 page on APTA’s website (http://www.apta.org/BeyondVision2020)for more information about crafting a vision statement. Examples from other professions are in that appendix too.

      We thought point #7 was particularly important in this endeavor and it guided us as we chose particular words. Laurie Hack, during the board’s deliberations, talked about the “Fog Index” which relates to the readability of English writing. More information about the fog index is available at http://en.wikipedia.org/wiki/Gunning_fog_index. Please also re-read #8 above as it is also particularly important.

      The task force spent considerable time choosing what we felt were just the right words to include in this statement. The Board of Directors then took some additional time to consider our work and eventually settled on what you see posted on the website. The changes the board made were enthusiastically supported by the task force. Please take a look at the power point presentation, also available at the Beyond Vision 2020 website, I gave to the board in early December. I spent some time discussing why we chose the words we did and what words we ultimately rejected.

      As one last piece of background, I would encourage you to read, or re-read, three Mary McMillan lectures…Dr. Ruth Purtilo’s from 2000, Dr. Andrew Guccione’s from 2010, and Dr. Alan Jette’s from 2012. They were very helpful as the task force completed our work. Of particular note are Dr. Purtilo’s periods of identity and Dr. Jette’s comments on systems thinking and positive deviants. These are all available at http://ptjournal.apta.org

      Physical therapists role in transforming society goes beyond what we traditionally think of when we think of PT. We have a role to play in being leaders in the public sphere in our communities by advocating for things such as walkable communities, physical education in schools, etc. However, we shouldn’t sell ourselves short in touting how improving movement in and of our society, in all forms that entails, will transform it..in many ways.

      Finally, let me suggest that a vision statement doesn’t need to include measureable and objective elements. Those are included in strategic and operational plans that flow out of the bold, overarching vision that guides an organization.

      Thanks for the opportunity to comment. I look forward to continued dialogue on this. The proposed language is now in the hands of our members and will be ultimately be decided by them, through their elected representatives, in the 2013 House of Delegates. I invite all of you to an open forum on the proposed vision that will take place on Wednesday, January 23rd, from 6-7 PM at CSM in San Diego. I hope to see many of you there.

      Kind Regards,
      Bill McGehee
      APTA Vice Speaker
      Chair, Vision Task Force

  8. C Jason Richardson says:

    Interesting discussion. I largely agree with all comments. The difficult part with constructing a vision statement for PT is the vastness of roles we play across settings and practices. What I think needs to be preserved in a new iteration is the focus on the PTs role in society. I sense that is what the task force was trying to cast.

    We have to view our services as a contract with society–that is the true definition of a profession. Once we establish a clear role in society we obtain public demand. With public demand we gain real political leverage.

    As Alan eludes, this will be a slow process without unrestricted direct access.

  9. Erica Meloe says:

    Well, this does not resonate with me. It’s all in the language as they say. We need to get consumers to recognize us as first line defenders in the prevention and treatment of musculoskeletal disorders. Sadly, this is not the case. I know direct access is still (!) a barrier in some states.
    Once a goal is defined, a strategy then becomes more clear. If our goal is to get more patients in the door, then we need to get our faces in front of them, where they hide. Lord knows, chiropractors do.
    But in our case, we have the goods to back it up. But consumers do not know that nor do they know we EXIST.
    This is the year that health care will radically change and consumers more than ever are paying alot more for their care and they are looking for quality. We have to be more strategic in how we define ourselves because when someone is looking for you they want out of pain. They don’t care about a movement dysfunction. In the end, they will. But that is not what is going to get them in the door.
    Erica

    1. Joe Brence says:

      Exactly, John. The primary complaint in an outpatient PT facility is “pain”. Something hurts. The language used appears to further support that altered movements are due to defect vs. defense – meaning that an altered movement pattern lead to pain vs. the altered movement pattern being a defensive output from the neuromatrix (along with pain). Our profession appears to follow the concept that altered movement is dysfunctional, but not quite sure this is in line with the evolving literature which appears to be indicating that altered movement patterns to be more defensive. So with all of this stated, will optimizing movement patterns/core strength/postural control/etc. lead to better outcomes? I doubt it. I think this will continue to reinforce unsupported notions and decrease the scientific plausibility of our interventions.

  10. John Childs says:

    I wonder how many patients upon being asked the question by their PT, ‘What brings you into my clinic, Ms. Jones?’ have responded with something to the effect of ‘I have a movement dysfunction.’. I would bet very low, almost as low as the odds of ND beating my beloved Bama tomorrow night.

    1. Joe Brence says:

      Exactly, John. The primary complaint in an outpatient PT facility is “pain”. Something hurts. The language used appears to further support that altered movements are due to defect vs. defense – meaning that an altered movement pattern lead to pain vs. the altered movement pattern being a defensive output from the neuromatrix (along with pain). Our profession appears to follow the concept that altered movement is dysfunctional, but not quite sure this is in line with the evolving literature which appears to be indicating that altered movement patterns to be more defensive. So with all of this stated, will optimizing movement patterns/core strength/postural control/etc. lead to better outcomes? I doubt it. I think this will continue to reinforce unsupported notions and decrease the scientific plausibility of our interventions.

  11. Larry Benz says:

    Interesting discussion and appreciate Bill’s detail on the process-this is not an easy task. The whole idea of “movement dysfunction” doesn’t resonate and is anything but stickily. Has any patient complained of a movement disorder recently? A good vision statement is memorable, portable, but not necessarily complete (we had an Impact article on this very topic a few years ago). There are some great examples. My personal favorite is the coalition of countries that formed a charity and are trying to “make poverty history”. There is no doubt that if you work for that group, you know have no doubt of why you are going to work every day. My encouragement would be to keep at it-don’t settle for something that is so ambiguous and without meaning for all stakeholders.

  12. Bill McGehee says:

    I’m curious about how everyone has linked “movement dysfunction” to this language. I realize “optimizing movement” contains the word movement but the word dysfunction is nowhere in the language. The concept of optimizing movement is so much broader. I think people do see us all the time to help them move better. They may not say, “I want to move better” but they do say things like “I want to get out of bed easier” How do we capture the myriad of those complaints? Optimizing movement was our attempt at it. Other suggestions?

    Bill

  13. The Vision Statement is fine as far as it goes, but is woefully incomplete. Now it needs several bulleted statements listed below the paragraph.
    A good starter might be “by developing an effective nationally focused
    Advertising Campaign to demonstrate PTs commitment to Performance, Wellness and Rehabilitation, through working with Congress to allow Direct access to Medicare and all other patient populations”.Without language such as the above, the Vision Statement is just words,nothing more. In short, model it after Vision 2020.

  14. “It’s all in the language” – so very true. So here’s a thought – let’s start with changing that language. No more party line “there are 48 states that have direct access” because it is a falsehood or half-truth to both legislators and the public. Language like this – coming from a professional association – just dilutes the harsh reality for consumers.

    As Erica noted, “Once a goal is defined, a strategy then becomes more clear”. Start with the reality of 17 states having “consumer direct access” (as any other non-gatekeeper-driven autonomous profession). This would clarify the goal – and the strategy required – without need for a new vision.

    Allan

  15. Barbara Van Gorp, PT, DPT, OCS says:

    I appreciate the above conversation and say a ” thank you” to the board for working hard. However, i agree with John Childs that we need greater clarification and specifics on a vision statement. To be visionary, one must have concrete goals with specific abilities to show progress. There is nothing specific in this newer vision statement. We as physical therapists must continue to advance our thinking and continue to pursue how we will fit into the changing health care system. I dont think such a broad vision statement answers this.

  16. I have to agree with Larry Benz and John Childs.

  17. Richard Zaruba, PT, PhD, OCS says:

    I have to agree with Larry and John also. The new statement is so ambiguous that it means nothing to any audience that it is directed at. My patients come to see me because they have pain; not being able to move well comes in at a distant second. They don’t really care about society at time either. A “Vision Statement” is supposed to give you an idea of where you want to be, this one just leaves me confused.

    Rich

    1. Randy roesch says:

      Nice job Jacki.
      We need a vision for our external communities that makes sense to them -and subsequently “moves” them into our practices

  18. Jacki Brechter says:

    I agree with the statements that are being made. The proposed vision is too vague and I have no idea what the proposed goal is, except ‘transform society’. I do not understand what transformation is being considered, but whatever it is, it needs to begin within the profession. We have sought to improve the understanding of what a PT is for many years. Why do so many people still not understand? Even PTs may seek other practitioners for movement disorders, why is that?
    I think we are really not connecting to the public. In utilizing wording that is too succinct or all encompassing, we end up missing the point.
    I know it is extremely difficult to come up with a short, succinct statement that addresses everything. I commend those of you on the committee and the difficulty you have faced. I also wanted to post an alternative as has been called for above.
    I am not suggesting that this posting is going to be an end to discussion, but I just wanted to advance an alternative that could perhaps capture some of the ideas that are being put forward. This may provide additional suggestions or alternatives instead of stopping at what is wrong with the posting. Take from it what you will!

    “The physical therapy profession will be the practitioners of choice for people with pain, disease, or other problems adversely affecting movement or function, as well as optimizing wellness to maintain and improve movement. PTs work with people of all ages and any movement goals, including the youngest neonate, the least and most active of individuals, and the oldest geriatrics. People will choose a PT that will be their source for annual wellness screens, performance improvement, for seeking relief from pain, or for rehabilitation from disease or trauma affecting function or movement. They will have direct access to their autonomous physical therapist who also works as an active part of the patient’s health care team, able to refer to other professionals to optimize patient/client care.”

    1. jerry Durham says:

      I like that!…. nice

    2. jerry Durham says:

      sorry…that should have been a response to Tim Flynn

  19. Tim Flynn says:

    Thanks to the task force on their important work. I agree that more work needs to be done.
    Here is how I see our purpose and thus our vision:

    The physical therapy profession exists to alleviate pain and suffering and keep people moving throughout their life.

    Tim

    1. jerry Durham says:

      nice work Tim…A true Vision to work from….

    2. Bill McGehee says:

      Thank you Tim for this.

      Bill

  20. jerry Durham says:

    Most of the comments still reflect the individuals ideas of WHAT a Vision Statement should be…only Bill McGehee in his comment defined what definition of a “Vision Statement” APTA was working from…. most people have commented on what goals, objectives and the mission should be…not a Vision as outlined by Bill… (FYI..I dont agree or disagree with it, just wanna see us having a productive discussion)

  21. Bill McGehee says:

    Most of my patients never complain about pain. I go to see them because they don’t have enough endurance and/or strength to make it from their bed to their bathroom so have to use a bedside commode. They are hoping to be able to breath and move better so they can take care of their own personal needs, alone.

    Bill

  22. GR Nessenthaler says:

    I know this sounds serendipitous, but I just evaluated a patient after his lumbar fusion and he mentioned how his experience as a human was really suffering beacuse he could not optimize the movement of his spine. In the course of his session, as I instructed him in optimal movement patterns, he was impressed and really felt that my instruction in body mechanics could transform society…
    I wonder how many committee meetings and hours it took to come up with this “forward thinking” sentence…

  23. BMF says:

    Physical Therapists are the professionals for patient’s to seek to relieve or remedy body aches and pains and/or difficulty with daily activities.

  24. Larry Benz says:

    Physical Therapists are the professionals patient’s first seek to relieve or remedy body aches and pains and/or difficulty with daily activities.

    minor revision from BMF. This is understandable. Not sticky enough but doesn’t have meaningless “transform society” or “human experience” in it.

    Something sticky might be: PT’s First

  25. C. Jason Richardson says:

    I don’t think “transform society” is meaningless, it’s just not clearly defined and doesn’t project a strong vision aligned with the intent of the words. The intent of these words, “transform society” is the essence of needing a new vision statement and suggests both a quest for unrestricted direct access and that PTs will the “provider of choice” and will impact “population health” and quality of life.

    My 2 cents.

  26. Erica Meloe says:

    Larry I like that! “PT’s First!” That should be the Vision! That should be our tagline! Where are the branding experts here? I truly appreciate all the work the task force has done but I think sometimes the message gets lost in the language.

    I had a patient today call me up and ask me if he could see me without an Rx. I live in NY and we have had direct access here for awhile. Clearly, we have work to do! Or I have work to do!
    Just some of my thoughts!
    Erica

    1. Joe Brence says:

      Agreed. It is bold and informative.

  27. I commend the task force on the time and effort which they put into the process and product. I consider it a work in progress, because it misses the mark of key points. A vision should state the desired state of the organization, creating an urgent message of change within the organization to to achieve the vision. A vision should compel its members to engage in the work of the organization to see that the vision is achieved. A vision should inform stakeholders about the organization and the relevance that organization has for the stakeholder and community outside the organization, such that the stakeholder would want to become engage in the what the organization is trying to achieve.
    So far the vision is not very compelling due to the lack of specific language that points a direction for the member to become engaged. It lacks relevance to the stakeholder and the consumer to access our services for prevention and rehabilitation. The concept of “movement related disorder” does not mean much if anything to the consumer. That term represents more about what we are comfortable with saying about ourselves vs. meeting customer demand. There is more work to be done.

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