The Experiences of Community Service Rehabilitation Professionals Who Managed Their Own Department in South Africa

Abstract

Background: A compulsory community service year for all healthcare professionals, including rehabilitation healthcare professionals was introduced to address the challenges of access to healthcare especially in rural South African communities as a result of inequalities brought about by apartheid. Even though the focus of the community service year was for healthcare professionals to render clinical services under the supervision of a more experienced healthcare professional, this has changed over the years. Due to the lack of resources and funding and subsequently the shortage of healthcare professionals, community service rehabilitation professionals often find themselves placed in healthcare facilities without the supervision of a senior member of staff. Community service rehabilitation professionals therefore end up taking up the role of head of department without prior preparation or training. Aim: The aim of this study is to explore the experiences of rehabilitation community service healthcare professionals who have managed their own department during their community service year. Methodology: Semi-structured interviews were conducted with 15 rehabilitation healthcare professionals. A purposive sampling strategy was used to recruit participants. Interviews were conducted online via Zoom. All interviews were transcribed verbatim and analysed using a framework analysis approach employing Faloy’s five elements of management. Findings: The following 16 themes demerged from data analysed from the semi structured interviews with participants: (i). Undergraduate training does not prepare students for managing a rehabilitation department; (ii). Insufficient handover from the previous community service therapist and not enough orientation at the beginning of the year; (iii). Create new documents that outline plans for their community service year; (iv). Duties expected of a community service rehabilitation professional, (iv- a) Clinical duties expected of a community service rehabilitation healthcare professional heading a department; (iv -b). Administrative duties expected of a community service rehabilitation professional heading a department; (v). Not having enough time for clinical and administrative duties; (vi). Co-ordinating with staff 3 members within the healthcare facility; (vii). Discovering outside resources to collaborate with to assist with managerial and clinical duties; (viii). Staff negative attitudes towards community service rehabilitation professional; (ix). Staff’s lack of knowledge of rehabilitation healthcare professions; (x). Meetings with other managers; (xi). Little to no feedback or verification structures in place, (xii). Creating a handover for the next community service therapist, (xiii) Ethical considerations, (xiii -a) Language barriers, (xiii-b) performing duties outside of scope of practice, (xiii -c) Lack of carryover of treatment due to lack of personnel (xiv) Safety, and (xv) Emotional toll on community service rehabilitation professionals Conclusion: Findings from the study suggest the need for different kinds of informal and formal support structures that are needed for rehabilitation community service practitioners who have no access to a supervisor during their community service year. This includes creating a better support network of professionals in the same district who can assist each other as well as better support from the healthcare professionals at the healthcare facility. Furthermore, the findings highlighted the need for continued professional development (CPD) courses that could be capacitate community service rehabilitation professionals who are heading a department by focus on providing both practical support and assistance with managerial duties. These implications will allow community service rehabilitation professionals to feel more supported and have greater confidence in their abilities as a clinician and a manager leading to better service given to patients