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1999 APTA Presidential Address |
JK Richardson, PT, PhD, OCS, is Chairman, Department of Physical Therapy and Occupational Therapy, Duke University Health System, and Professor and Chair, Doctor of Physical Therapy Program, School of Medicine, Duke University, Box 3965, Durham, NC 27710 (USA) (janrichardson{at}apta.org)
 | Introduction |
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Honored guests, members, friends, and families of our profession, we are here to celebrate our 74th Annual Conference in our historic nation's capital. We are also here to celebrate the first annual and historic meeting of the newly enacted Representative Body of the National Assembly. And we are here not only to celebrate the close of a decade and a century, but also to soon herald in the new millennium.
As great as the accomplishments of our civilization have been in the past thousand years, none have been as great as those that have been accomplished in the past 100 years, such as the inventions of space travel, the telephone, television, the personal computer, the Internet, air-conditioning, fast food, and, of course, Pop-Tarts.
Likewise, our Association, the APTA, has achieved great things in the past 78 years—licensure, independent accreditation, and direct access—and, most importantly, APTA has supported our commitment to our patients, to society, and to quality care.
What is the magic of our profession? What makes our Association strong? What is the motivating factor that has enabled physical therapists and physical therapist assistants to work their magic? It's the answers to these questions that we need to examine as we go forward into the new millennium.
Let me begin with a story. Back in the Middle Ages, a British knight was returning to the castle one evening after a long, hard day of battle. His armor was dented, his helmet was askew, and most of his plumes were broken off. His horse was limping. He was listing to one side of the saddle. The lord of the manor saw him coming and went out to greet him. "You look terrible! What hath befallen you, Sir Albert?" he asked.
The knight straightened himself up and said, "Oh, Sire, I have been striving on your behalf all day, robbing and pillaging, and burning towns of your enemies to the west."
"You've been doing what?" asked the astonished nobleman. The knight repeated his statement louder and slower in case the fellow couldn't hear well. "I've been robbing and pillaging, and burning towns of your enemies to the west!"
"But I haven't any enemies to the west," cried the nobleman.
"Oh!" said the knight. "Well, I think you do now."
There is a moral to this story. Enthusiasm is not enough. You have to have a sense of direction—a purpose—a vision! You need to understand not only what you are doing, but why you are doing it! The profession of physical therapy for the past 78 years has provided "compassionate care for the patients we serve," but we have done this under the direction and referral of physicians.
Now, this millennium is drawing to an end, and a new one is beginning. As we look to the future, we need a compass. A compass that will help us find new direction in the next century. And that compass needs to be our "2020 Vision." A statement that can be encapsulated in a single sentence. A sentence that is succinct, descriptive, and embraceable. A sentence that is attainable and yet far enough out of our present reach that it beckons us to leap for it, knowing that we are teetering on the cliff of risk. But also knowing that once the leap is taken, we rose to the challenge. That we accepted this "challenge by choice"—and that we chose to define our destiny.
In the next 20 years, we can achieve a single degree. We can all be titled "doctor." We can be primary clinical care practitioners ... while continuing to provide "compassionate care for the patients we serve."
If we look at how we treat our patients and their impairments today, such as treating spinal cord lesions with the use of electrical implants, in comparison to our historical beginnings of treating diseases, such as polio, with warm wool body wraps, we should not be surprised, because what was the future has become the present.
So we should look to the Vision Statement without hesitation or doubt, and believe that it is entwined with our basic fabric, our purpose, and our scope of practice. Some may be worried about what the future holds, wanting to cling to the past. Some may be worried about the present and the changes we have seen, reminiscing about the better times that have passed.
But when it comes to the future, we must learn from our experiences. When it comes to the future, we must rely on ourselves, not waiting for others to lead the way. When it comes to the future, we must be creative and inspirational. After all, isn't that what our members expect us to be—leaders?
As leaders, it's time to lead the way and inspire change. A change in our culture is necessary, and changing culture is serious business. It is not something to be taken lightly. We do it because we have to in an effort to survive and remain strong. Or, in our case, we change because we are smart enough and cunning enough to do it before we are forced to, knowing that we must stay on the cutting edge in an effort to remain competitive in a rapidly changing environment of practice and reimbursement.
Historically, other professions have not had the foresight to change, but were victims of the work forces that were thrust upon them. We must have the foresight to change our culture before work forces mandate it. We must have the determination to see our efforts through ... and we must do it with enough commitment, passion, and velocity that the world of change will not overtake us. We will not lose control of our destiny, we will not lose control of our vision, and we will not lose control of our profession.
This past year has not been easy for many of our members. I have heard the personal stories of lost jobs and lost homes through your letters and phone calls. I have visited chapters and spoken with students who are frustrated, fearful, and in some cases, even hopeless about the future.
Well, now is the time to be strong ... to be focused leaders who empower our members and others in the profession. Leadership is an act of faith on the part of the leader and of those who follow, because of their belief in the leader's vision and strength.
Well, I for one am not ready to give up the fight. I am ready to do what it takes to solidify our credibility and our contributions. I am ready to draw the line in the sand, and I know you are too!
We will not stand by idly and let our profession be relegated to subliminal obscurity and our patients denied needed care because third-party payers wish to deepen their profit margins and federal bureaucrats wish to diminish access and care to our patients, under the guise of cracking down on fraud and abuse.
If we don't lie down, nobody can walk on us. Or, as my father used to say to me, "Remember, no one can make you feel inferior without your consent." And we are not about to give them our consent.
But, the fight will not be an easy one. If we want the rainbow, we have to put up with the rain. We can fight the fight, and tolerate the torrents of rain, by beginning to change our culture. Pritchett and Pound, in their book entitled High Velocity Culture Change,1 present radical concepts to survive in an unstable environment. These concepts include:
Pritchett and Pound write, "Some that recognize the need to change, deceive themselves, thinking they can achieve a cultural transformation without pain and chaos. But it just doesn't work that way. Overhauling the culture is an agonizing process."1
Our current culture simply won't work for us anymore with the new reimbursement system. We need greater recognition in the food chain. We need a radical culture change with focus on the future, and we can't change our culture by dwelling on the past. Studying our history will only serve to slow down our move into the future. Change necessitates that we know where we want to go, not where we have been. We must look at our profession through the windshield, not the rear-view mirror.
We need to take action that turns heads! We need to hit with enough shock value to immobilize our old culture. We must hit hard, move fast, and follow through to establish a new culture. The force of our culture shift will be the Vision Statement that we will develop to drive us. We will not look the same or be the same as we were in the past. We will not be viewed the same or tolerate being treated the same as we have in the past.
It's time that we collectively care more deeply about our profession and our Association. We need to care deeply enough to take our profession through the difficult, unpopular struggle of a culture change so that we can survive.
Like "tough love," we must not confuse caring enough with making people happy, because we as leaders and members will be unable to please everyone. It's difficult enough to please everyone on a daily basis, much less while initiating a deliberate culture change in our profession.
My father always said to me, "Show me a person who is liked by everyone, and I will show you a person who cannot make a decision." After 20 years of service to APTA and 26 years of practice, I know all too well how true my father's wisdom is. Our behavior sometimes may not appear to be compassionate at face value, but—in the long run—when viewing the big picture, it will be apparent that a high-velocity culture change is the most caring move that we can make at this time.
We know that culture change is traumatizing to people. Some are demoralized, disoriented, and dispirited. Their world has been turned around, like children spinning in circles with their eyes shut. When they open them, they are unsteady and unstable. We must have a vision that helps them focus their attention, grounds them, and holds their heart. Our culture change needs to become a cause ... a crusade ... and it is our responsibility to be the champions of the vision.
Culture change cannot be achieved by a small group within our profession or Association. The initiative must be a campaign that is embraced and draws its strength from people like yourselves—those of you who have great influence with many of our members and nonmembers, because you are the role models.
The leadership of our profession can conceive the vision, but it will be our members who give it life. Align yourself with the culture change by promoting the vision. Help others see what to many may be invisible ... unbelievable ... unreachable.
To do this, we will need to crank up our efforts to communicate effectively. Standard communication procedures simply won't work. We will need a tremendous quantity of quality communications. Our members will need to hear the logic and rationale behind the decision to change our culture and formulate a vision for the future.
As outlined in High Velocity Culture Change, we will need "to give them an airtight case, based on hard facts about the marketplace"1 and our profession's competitive position. As Pritchett and Pound stated, "They will want to know what's coming next and how it will affect them personally. We need to sell people on the purpose, preach hope and explain the part they're expected to play in the change strategy."1 As leaders, we must be able to articulate the Vision so vividly, and so powerfully, that it becomes their vision.
As we define our Vision for the new millennium and change our culture to strengthen our profession during this time of unrest in health care, we can expect casualties. Pritchett and Pound stated, "Watching a culture change is like walking through a war zone. You see misery, wreckage, trauma, and casualties. The upheaval will be enormous and some people won't make the cut."1
We know in our profession that we have already had casualties. Some have lost their jobs, some have lost their competitive edge, and some have lost their hope, because times are not what they used to be, and we can't do business as usual anymore. While we, as leaders, may not be able to give them back their jobs, or turn back the clock, we can facilitate change, develop a vision to strengthen our position in the future, and thereby give them back their hope.
We need to demonstrate unwavering commitment. Our members need to know that we are serious about our culture change and vision and that we are determined to see it though to the end. We need to demonstrate burning passion, relentless determination, and ferocious courage. It is critical from the outset to prove to our members that we are going to change. Our initial moves to this end need to be bold and dramatic, and in some instances, totally out of character. Success will not come unless our efforts are fired with emotion. Our members must know that this is an investment of our heart and soul, paid for in our sweat and blood. That is where our commitment will draw its strength.
Our job as leaders is to give everyone in our profession personal accountability for transforming our culture. The idea is to make this an all-inclusive, persuasive, profession-wide movement. The cultural change advocates need to reach a critical mass as quickly as possible, so that those external to our profession know how committed we are to strengthening our position, elevating our recognition, and promoting our credibility as a profession.
We need to provide a living example. There is no better way to coach others on what the new culture will look like than by how you carry yourself. As leaders in the profession, you will be on display ... you will serve as the role models. You must let your attitude and your actions serve as your point of reference. It is said that "people may doubt what you say, but they will believe what you do!"
It will take a conscious effort to walk the walk, but this is what will put power in your requests of others. We must show enthusiasm and earnest commitment—not grudging compliance. Just as our behavior will influence the behavior of others, the honesty of our commitment will shape their attitudes.
Our workforce has been restructured—in some instances by turnover, in other instances by downsizing. It's now the time to restructure the workforce of our profession by choice. To lead the change, we must bring in a new breed, one that will breathe life into our vision and culture change.
We want tough-minded, hot-blooded, strong-willed people who are dead set on making their mark. We need to encourage eccentricity, become renegades, mavericks, Bill Gates and Walt Disney types who are creative and have inborn curiosity. Existing culture is imbedded and resistant to change. This is an impediment that can stifle creativity and innovation. We need to aim our creativity and innovative energies straight at the market force. We can tease out and entice hidden talents and traits in ourselves and others in the profession through greater involvement and participation.
We cannot achieve culture change without participation and the influence of nonconformist behavior. We need rebels, radicals, free spirits. People who think out of the box. Remembering that if it's out of the box, it's clutter ... and that's what we want now! Clutter, chaos, creativity ... all of it ... out of the box! Demonstrating a new mind-set and encouraging a new breed will make a very powerful statement about the kind of behaviors and characteristics that it will take to survive.
Our members will be willing to embrace new values and attitudes if they comprehend the situation. We must educate them through communication. We need to provide a penetrating orientation to the circumstances driving the changes. They need to know the dynamics that are at work and that the culture change and vision is our quest for the competitive edge. Education and orientation will build confidence, competency, and a willingness to change.
They need to know that we honor our past and recognize its successes, giving credit and homage to those who have gone before us. Then we need to help them see how this transformation is the logical and necessary next step to take, considering both our history and the situation of circumstances that lie ahead of us.
And we need to think about our future professionals and paraprofessionals: our students. They are the future of physical therapy and the lifeblood of our profession. We need to recognize that, in virtually any society, schools are the voice of the establishment, the training grounds for new recruits. So, if we are going to break the grip of our old culture, we need to "seize the schools." It's the one basic rule of all revolutionaries.
We need to fortify our educational curriculums by putting them in service of the cultural shift. Enact the vision at the heart of our training! Everything about our education, from scope of practice to research, should reflect a sweeping change in our beliefs, values, and priorities. We must empower our students to know who we are, what we want to be, how we wish to be viewed, and how we plan to get there!
There are many good reasons for a high-velocity approach to a culture change and no valid arguments for a slow approach. People talk about how it requires 10 or 15 years to transform a culture within a corporation or an organization. This mind-set enables people to believe that it requires a decade to be successful in enacting change. The problem is that the task then expands to fill the time allotted, and it becomes a self-fulfilling prophecy.
We should not believe that it will take this long...that we actually have till 2010, 2015, or 2020 to achieve our vision. Because the truth is we don't have the luxury of time! The speed of change of the marketplace is too intense, and it appears to still be accelerating. Market forces and the world we live in will not be that generous. We are warned that "long before we reach the 10-year finish line, the world will take matters into its own hands."1 The world will reshape our culture, or worse yet the federal government and businesses will leave our profession to die a slow death in health care.
Significant culture change needs to start now ... in the next few months, not years. We need to start out fast and keep gaining speed! Speed may frighten some of us, leading us to believe we are being reckless or out of control. But the truth is that a lack of speed will make us lose control. Being tentative and fearful will cause us to make more mistakes than speed will!
Speed creates a sense of urgency and is a very strong signal of our passion and commitment to change. "Speed" is a term that varies among organizations. Speeding up should not be mistaken with going fast, because some organizations are notoriously lethargic and slow. We need to move forward with a speed that is fast enough to keep us from steadily losing ground to health care's accelerating pace of change. Starting out fast and gaining speed means throwing gravel, laying rubber, and leaving skid marks. That will be our definition of speed!
We are now only 6 short months away from celebrating a new century, and a new millennium. What will it have in store for us? What will research look like in 2005, education in 2010, and practice in 2015? I don't have the answers ... because as Yogi Berra, that great Yankee catcher, orator, and philosopher, once said, "It's tough to make predictions, especially about the future."
But, if our past and present are truly a prologue, then I say that the future holds great promise for us ... and we must be exhilarated by the prospects of living in the new century. Our profession, the profession of physical therapy, may well be poised on the edge of the most exciting period in its history.
The possibilities of what we can do and will do are endless. Look to the future, my friends, with great optimism. Our minds are open and on the march. Each day we gain greater momentum. Be a part of the energy, the vision, and the future ... live in it. For, if we do our part, if we seize the opportunities and act with character, then for us ... and for our profession ... the best is yet to come. Some people succeed because they are destined to, but we will succeed because we are determined to ... knowing that only those who see the invisible can do the impossible!
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