Table 7 Physiotherapy examples of applications of technical and distributive criteria

Effectiveness

D1: we’ve very much put that on current practice and research.

A2: so we haven’t done any sort of study on that and I think that they’re hand in hand, we can only grow the service if we’ve got the evidence of best practice that we can then put to people who have money and purse strings… but we will never be able to, it would take a real reshuffle of how we do our work as two part timers to actually see how we could incorporate that.

Efficiency

D2: Look the biggest shift I think in Physiotherapy and Occupational Therapy is going to be in the ABF environment, and that’s going to be around the efficiencies and comparison between our services across our site, to look at the time of the intervention of Physiotherapy to particular diagnostic related groups based on the funding received.

D1: we’re always trying to work out where we’re getting our best bang for our buck and where the resources are best spent.

Appropriateness

D1: I think it’s about the services the hospital offers and looking at our staffing, where we think we can make the most impact. So we’ve had a lot of say over where we provide the services.

Need

D1: But whether that’s a values based thing too, rather than just choosing, it’s hard to call.

A9: So we look at the needs in our community and try and skill up with what we can do that makes it easier for them.

Merit/Demerit

A5: Oh constant friction – self friction – so it’s a judgement call, it’s not a right or wrong and other people may prioritise differently. I think it’s so simplistic to say that they’re acute patients…that they are inpatients so they deserve to be treated…So anyone that I don’t need to see I try not to… I certainly see people who are deteriorating.

Risk

A5: “Do they really need to see me?” “Yes I can see them as an out-patient”, and there is some pressure from them [ward nurses] but I can go back to the doctor and say this is why I haven’t see your patient; I do see its importance, but I’ve had to prioritise and I don’t get much problem with that, but the nursing staff I will get more just “Oh we never see the physio”.

Benefit

A5: but someone with just a chest infection to me, I’m going to have a limited evidence based effect on this person whereas someone with a serial cast after botox that’s where I need to prioritise.

Rule of rescue

A3: Priority one is the ICU sort of work.

A9: and certainly if anything comes across from ED that’s on the spot stuff.