Physiotherapist's Perceptions of Equity and Career Progression in the NHS - Literature review Example

 A Critical Review of Physiotherapists’ Perception of Equity and Career progression in the NHS Introduction The purpose of the paper is to evaluate critically the research paper of J. Bogg et al, published in Physiotherapy 93(2007) 137-143 with the title Physiotherapists Perception of Equity and Career Progression in the NHS. The objective of the paper under study was ‘to evaluate physiotherapists’ personal perception of equity and diversity both in NHS and within their profession’ (Bogg et al, 2007, p. 137). The purpose was to influence the policy to bring changes in actual practice by evaluating the personal beliefs of the staff and to challenge the incorrect beliefs. To reach the findings the design of the paper was National Survey, held in UK. Four hundred and twenty physiotherapists responded to help to assess the beliefs of respondents about equality and diversity in NHS. The survey was conducted by disseminating the study information to the NHS and professionals via journals, media publications and study websites and the Breaking Barrier questionnaire was available on the online to fill on the study websites. Moreover, 1000 paper-based copies were posted to the Health Department and to the individuals; who had requested for the copy. Critical Appreciation of the Paper In line with a series of researches on various aspects of the maintenance of diversity and equity in the workplaces including the NHS, the research paper of Bogg et al is a significant landmark in finding out the perceptions of the psychotherapists who play a crucial role in providing the service. Simply exceeding the demarcation of theoretical ideologies of equity and diversity and their effects on the career progression, the research on the fact and figures how the psychotherapists themselves perceive the importance and at the same time their evaluation in their career progression was a pressing demand for the development of the profession. Bogg et al are cautious enough to make their research pivot only on the diversity of race; rather they attempted to evaluate the diversity from an all-embracing point of view. According to Bogg et al, equality and diversity include ‘gender, sexual orientation, disability’ (Bogg et al, 2007, p. 137) etc. At the beginning of the paper, the authors of the paper ‘Physiotherapists’ Perception of Equity and Career progression in the NHS’ (Bogg et al, 2007, p. 137) clearly state the universality of their view of diversity in the sentence; ‘any area of difference can be recognized’ (Bogg et al, 2007, p. 137) or considered as the factors of diversity and equality. Consequently, the universality of their view of diversity and equity brings a twist of difficulty and hugeness on their research of the mentioned topic but at the same time, it makes their research all-embracing. Obviously, such a universal concept of diversity and equity is very pertinent to a design that is national. The width of Bogg et al’s definition of diversity and equity the questions are sufficient to determine the focus of the questionnaire of their research. Bogg’s research is based on several assumptions that are as following: a. The mission of the NHS is to ensure the workforce to be properly reflective of the communities. b. Lack of diversity and equity is barrier to the practice and service provision. c. Minority enrollment and Women-enrollment in the higher position in the NHS is too slow to be visible. d. There is a great discrimination between the percentages of gender participation in the total workforce and the higher positions in the NHS. For example, the participation of women in the total workforce is 86% but the participation of in the managerial position of women in the NHS is 45%. e. In spite of the policy of the NHS to ensure the racial diversity and equality in the workplace, BME individuals have to face barriers in their employment and career progression. f. Disability oriented discrimination is a common phenomena within the workplace of the NHS including other business places of British Nationality. g. Sexual orientation of labour is a potential issue of equality and diversity of the workplaces of the NHS. Clear Demarcation of the Area of Discriminations in the NHS The area of discrimination and inequality has been vividly demarcated by Bogg et al in the beginning of the research paper. As Bogg et al (2007) say, ‘BME staffs within the NHS can face discrimination from discrimination from co-workers and service users, which may include name-calling, racial slurs, unequal opportunities for promotion and even dismissal’ (Bogg et al, 2007, p. 138). Also Bogg et al are cautious enough not to fail to notice the discrimination committed the disable the workers of the NHS as well as to notice the discrimination on the on the ground of sexual orientation. In spite of the initiatives of the organizations to promote diversity and equity in the workplace, the employees are prone not to admit the contributions of these initiatives. In most cases, the responsibility of the organizations regarding the promotion of diversity and equality remains confined to the affirmative action awareness training, new recruitment strategies for diversity, maintenance of diverse environment, practices, and policies within the workplace. Bogg et al refer to the disparity between the claims of the organizations and the perceptions of the employees regarding the issues of diversity and equity in their workplace: In a recent NHS survey more than half (58%) of respondents reported that they had not received any training in equal opportunities and awareness with regard to race, gender, disability, religion, harassment or bullying since commencing work for their employer. (Bogg et al, 2007, p. 137) The ideology that lies behind the whole process of investigation is ‘in order for policy to make a difference and changes to occur in actual practice, personal belief s of front line staff must be evaluated and incorrect ones challenged’ (Bogg et al, 2007, p. 137). The focus of the investigation on the evaluation of the physiotherapists’ perceptions of equity and diversity in the NHS and their profession is too abstract to retrieve any concrete result. Yet Bogg et al’s expertise to outline the findings within few sentences is certainly praiseworthy. Critical Analysis of the Method Used in the Paper However, their approach to the investigation and accordingly the findings of the research were too general to be sure of the prime features of the perceptions of the physiotherapists. The findings were no new ones; rather they are the affirmations of both the ideological perceptions of diversity and equality. The results are what the employees perceive their ideology of diversity and equality. Such generalization happens to exist mainly due to the features of the questionnaires that tend to inspire the respondents to answer following what their ideologies assert. Indeed the questionnaire used in this research lacks proper aspiration for the respondents to perceive the real status of diversity in their workplace. Bogg et al (2007) fails to interpret the bias of psychology and consequently their questionnaire was not ideology neutral. Indeed the shift from the qualitative approach to quantitative approach in the evaluations of the perception makes the paper more reliable and concrete. However, in a reverse twist this shift from the qualitative has led the findings to primarily adopted ones. Further, it makes the whole research paper blunt and less convincing. The flaw within the research paper is that it is successful to perceive the nature of the topic of investigation. The nature of the topic of investigation necessarily sets the main approach of the investigation to be qualitative and some quantitative investigation may be used to assist the qualitative approaches. Combination of Qualitative and Quantitative Approaches in the Paper It is evident that Bogg et al (2007) combines both qualitative and quantitative approaches in their research paper as Bogg (2007) et al asserts, ‘the Breaking Barriers questionnaire was developed from pilot work to ensure face and content/construct validity and comprised both quantitative and qualitative responses, in relation to biographical data, equality, diversity…’ (p. 139). The question is whether the combination of both qualitative and quantitative approaches are effective for the nature of this investigation topic of the paper. Ideally, the topic to evaluate ‘Physiotherapists’ Perception of Equity and Career progression in the NHS’ (Bogg et al, 2007, p. 137) demands all the features of qualitative approaches. A qualitative researcher is meant to find out how people make sense of anything they are involved with (Babbie, 2001, p. 37). Obviously, the research on the mentioned topic can effectively be approached in both of the two ways: qualitative and quantitative. The quantitative findings must be considered supplementary to the qualitative findings of the investigation (Glesne & Peshkin 1992). But in most of the cases, it seems that Bogg et al are more inclined to the demarcation of their approaches. It is obvious that the paper does not begin with any hypothesis; rather its aim is to ground on a hypothesis that would be based on the findings of the investigation. Therefore, questionnaire that is prepared on primarily assumed hypothesis is a serious flaw within the investigation. Even though an effective attempt to combine both the qualitative and quantitative investigation was made in this paper, the excessive leaning to the quantitative efforts led the research towards something blur. Strength and Weakness of Bogg’s Questionnaire Bogg et al (2007) asserts that equality and diversity questions are ‘specific individual questions and are therefore not scaled’ (Bogg et al, p. 139). In regard, their attempt is quite correct to find out the nature of their subject. But their attempt, as they assert, ‘the response is derived from the level of agreement, based on individual perception, on a question by question basis’ (Bogg et al, p. 139), to get the response derived from level of agreement is questionable. Whether such answers ‘yes’ or ‘no’, or ‘I agree’ or ‘I do not agree’ are able to trace the reality of the perception of the physiotherapist may engender controversy (Dillman 2000). In such ‘agree’ or ‘disagree’ way does not allow enough options for the respondents to express their opinion freely. The Close-ended questions that Bogg (2007) et al used in their paper appear to be one of the major anomalies for the type of investigation used in the paper. Though it is difficult to obtain a conclusion from the open-ended questionnaire, the close-ended questionnaire used by Bogg (2007) et al should have been extensive enough to encapsulate the maximum of the findings of an open-ended questionnaire. To assess the response of equality and diversity in the profession individual questions (n=15 items) were asked, keeping in view the respondent’s profession and organization. ‘These were developed from pilot focus groups.’ (Bogg et al, p. 139) To measure each item Likert response scale (1-6) was used; ranging from very strongly disagree(1) to very strongly agree(6) The researchers are of the view that ‘this permits data to be aggregated to identify percentage agreement or disagreement with specific statements.’ (Bogg et al, p. 139) Critical Analysis of the Use of Likert Scale in the Paper The way in which Likert scale has been used in the paper rather indicates a major flaw of the research. Likert scale may be useful to indicate the intensiveness of the perception of the physiotherapists (Brunier & Graydon 1996). But the encapsulation of the entirety of perception of the physiotherapists depends on the number and quality of the individual questions (Guyatt et al 1987). In this regard, the questionnaire of the research paper is not ample enough to encapsulate the entirety of their perception of equity and career progression in the NHS. Hasson and Arnetz (2005) comments, ‘Limitations with the Likert scale is that wording of the descriptive categories most probably affect the responses and artificial categories might not be sufficient to describe a complex continuous, subjective phenomenon’. Accordingly the potential flaw within the descriptive categories of Bogg’s paper is that the wording of the questionnaire that affected the objectivity of the answers with the subjectivity of the researchers. In the paper Bogg (2007) et al seem to put more stress on how the physiotherapists perceive or feel about diversity and equality rather than what they feel. But the nature of the research demands more of what the physiotherapists perceive of diversity and equality. Likert scale, which is a type of psychometric response scale, is often used in questionnaires. It is extensively used scale in survey research. Respondents indicate their level of agreement to a statement by responding to a Likert questionnaire item. Bogg’s paper certainly fails to pursue what the physiotherapists feel about diversity and equity. Indeed the authors of this research paper did not include any question to exhume what they feel. Likert Scaling is uni-dimensional scaling method. The first step is to define what we are trying to measure since it is one-dimensional scaling method so it is supposed that the concept we want to measure is uni-dimensional in character. The disadvantages of using Likert scale in this research paper and at times the quantity shortage of questions to encapsulate the entirety of the research topic contributed to the weakness and the poor generalization of the findings of this paper. Again as Hasson and Arnetz says, Too many response categories may lead to difficulties in choosing and too few may not provide enough choice or sensitivity, forcing the respondent to choose an answer that does not represent the person’s true intent….Moreover, it has been indicated that the use of sum scores may lead to incorrect conclusions. (2005) Deviation from the Role of a Qualitative Researcher Denzin and Lincoln say (2000), ‘The word qualitative implies an emphasis on the qualities of entities and on processes and meanings that are not experimentally examined or measured (if measured at all) in terms of quantity, amount, intensity, or frequency’ (p. 8). According to the definition though the objective of the research paper demands a qualitative approach as a prime line and a quantitative approach as supplementary, the method that has been used by Bogg (2007) et al in this research to evaluate the physiotherapists’ perception of equity and career progression in the NHS shows a clear deviation from the role of a qualitative researcher and a more leaning to the quantitative research. The objective coded by Bogg’s (2007) et al for the research seeks an effective process to land on a hypothesis in an inductive way. So necessarily, the researchers’ investigation should have revolved around the following points that the paper missed seriously: a. Bogg et should have prepared their questions that would seek to identify what their informants know about diversity and the barriers on the way of career progression. The close-ended question to investigate the physiotherapists perceive of diversity creates a major information-gap in the research. As close-ended questions are convenient for any type of research (Waddington 2000), the justification of using close-ended questions in the paper can criticized on the point that Bogg et al failed to make fruitful combination of both open-ended and close-ended questions. It obviously indicates that Bogg et al fail to perceive the qualitative nature of their research topic. b. The present research paper significantly lacks the attempts to find out ‘What concepts the informants use to classify their experiences’ and ‘How the informants define these concepts’ (Spradley, 1979, p. 35) that are two of the major points of investigation of any qualitative research. Bogg et al were not expert enough to take a prying eye into what concepts they uses to refer to the idea of ‘diversity’ and ‘equity’. Critical Appreciation of the Method in Perceived Barriers to Career Progression, Gender and Race Barriers The method that Bogg et al used in their research would have been most effective to trace the status of diversity and equity in the NHS. However, it does not reflect properly the psychotherapists’ perception of diversity and equity. Even if some qualitative approaches that have been used in the research, they are not in proper combination with the quantitative approaches. The questions used to perceive the barriers to career progression, and gender and race barriers just simply allowed the respondents to tick the options that applied to them. So the questions did not seek into how they make sense of these barriers and description. As Denzin and Lincoln (2009) say, ‘Qualitative researchers stress….the situational constraints that shape inquiry. Such researchers emphasize the value-laden nature of inquiry.’ (p. 8) Even if the gross deviation from the true and effective approach that was the demand of the topic of the research, there was another potential threat from the Hawthorne Effect that negatively affected the findings. Hawthorne effect on the Findings The following nature of findings reveals the Hawthorne Effect largely: Ethnicity and Gender based feelings: The majority of respondents belonged to white ethnic background (n=370, 88%). Only fifty respondents were non-white background (12%). The statement to consider was, “In general, I think minority groups experience some barriers to career progression” 50% of all the respondents had the view that minority groups would face barriers in career progression. Three quarter of respondents, having non-white background, stated that minority does face barriers in career progression. (n=36, 72%). The people from non- ethnic background enjoyed promotion in the last three years. (n=207, 56%) whereas 44% people from non-white background were promoted. The majority 81% stated that they had never been treated differently at their workplace but respondents from non-white background expressed that they face discrimination at the workplaces. (n=18, 36%) X2 = 11.175, P Read More