Originally published in Massage Bodywork magazine, February/March 2007. Copyright 2007. Associated Bodywork and Massage Professionals. All rights reserved.
As the public's interest in complementary and alternative medicine (CAM) continues to skyrocket, hospitals are beginning to tap into that demand and create new revenue streams at the same time. As a result, the development of hospital-based massage therapy practices are beginning to grow. A new U.S. survey conducted by Health Forum, a subsidiary of the American Hospital Association, shows that the number of hospitals offering massage therapy has increased by more than one-third during the past two years.1
The integration of CAM into conventional medical practice is challenging, as I have learned firsthand during my seven years of experience at the massage clinic at St. John's Rehab Hospital in Toronto, Canada. However, our successful integration supports the increasing potential for CAM in conventional healthcare settings, as well as offers some key factors that contribute to that union.2Keys to Success
During my tenure, it became evident there are some key factors in running a successful massage therapy practice in a hospital environment. These factors include defining the role of massage therapy in a medical healthcare facility; providing education to staff and patients; having excellent clinical skills; engaging in hospital activities; and utilizing business skills. To successfully build a hospital-based practice requires vision, commitment, and engagement in various professional activities. Define the Role of Massage in a Multidisciplinary Team
The multidisciplinary healthcare model is commonly used in hospital settings so that all of the patients' needs are addressed. Although there are variations depending on the specific needs of the patient and the organization, a hospital team generally consists of a physician, nurse, physical therapist, and an occupational therapist. Other healthcare disciplines such as social work, psychology, speech pathology, and nutrition are brought on board as indicated. In this context, what is the role of massage therapy in the care of patients? What unique elements does massage therapy bring to the table so that care is enhanced, but duplication of services is avoided?
That answer depends on a number of factors, including the type of hospital and the population base. The approach taken at St. John's was to have a clear understanding of the scope of practice and the specific role of each discipline. To establish the presence of massage therapy meant identifying the special skill set brought forward by massage therapy into the present system. For example, emphasizing a holistic approach to patient care involved assessing and treating non-injured areas or compensatory structures. Along those lines, massage therapy can facilitate the healing process by decreasing stress, anxiety, pain intensity, and/or improve sleep (duration and quality). Lastly, the specialized palpation and manual skills of massage therapists was recognized in context of scar massage, manual release of soft-tissue restrictions, and manual drainage techniques for swelling reduction and management. Massage therapy also became recognized as an important pain management strategy. Although not an exhaustive list, it is an example of how the specific role of massage therapy can be defined within a multi-disciplinary team setting. Educate Your Clients
Education and knowledge are powerful tools. Educational initiatives about massage therapy were of high importance at St. John's, especially in the early stages of creating the program. Many conventional hospital clinicians and physicians expressed uncertainty about the integration of massage therapy, as they related it to a spa service and were unfamiliar with massage practice in a hospital setting. Through in-house seminars, presentations, newsletters, and brochures, the staff of St. John's was introduced to and educated about the profession of massage therapy. The scope of the session included regulation, education, benefits of treatment, indicators and contraindicators to massage therapy, and the specific role of massage therapy in a multidisciplinary context. In addition, through one-on-one conversations, massage therapists were able to speak to case-specific questions. The availability of massage therapists to take the time and speak to individual therapists, nurses, and doctors--introducing themselves and being visible in the various departments on a regular basis--contributed to the development of clinical relationships and trust with the various teams involved in patient care. The result: open lines of communication were established and referral numbers began to increase. Due to the high value of providing staff, patients, and the community with current information about massage therapy, various educational initiatives are an ongoing and regular activity for all of St. John's massage therapists.
Research articles can also be a key tool for educational purposes. It is vital that what you outline as a benefit or indicator is supported by research studies, since evidence-based practice is the gold standard with this crowd. As the area of research on massage therapy continues to grow and evolve, new research findings need to be highlighted and shared with the various disciplines with which massage therapists interact. Become a Hospital Clinician
The knowledge and skill level of the massage therapist is vital for effective treatment provision. Postgraduate education, which supports the development of hands-on skills, is very important. Excellent clinical skills should encompass assessment, clear identification of short- and long-term goals, the ability to develop an appropriate treatment plan, and determining the particular techniques appropriate to specific tissues or conditions. These skills not only result in excellent treatment provision, but they also demonstrate the clinical competency of the therapist.
The use of validated outcome measures (see Outcome Measures, see page 37) is a fundamental aspect of outcome-based practice. It enables other clinicians and physicians to identify the therapeutic outcomes and benefits of the massage intervention in a language that is shared by all healthcare professionals. In order for massage therapy to be integrated in any degree in a hospital setting, use of outcome measures and evidence-based practice must be a key component.
Hospital-based clinicians are involved in various activities, in addition to direct patient treatment, including completing various medical reports (discharge reports, assessment reports, progress reports), participating in family meetings and weekly team rounds, and handling administrative tasks such as documenting daily workload. It was the experience of the massage therapists at St. John's that participation in these activities further solidified the presence of massage therapy as a clinical discipline integrated into patient care.Establish Hospital Involvement
When the massage clinic was first implemented at St. John's, our therapists' involvement on various hospital committees, objective groups, accreditation teams, advisory councils, and interest groups ensured that the discipline of massage therapy was represented and visible on a hospital-wide level. Such professional involvement enables massage therapists to interact with various clinical, administrative, and management groups in numerous capacities, and establishes the presence of massage therapy as a stakeholder of the hospital, gives a voice to the profession, and further enforces the presence of massage therapy as an important aspect of healthcare provision.
Professional activities that go above and beyond hands-on treatments can be invaluable since they contribute to the reputation and public awareness of a clinic and its massage therapists.Be Business Savvy
Since massage therapy is not covered by Canada's public healthcare plans, the massage clinic is a revenue-generating source and operates as a business. With any business venture, large or small, a business plan is key in order to identify the strategies, goals, timelines, marketing and promotion, and various aspects of a business, in addition to hands-on treatment provision to build a successful clinic.
Basic knowledge of how to run a small business and how to develop a business plan is a tremendous asset to any individual who takes on the task of developing a revenue-generating clinic in a hospital. Most local colleges offer workshops on how to write a business proposal and plan--a worthwhile investment.
There are a few key business considerations that have a strong impact on the practice of massage in a hospital. First, negotiate with the proper parties whether massage therapists are salaried employees or independent contractors (there are pros and cons to both). Second, decide whether massage therapy is integrated into a hospital program or unit, or is a stand-alone, independent clinic. Also consider whether you want to work with a specific patient population. Third, consider how massage therapy will be financed by the patients or clients. Fourth, since patients cannot be solicited, the use of promotional tools and materials to inform and educate should be explored and clearly defined. And lastly, clearly outline what type of administrative support you will require (i.e., secretary for booking appointments and other clerical work) and it will be provided by the hospital or whether it needs to be organized independently.Rewarding Environment
During its existence, the Massage Therapy Clinic at St. John's has grown, as reflected in the number of working massage therapists, the variety of internal programs from which patients receive massage therapy, and the volume of patients referred internally and externally. The hospital-based practice has evolved as a direct result of the massage therapy team providing excellent treatments, interpersonal skills, and flexibility and adaptability in responding to various demands and changes. Most importantly, the recognition and support of the management team and clinical disciplines at St. John's Rehab Hospital was imperative in the growth and presence of the massage therapy profession in the hospital environment.
Developing a specialized niche for the practice of massage therapy in a multidisciplinary context can be challenging. However, having the opportunity to work with a team of talented and caring individuals who are open to exploring new therapies and approaches and interacting with patients is incredibly rewarding. Being part of such an environment is a constant reminder of why one chooses to become a therapist and be involved in the provision of healthcare. Anna Kania holds a bachelor of science degree in biology and has worked as a registered massage therapist in a hospital setting for the last six years. She recently applied her scar massage skills to work in Cambodia with burn patients. In addition to clinical work, Kania has published articles, is an educator, and plans to begin graduate studies in Community Health in September 2007. Contact her at firstname.lastname@example.org.Notes
1. "Table Talk," Massage. www.massagemag.com/News/2006/January/Hospital.php. (accessed July 13, 2006).
2. St. John's Rehab Hospital is a medium-sized rehabilitation hospital providing a specialized multidisciplinary, patient-centered approach. It is a leading burn rehabilitation center in Canada that also provides inpatient and outpatient care for neurological conditions, complex traumas, organ transplants, and amputee patients. The Massage Therapy Clinic at St. John's was established in 1999 and was formally integrated into the Back on Track program, an outpatient rehabilitation program providing specialized, multidisciplinary therapy to amputees, burn survivors, and other complex trauma patients.