If you're looking for innovation, regulatory authorities need to change

One of the challenges facing the physiotherapy profession today is not so much what the future might be, but how to get there.

Innovation requires creativity and imagination; going beyond oneself and the limits on what might be possible.

Georges Bataille called this transgression, and his work explores why our moral codes are set 'here' and not 'over there'.  His writings concentrate on some of most sensitive topics, particularly to do with sex, because, he argued, it's here where we choose to apply some of our most stringent social conventions and norms.  Bataille's idea was that we need to explore ways of thinking and being that are far beyond our present boundaries of convention if we are to see where our present level of tolerance lies.  It's hard to see it without doing this.  But from this new position, where everything is inconceivably gross and offensive (and if you read Bataille you'll see what I mean), it's at least possible to ask 'why do we think this is the right place for our moral threshold, and not somewhere else?' (See suggested readings below).

To imagine an alternative future for physiotherapy - one that will meet the needs of 21st century cultural, economic, political and social reform - we may need to perform the same kinds of transgression, through acts of creative thinking and practice.

The problem is that such acts require, perhaps even demand, that we go beyond the current rules about what is permissible.  But this means that regulatory authorities and professional boards come into conflict with the profession's imperative to change, because their role is first and foremost to protect the profession's vulnerable margins; to police the fringes of the profession for border incursions from other professions, or 'breaches' from within.  They secure the written word on what physiotherapy is, not what it might become.

Every profession needs forms of regulation, not least to make it easier to identify what the profession is and is not.  No profession could survive without some boundaries.  But in circumstances where change is needed, regulatory authorities need to have mechanisms that allow their influence to be softened: to fade into the background a little, and to allow purposeful, thoughtful, critical extrusions in the fabric of the profession to occur.

If a regulatory authority is allowed to construct an iron curtain around the profession, it forces people who want to explore the possibilities for an otherwise physiotherapy to leave and go elsewhere.  Not only is this a terrible waste of a talent and years of public investment, it also restricts physiotherapy to an image of yesterday.

On the other hand, a regulatory authority that is too porous, and allows anything to pass across the profession's threshold, risks losing the profession's sense of identity and, with it, the understanding and trust of the public, its partners, and its funders.

What is needed now then, perhaps more than ever before in our history, is a profession that is more amoeboid than box-like; more permeable than impregnable; more yielding and less resistant to transgressive, inconceivable, even silly ideas, and for that we need our regulatory authorities to play their part and quietly step out of the way.

Readings

Bataille, G., Botting, F., & Wilson, S. (1997). The Bataille reader. London: Wiley-Blackwell.

Nicholls, D. A., & Holmes, D. (2012). Discipline, desire, and transgression in physiotherapy practice. Physiotherapy Theory and Practice, 28(6), 454-465.

Noys, B. (2000). Georges bataille: A critical introduction. London: Pluto Press.

Williams, S. J. (1998). Health as moral performance: Ritual, transgression and taboo. Health:, 2(4), 435-457.