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Hi Karen, A long time ago I have worked in England and recognize your system. In fact I have introduced the LE gym sessions in the form of post total hip and total knee surgery clients that are stable in our OP department here in Canada. Previously all client were seen until discharged by individual therapists, now once stable, go into a group where a therapist attends to needs with an assistant utilizing various stations. I am not sure why you would see your spine and shoulder conditions in a gym and vise versa LE conditions in cubicles where appropriate. Perhaps that could be your solution. Any patient can be seen anywhere where best suited (cubicle or gym) and still establish LE conditions that are similar in groups. I think you have some therapist do only gym and others only cubicle? Get rid of that and make all do all conditions. If you need to run groups of conditions in a gym, make that rotational e.g. therapist A from 8 - 10, therapist B from 10 - 12 etc. Good luck, Please feel free to write me again. I have a lot of challenges in my OP department Maarten Supervisor PT At 07:08 PM 6/29/02 +0100, you wrote: >Hello, >Within our musculoskeletal team at a district hospital, we have a >department setting with individual cubicles where spinal and upper limb >conditions are treated. We also have a large gym where the lower limb >conditions are seen. The majority of physio's work within the department >setting. We are having problems with case mix, deskilling, poor morale and >poor communication due to the 'divide'. > >Could people let me know how a similar situation is managed in their >hospitals? > >Many thanks > >Karen Fechter >Senior I Physiotherapist