F E AT U R E
Building a workplace culture of occupation-based practice in a tertiary health service Jennifer Wort, Matthew Thorpe, Zoe Ellis, Danielle Hitch, Karen Kessner and Sue Giles
O
ccupation is the foundation of our profession’s unique expertise and contribution to care. Despite the challenges of the past three years, the profession has continued to support “the right of all people to engage in the occupations they need to survive … and that contribute positively to their own wellbeing and the wellbeing of the communities”1. The key to our ability to uphold these rights for our consumers is our commitment to occupation-based practice.
However, it can be difficult in practice to enact our fundamental values and principles, and long acknowledged barriers to occupation-based practice cause both frustration for therapists and suboptimal outcomes for our consumers2. The importance of occupation-based practice is especially urgent in tertiary care settings, as occupational therapy is the only health profession focused on occupation in relation to the person and their environment. However, the fast-paced and medicaloriented nature often leaves therapists providing reductionist or abbreviated services. This disconnect between our ambitions and realities potentially distresses staff, impacting recruitment and retention. For more than a decade, the Occupational Therapy department of Western Health in Melbourne has worked to sustain a culture of occupation-based practice by developing strategies that ensure occupation remains at the centre of everything we do. This commitment to occupation-based practice has informed the culture of the 20 otaus.com.au
department, and data from internal focus groups suggests it has contributed to the engagement and retention of staff. By sharing our strategy, we hope to provide colleagues around Australia with examples to draw upon in their own practice.
Why occupation-based practice?
In the Australian context, Di Tomasso et al characterised occupation-based practice as having “occupation as the foundation within the assessment, intervention and evaluation phases of the occupational therapy process”3. A key characteristic of occupation-based practice is its deep integration or embedding within daily practice, which is combined with accountability or governance processes that allow us to remain ‘true’ to its espoused values. Consistent evidence of its presence should be explicit within professional documentation, and in the language used by OTs with their colleagues and consumers. Explicitly enacting occupation-based practice can enable opportunities for consumers to engage in authentic occupations, which enhance their engagement in therapeutic processes4. It can also help to identify instances of ‘gap filling’, where OTs take on generic tasks and roles that don’t make the best of their unique skills and abilities. Greater clarity around what is and isn’t within the scope of OTs can prevent the dilution of their contribution to tertiary healthcare, enable clinicians to work more effectively at the top of their scope5 and have a positive influence on recruitment, retention and workplace wellbeing.
Our occupation-based strategy
Western Health is committed to empowering and supporting our clinicians to be occupation-based practitioners. To act on this commitment, the following multidimensional strategy was developed from Wilcock’s dimensions of ‘doing, being, becoming, and belonging’6, supported by our Senior Leadership Team and the Culture Committee. The strategy was also founded on the Sustainability Wheel7, which is an evidence-based assessment tool for embedding sustainability into process. The strategy aims to clearly communicate the unique contribution of occupational therapy to care, and counter frequently heard claims that it was “just like physio” or “just common sense”. Doing occupation-based practice The Sustainability Wheel7 provided a framework for developing occupationbased practice activities within Western Health. There are four elements to the wheel – fostering commitment, clarifying expectations, building momentum for change and instilling capacity for change. Existing activities were mapped to each element, along with gaps in the current approach that required further development. Using this tool, it became apparent to the team that doing occupation-based practice involves operating within four interdependent domains: Education, Communication, Demonstration and Evaluation. As shown above in Figure 1, Western Health now has specific strategies and tools to enable doing across all areas of our service.
