How Institutional Readiness Impacts Everyday Practice: An Experience in Agility
Occupational therapists work in settings requiring agility and flexibility to ensure appropriate and beneficial service delivery. My capstone experience with a contract therapy company necessitated a swift change in deliverables due to organizational readiness for change.
During the planning for the capstone experience, the contract therapy company appeared willing and able to investigate the question: What is the role of occupational therapy when focusing on client psychosocial factors to improve the overall quality of life for clients in traditional practice settings operating under a medical model?
During the on-site needs assessment and data synthesis using the Transtheoretical Model of Change (TMC) (Prochaska et al., 1994, as cited in Merryman et al., 2020) revealed an additional underlying question: When faced with organizational barriers to program development and implementation, what is the role of occupational therapy practitioners to facilitate change through meaningful deliverables?
To guide the process of knowledge generation and translation, the Knowledge to Action framework (Graham et al., 2006) guided the capstone experience with concepts of a needs assessment (Flecky et al., 2020) integrated into the knowledge inquiry phase and the TMC used during synthesis.
On-site data involved four stakeholder groups: corporate leadership at the contract therapy company, contract occupational therapists, administrators at a contract site, and site residents. Occupational therapist data gathering involved an electronic survey, a one-time focus group, individual interviews, and observation of occupational therapy sessions. One-on-one interviews provided data from corporate leadership, contract site administration, and contract site residents. Additional data came from reviewing internal and external documents, such as clinical frameworks and company newsletters.
Gathered data informed a comprehensive, multi-tiered needs assessment which revealed an incongruence in change valence and change efficacy among stakeholders at the contract therapy company regarding psychosocial programs. Data synthesis for each stakeholder group used a SWOT analysis, drawing attention to barriers in organizational readiness to implement psychosocial programs developed as part of the capstone experience. Notably, the contract company’s current clinical model and culture appear at odds with psychosocial programs.
During synthesis, data from each stakeholder group was evaluated using the TMC, resulting in multi-tiered deliverables congruent with each stakeholder’s place in the change cycle. All resources and deliverables incorporated quality of life, psychosocial concerns, and advocated for expanding the role of occupational therapy within each group. Stakeholders from the contract therapy company indicated that deliverables would go to practitioners immediately and recommended actions discussed at the next leadership team meeting. In contrast, the administration at the contract site noted that they felt validated, and that the provided and suggested resources would inform future program/policy development. Feedback on deliverables indicated that targeting the resources for each user group was successful. Meeting each stakeholder in a client-centered manner enabled the provision of deliverables within the medical model to address client psychosocial needs and readiness for change.
This material provides an example of one approach to reframing challenges into opportunities in response to perceived barriers in readiness to implant programming. This work advances the profession and practice of occupational therapy within medical model settings where organizational readiness impacts program implementation.
Capstone PosterReferences:
Graham, I. D., Logan, J., Harrison, M. B., Straus, S. E., Tetroe, J., Caswell, W., & Robinson, N. (2006). Lost in knowledge translation: time for a map?. The Journal of continuing education in the health professions, 26(1), 13–24. https://doi.org/10.1002/chp.47
Merryman, M. B., Heatwole Shank, K., & Reitz, M. (2020). Theoretical frameworks for community-based practice. In M. E. Scaffa, & Reitz, S. M. (Eds.) Occupational therapy in community and population health practice (3rd ed., pp. 38-58). F.A. Davis.
Flecky, K., Doll, J., & Scaffa, M. E. (2020). Program planning and needs assessment. In M. E. Scaffa, & Reitz, S. M. (Eds.) Occupational therapy in community and population health practice (3rd ed., pp. 73-93). F.A. Davis.
