Canadian Association of Occupational Therapists

Becoming an employer of choice: A workplace solution to recruiting and retaining occupational therapists
by Claudia von Zweck

Occupational therapists have a long-standing reputation as being “hard to recruit.”  Problems recruiting and retaining occupational therapists are reported by employers across Canada – in urban locations as well as in rural and remote areas. The reasons are complex and remain largely unexplored in the recent research literature. There are serious gaps in both what we know about Canada’s health human resources and in strategies to address the education, supply and distribution of the Canadian health work force (Commission on the Future of Health Care in Canada, 2002).

Shortage of occupational therapists
The root of problems with recruitment and retention appears to lie in an overall shortage of occupational therapists. While there are wide variations in the supply and distribution of occupational therapists in Canada (Canadian Institute for Health Information, 2001), even provinces such as Quebec that have a high number of occupational therapists are reporting severe shortages. In the only available recent comprehensive survey on the supply and demand of occupational therapists conducted in Canada, it was identified that in order to satisfy current and projected vacancies in physical medicine positions alone, Quebec requires a twenty percent increase in the number of occupational therapists (Québec Santé et Services sociaux, 2002). Factors such as early hospital discharges, an aging population, technological advances, a more educated public and heightened concern for quality of life have lead to an increased role for occupational therapy within the health system. In addition, approximately five per cent of occupational therapists leave the profession annually through attrition (British Columbia Health Human Resources Advisory Committee, 2002; Salvatori, Williams, Polatajko, & Mackinnon, 1992) and many occupational therapists are migrating away from traditional health care roles. Occupational therapy is a diverse profession with expanding practice areas in many sectors outside of health; for example in education, employment and community development (Manojlovich, 2002). The availability of third-party funding for occupational therapy services has increased these opportunities. The number of CAOT members in private practice has grown from three to 25 per cent in the last decade. Over 50 per cent of CAOT members now have at least one source of third-party funding for the services they provide (Canadian Association of Occupational Therapists [CAOT], 2002a).

Workplace factors
While shortages in the supply of occupational therapists offers a partial reason for recruitment and retention problems, workplace factors also appear to play a significant role. In the past decade, occupational therapists have experienced a growing disparity between professional practice demands and the work environment. Huge changes in the health care work environment in Canada have occurred since the early 1990s. These changes have been driven by cuts in health spending, with massive organizational restructuring and increased emphasis on the bottom line. CAOT members reported that their work environment has become more reflective of the conditions most frequently cited by occupational therapists in the research literature as reasons for leaving a job – lack of resources, lack of staff, unrealistic workloads, lack of professional prospects and lack of professional status (von Zweck, 2003; Jenkins, 1991; Rugg, 1999). Occupational therapists are working in less secure contract, casual and part-time employment, often facing high caseloads with stringent productivity demands and scarce resources for service provision and professional development. Frequently occupational therapists are supervised by other health professions and within such structures they report few opportunities for professional support and leadership. Such interprofessional relationships can be problematic owing to role confusion and competing priorities (Atwal, 2002).

The professional practice demands for occupational therapists have also changed. Health professionals face heightened accountability for providing cost-effective, efficacious health services. The flattening of organizational hierarchies and increases in community-based service and private practice require health practitioners to be autonomous and able to juggle clinical and administrative responsibilities. Research-based practitioners are needed that are able to integrate the quickly growing knowledge base of occupational therapy into practice and base service delivery on the best available evidence. Continuing competency requires an ongoing commitment to professional development (Coulthard, 2002; CAOT, 2002b).

Occupational therapists consistently rate the intrinsic qualities of their work as most important, work values such as the opportunity to develop their skills and abilities, the ability to contribute to a worthwhile endeavour, opportunity for decision-making, positive interaction with peers, effective supervision and demonstrated respect (Sutton & Griffin, 2000). While the work values of occupational therapists are compatible with professional practice expectations, these same values also can create vulnerability for burnout, a syndrome characterized by emotional exhaustion, depersonalization and reduced personal accomplishment that can lead to reduced job satisfaction and attrition (Schlenz, Guthrie, & Dugeon, 1995). Work pressure, caseload size and the amount of overtime performed on a weekly basis are significant predictors for burnout (Browne, 1992).

Employers of choice
Innovative and meaningful strategies that address the professional practice needs of health professionals can be used to become an “employer of choice” to attract and retain occupational therapists. Effective recruitment requires a proactive approach that recognizes desired job features and maximizes the unique benefits of the workplace in a way that responds to those features. Occupational therapists are attracted to positions that offer variety with good working relationships and realistic workloads (Jenkins, 1991). Professional freedom, workload diversity and lifestyle are particularly attractive to persons who work in rural and remote locations (Polatajko, 1986). Recruitment incentives need to address professional practice needs such as mentoring for newer graduates, continuing education opportunities and appropriate staffing and resources. Occupational therapists should be involved in the recruitment and hiring process to ensure that role expectations are clear and realistic and support workers are used appropriately to assist in the provision of occupational therapy services whenever possible.

Many formal mechanisms exist to help employers share information about job openings and become known as an “employer of choice.” These mechanisms include advertisements in professional journals, web sites and job fairs. While using a diversity of methods to convey information is necessary, peer contact has been demonstrated to be the most effective method of obtaining new recruits in occupational therapy (Smith, Schiller, Grant, & Sachs, 1995). Enthusiastic and satisfied staff can serve to validate the “employer of choice” workplace (New Brunswick Association of Occupational Therapists, 2002). Profiling staff involvement in visible activities within the profession such as in professional development activities, quality improvement initiatives, committee work, conference presentations and journal publications can promote a supportive and progressive image of the employer. Involving staff in the education of students can advance the image of the workplace among persons entering the profession (Crowe & Mackenzie, 2002). Student fieldwork placements have been demonstrated to influence career choices and change negative attitudes toward particular work environments (Gilbert & Strong, 2000).       

Magnet hospitals
The concept of “magnet hospitals” was developed in the 1980s in the U.S. as a method to attract and retain nursing staff during an acute nursing shortage (Kramer & Schmalenberg, 1988a). Strategies in magnet hospitals were directed to provide a work environment that supports a model of professional practice emphasizing organizational and clinical autonomy and effective interdisciplinary teamwork. Initiatives included de-layered organizational structures, all RN staffing, increased staff-per-patient ratios, professional development opportunities, salary versus hourly wage payments and flexible health care delivery models to meet patient and staff needs. Magnet hospitals demonstrated positive outcomes such as increased nursing staff retention, improved patient satisfaction, decreased mortality, heightened nursing job satisfaction and better workplace safety (Sullivan-Havens & Aiken, 1999).

Workplaces wishing to become an “employer of choice” can learn from these experiences to develop shared organizational values that recognize staff as key strategic resources. In such organizations, individuals are valued for their autonomy and ability to contribute to consistently high standards of service. Teamwork is based on mutual trust, respect and recognition. Services are planned and organized with clear definitions of roles and responsibilities and managed to ensure they are necessary, appropriately resourced, supported, reviewed and improved. Clear, flexible and integrated processes are in place to facilitate communication, decision-making and action (Kramer & Schmalenberg, 1988a, 1988b).

Success of these strategies for recruitment and retention of staff is not dependent upon more money or resources, but on strong and visionary leadership (Gleason-Scott, Sochalski, & Aiken, 1999). Leadership is required at the senior executive level but also within individual professions to help practitioners develop and maintain a strong sense of professional identity. This is particularly important in small professions where other professions dominate in size and can lead to imbalances in power, influence and opportunity. These potential problems may be mediated by facilitating networking and information sharing within as well as between professions, inviting and recognizing the contributions of different health practitioners in decision making and implementing competency rather than credential-based criteria for selecting candidates for career advancement opportunities.

There are no quick-fix answers to the complex issues that underlie problems with the recruitment and retention of health professionals. Long-term, integrated strategies involving professionals associations, educators, governments and employers are needed to ensure the availability of an adequate supply of appropriately trained and competent health practitioners. However, strategies to make a workplace an “employer of choice” can lead to both career satisfaction for the practitioner and the attainment of coveted organizational outcomes for the employer, including less difficulties in recruiting and retaining staff.

Acknowledgements
The author would like to thank Sandra Bressler who provided input for the development of this article.

About the author
Claudia von Zweck, M.Sc. is the executive director of CAOT. and can be reached by e-mail at: cvonzweck@caot.ca or 1 (800) 434-2268, ext. 224.

References
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