September / October 2000 Table of Contents
In this Article
External challenges to the content of work rehabilitation practice
Meeting the challenges of work rehabilitation practice
Institutional / organizational issues
by Lynn Shaw
Work rehabilitation is a challenging area of practice for occupational therapists since it requires therapists to develop an understanding of the diverse and somewhat opposing needs of individuals and organizations. In many cases, external institutional pressures have led to therapist job dissatisfaction, and for some, an exit from this area of practice. This article explores how a client-centred approach can be used to address some of the current challenges in enabling occupational performance in work rehabilitation.
External challenges to the content of work
rehabilitation practice
Recent challenges in work rehabilitation practice appear to be mainly rooted in organizational and institutional changes. For example, many workplaces have experienced widespread organizational change. In the past decade employees were required to adjust rapidly to new jobs, technologies, and cultures, and subsequently, to employ a variety of new skills. Work-related stress among employees has increased and organizations are now experiencing higher incidences of workplace accidents and absenteeism due to stress (McShane, 1997). Subsequently, occupational therapists had to gain an appreciation of the multidimensional factors involved in organizational change to be effective in facilitating return to work and reducing work place injuries.
Institutional challenges also contribute to content changes in work rehabilitation practice. The economic boundaries and rules of government policies and programs have limited not only the rehabilitation resources available to the consumer (Crichton & Jongbloed, 1997) but also the realm of return to work practice for therapists. For example in 1998, the Ontario Workplace Safety and Insurance Board (WSIB) return to work policies limited functional capacity reporting requirements to a one-page form and capped reimbursement rates. Similarly, other insurance and litigious institutions demanded shorter and more succinct reports of only the pertinent information for managing the claimants' case or a return-to-work program, and preferred two-day functional assessments versus long-term vocational assessments. A domino effect began where the scope of work rehabilitation practice was determined by external agencies, rather than by evidenced-based rehabilitation practices. Therapists became limited to addressing clients' objective physical/cognitive work capacity. Imposed practice limitations increasingly became a source of frustration for many therapists. Some therapists chose to leave due to their inability to engage more actively with clients in the return-to-work process.
Meeting the challenges of work rehabilitation
practice
In reflecting upon the changes to work rehabilitation, I asked myself how should occupational therapists respond to the many challenges in this area of practice? Should we walk away or embrace these challenges as opportunities to re-focus and re-examine our values and purpose in work rehabilitation? As a client-centred profession we have much to offer our individual, group and organizational clients. It was suggested elsewhere that many of the solutions to current challenges may in fact lie within our own theories and understanding of enabling occupation (Townsend & Dick, 1998). The complexity of enabling occupational performance within an organization may be simplified by understanding and using the Canadian Model of Occupational Performance (CMOP) (CAOT, 1997). The CMOP assists the therapist in identifying the relevant person-occupation-environment issues and guides the therapist in implementing the client-centred approach needed to comprehensively address occupational performance of both persons and organizations. The remainder of this article will describe how therapists can utilize the CMOP as a framework to both respond to and manage external challenges in work rehabilitation practice. A case example from industry is used to highlight the challenges of organizational change.
Case Example
An occupational therapist was hired to assist employees with back, shoulder and neck problems to return to work. In addition, the therapist was requested to educate staff at risk of further injury on preventative strategies. The organization's occupational performance goal was to have all customer service representatives (CSR) staff work productively and in a safe manner while in a standing position. The CMOP was used as a guide to identify the inter-relationships of the workplace environment, the work processes (occupations), and the person-related issues that contributed to the occupational performance problems. A collaborative approach involving input and knowledge exchange among employees, managers and therapist was used and this dialogue resulted in the following occupational performance issues:
Occupation-issue
A recent merger required staff to perform CSR jobs in a standing position rather than sitting. All previous CRS workstations had been altered to accommodate a standing posture.
Institutional/organizational issues
- The newly merged organization wanted to adopt a professional image for the CSR role. Part of achieving this image required a cultural shift - all customer service representatives must accept the change and adopt standing work postures.
- Increased incidence of musculoskeletal injuries.
- The staff expressed dissatisfaction with the transition to standing, and the lack of support in managing the change from sitting to standing.
- All staff complained of neck, shoulder or back pain throughout the day.
- The staff on health leaves wanted to come back, but they were unsure of their ability to stand without re-aggravation of their problems.
The intervention: A collaborative process
Resolution of the performance issues in this situation required a multi-dimensional, client-centred approach. Recommendations for achieving the organizational goals of enabling the occupational performance of the CSR's included; the negotiation of employee involvement, implementation of strategies by managers to enable organizational change, development and delivery of education programs, and establishment of individualized return to work plans.
Initially, an organizational/socialization response to encourage employee acceptance of the new culture and professional image was implemented by management. Organizational resources were then provided to facilitate employee transition from a position of resistance, to one of exploration and commitment to the new organizational visions and culture. 'Employee involvement' was adopted as a part of the strategy to develop employee commitment to the new ideas of the merged organization (Dirks, Cummings & Pierce, 1996). Management acknowledged their role in enhancing commitment to organizational values and culture by directly involved employees, and in consultation with the therapist, planned and developed an education program and a socialization program for CSR employees. Further, as part of the individualized return to work programs, returning employees participated in the education programs delivered by co-workers.
In this example, a client-centred approach was used to foster organizational support and employee involvement throughout the decision-making processes. Ultimately, this lead to employee commitment to the new culture, to educating each other on the use and adoption of healthy workplace practices for occupations requiring standing, and to a reduction in workplace injuries.
The use of the CMOP enabled the therapist to identify the complex interplay of issues that contributed to poor occupational performance resulting from an organization faced with the challenges of managing change. Additionally, it provided an opportunity that can only be viewed as exciting for occupational therapy, since it required the therapist to explore and expand their work rehabilitation knowledge and practice beyond person-centred issues to include organization-centred issues.
References
Canadian Association of Occupational therapists. (1997). Enabling occupation: An occupational therapy perspective. Ottawa, ON: CAOT Publications ACE.
Crichton, A., & Jongbloed, L. (1998). Disability and social policy in Canada. North York, ON: Captus Press.
Dirks, K.T., Cummings, L.L., & Pierce, J.L. (1996). Psychological ownership in organizations: Conditions under which individuals promote and resist change. Research in Organizational Change and Development, 9, 1-23.
McShane, S.L. (1998). Canadian Organizational Behaviour. Toronto, ON: McGraw-Hill.
Townsend, E., & Dick, J. (1998). Using enabling occupation in daily practice. CAOT National Newsletter, 15(2), 9.
L.E. Shaw B.Sc.O.T., M.Sc.O.T.(c) is a Ph.D. Candidate in the Rehabilitation Science Doctoral Program at the University of Western Ontario, London, Ontario, Canada. Lynn has 15 years experience in work rehabilitation practice as a clinician and as an occupational health administrator. Lynn can be contacted at leshaw@julian.uwo.ca.
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