THE CHANGE AGENT ROLE OF OCCUPATIONAL THERAPISTS: TOWARD FURTHER ACTIONS? Annie CARRIER, OT, BA (psy), LLM, MSc
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, Andrew FREEMAN, OT, PhD , Mélanie LEVASSEUR, OT, PhD , Johanne DESROSIERS, OT, PhD 3,4
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1,2
1. School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke 2. Research Centre on Aging, Health and Social Services Centre – University Institute of Geriatrics of Sherbrooke (CSSS-IUGS) 3. Departement of Rehabilitation, Faculty of Medicine, Université Laval 4. Research team on the personal, organizational and social interrelationships of work, La Vieille-Capitale Health and Social Services Centre
INTRODUCTION • In order to optimize access to healthcare services and promote health, occupational therapists (OTs) act as change agents1 • Change agent: important yet challenging role2 • To meet this challenge: critical to better understand the nature of this role2
OBJECTIVE To describe the change agent role of OTs
METHODS • Scoping study3 of the scientific literature from January 1975 to February 2012 • Search in legal and organizational (n = 2) and health sciences (n = 7) databases including Medline and CINAHL • Keywords varied according to databases and included Advocacy • Extended strategies: manual search of bibliographies and grey literature • To comprehensively map the change agent role and because of paucity of documents specific to OTs, French- and English-language articles that described this role of health professionals in general were included • Contextual and qualitative data were respectively extracted and analyzed using descriptive statistics and thematic analysis4 • Results were then linked to the Profile of Practice of OTs in Canada1
• Two change agent configurations were identified: global (Figure 2) and clinical (Figure 3). • Change agent role and competencies described in the Profile of Practice1 relate to both configurations (Figure 2 and 3, in capital) • Acting as a change agent: - Global: an opportunity to seize - Clinical: an obligation inherent to being a healthcare professional - Closely linked to promoting the profession and professional autonomy → raises ethical and legal dilemmas (e.g., promoting professional services for the benefit of clients, not the profession’s interests; reconciling right to services of the population with right to services of individual clients)
• The change agent role is multi-facetted and varies according to: aim pursued, clients involved, context of achievement, and actions used • Therefore, acting as a competent or proficient change agent requires familiarization and mastery of a variety of actions • In light of this scoping study, OTs’ Profile of Practice1: - Lacks description of specific actions to undertake as a global change agent - Offers a restricted description of aims and actions to undertake as a clinical change agent - Offers no guidelines to address ethical and legal dilemmas that might arise
Figure 2. The global configuration of the change agent role
Figure 3. The clinical configuration of the change agent role
Context
Context
MACRO-LEVEL
MICRO-LEVEL
(Society)
(Clinical setting)
IMPLICATIONS FOR OCCUPATIONAL THERAPY PRACTICE • For clinicians: Identify actions according to global and clinical configuration and determine the ones you are already comfortable with2 and master and those requiring further training • For educators: Develop change agent role of OTs by addressing global and clinical configurations in entry-level and continuing education • For researchers: Explore potential ethical and legal conflicts associated with the change agent role and develop tools to support OTs’ decision-making and actions in this role
CONCLUSION • The change agent role encompasses two configurations, global and clinical, each operating at a different level, according to aims and clients, leading to distinct actions • Better understanding these configurations is important to inform OTs about possible actions to optimize their change agent role
REFERENCES 1. Canadian Association of Occupational Therapists [CAOT] (2012). Profile of Practice of Occupational Therapists in Canada. Author: Ottawa. 2. Finlayson, M. L. (2013). Muriel Driver Memorial Lecture 2013: Embracing our role as change agents. Canadian
FINDINGS • Documents (n = 43; Figure 1) were most frequently: theoretical articles (n = 33; 76.7%); published during the last 10 years (n = 30; 69.8%); from the United States (n = 25; 58.1%); and nursing (n = 20; 46.5%)
Aims: I HEALTH AND SOCIAL JUSTICE, including ACCESS TO SERVICES
Global Configuration
Figure 1. Findings from scoping study strategies n=302
n=193
documents found
rejected
n=109
Clients
COMMUNITIES AND POPULATIONS retrieved for further analysis
Actions • Asking questions • Assuming a formal duty in an advocacy group • Discussing with and making demands to politicians • Giving or collecting funds • Giving public speeches • Making phone calls • Promoting research results • Using media • Writing
Aims: INFORM, SUSTAIN AND PROMOTE DECISION-MAKING Protect civil rights Resolve ethical dilemma
Journal of Occupational Therapy, 80(4), 205-213. doi: 10.1177/0008417413499505 3. Arksey, H. & O’Malley, L. (2005). Scoping studies: Towards a methodological framework. International Journal of
Clinical Configuration
Clients
INDIVIDUALS AND GROUPS
Social Research Methodology, 8, 19-32. doi: 10.1080/1364557032000119616
Actions • Discussing with the client to understand his / her values and provide information about rights and options • DISCUSSING WITH AND MAKING DEMANDS TO COLLEAGUES AND MANAGERS • Whistleblowing • Writing records and charts systematically and accurately
4. Braun, V. & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77-101. doi: 10.1191/1478088706qp063oa
ACKNOWLEDGMENTS The authors wish to thank • for her helpful comments, Prof. Catherine Régis, Faculty of Law, Université de Montréal; • for their financial support, the Canadian Institutes of Health Research (CIHR), the Fonds de la recherche du Québec - Santé (FRQ-S), the Canadian Occupational Therapy Foundation and the Réseau provincial de recherche en adaptation - réadaptation of the FRQ-S.
For more information §
[email protected]
n=14
documents (extended search strategies)
n=80
rejected
n=43
for final analysis
Graphic design: Christian Audet, Bureau des communications, FMSS, Université de Sherbrooke
