When you’re at university, you learn that the OT process has a clear start, middle and end. At the end, before you discharge the client from your service, you’re supposed to evaluate the effectiveness of the service you provided.

But how often does this happen?

There are many barriers to follow-up and evaluation. Sometimes there’s no funding. Other times the client says no – they either think they are “fine” so don’t feel the need to get you back, or sometimes they aren’t impressed with our work and they don’t want a round two!

While it’s easy to write-off these missed evaluation opportunities as just the nature of the systems we work in, or something that’s not a big deal, there’s actually a lot that is lost when we fall into the autopilot trap of just assuming it’s too hard, instead of doing everything in our power to try to make it happen.

In this article I’ll outline what those losses are, then point you to where you can go to get some help with making your evaluations a reality.

The loss felt by clients

This is the obvious one. Plenty can go wrong for a client if we’re not there to check-in later. Here’s some examples…

Spending thousands of dollars of funding on OT assessments and reports to have a high-cost piece of equipment delivered, only to have it sit in the corner of the spare room as a glorified dust collector or spare clothes holder.

Often it was the lack of follow-up that meant proper training wasn’t provided, so the person wasn’t confident to use it. Or there was something that wasn’t setup quite right, and it was too uncomfortable to use. Or they decided the equipment was to big and ugly, and the OT wasn’t there to support them to see the extra opportunities that came with using the AT, that may have meant these aesthetics weren’t a dealbreaker.

In this case the client loses not only the funding, but the opportunity to have their functional difficulty solved, and often with no option to try again because the funding scheme only gives you one shot at getting the prescription right.

Or what about the client who committed months to ongoing capacity building sessions to build their meal preparation skills, only to suddenly decide it was too hard and they weren’t getting any better at it.

A good capacity building program has monitoring and evaluation built into the sessions themselves, not something that is saved for a final assessment at the end. The value of evaluating with standardised tools or objective data that demonstrates to the client that they are making progress, even when that progress is small steps only, shouldn’t be underestimated.

Maybe for this client it would have been enough for them to keep trying because they weren’t too far away from a break through. Or it could have helped the OT realise that something wasn’t working, so they could pivot before it was too late.

The loss felt by clinicians

Imposter syndrome is something that is becoming increasingly common for OTs, for both experienced and new graduate staff. I’ve had a few conversations with OTs and their managers lately which makes me think that lost opportunities for evaluating our services is contributing to this.

The first example was a new grad who thought she was skipping over the assessment part of the OT process and jumping to prescribing pieces of AT from a checklist of favourite items in her head. When we unpacked the situation though, this wasn’t the case at all; she had actually just become so good at the type of equipment prescription she was doing, that she was doing it on autopilot.

But she couldn’t see this immediately because she wasn’t formally evaluating her prescriptions to know that she was nailing it. Her clients were happy – they liked the AT and their functional difficulties were solved, but she didn’t realise this until she was prompted to think about it. If we evaluate our service provision on a regular basis, it could be the hidden secret to unlock a new wave of confidence. It could provide the proof that we know what we’re doing, and are doing things well, even if the caseload still feels challenging.

The flip side is that without follow-up, there’s no opportunity to identify what you could be doing better. Not all OTs have imposter syndrome; some have a little too much confidence because they’ve never followed-up their service provision to see that it all fell apart after they left.

An example could be that they delivered a one-hour education session to their client on sleep hygiene. They thought they nailed it – they covered 20 strategies, and the client smiled and nodded at the end. But if they had gone back to evaluate how well that education worked, they would have found that the client didn’t use any of those 20 strategies because brain fog kicked in after the OT started explaining strategy number 3, and the paper handout left at the end was too overwhelming and boring to try to figure out themselves.

Going back to evaluate that service provision would have taught the OT a valuable lesson (hopefully!) about whether they should try a different approach for their next education session.

The loss felt by the profession

Unfortunately, often the culmination of many missed opportunities for evaluating service provision ultimately hurts the profession. Missed opportunities for evaluation means OTs aren’t able to fix mistakes or fine tune recommendations that weren’t optimised, so OTs start to be talked about as money-hungry people who charge too much and don’t even do a good job to start with (Facebook groups can be brutal for hearing these opinions!). We know this is not the case, but we’ve also all heard a story where an OT could have done better, and I wonder how often in these cases it only comes to this because the evaluation step was missed.

When we don’t formally evaluate our services, we also make it harder on ourselves as a profession when advocacy submissions are needed. Our justifications for fairer pay centre around the costs of running a business, rather than on highlighting the value for money our services actually provide, and often this is because we don’t have the data on a large scale to demonstrate this.

Yes, there are plenty of case studies where an AT prescription reduced the need for funded support worker hours, or a series of capacity building sessions allowed the person to maintain stable employment so they could contribute financially to society, but we aren’t capturing these outcomes on a large scale. I’m not suggesting doing so would be easy, but it is much easier to at least start with each clinician doing a better job of evaluating the services they provide to each client they work with.

My final thoughts…

This article has probably been a bit of a downer for some to read, so I wanted to finish on a positive note. These scenarios don’t apply to all OTs. There are many OTs out there doing brilliant work with setting meaningful goals, planning and delivering services that are efficient and effective, and they’ve even mastered how to capture their outcomes and present them in a way that clients and funders will care about.

And if you’re still reading and thinking, “I could do better with this…” then that’s a perfectly OK place to be too. You’ve identified there’s something you could be doing better, so now you can do something about it.

I’ve got a few options to help you get started:

1.Read my blog on tips for measuring outcomes - https://yott.au/blog/b/start-measuring-outcomes

2.Sign-up for my new course “Measuring outcomes to prove our value” – it goes through goal setting, monitoring progress and presenting outcome data in an effective way (perfect for any NDIS OTs who deliver capacity building programs). https://yott.au/measuring_outcomes

3.Come along to my workshop at the Australian Assistive Technology Conference in Melbourne in November. I’ll be covering practical ways to overcome barriers to AT follow-up, so you can start capturing outcome data without the overwhelm: https://aatc2026.com/

Or if you want some 1:1 help, send me a DM and I’ll help you work out where to start. There’s always room for improvement. Acknowledging the gap and looking for ways to address it – even when there’s no quick fix – is the starting point.

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