Do you sometimes get to the end of your workday as an OT and think, “Wow, why did that take so long!” Maybe you’ve got lots of different quality improvement ideas in mind, but you’re not sure where to start. Well in this newsletter I’ll help you embrace your inner OT Nerd, throw back to your uni days, and use an OT process framework to pinpoint some areas of your service provision where you can make some improvements.

The framework we’re using is the Canadian Practice Process Framework – does it look familiar?

Let's get started!

Action Point 1. Enter/initiate

In this step, the OT reviews the referral, gathers background information, and ensures that occupational therapy services are appropriate. If we do it well, we capture the clients who need our services, and don’t waste time ‘ticking a box’ for those who don’t.

We’ll kick off with an example from a hospital setting – the ‘blanket referral.’ This means everyone admitted to a particular ward or with a particular condition gets seen by an occupational therapist. I’ve worked in plenty of wards where this has been appropriate, but also in wards where I felt our time could be better spent. I’m talking about those situations where we see everyone on the list, but about 20% didn’t really need us. We would review their medical file, see they were independent with self-care and back to their baseline function, but still go and complete our initial assessment because we had to, only to confirm ‘Yep, they are fine.’

If you’re in this situation, consider this approach. Collect some data – how many patients did you see that you didn’t really need to? How many minutes of your day was spent reviewing notes, seeing patients and documenting for these referrals? And how accurately could you predict from a brief file review, that you weren’t really needed? You don’t want to make drastic changes to your practice based on a gut feeling, but if the data suggests it may be a good decision, it’s worth considering.

Action Point 2. Set the stage

This is all about establishing a good rapport with your client from the start. Having clear communication, setting expectations and explaining your role clearly can all make a difference with how smoothly the therapeutic relationship will run.

In this example I’ll shift to the private sector; let’s talk about NDIS service agreements. If you think about some of the most common awkward or challenging situations that arise in an NDIS caseload, how many could be traced back to not spending enough time explaining how long things take, what we’re doing when we’re not with the client that we actually bill for, or outlining what we can realistically achieve? My guess is plenty.

But a clear service agreement, which you actually take the time to talk through with your client in your first meeting, could avoid these situations. Ensure your agreement has a clear description of how many hours you require to deliver a service, what your cancellation policy is, and have transparent billing procedures. Talk it through and give them an opportunity to ask questions so you are sure they understand. This time spent up front could save you from stress or hours of unpaid work trying to meet unrealistic expectations.

Action Point 3. Assess/evaluate

In this phase we are OT detectives. We use interview, observations and standardised assessments to determine our client’s barriers and enablers to optimal function.

In this example imagine you’re an OT working in a community aged care role. Your information gathering involves lots of interview questions and observing functional activities, followed by recording all of this valuable information into your clinical notes. You spend time handwriting notes during your visit, then spend more time typing up the same information as part of your progress notes, then again as the beginnings of a report.

If this is you, it may be time to embrace AI and claim some of that time back. With the right software (choose something that meets all the privacy regulations) and client permission, you could switch on a transcription feature that captures the audio from your session and turns it into SOAP notes for you. Or you could brain dump your thoughts in the car between appointments and let AI create a draft progress note for you to edit, instead of typing everything yourself. It can take some investment in time and brain space to use AI efficiently, but you’ll get that time back.

Action Point 4. Agree on objectives/plan

In this step we use our information gathering to form some client-centred goals and put together a plan for how we will achieve them.

This can be an exciting step, but if you’re a hospital OT, it could also be a frustrating one. Say you’re working with 80-year-old Mrs Smith to get her home safely after an admission to manage lower limb cellulitis. You quickly work out she’ll need a shower chair and toilet frame to be ‘safe for discharge’ but you also identify lots of other areas where an OT could make a difference. She could do with some minor mods for her bathroom to make it safe long term. She finds it hard to prepare her meals because her hand arthritis is causing her pain, and she’s given up knitting because she’s finding it hard to focus due to her cataracts. But you know as a hospital OT with 10 other clients to screen or see that day, that you won’t be able to help with all those things.

This can be a challenging feeling to sit with – seeing a need, but knowing it was outside your scope to address it. But what if you knew exactly who could help? What if you had a database of other public health services, volunteer or charity organisations, or other private services that you could refer on to and know that Mrs Smith would be in good hands? Often there are services out there that can help, but we don’t know they exist. Sounds like a great idea for a student project to me…

Action Point 5. Implement the plan

This is the fun bit – we work with our client to implement our therapy plan and start working towards helping them reach their goals. We take an evidence-based approach to ensure what we have in that plan will be effective.

In this scenario you’re a sole trader OT who has submitted an assistive technology application for your NDIS client, only to have the planner knock your recommendation back and say what you have recommended is not likely to be ‘effective and beneficial’ for your client. You know they’re wrong, but do you know the evidence to back your reasoning up?

One way to feel confident the next time this happens is to find ways to keep up-to-date with the latest research evidence in your clinical area. Identify the clinical practice guidelines that are relevant (sometimes you need to look internationally) and make sure you know what’s in them. Learn how to do a basic database search so every now and then you can see what new studies have been published. And even better, make it a habit to chat with other OTs about the evidence – the Your OT Tutor Journal Club could be just what you need to make this happen 😉

Action Point 6. Monitor/modify

This step happens once we start implementing our therapy plan. We should be constantly asking, “Is this working?” and making adjustments if it’s not.

This time you’re a new grad OT working on some cooking skills with your young adult client. One day you stop and realise you’ve been working with the same clients for months, and while they’ve been making progress, you wonder if there could be a more effective way to deliver the therapy plan.

This is exactly what you should be thinking! Instead of you coming for fortnightly sessions, have you considered how you could enhance the carryover of your strategies between your sessions? Could you upskill their support worker to implement the strategies when they come to help with meal preparation? Could you start to wean down the frequency of your sessions and replace some of them with an Allied Health Assistant instead, so their funding stretches a bit further? Sometimes you need to be actively looking for ways to work yourself out of a job!

Action Point 7. Evaluate Outcomes

In this step we evaluate whether the client’s goals have been achieved, and whether we should set new ones or move towards discharging them from our service.

In this example we’ll head back to the hospital setting. This time you’re in an outpatient hand therapy clinic working with clients with chronic conditions like arthritis. Many of your appointments are spent delivering the same education on splint use, joint protection and activity modifications. The waitlist is long and funding is tight, so you’re only able to see each patient once or twice. So how and when do you find out if that education actually led to meaningful improvements in function?

For all the OT nerds out there, you’re right to feel excited – this is the perfect opportunity for a quality improvement project! Set aside some time (or better yet, get some OT students on board to help) and map out your plan. Find ways to test your client’s knowledge – how much could they remember a month down the track? Find out how satisfied your patients were with how you delivered the education, and get their ideas for whether different delivery methods should be considered. Then use what you found out to create a sustainable system where the effectiveness of your education is evaluated routinely.

Action Point 8. Conclude/exit

Finally we’ve arrived at the final step – our client’s have achieved their goals and now it’s time to say goodbye.

Hopefully it’s all gone to plan and the parting is a happy one. But sometimes it won’t be. Sometimes you decide you’re just not the right OT for your client. Every time you see their name in your inbox or your missed calls list you get anxious. You’re spending way too much time jumping to fix their ‘emergencies’ and now your other clients are not getting the opportunity to work on their own goals. And the stress of having to defend or second-guess every decision you make is no longer sustainable.

When you’re in a situation like this it can be hard to think clearly, but having a ready-made “toolbox” of strategies you can draw on can help. Strategies could be booking in a session with a supervisor, using Chat GPT to script your ‘time to cease services’ email to your client with the right content and tone, and having a ready-made list of other OTs you could suggest so they aren’t left to start again without a little direction.

If these examples have inspired you to look at your own service provision step-by-step, why not check out the Your OT Tutor Alliance. We covered all these examples and more, in much more detail, as part of this month’s workshop on how to streamline your services using the CPPF. It’s available on-demand now alongside hours of other CPD content exclusive to YOTT Alliance members. Or if you’re super excited and keen to get started, but need some one-on-one help to help you identify what aspect of your service provision to work on first, send me a DM and I’ll tell you how I can help!

P.S. If you found this newsletter helpful, check out the rest of the Your OT Tutor website and subscribe to the mailing list or sign-up for the Learning Library – there are heaps of resources, courses, and CPD opportunities, with more being added regularly. Or go all out and join the Your OT Tutor Alliance and become a better OT who loves what you do!

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