#OTalk 14 July 2020 – Exploring the impact of COVID-19 on occupational therapy practice.

This weeks #OTalk is being hosted by Katy Williams (@Katy_WilliamsOT) and Paul Wilkinson (@PaulWilkinson94) both of whom are part of the Year One: Thriving Not Surviving project team. Katy is newly qualified, currently working at Gloucestershire Royal Hospital on a rotational post. Paul is also newly qualified, working at South Tees Hospitals NHS Foundation Trust on a rotational post. We are both extremely interested in exploring the changes to practice which have occurred during the Covid-19 pandemic and their impact upon the profession moving forward. 

Unprecedented, unchartered, the new normal, phrases that have shot into common parlance over the last few months, along with key worker, frontline and hero. Behind every use of these words lies a personal story. Triumph in the face of adversity, tragedy, a story of renewal and even, at times, moments of laughter. Personal accounts of living and working through a unique moment in global history. A time we will undoubtedly start to mark as pre and post COVID. 

The media has been full of stories of the heroism of people working on the front line. The country has come together to support our courage, bravery and self-sacrifice. However, this generic narrative is challenged by many of the personal stories that are starting to emerge from those working in health and social care. 

Some occupational therapists have indeed experienced working ‘on the front line’ in life and death situations either in their role as occupational therapists or in roles to which they have been deployed.  Across the profession as a whole however, the experiences are more varied. 

None of us could have envisioned that one of the challenges of our career paths would be playing a role in a worldwide pandemic. Covid-19 has influenced services, procedures and the way we practice. Some of us have been continuing in our usual roles experiencing a reduced case load whilst others have started new jobs or rotated into new specialties. Those in managerial positions have been challenged by a level of logistics they may never have faced before and those leading our profession have been required to lead through completely uncharted territory. The majority of us have been required to adjust considerably our mode of practice. 

Whilst responding to the daily situation we continue to find ourselves in, it is easy to lose sight of the path travelled on a personal level. Due to the service focused values of health professionals the focus tends to be outwards with less attention being paid to self-care and personal wellbeing. Add to this the backdrop of responding to the impact of the pandemic on home life and taking time to reflect, make sense, heal and recharge, for many, has been at a premium.

We started working on the Year 1 Thriving Not Surviving project at the start of the pandemic. Many of our plans have had to be adapted but over the last three months but we have found support in sharing our COVID-19 experiences. It’s been interesting to learn how occupational therapists working in different environments and different parts of the country are responding to the pandemic. 

This led us to think about extending the conversation into an OTalk, which is what we hope to achieve in this talk. A chance for a community to come together and share this experience. The questions we will be exploring are:

  1. How has Covid-19 impacted on your role & the way you practice? 

  1. What have been your biggest challenges during Covid-19?

  1. What have you done to promote/manage your own wellbeing during Covid-19?

  1. What are the important things have you learnt about yourself and the way you practice during the COVID-19 pandemic?

  1. What changes to practice have occurred that you hope will remain? 

#OTalk Research 7th July 2020 – Patient and Public Involvement (PPI) in OT Research

Like all shifts, it wasn’t an overnight change, but gradual and perhaps clearest to see on reflection. When I first started getting involved with patient and public involvement (and patient leadership), many conversations felt like persuading researchers ‘why’ they needed to involve and engage patients and the public in their work. In recent years, most conversations have moved on and are more often initiated by researchers asking about the ‘how’, and it’s the ‘how’ to make PPI meaningful, impactful and effective that I want to explore with OTs in this chat! 

After being asked by Jenny to host this chat, and saying a very enthusiastic yes, the next obvious  thing to do was to talk with people who live with health conditions and are involved in research about what questions they feel are important to pose… Although I have plenty of experience as a patient and patient leader, none of which are invalidated by being an OT student, it felt important get other perspectives, and practice what I preach! 

So in conversations with Tina Coldham (@TinaColdham), Carol Liddle (@LiddleCarole) and Natasha Liddle (@NatashaGarswood), we talked about the range of positive and challenging experiences we’ve had as patients involved in research, including making it meaningful, appealing and being respectful to those we are ‘engaging’. 

Many of our experiences and perspectives are summed in this letter (hyperlink to https://onlinelibrary.wiley.com/doi/10.1111/hex.13087) by e-patient Sara Rigarre (@SaraRiggare) and colleagues very recently published in the journal Health Expectations, in response to a paper on PPI in research studies, in terms of PPI as an approach underpinned by person-centred values rather than isolated actions within a research project. 

And these are the questions that we’d like to use to stimulate some healthy debate on Tuesday 7th July! 

Questions 

  1. How can we engage and use PPI in our research as OTs? 
  2. How can we make the language and activities of PPI in research more relevant to the person on the street?
  3. How can you bring the national standards for PPI to life, to make PPI in your research meaningful throughout the research process? 
  4. What transferable skills do we have as OTs that lend themselves to supporting PPI?

Just in case you need a reminder about the ‘why’, here are some of the key references regarding PPI in research for OTs. It’s a core part of the higher levels of the Evidence, Research and Development Pillar in the RCOT Career Development Framework:

Facilitate the involvement of service users, staff and/or students to co-design and co-produce aspects of research and/or service development with more experienced colleagues.” (RCOT, 2017, pg. 44)

The first of 10 key principles underpinning the RCOT Research and Development Strategy 2019-2024 is: 

“The individuals, groups and communities that we work with are at the core of occupational therapy practice, and the effectiveness and efficiency of service delivery are at the core of this R&D Strategy. RCOT expects people who access occupational therapy services not only to benefit from the evidence base underpinning practice, but also to play an active role in shaping research to develop new knowledge in line with national standards for public involvement in research.” (RCOT, 2019, pg. 9)

Indeed, the RCOT are already working with service users, patients and clients as key stakeholders in setting the research agenda for occupational therapy via their Priority Setting Partnership with the James Lind Alliance. 

Within healthcare research more generally, the NIHR have collaborated with many stakeholders to develop the UK Standards for Pubic Involvement in Research, which are a great place to start to think how to embed these principles across all aspects of health and care research. 

Anya de Iongh (@anyadei) is a first year pre-registration OT MSc student at UEA. Having been diagnosed with a number of health conditions in her early twenties, she got heavily involved in research as a patient leader, inspired by a gang of emerging patient leaders (see The Patient Revolution by David Gilbert, 2019, to get inspired yourself!) and having met OT and PPI research guru, Claire Ballinger. Her roles within the world of research have included working on research projects around nursing staffing with Wessex CLAHRC and online patient feedback with a team at Oxford University, as a PPI representative reviewing funding bids as part of a regional NIHR panel, and as Patient Editor at the British Medical Journal. 

References

Gilbert, D. (2019) The Patient Revolution: How We Can Heal The Healthcare System, Jessica Kingsley Publishers 

RCOT (2017) The Career Development Framework: Guiding Principles for Occupational Therapy. Available at: https://www.rcot.co.uk/sites/default/files/CAREER_FRAMEWORK.pdf

(Accessed: 18 June 2020) 

RCOT (2019) Royal College of Occupational Therapists’ Research and Development Strategy 2019-2024. Available at: https://www.rcot.co.uk/practice-resources/rcot-publications/royal-college-occupational-therapists-research-and-development-strategy-20192024 (Accessed: 18 June 2020) 

RCOT (2020) Setting the research agenda for occupational therapy, Available at: https://www.rcot.co.uk/setting-research-agenda-occupational-therapy (Accessed: 18 June 2020) 

NIHR (2019) UK Standards for Public Involvement in Research. Available at: https://drive.google.com/file/d/1U-IJNJCfFepaAOruEhzz1TdLvAcHTt2Q/view (Accessed: 18 June 2020) 

#OTalk 30th June 2020: Community Stroke Rehabilitation

This weeks chat is being hosted by the Stroke Forum of the Royal College of Occupational Therapists- specialist section neurological practice. They will guide a discussion on this rehabilitation, joined by national leaders in the field.

Here’s what Louise Clark @louiseclark15 has to say:

Never before has rehabilitation had a higher profile: with stroke rehabilitation featuring as a priority in the NHS long term plan; the  right to rehabilitation movement; and the focus on recovery after the COVID-19 pandemic, as we identify those who didn’t present to hospital and those discharged very rapidly.

The majority of services now have established ESD services, based on a wealth of strong research evidence, demonstrating ESD to be one of the most powerful post stroke interventions, as well as releasing significant savings across the system.

However ESD is aimed at those with mild to moderate impairment post stroke, with little evidence regarding rehabilitation outcomes and service models for those with more significant post stroke disability.

As the NHS long term plan is implemented, identified sites around the country will be developing the rehabilitation evidence base for all patients post stroke. Now is the time to better understand our patients needs and wishes, our service structure, unmet need and to dream big for community stroke rehabilitation.

Join us on Tuesday 30th June between 8-9pm to be part of the discussion.

#OTalk 23rd June 2020: TECS – button ‘n’ box and beyond

This weeks host is: Deb Knowles (@Debbieduckie). Here’s what she has to say on this week’s topic:

Technology Enabled Care: beyond button and box

I’m an occupational therapist working in Technology Enabled Care/Assistive Technology, commissioned to a county council to provide a service for reablement and those with long term needs (Care Act,2014). We use traditional telecare equipment with falls detectors, pendants, smoke and CO either as standalone or monitored services through a call centre – service users either provide their own responders or we have a response service. We use a strengths and assessment based, outcomes focussed approach and have access to a contact list of equipment and can source special equipment to meet identified needs.

 

As part of our commitment to prevent, delay, reduce services we consider equipment beyond the original scope of traditional telecare eg: artificial intelligence, activity monitoring and app based technology.

 

Here are some of the questions she’d like to discuss:

 

  1. What is your experience of TECS/AT?

 

  1. How can traditional telecare be used more innovatively?

 

  1. Considering TECS as an upstream intervention, what outcomes would you like to see being met?

 

  1. How do you see new technology eg Alexa supporting prevent, delay and reduce?

 

  1. What technology would you like to see in the future to support meaningful occupation?

 

 

 

#OTalk 16th June 2020 – Leadership? What me!

This week Natalie Jones @natlouj and Dee Christie @OTinretirement will be hosting this what they had to say. 

growth mindset

In 2018 Karin Orman RCOT’s Lead Professional Advisor posted a blog about Leadership in Occupational Therapy, challenging us ‘to think differently about how we grow leadership within the profession and to start thinking about ourselves as leaders.’ Karin hits on an issue which is important to me. “We may have, in many areas of practice, lost our traditional management structure but that does not have to mean we lose leadership within the profession”. 

I recently wrote an article about this in OTnews (Jones 2019) describing my voyage into professional leadership. This challenge from Karin resonates with my experience of therapy management structures. Over the last ten years we have moved towards integrated teams and allied health professional leadership has taken root. Which means single profession line management is no longer the ‘norm,’ you are more than likely to be managed and led by someone from another professional background and this brings both challenges and new opportunities. Occupational Therapists that don’t have a professional led talk about ‘not having a voice’, or the ‘OT voice is not loud enough’.  This makes it more important to think about and reflect on opportunities to lead and influence, regardless of the organisational structures you work in.

It’s no accident that the 3rd pillar of the RCOT Career Development Framework is leadership. It starts at entry level where newly qualified OTs can act as role models to promote the profession and find ways to lead by sharing their unique contribution to occupational therapy. Right through to level nine where executive leadership is described as ‘Lead and influence the political and economic

climate, locally, nationally and internationally, which impacts on service delivery’.  The last column in the framework is titled ‘mind-set’. It’s this word that I would like us to reflect on in today’s #OTalk. 

What is a leadership mindset? Do you have one? You might recognize the traits in yourself or others? It’s interesting to reflect firstly on ‘what does a good leadership mind-set look like?’ You will have positive roles models that have influenced your career, you will have also experienced the converse and perhaps can describe what this looks and feels like. It’s worth taking some time to explore what qualities and values you would like to lead with? Once you have identified these you can then think about creating opportunities for yourself to develop your skills and knowledge aligned to your leadership aspirations, thereby creating ‘the leadership mind-set’. 

All too often I have observed excellent Occupational Therapists at all levels in their career, that have a lack of self and professional confidence. Despite the apparent evidence of competence, the imposter syndrome (IS) hits.  Chris Lake describes imposter syndrome (IS) in his blog on leadership and self-doubt. https://www.leadershipacademy.nhs.uk/blog/leadership-doubt-and-humility/

“You’ll remain convinced that you do not deserve the success you’ve achieved, dismissing this as luck or fortuitous timing”. Psychologists might describe the phenomenon as ‘failing to internalise your accomplishments, unable to believe that you yourself are deserving of the position you’ve achieved’. How often have you brushed off a complement? Chris offers some tips for when IS strikes, ‘believe that it’s normal and look around the department at those you admire, and know they’ll experience this too’. 

If you identify with imposter syndrome, how do you build personal and professional confidence so that you feel able to take leadership opportunities when they come along? What tips do you have to share with others about how you have overcome the nagging and disabling self-doubt? If you were mentoring yourself on leadership mind-sets and building self-confidence ‘what would you tell yourself’? If you’re not able to hold up the mirror and do some self-reflection, what about getting a leadership mentor?  A mentor with the experience, skills and knowledge to provide you with constructive feedback and a friendly listening ear. They don’t need to be from the same profession as you. A mentor is someone who will nurture you as a leader, help you see different perspectives and at times help you wrestle with the imposter syndrome monster who lives under the bed. I have had several mentors and role models which haven’t been Occupational Therapists, however they have brought to the relationship many other skills, qualities and experiences that were valuable and supported my leadership development. 

Perhaps you are already on the leadership journey and can share with the #OTalk community some examples of ways in which you have developed as a leader? What strategies have you tried and tested in your leadership journey so far? 

What opportunities are there for you to experience leadership in your role. Novel and new opportunities open you up to situations and people you would normally not get exposure to. What about trying a ‘shadow board’ where you emulate an executive board with peers using the same papers and have your own ‘mini’ board to experience what the conversations might be like and explore new points of view? These experiences could add richness to your leadership development, gaining new skills and knowledge. 

Occupational Therapists are natural problem solvers and with a dash of creativity I’m sure you can contribute ideas for others about how to develop learning opportunities and environments, which will be added value to the leadership voyage. So, if we put our collective brains together, can we come up with some new and novel activities for continuing professional development, to enhance leadership skills and knowledge?

There have never been more opportunities for Occupational Therapists to move into leadership roles. From leading a Band 5 peer support group, to pioneering in a new and emerging roles, to AHP Director roles in the NHS and Principle OT roles in Social Care. Stuart Palma, Head of Allied Health Professions (professional leadership) at NHS England and NHS Improvement produced some recommends that the NHS starts to explore having Chief AHP within their organisations, creating greater visibility at board level. There are already OTs taking up these positions. https://improvement.nhs.uk/resources/investing-chief-allied-health-professionals/  we must be ready!

So why is ‘mind-set important in leadership? A growth leadership mind-set is a belief that you can change, develop and improve your leadership skills. Research has shown that those with a growth ‘mind-set’ are mentally prepared to take on challenges, adapt to feedback and adopt effective problem-solving’.  As a leader I am continually learning and motivated towards self-improvement. Mastering leadership skills to create a toolbox which helps with mental preparedness when engaging with new and difficult situations. I am opening minded about taking opportunities that don’t always come with the ‘OT’ job title. Stepping out of the professional comfort zone is a risk, but it can work out to be the best risk you ever took. Last year I took an opportunity to work in an integrated care system workforce hub, to support workforce innovation and development This was completely different to anything I’d ever done before but I found my self-utilising every skill in the tool box labelled ‘leadership’. I managed to influence the development of Occupational Therapy roles in primary care, which resulted in a primary care network employing an OT for a frailty project. A ‘small change’ which I hope will have a ‘big impact’ and ripple effects for years to come. 

Experience of leadership coaching has taught me that taking time to reflect and explore my own leadership mind-set is a good starting point for a developing leader. Opportunities for OTs to be ‘loud and proud’, have their voice heard and be present in the room are abundant but we need to first of all create ‘a leadership mind-set,’ to be able to grasp and seek out these opportunities.

This #OTalk is in collaboration with Dee Christie Chair of the Elizabeth Casson Trust. https://elizabethcasson.org.uk/about-us/ The trusts strategic intensions include helping to develop leaders in occupational therapy with the capability of taking the profession forwards within the context in which it needs to operate. The Elizabeth Casson trust considers leadership within the profession to be the ability to envision, articulate and clearly demonstrate by example the scope and benefits of occupational therapy to individuals and society as a whole thereby positively promulgating the profession to as wide an audience as possible”.

Questions 

  1. what does good leadership ‘mind-set’ look like? 
  2. How do you build personal and professional confidence so that you feel able to take leadership opportunities when they come along?
  3. What strategies have helped you develop as a leader? 
  4. What novel activities have you used as part of your continuing professional development to enhance your leadership skills and knowledge? 

Why is leadership such a hot topic for occupational therapists right now? Karin Orman 23rd of April 2018 https://www.rcot.co.uk/news/why-leadership-such-hot-topic-occupational-therapists-right-now 

Jones, N (2019) The Voyages of Professional Leadership. OTnews 27(11): 22-24.

 Chief Allied Health Professions Officer’s Team (2017) AHPs into Action. Using Allied Health Professions to transform health, care and wellbeing. Available at https://www.england.nhs.uk/wp-content/uploads/2017/01/ahp-action-transform-hlth.pdf (accessed 26 March 2019).
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Faculty of Medical Leadership and Management (2018). Barriers and enablers for clinicians moving into senior leadership roles. Available at https://www.gov.uk/government/publications/clinicians-moving-into-senior-leadership-barriers-and-enablers (accessed 7 January 2019).
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Royal College of Occupational Therapists (2017) Career Development Framework: Guiding Principles for Occupational Therapy. London: Royal College of Occupational Therapists. Available at www.rcot.co.uk/careerdevelopmentframework (accessed 27 February 2019)
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