This much anticipated plenary session, delivered by Dr Duncan Pentland, launched the Royal College of Occupational Therapists’ new publication Occupational therapy and complexity: defining and describing practice. This publication serves as a revision to Occupational therapy defined as a complex intervention (Creek 2003).
The work of Creek is widely used by practitioners and students alike, however 15 years have now passed since this seminal work was published, and we all understand that healthcare is constantly changing and evolving. Our NHS today is continually seeking new ways to improve the delivery of care, alongside advancements in technology, research and treatment modalities.
Our NHS tomorrow will be different to what it is today. In response, this publication seeks to define and describe contemporary occupational therapy against the back-drop of the ever-changing face of global health and social care. Additional objectives were the creation of a new model of contemporary occupational therapy, and the identification of how this aligns with the concept of complex interventions.
Duncan gave an overview of the methodology and process of the project. To examine multiple perspectives of occupational therapy, three different data collection methods were employed. This included a literature review of 256 papers published between March 2015 and October 2016 describing current practice, a survey of practitioners, educators and students and online focus groups.
Within the model, occupational therapy is defined as a complex and dynamic process undertaken to enhance the health and wellbeing of people. Context is a key focus within the model, with the proposal that occupational therapy is based on the causal assumption that the “doing” of occupations facilitates change within the components of person(s)-in-context.
This context is dynamic across the lifespan of an individual, influenced by lived experience and functional capabilities. Equally important are therapist(s)-in-context, used in plural to represent how an individual may encounter a number of occupational therapists across their life course. Occupational therapy interventions can be viewed as the shared context that occurs when person(s)-in-context and therapist(s)-in-context join together. Contexts work in synergy and the changes that occur restructure the person-in-context.
Within the model, intervention context is formed by implementation content and mechanisms of impact – the wide variety of strategies that occupational therapists use to deliver therapy and the causal factors we understand to facilitate change. On average, an occupational therapist will use 11 different types of practices and approaches with an individual client. Therapeutic changes can be either expected or unexpected, forming transitions or therapy outcomes. It is important to note how this process continues dynamically across the life span for both the individual and therapist alike – their life course has been altered by their experiences of the occupational therapy process. These processes play out against the foundational backdrop of the overall macro-context – which includes environmental, political, technological and global influences. Duncan warned how models do not always explain how therapeutic processes will occur, rather they seek to explain how therapeutic processes may ensue.
Duncan concluded the session by leaving us with the thought that occupational therapy is complex, because people are complex. It is clear that occupational therapy is indeed a complex intervention. Wider theories on complexity have illuminated how complex processes cannot be understood by looking at the individual components, they must be examined as a whole. This is known as systems thinking. As Occupational Therapists we are inherently systems thinkers – we understand the human body to be formed from multiple systems and sub-systems, furthermore the occupational therapy models we use to shape our thinking and practice are comprised of interactive systems. The implementation of boundaries are necessary to examine systems, however this can result in the loss of something significant. Holism is embedded with our core philosophy – herein lies the future challenge for the occupational therapy workforce to describe and explain our practice.
A copy of the full publication, Occupational therapy and complexity. Defining and describing practice, can be downloaded for free by members from the RCOT website.
Written by Cathy Roberts – @CathyARoberts