Can interprofessional practice solve the vexing question of 'What is occupational therapy'?

Abstract

The sustainability of health services globally is under increasing pressure with a rise in chronic conditions, an ageing population, ageing workforce and increased fiscal, safety and quality issues. One important strategy acknowledged to address these pressures is greater collaboration between health professions, often described as interprofessional practice (IPP) or collaborative practice. While many health professionals believe they already engage in IPP, in reality they are working alongside each other within their own professional silo (World Health Organization, 2010). The continuation of this siloed way of working impacts the occupational therapy profession, particularly evident in the lack of understanding of how occupational therapy contributes to the health of individuals, communities and the health system. Few people, including those with whom we work, understand what constitutes occupational therapy (Alotaibi, Shayea, Nadar & Tariah, 2015). Without that understanding, members of the health professional team are not able to appropriately refer to our services, or include occupational therapy in the delivery of care. An evident lack of understanding of the role of occupational therapy frustrates occupational therapists and denies clients access to services and achievement of their occupational goals (Britton, Rosenwax & McNamara, 2015; Keesing & Rosenwax, 2013). It also impacts the status of the profession, job satisfaction and retention (Moore, Cruickshank & Haas, 2006). Limited understanding of other professions not only impacts occupational therapy; health professionals generally do not fully understand the scope of practice, knowledge, skills and core values of other professions (Aguilar, Stupans, Scutter & King, 2014). Without this understanding, effective IPP is not possible. IPP does not just happen. It is widely recognised that interprofessional education (IPE) is needed to build staff capacity/capabilities for IPP. The World Health Organization defines IPE as ‘occurring when two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes’ (World Health Organization, 2010). Many Universities have embedded IPE into health curriculum including two-thirds of Universities in the UK (Barr, Helme & D'Avray, 2014) and 85% of Universities in the USA (Greer, Clay, Blue, Evan & Garr, 2014). Unfortunately the same cannot be said for Australia and New Zealand. A recent review indicated that while 80% of the universities stated they had IPE in the curriculum, only 24% met the definition of IPE (Lapkin, Levett-Jones & Gilligan, 2012). This lack of IPE and IPP extends beyond universities and into student fieldwork placements. Even when IPP experiences are reported to occur during placements, the majority of these entail tutorials and education sessions (Davidson, Smith, Dodd, Smith & O'Loughlan, 2008) rather than structured learning experiences where students are facilitated to learn about, from and with other health professionals, clients and carers. Health students need to be provided with opportunities for IPP, particularly as it happens rarely within Australian health settings. Based on our experiences, students provided with such opportunities demonstrate increased valuing of teamwork, confidence in sharing expertise, trust and respect for other professions, altered stereotypical views and appropriate referrals. Additionally, having experienced IPP, clients cite high satisfaction with their care (Brewer & Stewart-Wynne, 2013). Our experiences include a training ward, dementia unit, primary schools, integrated primary care health facility, aged care, rehabilitation, mental health and an international service learning programme running for the past decade. While barriers exist to imbedding IPE and IPP, they should not be accepted as an excuse to persist with our current siloed approach to health education and practice. Universities have a responsibility to prepare our graduates to be leaders and agents of change to better meet the needs of the community (Frenk et al., 2010). Based on our experiences, we believe that IPP can help address the vexing question of ‘What is occupational therapy?’ By learning about, from and with each other, there is the opportunity to understand and experience the breadth, depth, values and scope of occupational therapy and other professions. With IPP as the norm, health professionals, clients and carers will be much better situated to work in partnership with occupational therapy.