Practice Style Research Articles

Perceptions of leadership styles in occupational therapy practice

PurposeLeadership is a critical topic in healthcare because of its influence on direction and culture. This study aims to measure perceptions of leadership styles amongst occupational therapy clinicians. The study also sought to identify any significant differences between the perceptions of clinician groups, compare findings with established norms and explore associations between leadership styles and outcomes.Design/methodology/approachA cross sectional, descriptive study method was used, using the multifactor leadership questionnaire 5X (MLQ-5X) to survey occupational therapists working in physical and mental health clinical services in Australia. Descriptive statistics were used to address the aims of this study.FindingsA number of significant differences in leadership perceptions were identified between junior and senior clinicians, however, very few differences were detected between the physical and mental health settings. The scores provided by participants were consistently lower than those reported for geographically relevant norms, with the majority on or close to the 40th percentile. A significant relationship was found between transformative leadership and outcomes, and a strong relationship between contingent reward and outcomes. However, the negative relationships between other leadership styles and outcomes reported in other studies were not found.Research limitations/implicationsTransformational leadership, and some aspects of transactional leadership, are used in occupational therapy. The career stage has an impact on how leadership behaviours are perceived. The MLQ-5X could enable a consistent approach to research into healthcare leadership, and the exploration of whether these findings are generalisable beyond the Australian context.Practical implicationsCareer stage may be a more significant influence on leadership perception than service setting, and efforts to develop leadership in occupational therapy should focus on both transformative and transactional leadership. Perceptions of occupational leadership from all areas of the workforce are important to understand, given their potential impact on workplace behaviour, career progression, recruitment and retention.Originality/valueThis study is a partial replication of a previous study conducted in the USA, being the first to use the MLQ-5X with the Australian occupational therapy workforce. As such, it consolidates the existing evidence base in this area and also enables international comparisons of findings.

The Transformative Influence of La Varenne's Le Cuisinier Francois (1651) on French Culinary Practice.

The current proliferation of modern cookbooks targeted to the public at large makes it impossible to conceive of there being any that could have had an overriding influence on culinary practice or eating preferences, even at a local level. However, when there was a historical absence of cookbooks for a half-century, as there was in France in the first half of the seventeenth century, it is argued herein that the advent of a single cookbook in 1651, Le Cuisinier Francois by La Varenne, could have had a transformational influence on culinary practice over the ensuing half-century. The book went into more than 50 subsequent editions in the second half of the century. La Varenne stated clearly that his intent was to provide a guide for professional cooks. However, it is hypothesized in this article that the widespread and enduring success of the book was due to its attraction to and acquisition by the general public, including household cooks. This can be ascribed to (i) the fact that there had been no French cookbook describing novel culinary approaches in the preceding 50 years, (ii) La Varenne's concise, uncomplicated, and practical style of presentation of recipes, and (iii) his selection of principal ingredients, which were within the reach of the household cook and which reflected the availability of foods at the time of writing. Furthermore, because Le Cuisinier Francois was laid out according to widely observed religious practices, finding the best options for the appropriate day of the month became an easy task for the user. La Varenne initiated a departure from an earlier style of heavily spiced cooking to one that was based on natural flavors, a limited use of spices, and uncomplicated cooking methods. Thus, rather than assuming that the enduring popularity of the book was due to its widespread use by culinary professionals, it is argued that its style and substance must have imparted a sense of empowerment and confidence in the home cook and that, in these terms, La Varenne's influence on culinary practice was far more widespread and truly transformative, accounting for the remarkable success of Le Cuisinier Francois.

Primary care physician practice styles and quality, cost, and productivity.

To assess quality, cost, physician productivity, and patient experience for 2 primary care physician (PCP) practice styles: the focused, who typically address only the patient's acute problem, versus the max-packers, who typically address additional conditions also. Retrospective observational study using administrative data, electronic health record (EHR) data, and patient surveys. Data represent 285 PCPs (779 PCP-years) in a large, multispecialty group practice during 2011, 2012, and 2013. PCPs were ranked each year by their number of additional conditions addressed during acute care visits. The top one-third (max-packers) addressed 25.4% more"other problems" than expected, while focused PCPs (bottom one-third) addressed 20.3% fewer than expected. Outcomes were resource use, clinical quality metrics, patient-reported experience, physician time using the EHR, and physician productivity. All measures were risk-adjusted to account for patient mix. T tests were used to compare measures. Relative to a focused pattern of care, max-packing was associated with 3.4% lower overall resource use, consistently better scores for the available clinical quality metrics, and comparable patient experience (except for worse wait time ratings). Patients of focused PCPs used 7.3% more specialist services, in terms of costs, than patients of max-packers ($1218 vs $1136; P <.001). Max-packers spent 40 minutes more per clinical day using the EHR. PCPs with less appointment availability and who used a mix of appointment slots were more likely to be max-packers. Max-packing behavior yields desirable outcomes at lower overall cost but involves more conventionally uncompensated PCP time. Alternatives to compensation just for face-to-face visits and using more flexible scheduling may be needed to support max-packing.

Variation in surgical treatment advice for women with stress urinary incontinence: a study using clinical case vignettes

IntroductionThe aim of this study was to determine how recommendations of gynaecologists on surgical treatment for stress urinary incontinence (SUI) were influenced by patient characteristics.MethodsTwo hundred forty-five gynaecologists in the UK fully responded to an online questionnaire including 18 vignettes describing 7 clinical characteristics of women with SUI (age, body mass index, SUI type, previous SUI surgery, frequency of leakage, bother, physical status). The gynaecologists scored recommendations for surgery ranging from 1 ‘certainly not’ to 5 ‘certainly yes’. Mean scores were used to calculate the relative impact (‘weight’) of each clinical characteristic. Latent class analysis was used to distinguish groups of gynaecologists with a particular practice style because they responded to the patient characteristics captured in the case vignettes in a similar way.ResultsThe gynaecologists’ overall average recommendation score was 2.9 (interquartile range 2 to 4). All patient characteristics significantly influenced the recommendation scores (p always < 0.001) but their impact was relatively small. SUI type was most important (weight 23%), followed by previous SUI surgery (weight 21%). Latent class analysis identified five groups of gynaecologists with practice styles that differed mainly with respect to their mean recommendation score, ranging from 1.3 to 4.0.ConclusionsSurgical treatment advice in response to case vignettes was only minimally influenced by patient characteristics. There were five groups of gynaecologists whose inclination to recommend surgical treatment varied. This suggests that there is lack of consensus on the role of surgery as a treatment for SUI. A considerable number of gynaecologists were reluctant to recommend surgery.

Primary care physician practice styles and patient care: Evidence from physician exits in Medicare

Primary care physicians (PCPs) provide frontline health care to patients in the U.S.; however, it is unclear how their practice styles affect patient care. In this paper, we estimate the long-lasting effects of PCP practice styles on patient health care utilization by focusing on Medicare patients affected by PCP relocations or retirements, which we refer to as “exits.” Observing where patients receive care after these exits, we estimate event studies to compare patients who switch to PCPs with different practice style intensities. We find that PCPs have large effects on a range of aggregate utilization measures, including physician and outpatient spending and the number of diagnosed conditions. Moreover, we find that PCPs have large effects on the quality of care that patients receive, and that all of these effects persist for several years. Our results suggest that switching to higher-quality PCPs could significantly affect patients’ longer-run health outcomes.

The Relationship of Thinking Style and Motivation Features of Sales and Advertising Managers.

The thinking of a manager is conditioned by their motivational features which determine their personal professional success and the effectiveness of the organization’s activities. In this study, we assumed that two groups of sales and advertising managers had differences in the relationships between thinking style and their motivational qualities, as well as their individual need for achievement. We used the following sources: The methodology of A. Belousova for the diagnosis of thinking styles, the “scale of control over action” by J. Kuhl, and “the need for achievement” by Yu.A. Orlov. The selection consisted of 61 people, 25 to 30 years of age, of which 41 were men and 20 were women, from organizations engaged in the sale of a technical group of goods (also known as Group A) and advertising services (also known as Group B), in Rostov-on-Don. The Spearman rank correlation method was used for quantitative data processing. In group Group A, the analysis showed the presence of statistically significant connections. A critical style of thinking has a significant relationship with the level of clarity about the need for achievements and practical thinking is statistically significantly interrelated with control over action in a situation of failure. Whereas, in Group B, an initiative, managerial, and practical style of thinking has a significant correlation with the need for achievement.

Piano concertos by F. Chopin: “composing center” means

Piano concertos by F. Chopin: “composing center” means

Does Changing Residency Obstetric Call to a Group Model Significantly Impact Patient Continuity?

Group sharing of prenatal care and inpatient obstetric (OB) call is increasingly replacing single-provider longitudinal models including in family medicine (FM) residencies. Such change in care models could impact continuity of prenatal and delivery care.The University of Rochester's family medicine residency program changed the resident maternal care coverage to an obstetric group model from a single-provider model in 2016 to improve work-life balance, which provided an opportunity to examine how these two practice styles impacted provider continuity. We performed a retrospective chart review of family medicine resident-assigned obstetric patients receiving care at the University of Rochester's residency clinic. The study evaluated provider continuity differences in two models of prenatal care and obstetric call: (1) single provider model (SPM) with one primary provider and one backup support resident vs (2) OB group-provider model (GPM) with three to four resident providers and one primary provider. The average number of different providers seen significantly increased in the GPM vs SPM (3.47 vs 2.87, P=.02), however the average percentage of prenatal visits with either a primary or designated backup provider was not statistically different (83.1% vs 90.1%, P=.07). Among delivery continuity measures, there was no significant difference between models in the percentage of deliveries attended by the primary or designated backup residents compared with nongroup providers. (76.9% vs 82.3%, P=.51). This study provides quantitative evidence on how differing models of residency maternal care coverage impact continuity of care. Study findings did not show an inferiority of an OB group-provider model compared to a single-provider model when considering how often patients were seen prenatally and delivered by providers from their continuity group.

Key Performance Indicators for program scale-up and divergent practice styles: a study from NSW, Australia.

Implementing programs at scale has become a vital part of the government response to the continuing childhood obesity epidemic. We are studying the largest ever scale-up of school and child care obesity prevention programs in Australia. Health promotion teams support primary schools and early childhood services in their area to achieve a number of specified, evidence-based practices aimed at organizational changes to improve healthy eating and physical activity. Key performance indicators (KPIs) were devised to track program uptake across different areas-measuring both the proportion of schools and early childhood services reached and the proportion of practices achieved in each setting (i.e. the proportion of sites implementing programs as planned). Using a 'tight-loose-tight' model, all local health districts receive funding and are held accountable to reaching KPI implementation targets. However, local teams have independent discretion over how to best use funds to reach targets. Based on 12 months of ethnographic fieldwork and interviews across all districts, this study examines variations in the decision making and strategizing processes of the health promotion teams. We identified three distinct styles of practice: KPI-driven practice (strategic, focussed on targets); relationship-driven practice (focussed on long-term goals); and equity-driven practice (directing resources to sites most in need). In adapting to KPIs, teams make trade-offs and choices. Some teams struggled to balance a moral imperative to attend to equity issues, with a practical need to meet implementation targets. We discuss how models of program scale-up and tracking could possibly evolve to recognize this complexity.

Opportunities for, and implications of, skill mix changes in health care pathways: Pay, productivity and practice variations in a needs-based planning framework.

Health workforce planning is traditionally based on demographically-driven 'silo-based' models in which future requirements for particular health professions are determined by applying estimates of the future population to the existing population-based level of workforce supply. Estimates of future workforce requirements are focused on, and constrained by population size and requirements increase monotonically. Key failures of existing models include (1) lack of integration between planning the health care workforce, health care services and health care funding and (2) lack of integration between planning different health care inputs and the potential for substitution between inputs. Hence planning models fail to incorporate emerging developments in healthcare delivery and workforce change. We present an integrated needs-based framework for health workforce planning and apply the framework using data from nine European countries to explore the workforce and financial implications of re-configuring the delivery of care through changes in the allocation of treatment tasks between health care professions (skill mix). We show that cost consequences depend not only on pay differences. Instead, workforce planning in rapidly changing workforce environments must consider and incorporate between-provider group differences in productivity (the number of patients that are served per fixed period of time) and practice style (the number and mix of tasks used in providing care to the same type of patient).

Exploring variations in health-care expenditures-What is the role of practice styles?

Variations in medical resource usage, both across and within geographical regions, have been widely documented. In this paper, we explore physician practice styles as a possible determinant of these variations. In particular, we exploit patient mobility between physicians to identify practice styles among general practitioners (GPs) in Austria. We use a large administrative data set containing detailed information on a battery of different health‐care services and implement a model with additive patient and GP fixed effects that allows flexibly for systematic differences in patients' health states. We find that, although GPs explain only a small part of the overall variation in medical expenses, heterogeneities in spending patterns among GPs are substantial. Conditional on patient characteristics, we document a difference of € 751.47 per patient per year in total medical expenses (which amounts to roughly 45% of the sample mean) between high‐ and low‐spending GPs.

Support for rural practice: female physicians and the life-career interface.

The need for family physicians in rural areas across the USA and Canada is a longstanding issue that has been well documented. Since family physicians constitute the largest population of rural practitioners, the problem has been exacerbated by a sharp decline in medical students' interest in the field of family medicine and the aging of the current rural workforce. Previous research has shown that female physicians in rural areas need strong support networks to maintain a healthy work-life balance. The purpose of this study was to better understand the types of support they need and how they find it, as well as how their needs change over time. Twenty physicians from the same rurally focused family medicine residency were interviewed over a 3-month period using a semi-structured format. Physicians ranged in experience from 1 year out of residency to 25 years out of residency. Using a phenomenological approach, interviews were transcribed and then coded and analyzed by three members of the research team, one of them an experienced qualitative researcher, who met periodically to reflect on the process of coding. Emergent subthemes and themes were discussed by the multidisciplinary team. The participants discussed in detail the types of support they relied on and the continuing challenges of maintaining a healthy work-life interface. Main themes included the need to select carefully one's life partner and practice partners and the difficulties in setting up practice in an area without family, friends or professional mentors nearby. Although forming boundaries was important, so was developing close relationships with patients and their families. The one thing that sustained all of the physicians was a meaningful relationship with their patients. The doctor-patient connection is what brings joy and helps every one of them cope with the harder aspects of life in rural areas. The general consensus of respondents was that the career-life interface varies across individuals, changes over time and is always a work in progress. Rural female physicians think of their work in relational terms, and it involves a great deal of emotional labor. Support systems mitigate the psychological effects of this labor and help physicians develop resilience in managing both career and life. Educators can better prepare female physicians by discussing the costs and benefits of emotional labor and the necessity of support networks, as well as how to negotiate a contract that is consistent with one's values, practice style and family life.

Association of Surgical Treatment With Adverse Events and Mortality Among Medicare Beneficiaries With Proximal Humerus Fracture

Meta-analyses of randomized clinical trials suggest that the advantages and risks of surgery compared with conservative management as the initial treatment for proximal humerus fracture (PHF) vary, or are heterogeneous across patients. Substantial geographic variation in surgery rates for PHF suggests that the optimal rate of surgery across the population of patients with PHF is unknown. To use geographic variation in treatment rates to assess the outcomes associated with higher rates of surgery for patients with PHF. This comparative effectiveness research study analyzed all fee-for-service Medicare beneficiaries with proximal humerus fracture in 2011 who were continuously enrolled in Medicare Parts A and B for the 365-day period before and immediately after their index fracture. Data analysis was performed January through June 2019. Undergoing 1 of the commonly used surgical procedures in the 60 days after an index fracture diagnosis. Risk-adjusted area surgery ratios were created for each hospital referral region as a measure of local area practice styles. Instrumental variable approaches were used to assess the association between higher surgery rates and adverse events, mortality risk, and cost at 1 year from Medicare's perspective for patients with PHF in 2011. Instrumental variable models were stratified by age, comorbidities, and frailty. Instrumental variable estimates were compared with estimates from risk-adjusted regression models. The final cohort included 72 823 patients (mean [SD] age, 80.0 [7.9] years; 13 958 [19.2%] men). The proportion of patients treated surgically ranged from 1.8% to 33.3% across hospital referral regions in the United States. Compared with conservatively managed patients, surgical patients were younger (mean [SD] age, 80.4 [8.1] years vs 78.0 [7.2] years; P < .001) and healthier (Charlson Comorbidity Index score of 0, 14 863 [24.4%] patients vs 3468 [29.1%] patients; Function-Related Indicator score of 0, 20 720 [34.0%] patients vs 4980 [41.8%] patients; P < .001 for both), and a larger proportion were women (49 030 [80.5%] patients vs 9835 [82.5%] patients; P < .001). Instrumental variable analysis showed that higher rates of surgery were associated with increased total costs ($8913) during the treatment period, increased adverse event rates (a 1-percentage point increase in the surgery rate was associated with a 0.19-percentage point increase in the 1-year adverse event rate; β = 0.19; 95% CI, 0.09-0.27; P < .001), and increased mortality risk (a 1-percentage point increase in the surgery rate was associated with a 0.09-percentage point increase in the 1-year mortality rate; β = 0.09; 95% CI, 0.04-0.15; P < .01). Instrumental variable mortality results were even more striking for older patients and those with higher comorbidity burdens and greater frailty. Risk-adjusted estimates suggested that surgical patients had higher costs (increase of $17 278) and more adverse events (a 1-percentage point increase in the surgery rate was associated with a 0.12-percentage point increase in the 1-year adverse event rate; β = 0.12; 95% CI, 0.11 to 0.13; P < .001) but lower risk of mortality after PHF (a 1-percentage point increase in the surgery rate was associated with a 0.01-percentage point decrease in the 1-year mortality rate; β = -0.01; 95% CI, -0.015 to -0.005; P < .001). This study found that higher rates of surgery for treatment of patients with PHF were associated with increased costs, adverse event rates, and risk of mortality. Orthopedic surgeons should be aware of the harms of extending the use of surgery to more clinically vulnerable patient subgroups.

Coaching leadership style: a learning process

The purpose of the paper is to outline a coaching leadership style based on an optimistic view of individuals. It is a method based on optimism, self-efficacy, positive emotions and learning. Focus is on the employee who wants to develop his potential and become the best version of himself. The aim is to achieve both personal and organisational goals. The paper describes how a method consisting of two learning processes can help to implement a coaching leadership style in practice. Learning 1: Using mental models to understand one's own situation and how others think. Learning 2: Using tools to change one's own and others' behaviour. The paper shows that to succeed with a coaching leadership style, leaders must have a large toolbox, which includes tools such as self-management and a give-culture.

Patient-Centered Medical Home With Colocation: Observations and Insights From an Academic Family Medicine Clinic.

There is a movement in the United States to transform family medicine practices from single physician–based patient care to team-based care. These teams are usually composed of multiple disciplines, including social workers, pharmacists, registered nurses, physician assistants, nurse practitioners, and physicians. The teams support patients and their families, provide holistic care to patients of all ages, and allow their members to work to the highest level of their training in an integrated fashion. Grouping care team members together within visual and auditory distance of each other is likely to enhance communication and teamwork, resulting in more efficient care for patients. This grouping is termed colocation. The authors describe how the use of colocation can lead to clearer, faster communication between care team members. This practice style has the potential to be expanded into various clinical settings in any given health system and to almost all clinical specialties and practices.

Sola Scriptura's and the Chinese Union Version Bible's Impact upon Conservative Christian Leaders: The Case of Watchman Nee and Wang Mingdao

AbstractThe majority of Chinese Christians can be considered to be theologically conservative. One distinctive feature of conservative theology is Biblicism, according to which Scripture occupies a central role. The Reformation principle of sola scriptura legitimises this conservative stance and calls for a stern application of this principle. As Biblicists, they are discontented with the ‘unbiblical’ practices and ministries of missionaries. On the other hand, missionaries have put forward the Union Version translation project on the basis of the principle of sola scriptura. This article investigates how Watchman Nee (1903–72) and Wang Mingdao (1900–91) were discursively influenced by the missionaries’ Union Version Bible translation project through their different understandings of sola scriptura. For missionaries, sola scriptura required the translation of a faithful and popular Chinese Bible, and Mandarin was deemed an appropriate language for the task. While Nee and Wang did not appreciate the missionary enterprise, for sola scriptura they valued the Chinese Union Version as an outstanding and up-to-date translation of the Scripture. For Nee and Wang, sola scriptura was not only a translation principle, but also a principle underpinning religious life. Conservative Christians’ devotional practice emphasises the memorising of biblical texts and verbalising them throughout the day. This practice resulted in the Union Version, which is written in eloquent modern Chinese, becoming an integral part of Chinese Christian practice rather than a mere translation. Though Nee and Wang accused missionaries of having betrayed the Reformation principle, they were still under its influence thanks to the Chinese Union Version Bible. Also, their teaching on biblical reading had similarities with the medieval monastic practice of lectio divina. In this sense, the Chinese Union Version Bible reveals an interesting integration of Chinese conservative Christian faith, missionary enterprise, sola scriptura, and a monastic style of spiritual practice within the Chinese Church.

Professionalisation and Professionalism: Diphtheria and Medical Practice in Minnesota 1850–1910

Summary The evolution of professionalism in Minnesota began when allopathic and homeopathic physician leaders organised medical societies and colleges to define and perpetuate their styles of practice. The epidemics of diphtheria that ravaged the state demanded prompt public health measures of quarantine to reduce the spread of the disease. Then the successful utilization of diphtheria antitoxin in Europe encouraged its local production in Minnesota and the re-education of all physicians there to convince them that they were no longer helpless to treat this infection that killed so many children. Their professionalisation was completed when they implemented the cure for diphtheria that laboratory science had produced. Homeopathic and allopathic practices converged as Minnesota physicians transformed their occupation from merely caring and comforting to actively treating and curing a serious infection.

Introducing Fluorescence Guided Surgery into Neuro-Oncology Practice and Getting It Right First Time

Abstract Introduction Fluorescence Guided Surgery (FGS) using 5-ALA is recommended for patients undergoing resection of suspected high grade glioma and this type of surgery is increasingly being used in more units throughout the UK. We report on our experience of introducing 5-ALA guided surgery for suspected HGG in a regional neurosciences unit. Methods Consecutive series of the first 24 patients in our unit to receive 5-ALA guided surgery for suspected HGG from June 2017 to October 2018. Data was prospectively collected. Results 5-ALA fluorescence guided surgery was used for a range of histologically confirmed WHO grade III-IV gliomas. All but 1 tumour (GBM) fluoresced with 5-ALA, with strong fluorescence in recurrent GBM and anaplastic foci of grade 3 tumours. EOR varied according to the eloquence of the lesion with 70% of cases achieving gross total resection. 40% of cases used awake mapping or intraoperative neurophysiology. 5 patients (20.8%) had temporary neurological deficits which resolved in all cases. Individual surgeon learning curves resulted in 2 styles of practice- complete FGS with fluorescence used throughout the case, and intermittent use of fluorescence as an adjunct often at the end of debulking under white light. Conclusions Adopting 5-ALA use comes with specific challenges in terms of service organisation, learning curves and complication avoidance. Our experience is that it is useful both to improve EOR and as an adjunct to identify tumour tissue in eloquent region tumours with monitoring of function. This is possible through a day admission pathway in line with GIRFT.

Midwifery students’ perspectives on how role models contribute to becoming a midwife: A qualitative study

BackgroundThe dynamics of maternal and newborn care challenge midwifery education programs to keep up-to-date. To prepare for their professional role in a changing world, role models are important agents for student learning. ObjectiveTo explore the ways in which Dutch and Icelandic midwifery students identify role models in contemporary midwifery education. MethodsWe conducted a descriptive, qualitative study between August 2017 and October 2018. In the Netherlands, 27 students participated in four focus groups and a further eight in individual interviews. In Iceland, five students participated in one focus group and a further four in individual interviews. All students had clinical experience in primary care and hospital. Data were analyzed using inductive content analysis. ResultsDuring their education, midwifery students identify people with attitudes and behaviors they appreciate. Students assimilate these attitudes and behaviors into a role model that represents their ‘ideal midwife’, who they can aspire to during their education. Positive role models portrayed woman-centered care, while students identified that negative role models displayed behaviors not fitting with good care. Students emphasized that they learnt not only by doing, they found storytelling and observing important aspects of role modelling. Students acknowledged the impact of positive midwifery role models on their trust in physiological childbirth and future style of practice. ConclusionRole models contribute to the development of students’ skills, attitudes, behaviors, identity as midwife and trust in physiological childbirth. More explicit and critical attention to how and what students learn from role models can enrich the education program.

Learning thresholds for early career occupational therapists: A grounded theory of learning-to-practise

Introduction Early career occupational therapists experience considerable learning. This research sought to develop a theory of how they learn once practising. Method The research employed a constructivist grounded theory methodology. Interviews were conducted with 20 participants who were either experienced ( n = 8), early career occupational therapists ( n = 10) or in supporting roles for early career occupational therapists ( n = 2). Participants were asked their views about what early career occupational therapists find troublesome and how they respond. Data were collected and analysed concurrently. Open, focused and theoretical coding were used to develop a theory. Findings The theory of learning-to-practise occupational therapy included four learning thresholds: consolidating professional reasoning; navigating into the workplace; building competence and confidence; and developing a personal theory and practise style. There were 11 strategies identified that early career occupational therapists use to cross the learning thresholds. Early career occupational therapists’ understanding and value of knowledge shifted, which culminated in them ‘realising’ their personal theory and practice style. They refined their values and beliefs and learned to be more deliberate and reflective in their thinking and actions. Conclusion Early career occupational therapists were challenged, which promoted learning. This research extends understanding of the learning needs, thinking and actions taken by early career occupational therapists to cross learning thresholds and to develop their personal theory and practice style.