Academic journal article British Journal of Occupational Therapy

Therapists' Perceptions of How Teamwork Influences Client-Centred Practice

Academic journal article British Journal of Occupational Therapy

Therapists' Perceptions of How Teamwork Influences Client-Centred Practice

Article excerpt

Introduction

It is important to ensure an ongoing examination of the components of client-centred practice because it forms the basis for interventions conducted by Canadian occupational therapists (Canadian Association of Occupational Therapists 2002). Other occupational therapy authors have outlined important barriers and facilitators to the application of this approach within occupational therapy, including the therapist and client having differing goals, understanding the approach and living the philosophy (Sumsion and Smyth 2000, Wilkins et al 2001).

Literature review

Authors in other disciplines have stressed the importance of having structures and attitudes within the organisation that move the power and control to the client (Fitzpatrick 2006). Time has been identified as an important benefit because a person-centred focus can save time and enhance job satisfaction (Moulster et al 2007). Others have found that family-centred rounds enable time to be used more efficiently (Muething et al 2007). Time can also be a challenge to the implementation of this approach, especially if it is not used well (Murphy 2007). The efficient, effective and creative use of other resources, such as money, will also ensure that these are targeted to the right population at the right time (Fitzpatrick 2006, Wasson et al 2006). For example, Moulster et al (2007) encouraged team members not to waste time and money doing things that clients did not want just because they had been done in the past.

Over the past two decades, interprofessional teamwork has been proposed and implemented as a means of achieving more systematic and quality care for individuals in the mental health system. A survey of the teamwork literature suggests common challenges to, and characteristics of, effective teamwork in this environment.

Such challenges include additional time required to work in a team (Buszewicz 1998, McCallin 2001, Grumbach and Bodenheimer 2004); interpersonal and professional differences and hierarchies (Buszewicz 1998, Hannigan 1999, McCallin 2001, Stark et al 2002, Grumbach and Bodenheimer 2004); and the lack of training to work as a team (Buszewicz 1998, Hannigan 1999, McCallin 2001).

The characteristics of effective teamwork include clear goals (Buszewicz 1998, Grumbach and Bodenheimer 2004); frequent and effective communication (McCallin 2001); commitment by all team members (Buszewicz 1998); and clear roles and responsibilities (Buszewicz 1998, Hannigan 1999, McCallin 2001, Stark et al 2002, Grumbach and Bodenheimer 2004). Buszewicz (1998) highlighted the challenges and components of effective teamwork in the mental health setting and concluded that teamwork enhanced the opportunity to share background and management information about clients, to share referral information more appropriately and for professionals to learn about each other's disciplines, and also enhanced the scope of expertise in dealing with particular client issues.

Others have focused on the need for staff members to receive further training to enhance their ability to involve families and clients in the process (West et al 2005, Cook and Abraham 2007). Additional challenges come from required changes to the system to facilitate a client-centred approach. There is often a disconnection between the client-centred objectives of a programme and the operational policies that are in place (Townsend et al 2003). For this approach to be effective, structures need to change rather than simply adding a new approach to an old system (Dowling et al 2007). Examples here relate to a new format for conducting rounds that has to be supported by all players, including the family (Muething et al 2007), and the recognition of the roles of all the players, including employer, physician and community, that needs to be in place to ensure success (Webber and Mercure 2006). Families also play a key role and should be involved in the care planning (Peek et al 2007). …

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