INTEGRATION FEATURE
barriers to ensure that staff can deliver the best work they can
without creating unnecessary onward referrals. At the same time,
there was a need to recognise that some tasks still needed staff
with specialist knowledge in certain aspects of the roles to deliver
them.
The description was already lending itself to an analogy to
explain the new role for Dorothy and Hilary Bell who were leading
the work: traffic lights.
A set of three main competency groups were set up. Any
occupational therapist can undertake a core green light task. By
contrast, no occupational therapist can take on a complex red light
task if they do not have the specialist competencies to deliver the
tasks.
Where it gets interesting is the amber tasks, and this is where a
lot of the work has focused. It includes tasks that any occupational
therapist plausibly could do, but which they aren’t currently able to
confidently complete.
Staff have been provided with the
framework and a supportive structure
while they become accustomed to
taking these tasks on. Ultimately it
is anticipated that tasks that were
amber will become green.
Establishing which tasks went
into which category involved a
lot of staff consultation, with 90
staff so far involved in the work
to establish competencies. The
development of the new role
initially focused on older adults, so
the first care groups to be covered
by the process were the community
occupational therapists, occupational
therapists within rehabilitation and older people’s
mental health services. Representatives from across the
city met on a monthly basis to help develop the new competencies.
‘We identified the similarities in what people were doing,’ says
Dorothy. ‘While there was difference in the language they used,
actually some of the tasks they did were very similar, so we could
then identify from across the teams what the green tasks would be
that we all do on a routine basis.
‘Sometimes the meetings would be the first time teams heard
about the complexity of each other’s role, so there have been
benefits beyond the staff engagement exercise as practitioners
came to better understand what each other did.’
Take showering: under the old system, a health occupational
therapist might know when an individual needed a level access
shower, but they would still have to refer an individual to a social
work occupational therapist to make that recommendation and
then conduct an assessment to have it installed.
Now, this task is identified as an amber task and undertaken by
the health occupational therapist, with support from community
colleagues and no referral is necessary.
Building the system
The development process for the new system has involved a lot
of detail. Competency frameworks and process maps have been
developed to establish granular detail on each task, sources of
guidance and additional reading where required, and indicators
of when further referral would be necessary
While most were able to see the benefits, there has also been
concern expressed about the changes, particularly about what is
seen as a complex red task which identifies the specialism within
service pathways.
‘‘The description
was already lending
itself to an analogy to
explain the new role:
traffic lights.
‘We asked staff to demonstrate why a task was specialist,’
says Dorothy. ‘If they told us about additional training, or how
users could have complex multifactorial issues, then that task
would continue to sit with that team.
‘If someone has advanced dementia, for example, then that
case will very clearly sit with the older adults mental health
service. But if someone has a mild memory problem then
they may not require the specialist support at that
point, even if that has to change down the
line.’
There has also been concern among
staff that even when training was
provided for some amber tasks, it
would be difficult to remember the
particulars of completing them if they
didn’t become a regular part of their
jobs.
So support networks have
also been developed, with new
‘professional triangles’ implemented
between teams. Face-to-face links
were built between staff who took part in
the consultation process so they can stay in
contact with each other to provide support, advice,
learning and joint working where necessary. So if a mental
health occupational therapist is providing a shower adaptation,
it’s now easier for them to pick up the phone to a social work
colleague and talk through the particulars of delivering it without
needing to trigger a new referral.
‘The whole point of the professional triangles is that if joint
work is needed it can be provided without jumping through a lot
of hoops,’ says Dorothy. ‘If it just needs a phone call or even a
joint visit then that can be easily done.’
Dorothy and other professional leads are still nudging staff to
think outside their own teams and really embrace the full range
of possibilities for them. ‘Staff can often feel quite confident
in their own field; I have to remind them that their holistic core
training enables them to work in any field of practice to the level
of the established competencies,’ she says.
‘If a staff member is assessing cognition and there is a
problem with their arm, they should also consider completing an
upper limb assessment. The competencies are a reminder about
whether they should consider wider tasks than previously.’
OTnews August 2020 49