Analyzing the professional practice context using three lenses: An essential step for responding strategically

Freeman, Andrew; Jauvin, Nathalie

doi:10.1080/07380577.2018.1553086

Cited by 5 publications

(17 citation statements)

References 49 publications

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Section: Discussionmentioning

confidence: 99%

“…Our findings show how the three lenses of professional practice context analyses, namely, accountability, ethics, and professional-as-worker [ 69 ], can be used to shed light on the tensions case managers experience in their work. Accountability refers to whom case managers answer to and for what obligations [ 69 ]. Indeed, as professionals, through their licensing bodies, case managers are accountable to the State to ensure the quality of the services, but also to their employer, service funders, clients and families, and colleagues [ 70 ].…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, as professionals, through their licensing bodies, case managers are accountable to the State to ensure the quality of the services, but also to their employer, service funders, clients and families, and colleagues [ 70 ]. Ethics refers to the balance between two values (e.g., quality of services vs. access to services) that case managers are confronted with [ 69 ]. This lens is of importance as professionals must put their knowledge to the service of the older adults, which in this situation, are vulnerable as they do not have that knowledge [ 71 ].…”

Section: Discussionmentioning

confidence: 99%

“…This lens is of importance as professionals must put their knowledge to the service of the older adults, which in this situation, are vulnerable as they do not have that knowledge [ 71 ]. Professional-as-workers refers to the actual organisational conditions (workload relative to resources available) that enable (or not) professionals to accomplish their mandate while maintaining their well-being [ 69 ]. This is because work organisation (e.g., workload, control, support), might influence well-being at work [ 72 ].…”

Section: Discussionmentioning

confidence: 99%

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Tensions experienced by case managers working in home care for older adults in Quebec: first level analysis of an institutional ethnography

Ethier,

Dubois,

Savaria

et al. 2024

BMC Health Serv Res

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Background Case managers play a vital role in integrating the necessary services to optimise health-related goals and outcomes. Studies suggest that in home care, case managers encounter tensions in their day-to-day work, that is, disjuncture between what they should do, in theory, and what they actually do, in practice. However, direct exploration of these tensions is lacking. As such, this study aimed to describe the tensions encountered by case managers in public home care for older adults in Quebec and their influence on day-to-day work. Methods An institutional ethnography was conducted through observations of work, interviews and a survey with case managers working in home care in Quebec. Data were analysed using institutional ethnography first-level analysis procedures. This included mapping the work sequences as well as identifying the tensions experienced by case managers through the words they used. Results Three main tensions were identified. First, case managers perceive that, despite working to return hospitalised older adults at home safely, their work also aims to help free up hospital beds. Thus, they often find themselves needing to respond quickly to hospital-related inquiries or expedite requests for home care services. Second, they are supposed to delegate the care to “partners” (e.g., private organisations). However, they feel that they are in effect managing the quality of the services provided by the “partners.” Consequently, they go to great lengths to ensure that good care will be provided. Finally, they must choose between meeting organisational requirements (e.g., reporting statistics about the work, documenting information in the older adults’ file, doing mandatory assessments) and spending time providing direct care. This often leads to prioritising direct care provision over administrative tasks, resulting in minimal reporting of essential information. Conclusion The results are discussed using the three lenses of professional practice context analyses (i.e., accountability, ethics, and professional-as-worker) to formulate recommendations for practice and research. They suggest that, despite their important role, case managers have limited power in home care (e.g., with partners, with the hospital).

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Tensions experienced by case managers working in home care for older adults in Quebec: first level analysis of an institutional ethnography

Ethier,

Dubois,

Savaria

et al. 2024

BMC Health Serv Res

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“…In a recent study conducted with Canadian occupational therapists, VanderKaay, Letts, Jung, and Moll (2018) found that therapists sometimes exercised discretion in ways that countered policy and system guidelines and put them at risk for employment termination or being reported to regulatory bodies. Other literature illustrates how critical and theory-informed reflexivity, which can be considered a part of the discretionary process, helps practitioners negotiate tensions between professional ethics and organizational mandates, mediate policies, and make choices within contemporary health care systems (Freeman, & Jauvin, 2019; Mackey, 2014). In general, studies of occupational therapists’ discretion are much less common than studies of reasoning processes and the outcomes of those processes, pointing to a need to further investigate if and how discretion relates to policy and system perpetuation or transformation.…”

Section: Argument and Critical Discussionmentioning

confidence: 99%

Occupational Therapists as Street-Level Bureaucrats: Leveraging the Political Nature of Everyday Practice

Aldrich¹,

Rudman²

2019

Can J Occup Ther

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Background. As front-line service providers who often work in systems regulated by governmental bodies, occupational therapists can be conceptualized as “street-level bureaucrats” ( Lipsky, 1980/2010 ) who effect and are affected by policy. Purpose. Drawing on understandings from a study of long-term unemployment, this article proposes that occupational therapists, as street-level bureaucrats, respond to inter-related policies and systems in ways that can perpetuate, resist, or transform opportunities for doing and being. Key Issues. By highlighting practitioners’ everyday negotiation of governmental, organizational, and professional power relations, the notion of street-level bureaucracy illuminates the political nature of practice as well as the possibilities and boundaries that policy can place on ideal forms and outcomes of practice. Implications. Framing occupational therapists as street-level bureaucrats reinforces practitioners’ situatedness as political actors. Mobilizing this framing can enhance awareness of occupational therapists’ exercise of discretion, which can be investigated as a basis for occupation-focused and emancipatory forms of practice.

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Attrition and Retention of Rehabilitation Professionals: A Scoping Review

Mak

Hunt

Riccio

et al. 2023

J Contin Educ Health Prof

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Introduction: Attrition is defined as a permanent departure from one's profession or the workforce. Existing literature on retention strategies, contributing factors to the attrition of rehabilitation professionals and how different environments influence professionals' decision-making to stay in/leave their profession, is limited in scope and specificity. The objective of our review was to map the depth and breadth of the literature on attrition and retention of rehabilitation professionals. Methods: We used Arksey and O'Malley's methodological framework. A search was conducted on MEDLINE (Ovid), Embase (Ovid), AMED, CINAHL, Scopus, and ProQuest Dissertations and Theses from 2010 to April 2021 for concepts of attrition and retention in occupational therapy, physical therapy, and speech-language pathology. Results: Of the 6031 retrieved records, 59 papers were selected for data extraction. Data were organized into three themes: (1) descriptions of attrition and retention, (2) experiences of being a professional, and (3) experiences in institutions where rehabilitation professionals work. Seven factors across three levels (individual, work, and environment) were found to influence attrition. Discussion: Our review showcases a vast, yet superficial array of literature on attrition and retention of rehabilitation professionals. Differences exist between occupational therapy, physical therapy, and speech-language pathology with respect to the focus of the literature. Push, pull, and stay factors would benefit from further empirical investigation to develop targeted retention strategies. These findings may help to inform health care institutions, professional regulatory bodies, and associations, as well as professional education programs, to develop resources to support retention of rehabilitation professionals.

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Analyzing the professional practice context using three lenses: An essential step for responding strategically

Cited by 5 publications

References 49 publications

Tensions experienced by case managers working in home care for older adults in Quebec: first level analysis of an institutional ethnography

Tensions experienced by case managers working in home care for older adults in Quebec: first level analysis of an institutional ethnography

Occupational Therapists as Street-Level Bureaucrats: Leveraging the Political Nature of Everyday Practice

Attrition and Retention of Rehabilitation Professionals: A Scoping Review

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