To Serve Better: Addressing Poor Performance in Occupational Therapy

Abstract

A health care professional is not always ‘the right person, doing the right thing, in the right way, in the right place, at the right time and with the right result’ (Mead, quoted in Potter 2000, p3). In some renowned cases, health care professionals' interventions have resulted in the deaths of patients. For this reason and others, such as unacceptable variation in practice, poor performance is one of the six aspects of clinical governance, which is an integrated quality framework (Sealey 1999). Clinical governance, although a National Health Service development, has implications for all occupational therapists, whatever setting they work in. This discussion paper presents the concept of poor performance in the context of performance management, which is a mechanism for the early identification and the remedying of poor performance. Early recognition, feedback on performance, decisive intervention and effective self-regulation are the headings used to frame this discussion. The implications for occupational therapists nationally, locally and personally are also explored. The central theme is that identifying and dealing with poor performance is every occupational therapist's personal responsibility.

Assisting allied health in performance evaluation: a systematic review

“… Performance measures are based on standards of care, which can be evidence-based or, in the absence of scientific evidence, determined by an expert panel of health practitioners [ 19 , 27 , 36 ]. Performance measures must be clear, valid, reliable, reproducible, discriminative and easy to use [ 4 , 18 , 22 , 25 , 36 , 41 , 44 , 50 , 51 ]. They should be comprehensive yet practically relevant and meaningful [ 24 , 36 ].…”

“…Reporting of results should be built into the performance evaluation system [ 18 , 42 ]. The results serve as feedback to health practitioners and their organisation, either as recognition for good performance or as a prompt for further improvement or development, which can increase service performance or work motivation [ 21 ].…”

“…‘Standards’ or audit is a practice-focused tool in which the performance data collected are compared with pre-determined standards of practice, locally or nationally [ 18 , 27 ]. These standards define the level of performance required for the successful achievement of work expectations and specify what the consumers can expect from the practitioners [ 27 ].…”

“…Practitioner-focused tools consisted of the following: direct clinical observation of the clinician in the patient’s setting [ 20 , 23 , 24 ], interview with practitioner [ 24 ], critical incident reporting [ 18 ], self-reflection or self-appraisal [ 24 ], peer review or appraisal [ 17 , 18 , 20 ], and chart-stimulated recall [ 28 ].…”

Performance assessment in health care providers: a critical review of evidence and current practice

“…The use of standards is vital also in the identification of poor performance, defined as ‘a performance issue when a practitioner is repeatedly falling within unacceptable standards’ (adapted from DHSSPS 2002). In her review of poor performance in occupational therapy, Bannigan proposes performance management as the primary mechanism for the early identification and remedying of poor performance, with early recognition, feedback on performance, decisive intervention and effective self‐regulation being key factors (Bannigan 2000).…”