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Insights from Investigations: Communication is Key

Occupational therapists often ask how they can avoid complaints from clients. While there is no specific formula to 100% protect yourself from a complaint, the good news is that there are things you can do to promote good practice and help avoid a complaint. Clients have the right to complain and by law, the College must investigate all complaints.

What we commonly see is a breakdown in communication. Sometimes clients complain because they did not get the service or products they needed, and they believe this was the fault of the occupational therapist. Most of the time, the occupational therapist did not do anything wrong. What happened was the client did not understand either:

  • the role of the occupational therapist,
  • the role of other service providers,
  • the limitations of what the occupational therapist can do, and/or
  • the limitations of the system the client is in.

We understand the pressure and time constraints that occupational therapists can experience. Clients are navigating an increasingly complicated and resource-constrained health care system. These factors can be frustrating for both occupational therapists and the client. Showing empathy for a stressed or frustrated client is a powerful tool, especially when delivering a message that a client may not be happy to hear.

General communication tips for occupational therapists

Using the following communication tips* when explaining your role, the role of others, or system and funding limitations can help build trust and understanding with the client.

1. Show basic courtesy

This is the start to building trust. Introduce yourself to clients, families, caregivers and colleagues. Be on time for appointments or call if you are going to be late. Apologize if you are wrong or make a mistake.

2. Be clear

Use plain language to explain your role, what is going to happen in your session and why. Give clients time and opportunity to ask questions and take the time to answer them.

3. Listen.

Listen to your client and ask about their concerns and feelings. Show empathy and let them know that they have been heard by paraphrasing.

4. Consider culture

Consider culture, equity and justice principles (as per the Competencies). Each person has a unique mix of experiences and circumstances. These cultural influences can shape their health and their perspective on health. Learning more about your client’s experiences and requirements will enable you to tailor your care and communications and provide a culturally safe environment.

5. Confirm understanding

Confirm understanding by checking in with your client about goals, next steps and timelines. Ask clients to recap what was done or discussed to confirm their understanding and expectations.

6. Watch your body language

Communication involves more than the words spoken. It also includes how we say them such as our tone, volume, and pace. Non-verbal communications, like expressions, gestures and posture can also send signals to your client. Folded arms, raised eyebrows, smiles, frowns, slumped shoulders, glances at the clock, sighing, and clenched hands can all leave clients with lasting impressions.

The concerns received at the College may appear to be about a standard of practice, but often they are rooted in communication issues. Communication skills are like any other clinical skills – they can be learned and improved upon. Communication is essential to quality occupational therapy practice.  Incorporating these communication tips may help prevent a complaint.

Considerations for assessments

Our data shows that 85% of communication complaints involved an occupational therapist doing an assessment. The College understands that there are additional factors in the assessment process that can lead to communication breakdowns.

Some of these factors include:

  • Most occupational therapists meet their client for the first time when completing an assessment. It can be challenging to build trust and rapport in that first encounter with a limited amount of time.
  • There is a lot of new information to cover during an assessment (role of the occupational therapist, consent, findings, recommendations, etc.) which may be challenging for clients to understand, process and remember.
  • The occupational therapist may be perceived as the decision maker to grant services or equipment. When services or products are later denied by organizations or funders, the client is often left unhappy and believe that the occupational therapist was at fault.

Additional tips that may help during assessments:

  • Take the extra time to talk with your client, using the communication tips outlined above. Recognize that assessments require more time compared to treatment and try to build that into the schedule if possible so that you are not rushed.
  • Following up with any written information or other resources can be very valuable. Be sensitive to clients’ needs when providing supplemental information. For example, some clients may not have access to technology or be comfortable using it.
  • Document your communications with the client.All communications with the client form part of the health record, including notes of phone calls, emails, and text messages, and provides evidence of your occupational therapy service should the client file a complaint.
  • Review the College’s Standards and Practice Resources for Occupational Therapists in Ontario (coto.org) to ensure you are meeting expectations for safe, competent and ethical care.

For any questions, please contact the Practice Resource Service.

*Adapted with permission from the College of Physiotherapists of Ontario