Learnings from the Quality Assurance Program Competency Assessments
Conflicts of interest (COI) arise when personal, financial or relational factors have the potential to influence an occupational therapist’s professional judgement. In practice, this can impact objectivity, client trust, and quality of care.
Common Conflicts of Interest
These are the six most common COI themes identified from 280 competency assessment responses:
Familiarity with Clients
Referrals for clients known through personal, social or community connections that could influence objectivity or create preferential treatment
Vendor Referrals
Referring clients to a particular vendor without presenting options, not comparing or disclosing alternatives, or defaulting to familiar vendors.
Gifts & Benefits
Exchanges that alter the therapeutic relationship or create preferential treatment including high- value or repeated gifts
Self-Referral
Clients directed to services where the occupational therapist has a personal or financial interest.
Preferential Provider Referrals
Referring to service providers based on familiarity or workplace relationships rather than offering a client multiple options/choice.
External Influences
Influence from outside parties affecting clinical decisions. For example pressure from employers, families, insurers, colleagues, lawyers, etc.
How Did Occupational Therapists Manage These Conflicts of Interest?
Four common COI management strategies emerged from 280 assessments:
Proactivity
Prevent COIs early: Avoid working with familiar clients, maintain clear professional role boundaries, avoid self-referrals, transfer of care to another occupational therapist prior to providing services.
Transparency & Collaborative Guidance
Address COIs openly: Discuss COI to clients and families, document COI decisions and actions, consider consultations with supervisors, managers, or regulatory body (COTO).
Client Choice
Support client-centred decisions: Provide multiple vendor/provider options, prioritize client’s best interests, avoid biased recommendations, maintain impartiality with inquiries.
Management of Gifts & Benefits
Address gifts appropriately: Decline inappropriate gifts, accept only low-value, non-recurring items, ensure gifts do not compromise therapeutic relationships, establish professional boundaries at the onset and throughout care, ensure conduct doesn’t lead to preferential treatment.
Why Does This Matter To Occupational Therapists?
- Some COIs aren’t always obvious—you may encounter them without realizing it
- COIs can influence client care and trust in the occupational therapist
- Use this information to recognize, address and manage COIs to protect your clients and your practice.
Review the Standard for the Prevention and Management of Conflict of Interest.
Learn more information about the competency assessment.
If you have any questions, contact the Quality Assurance team at qaprogram@coto.org.