Guidance: Working Within Managed Resources, 2021

The delivery of health care services occurs within a complex system of stakeholders such as government, health-related organizations, employers, administrators, insurers, health care professionals, clients, and the public. Within the healthcare environment, balancing service delivery demands and client expectations with fiscal responsibility, health funding reform, and resource management can present challenges for health care professionals. Working within managed resources requires professionals to prioritize how limited resources are used and to consider the most effective and efficient models for service delivery. In addition to meeting client and employer expectations, occupational therapists must also ensure they are maintaining professional standards at all times. 

The purpose of this document is to review expected practice and provide strategies for occupational therapists when working within practice settings with managed resources beyond the control of the occupational therapist. Resource management is the “process of using a company’s resources in the most efficient way possible. These resources can include tangible resources such as goods and equipment, financial resources, and labor resources such as employees.”¹ For the purposes of this document, managed resources are defined as the resources that are allocated to occupational therapy service delivery. 

This document is intended to be used along with applicable legislation and College standards to enable occupational therapists to provide safe, competent, and ethical care. 

Quick Links to College Resources

In working within managed resources, occupational therapists must be aware of the expectations outlined in related College documents: 

• Code of Ethics
• Standards for Assessments
• Standards for Consent
• Standards for the Prevention and Management of Conflict of Interest
• Standards for Record Keeping
• Standards for Professional Boundaries
• Standards for Supervision of Occupational Therapist Assistants
• Guide to Discontinuation of Services

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¹ Retrieved from http://www.businessdictionary.com/definition/resource-management.html on November 24, 2017.

This document cannot address all circumstances that may exist. Occupational therapists are expected to stay informed of changes to relevant legislation, regulations, standards of practice, and policies and procedures pertinent to their organization. Occupational therapists are welcome and encouraged to use the College as a resource to ensure they continue to practice safely, effectively and ethically. 

Although decisions about funding for occupational therapy services may be outside the occupational therapist’s control, occupational therapists can take an active role in assisting their organization to determine how occupational therapy services can be delivered in a safe, efficient, and ethical manner.

The College has a mandate to protect the public by regulating the practice of the profession of occupational therapy in accordance with the Regulated Health Professions Act, 1991 (RHPA). The College has a responsibility to ensure that clients who are in receipt of occupational therapy services are provided with safe, effective, ethical care consistent with the standards of practice for the profession. 

Advocacy for occupational therapy service falls under the mandate of the professional associations. Some examples of associations that occupational therapists may choose to contact include the Ontario Society of Occupational Therapists (OSOT) and the Canadian Association of Occupational Therapists (CAOT). 

The Code of Ethics serves as a foundation for occupational therapy practice regardless of the model that is being used to deliver occupational therapy services. Occupational therapists must be guided by the core values of Respect and Trust and the principles of practice that follow: Client-centered practice, Respect for Autonomy, Collaboration and Communication, Honesty, Fairness, Accountability, Transparency, Professional Boundaries and Conflict of Interest. When working within managed resources, occupational therapists are expected to uphold the core values and principles of the profession and to remain professional and ethical in all of their interactions. 

When faced with an ethical dilemma related to managed resources, such as deciding which clients will receive service or how much occupational therapy service can be provided, occupational therapists are expected to engage in a decision-making process to arrive at a decision that is reasonable and sound. The Decision-Making Framework is a resource that provides a framework for this purpose. 

The Essential Competencies of Practice for Occupational Therapists in Canada describe the skills, knowledge, and judgment that occupational therapists should demonstrate in clinical and non-clinical practice. Even when practicing within managed resources, occupational therapists must ensure that they are competent and follow a systematic approach to service delivery in keeping with the standards of the profession. 

Despite limitations or constraints placed on occupational therapy service delivery, occupational therapists have a responsibility to uphold and maintain the accepted standards of practice. Occupational therapists are expected to:

• Follow the relevant legislation, professional standards, and organizational policies; 
• Ensure that clients are provided with appropriate information to make informed decisions about their care; 
• Engage in open and honest communication to promote realistic client expectations; 
• Describe the scope, role and purpose of the service to be provided 
• Ensure the client and referral source are aware of the service model in terms of the amount of service available; 
• Provide services appropriate to the client’s needs and not discontinue services without an acceptable reason; 
• Provide clients with a clear understanding of their treatment status if resources are exhausted prior to client goals being met or the expected discharge; 
• Take necessary steps to ensure a safe and effective transfer of care when service is to continue with another provider. 

Occupational therapy can occur using various models of service delivery: 

• Direct 1:1 care where an occupational therapist provides individual care to each client separately 
• Groups where an occupational therapist provides care to multiple clients simultaneously in a group setting 
• Consultation where an occupational therapist provides recommendations for a client or type of client to be carried out by someone else 
• Collaborative or interprofessional care where an occupational therapist works with other providers in delivering client care 
• Assigning care where an occupational therapist assigns aspects of client care to another person, for example, an occupational therapist assistant 
• Virtual Services where an occupational therapist uses information and communication technologies (ICT) to deliver services when the client and occupational therapist are in different physical locations.² 

If resources are limited, it may be beneficial to examine the current model of service delivery that is used and consider alternative options that are safe, evidence-informed, and cost effective for the delivery of occupational therapy services.

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² College of Occupational Therapists of Ontario. Virtual Services (2021).  

Occupational Therapy Services 

Strategies 

• Consult and collaborate within your organization to develop priorities for occupational therapy services; 
• Set realistic limits on the type of occupational therapy services that can be delivered within the current funding model and communicate this with management, the treatment team, and clients; 
• Use the Decision-Making Framework to assist you in determining the type and amount of occupational therapy services that can reasonably be delivered; 
• Consult, share, and collaborate with occupational therapists and other stakeholders within and outside the organization to investigate alternative ways of dealing with limited resources; 
• Use evidence-informed practice to develop service models and provide rationale for service delivery recommendations when presenting options to management or payers; 
• Investigate and develop new, innovative service models and advocate for permission or resources to carry out a pilot project to evaluate effectiveness; 
• Notify employers or management if workplace policies and procedures are inconsistent with College standards. 

Additional Considerations 

• Identify risks to clients in the event that resources are insufficient. If client safety is a concern at any time, the occupational therapist should alert the appropriate stakeholders and explain the potential impacts of reduced resources on the occupational therapist’s ability to provide safe care; 
• Discuss with management any requests to perform activities that are outside the occupational therapist’s scope of practice in any service delivery model; 
• Make evidence-informed recommendations for clients based on objective assessment and what is in the best interest of the client. Remain impartial and objective in the decision-making process regardless of outside pressures. 

Managing Caseloads 

Strategies 

• Critically review and evaluate the services being delivered; 
• Propose modification to the scope of occupational therapy services provided to ensure the service delivery model is safe and effective for clients; 
• Consult and collaborate with team members regarding any change to occupational therapy services; 
• Develop an occupational therapy priority matrix that supports decision-making for effective allocation of resources; 
• Conduct an environmental scan of occupational therapists in similar roles to determine any strategies that could assist with caseload management; 
• Engage in discussions regarding caseload demands with relevant management within the organization; 
• Speak with management regarding any identified risks to clients in the event the occupational therapist feels the provision of care is compromised or unsafe due to the allocation of resources or staffing; 
• Explore tools to assist you in caseload management.³ 

Additional Considerations 

• Use discretion and professionalism when documenting in the client record as the client record pertains only to the client’s care. Consider how documentation in the client record will reflect the organization and other stakeholders; 
• Examine the current priorities established by the organization. If the current prioritization process is no longer effective, then this may warrant the review and development of new priorities within the organization. 

Collaborative Care 

Strategies 

• Engage collaboratively with other service providers in the management of resources; 
• Communicate effectively with other service providers to ensure that client care is coordinated; 
• Determine if there are members of the team to whom you can assign care, for example, occupational therapist assistants. Additionally, examine if there are members of the team to whom you can refer to, for example, social workers or case managers; 
• Work with team members to ensure that each provider’s scope, responsibilities, and role is clarified to prevent duplication of service when engaging in collaborative care. 

Additional Considerations 

• Ensure that the client understands each provider’s scope of practice, role and responsibilities; 
• Refrain from assigning tasks to occupational therapist assistants that require clinical judgement; 
• Ensure that the model of supervision allows for adequate supervision of all occupational therapist assistants. 
  

Professional Behaviour 

Strategies 

• Engage in clear and transparent communication to assist clients in understanding the current service delivery system and any variations between the expectations of the client and available resources; 
• Maintain positive inter-professional relationships that support the best interests of the client; 
• Maintain professional boundaries with clients and stakeholders. 

Additional Considerations 

• Use discretion and professionalism when communicating to clients any restrictions or limitations to funding or services; 
• Avoid engaging in conflicts of interest by self-referring and/or directly soliciting business; 
• Adhere to ethical practice when working within managed resources. 
  

Record Keeping 

Strategies 

• Determine the most appropriate frequency of documentation by examining the frequency of client interaction, change in the client’s status, the type of occupational therapy services being delivered, the setting in which services are being provided, and any relevant organizational policies that apply; 
• Reflect on the length and quality of the documentation to ensure all relevant information is included and consider if there are opportunities to be more concise; 
• Examine the clinical record to minimize the duplication of information, for example, if other providers have already documented about the same thing; 
• Tailor your documentation to the client aspects that apply to occupational therapy; 
• Use templates and forms when engaging in record keeping to support efficient documentation; 
• Consider the use of organizationally accepted acronyms; 
• Utilize technology such as secure dictation systems, tablets and laptops to assist with documentation efficiency. 

Additional Considerations 

• occupational therapists have a responsibility to maintain clinical records according to the Standards for Record Keeping regardless of perceived time constraints; 
• If the occupational therapist is also the Health Information Custodian (HIC) of the record, they must take reasonable steps to ensure the preservation, security and ongoing access to the client record in events such as the organization/agency within which the occupational therapist is providing (or has provided) service ceases to operate, or if the occupational therapist’s contract is terminated prematurely. 

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³ For example, Caseload Management Planning Tool available through the Canadian Association of Occupational Therapists (CAOT).  

Regulated Health Professions Act, 1991. https://www.ontario.ca/laws/statute/91r18

College of Occupational Therapists of Ontario (2016). Standards for Record Keeping. Toronto, ON.

College of Occupational Therapists of Ontario (2020). Code of Ethics. Toronto, ON. 

College of Occupational Therapists of Ontario (2021). Decision-Making Framework. Toronto, ON. 

College of Occupational Therapists of Ontario (2021). Virtual Services. Toronto, ON. 

College of Occupational Therapists of Ontario (2018). Standards for the Supervision of Occupational Therapist Assistants. Toronto, ON. 

Canadian Association of Occupational Therapists, Canadian Physiotherapy Association, the Canadian Association of Speech Pathologists & Audiologists (2011). Caseload Management Planning Tool. 

Ottawa: ON. 

Association of Canadian Occupational Therapy Regulatory Organizations (2011). The Essential Competencies of Practice for Occupational Therapy. Canada. 

Resource Management. Retrieved from http://www.businessdictionary.com/definition/resource-management.html on November 24, 2017. 

This document replaces: 

College of Occupational Therapists of Ontario (2012). Practice Guidelines for Working Within a Climate of Managed Resources. Toronto, ON.