Changing Jobs and Responsibly Transferring Clients

BACKGROUND 

Ally is an occupational therapist who is new to the position of clinic manager. As part of this role, they manage a small interdisciplinary team of health providers. Much of their work involves clients that have been injured in motor vehicle accidents. 

Henny, one of the occupational therapists has just met with Ally to let Ally know that she will be leaving her role as occupational therapist within the clinic for another job that she considers a better fit.  She will be leaving in two weeks.

During their meeting, Henny asks Ally lots of questions about how she should finish things up with her current clients in this short time before she leaves.  Some clients she will be able to see through their care plan, but others are booked for initial assessments and many are just part way through treatment.

Henny asks questions like; “what should she document about why the services are being stopped and who is responsible for letting clients know she is leaving?” “Continuity of care is important but who will take over services as there isn’t another occupational therapist available to take on the work?” Although it may be awkward, Henny and Ally agree to meet again tomorrow to talk about a plan for the clients on her caseload. 

What responsibilities does Henny have as she leaves her current role?

CONSIDERATIONS 

Clinical

  • Whether her involvement with clients on her caseload has been brief or longer term, Henny is aware that leaving may cause disruption. Both Henny and Ally agree that the client experience is most important, and they will each take actions to minimize any negative impact to the clients.

  • Henny reflects on the principles of trust, respect, and accountability as outlined in the Code of Ethics and how they apply to this situation.

  • Thinking about her caseload, Henny considers which clients are at higher risk and recalls a recent PREP module on managing risk.  She reviews this resource.  

Legislation

  • Henny knows that to protect the public there are rules she needs to follow when ending services. These are set out in Professional Misconduct (Ontario Regulation 95/07) of the Occupational Therapy Act, 1991.

  • She reviews the College’s Discontinuing Services document which outlines the rules for ending services.  
Record Keeping
  • When it comes to documenting, Henny reviews the Standards for Record Keeping (Indicator 1.15) and confirms that she must ensure that the clinical record includes “Discharge information (for example, client status at discharge, reason for discharge, explanatory note when intervention was initiated but not completed, summary of outcomes attained, recommendations for post-discharge home program, record of referrals).”

Organizational

  • During the orientation to the clinic Henny recalls Ally speaking about a checklist that staff are to follow when leaving the organization.  She wonders if there is a discharge template that she can use to prepare a summary for each client.   
  • Henny considers how to manage the expectations and relationships with funders and third-party payers if services are delayed or discontinued.  Ideally, she does not want her departure to impact the organization.


ACTION

Ally and Henny meet several times over the next two weeks to regularly discuss the status of the clients on Henny’s caseload.  They discuss what factors to consider when identifying any clients who may be at risk with a delay in services. Using this agreed upon criteria, Henny has identified several high-risk clients who will require ongoing services.  Together they develop a transition plan and suggest other providers who could assist with these clients until a new occupational therapist can be hired to continue services.

Henny has entered a summary note into the clinical record for each client which “closes the loop” and makes it easier to understand the status of treatment and which goals were achieved, which are outstanding and other relevant clinical information. Ally also recommends that Henny include in the clinical record the reason that services are being delayed or discontinued.  They agree that Henny will contact current clients to inform them of the change and Ally has instructed the administrative staff to call those who have been booked for an initial assessment, but not yet seen. Henny lists some of the questions she expects clients will ask her, for example, when they can expect a new occupational therapist, what to do in the meantime if symptoms change or worsen, and options to use other providers. Together they agree on some consistent messaging to share with clients to avoid any risks or feelings of abandonment by the clients, and to reduce impact on the organization. 

CONCLUSION

There are many reasons occupational therapists may end services, including the decision to leave a position.  Regardless of the circumstance, when ending service, it is expected that occupational therapists maintain professional attitudes and actions with clients and within the workplace. The client experience is at the forefront throughout the transition.  Thoughtful planning and good communication between the client and with the organization can help to ensure minimal disruption to the client.    

REFERENCES 

CONTACT

If you have any questions about this case, or have any ideas or requests for future cases, contact the Practice Resource Service: 1.800.890.6570/416.214.1177x240 or practice@coto.org.

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