BACKGROUND

Dayne is an OT on an acute general medicine unit who will be going on vacation for a week. He reviews his caseload with Aspen, the program case manager. They discuss Mr. Raymond, a recent admission, who lives alone and wants to return home independently. Dayne strongly recommends discharge to a short-term rehabilitation facility to build Mr. Raymond’s strength, gain independence with bed transfers, and using his walker without assistance. 

When Dayne returns from vacation, he is surprised to hear Aspen report in team rounds that Mr. Raymond is going home later that day. Dayne reads the client's clinical notes and sees that Aspen has documented that Mr. Raymond does not need rehab and can go directly home with community supports.

Dayne goes to Mr. Raymond's room to provide discharge education and sees Mr. Raymond struggling to get out of bed and almost falls while trying to reach for his walker. Mr. Raymond states he still feels weak and is nervous about returning home. Dayne believes if Mr. Raymond goes home, he will be at considerable risk for falls. 

Dayne contacts Aspen to obtain additional clarification around the rationale for the change in the discharge plan. Aspen states that, in her professional opinion, Mr. Raymond is functioning well and should be fine to go home with community resources in place. Dayne feels frustrated that his recommendations are not taken seriously, and now he is in a position where he disagrees with his team member and must advocate for his client to mitigate risks.

MANAGING DISAGREEMENTS 

Whenever people work together, regardless of the setting, there is the potential for disagreement. Conflict is often viewed as unfavourable; however, conflict can be seen as an opportunity for problem-solving and change in processes, resulting in a resolution amenable for all interested parties involved.

Deciding how best to approach a potentially controversial situation can be complicated. When there are differing opinions or disagreements, consider each issue case by case. OTs use their professional judgement and follow the Standards for Practice, Competencies, and organizational policies. OTs can seek out support from peers and managers or consult with the College to clarify and discuss possible approaches to assist in helping the OT come to a resolution.  

The clinical record should be objective and pertain to the client and should not be a place to air out team discourse or issues. When the opinions of the OT and other team members clash or disagreements emerge, avoid disrespectful language and behaviours. Finding common ground through mutual understanding, respect, and clear communication is the goal.  Promoting constructive communication around difficult issues can result in better long term interprofessional collaboration.

OTs are encouraged to find a way to discuss or create a forum where the team can come together to discuss opinions, expectations, and an action plan. Are there any other individuals that can facilitate these conversations objectively? (for example, ethicists, risk managers, and legal)

Within this safe environment, participants can express their viewpoints, obtain clarity, and constructive feedback can be given and received. The OT must communicate their views about the issues in a non-judgmental and transparent manner. The OT should listen carefully to each person's point of view, periodically checking for understanding of the disagreement by re-stating the core issues as they understand and consider what is in the client's best interest.  

STRATEGIES  

Options for resolution can include organizing a meeting, preferably face-to-face, with all relevant interested parties, including the client, if appropriate.

  • Use active listening; check in with how others are feeling throughout the meeting;
  • Avoid behaviours that are dismissive, blaming, or judgemental
  • Help all participants to hear and understand the main elements of the issue (“I value your input, I see that we have come to different conclusions, do you mind if we discuss this a bit further so I can explain how I arrived at my opinion?”)
  • Try to help identify the core issues in the conflict and move the participants to reach a solution 
  • Document the outcome of the team decision

OUTCOME

Dayne checked the College website and reviewed the new Competencies for Occupational Therapists in Canada. Under Competency B Communication and Collaboration, a competent OT is expected to communicate respectfully and effectively and collaborate with clients, other professionals, and interested parties. Dayne also worked through the decision-making framework to identify a few options to help resolve the situation.

Dayne and Aspen met to discuss Mr. Raymond's case. Each listened to the other's clinical rationale for recommendations, using the described strategies. Dayne and Aspen agree that their clinical judgement was appropriate during their assessment. The difference in recommendations may result from Mr. Raymond's fluctuating condition  while in acute care and the pressures to discharge by the interdisciplinary team. Both agreed moving forward, if the primary OT is not available and there is a difference in professional opinion, a reassessment by a covering OT may be appropriate. 

CONCLUSIONS

Occupational therapists often encounter disagreements in practice. Interprofessional collaboration and communication are essential. Occupational therapists can foster respectful and professional working environments by using constructive communication skills where all opinions are valued equitably without retribution and by displaying behaviours that are collegial in reaching resolutions that support better service provision and client outcomes.

CONTACT

If you have questions about the application of College Standards and resources, contact the Practice Resource Service: 1.800.890.6570/416.214.1177x240 or practice@coto.org.

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