Thinking OT

Thoughts from Harrison Training and the occupational therapy world

Posts Tagged ‘practice

OT Blogs, Social Media and Confidentiality

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Salford University’s excellent OT blog had a timely reminder on confidentiality within OT blogging, together with several useful links.  You can read their entry here.

I was reminded of another blog article  had written from outside the OT sphere about a useful test on blogging confidentiality and I share it below.  This blog, as you will see, originated from an indiscreet comment on Twitter, but the test still applies;

“Hey look that’s me!”

I spotted a twitter exchange yesterday that caused me some concern.

A case was being discussed on Twitter that referred to identifying features. No names were mentioned and in that sense, at least, the clients were anonymous.  However, the details being discussed, such as appointments, some figures and issues would have been enough for the clients concerned to identify themselves in a flash.

I cannot recall where I learnt this “Hey look, that’s me!” test for confidentiality.  I do not know if it is enshrined in protocol or case law – perhaps a reader might care to tell us – but it makes perfect sense.

If a client can recognise themselves then that is perhaps the lowest cognitive bar we can set.

That is no reason to disregard that low bar, or dismiss it with an argument that “No-one else would know who it was.”  After all, if the client complains to us or relevant supervising bodies, then that will be more than enough to land us in hot water.

This incident also highlighted another issue.  We need to be diligent ourselves in testing confidentiality, but also in pointing out possible problems to one another.

By doing so we can self police effectively.  The alternative is likely to be a blanket ban or some other hysterical over-reaction.

I hope that if I have such a lapse in future that someone would quickly send me a direct message discretely to point out a possible problem.

I also hope that I would receive it with the same good grace and politeness that my Twitter friend did.

In the words of High School Musical “We’re all in this together…”


Written by harrisontraining

September 2, 2010 at 7:30 am

We make sense of the world depending upon our experiences of it.

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There are a great couple of posts over at the A Voice In The OT Wilderness blog.

Part one is here.

Part two is here.

The story revolves around a conflict arising from a client’s non-compliance with a specified art exercise.  When asked to create a collage, one user, instead, created a 3D model.

This was used by one observer as evidence of that client’s “defiance” – a chilling thought redolent of One Flew Over The Cuckoo’s Nest.  There was a fascinating reason however for the deviation between the expectation of the observer and the interpretation and actions of the client.

The story reminds us that although we might be absolutely clear about communicating what we are asking clients to do, they, being the recipient of the message, receive the message and interpret it through their own filters.

Those filters are, in turn, shaped and coloured by their life experiences.

Go to Allie Hafez’ A Voice In The OT Wilderness blog now and read the story for yourself.

What is Occupational Therapy To You?

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The walk to Harrison Training's offices/ What Is Occupational Therapy?

View From The Bridge

I love coming to work at Harrison Training’s offices here in Bradford on Avon.

The walk from the station takes you across the river, filled with waterlillies and cool promises.

From there you go through the old part of town with its stunning Georgian properties and then walk past the church and up some steps, worn through centuries of use.

Steps leading to Harrison TrainingIt is hard not to imagine the lives that have been lived here over the years.

And then my thoughts shift.

How fortunate we are, those of us able to take these walks and enjoy our surroundings because, let there be no doubt, for all of the beauty in this town, accessibility must be a nightmare.

Inevitably, perhaps, I am drawn once again by this consideration of accessibility, to that old chestnut of a question – What is occupational therapy?

Take me as an example.  I am able to draw meaning, pleasure and fulfilment from being in, walking through and interacting with these surroundings.  And I wonder, is that the point?  Is that what occupational therapy is?

When we enable, reable, rehabilitate, when occupation is not career or work, but being meaningfully occupied, or stimulated, is this what we do?

Forgive me my more metaphysical ramblings this morning, but please share your thoughts.

What is it that you do when you do what you do?  What is occupational therapy to you?



What Is Narrative Medicine?

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As I was reviewing the Mayo Clinic’s various social media channels (see my earlier blog post here) I came across this blog post by former patient/client Jillayn Hey.

Click through on the picture to read the blog in full

That in turn led me to this interview of Lewis Mehl-Madrona and his thoughts on Narrative Medicine.

The article suggests that “Narrative Medicine…asserts the importance of an individual’s whole life story to the person’s health-not just the medical history, but a story that includes ancestors and friends, interests and spiritual orientation.”

Given that the subtitle to this blog is “Thoughts, observations and provocations from the occupational therapy world” I thought this would make for good debate.

To what extent do we agree the premise?

The narrative movement can be seen in many disciplines other than medicine.  Another example can be found in narrative mediation, for example, as a dispute resolution process.

Allow me to break out of the OT silo for a moment, and look over to see what they do there.

Within narrative mediation the conflict that disputants find themselves in is held up as being a story that they are involved in.  Referring to the dispute, or, here, the question of illness or wellbeing, as a story is not intended to diminish how real that situation is.

The “Story” label, however, allows mediators, or maybe practitioners, to deconstruct the story.

  • Who are the players in this story? 
  • Who else is effected by it?
  • What is the plot? 
  • Crucially, what is the outcome?
  • How are we using language to tell this story?
  • How else might we re-tell the story, perhaps to a different audience?

A powerful part of narrative mediation, and I can see no reason why it would not have an impact here, is to set up the problem – the dispute or illness – as an entity within the story.  that in turn enables us to ask questions such as

  • How did this thing called conflict lead you to feel or react?
  • When conflict was around, did you notice anything different?
  • How did the pain invite you to respond to others?

That line of questioning can be developed further

  • What was your relationship like before conflict arrived on the scene?
  • How did you imagine your career progressing before the illness?
  • Can you think of a time when the illness didn’t have stop you from doing something?

and further still by asking

  • Am I right in thinking that you would rather this conflict was not ongoing, that you would like to see an end to it?
  • If so, what other ways might you react when conflict appears? What might you do differently?

and so on.

As the dialogue is developed, conflict, or illness, is first recognised as having an impact on our lives and behaviour.  We then go further and look at how we can explicitly recognise the grasp that it has upon us and how we can start to loosen its grip. 

In the words of Winslade and Monk, authors of Narrative Mediation, we then allow room for alternative, newly created and more helpful narratives, or stories to be constructed by ourselves and retold to others. 

In the words of Jillayn Hey herself “Through telling our personal stories of illness and disease, we assist in creating a new story of wellness that facilitates healing and in turn directs a person towards recovery.”  Note how Jillayn explicitly speaks of her new wellness.  In doing so she brings her new symptoms of being well to the foreground.  If she had not done so, then the grasp, or the narrative, that her former condition had on her own expectations of what it is to live day to day might have continued and therefore limited her activities and perceptions.

What are your thoughts?


Social Media in Occupational Therapy. Why Bother?

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Here at Harrison Training, we are discovering more fascinating OT blogs every week.

Today we came across Kara, a newly qualified occupational therapist in America, and her very personal and intimate blog “Be the change you wish to see in the world”

This particular post, “Another chapter in my book of life” impressed for several reasons, the first of which is this;

Many of you may have seen this already, judging by the massive number of viewings this clip has had, but it bears repeating because it is so charming.  It also demonstrates one of the powers of social media within occupational therapy.

The YouTube video is so evocative in setting up a vision, an aspiration of what older adult life can be like.  In doing so, it challenges our preconceptions about older people, their needs and what we might expect for ourselves in the years to come.

Other reasons for the success of the “Another chapter..” post by Kara, and social media generally, is that Kara talks about why she is passionate about her work.  She can pass on the YouTube video and in doing so relay that story but she also uses social media to pass on other memorable stories… The dead body of Mussolini hanging upside down from a tree, anyone.

But so what?  Why bother?  What is in it for Kara?

Probably nothing tangible, nothing that can be counted in pounds and pence, or dollars and dimes, or at least not yet.

But we all have a need to tell these stories, to hand them on.

In doing so, isn’t she honouring the gifts that her clients have to offer?

Kara is adding to the occupational therapy and healthcare community by sharing optimistic viewpoints but also, elsewhere on her blog, sharing challenges that she is facing.

Maybe we’re just being overly sentimental here, but we believe that social media has a critical role to play for all of us,  in our work and development as OTs and health care professionals.  We need the OT community to be fully effective so that we can support and encourage one another.  After all, there may be trouble ahead.

There are also benefits for our clients.  In a second article, next week, we will look at the Mayo Clinic from which this video stems, the work that they are doing with social media, some of the downsides but also the benefits.


NHS Cuts, Budgets and That Thing Called Leadership

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Leadership needs to be inside out, not back to front.

With the imminent election, and even more imminent budget, the future funding of the NHS, and possible NHS spending cuts is a real hot topic.

In my previous post I highlighted the NHS Confederation’s report on Rising to the Challenge.

I have just been recapping their fascinating series on leadership from Spring 2009.

The fact that there are going to be massive cuts and the need for efficiency drives within the NHS is a given.  It is going to be unavoidable, as it will be in any other public sector.  What is not clear is how the system, and the individuals within it, will respond to those changes.

It is a time for leadership to come to the fore on a corporate and individual basis.

Leadership needs to be inside out, not back to front.

What is back to front leadership?

Back to front leadership is reactionary knee jerkism.  Back to front leadership only looks ahead at what is to come and reacts to it.

It is like reading the last page of a novel and guessing what might happen in the other 250 pages for yourself to fit with the conclusion you have just seen.

It is reactionary and often misguided.  The steps that are taken might match the predicted outcome (reduced costs) but may make no sense along the way.

Inside out leadership is different.

It still sees what the big picture is – there is no self deception or self comforting delusion here.  However it then works from the inside outwards to ensure that the necessary re-organisation fits the outcome and is consistent and coherent throughout the organisation.

This is much more challenging.  It requires the ability of managers and leaders (very different roles by the way) to be able to communicate, reassure, be honest and yet still move the team forward.  It takes courage to make those unattractive decisions.  There is no room here for procrastination or avoiding tough decisions and the subsequent conflict that will arise.

These leadership traits are not simply required in those we follow or look to for guidance and decision-making.  We can all develop leadership qualities ourselves and, as we do so, then we strengthen our own positions within our teams, employment but also within our personal lives and decision making.

Personal leadership also needs to be inside out, not back to front.

As we challenge ourselves to face up to several years of turmoil within the NHS , we have a choice.

We can read the writing on the wall and despair.  Maybe some will just give up, or others will keep a low profile hoping not to be noticed in any cutbacks.  That is the back to front approach.

The inside out approach to self leadership will be to look at ourselves.

What is it that we do really well?

Where can we improve?

What value and importance do we offer to our clients?

What value and importance do we derive for ourselves from what we do?

What is it that really fires us up?

Where do you want to be in say 3 to 5 years time, rather than where do you think the system will leave you in 5 years time?

These are all internal questions but they will have a profound impact and shape your external presentation.

If you are sure of why you do what you do, and if you have a vision for your career which is rooted to your values then you will be seen as someone to be kept hold of, and even promoted as and when opportunities continue to arise.

People will see you as bold, courageous.  You will be called inspirational.  People will turn to you for your opinion and guidance.

You become sought after and increasingly central to your team or organisation.

You will not avoid the tough times ahead but will be better positioned to roll with them, take the blows and carry on forward instead of falling into despair.  This resilience will, again, position you as a natural leader within your organisation as a result of developing your internal self leadership characteristics.

Here at Harrison Training we are continuing to expand our leadership skills training program for occupational therapists and other health care workers at all levels of seniority.  Let us know if this is something that you would like to bring into your organisation, or access personally, to help you and your people rise to the challenges that are to come.


The OT’s Role in Helping The NHS Rise To The Challenge

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If you have not yet read the NHS Confederation’s report “Rising to the Challenge” then take the time to do so.

The NHS Confederation is the voice for NHS leadership. Their report is a call to the vying political parties about how they should approach NHS policy after the imminent election.

The whole report is only 20 pages.  The report offers some reassurance that the right noises are being made by the professions leaders.  Of course, whether they are heard or not remains to be seen.

Consider, though, this excerpt;

“Patients and groups of patients need more support to manage their own conditions.  National policy can help by commissioning training and education, evaluation of programs and research to support new approaches.  however most of this has to be local and may be organised by patients or social enterprises.  It could include:

  • telecare and homecare services
  • faster procurement of aids and home adaptations
  • more responsive rehabilitation services that are more accessible to both patients and professionals”  page 12 Rising to the Challenge

With all of that in mind, it seems clear to us, that this call, together with Gordon Brown’s call for greater reablement service provision could place occupational therapy at the very front of health care reform in the near future.

Are you ready for that?