Background/aim: There is anecdotal recognition within the profession that novice occupational therapists who perform well at interview do not necessarily make the best practising clinicians. Further anecdotal evidence suggests that it is difficult to tell (at interview) which occupational therapists will follow which path and whether further training can achieve excellence in existing staff. What is it that makes the difference? What attributes do those truly 'excellent' clinicians have that makes them better than others? Method: A two-round Delphi survey was utilised and 18 expert occupational therapists were purposively recruited from Perth's three adult tertiary hospitals. Panellists rated and ranked sixteen possible attributes that could comprise excellence in an acute practice occupational therapist. Results: The final order of importance (from most to least) of the 16 possible attributes of excellence was determined. Communication, Self-management and Critical Thinking were found to be the three most important attributes, whereas Humility was considered the least important attribute. All attribute rankings achieved at least a low level of consensus. Conclusion: We now have a much clearer picture of what excellence looks like in the acute practice setting, giving managers a new understanding. There is now the possibility of integrating this information into both the recruitment of new staff and the professional development of existing staff. In this way we can move forward to a future that includes the active development of occupational therapy excellence in ways that were not possible before these results were available.