Managing the Occupational Environment of Managed Care

Abstract

The emergence of managed care has resulted in a practice environment buffeted by rapid and sweeping changes. Shifts in philosophy and approach to payment for health care affect the nature of the service and the method of its delivery. The occupational adaptation frame of reference is used to illustrate the challenges imposed by the physical, social, and cultural components of the changing occupational environment. Perceptions, observations, and concerns of middle level occupational therapy, physical therapy, social work, and nursing managers illustrate the impact of this new environment. Therapists are challenged to understand their own changing work setting and to apply the same effort to mastering its challenges as they would to examining the context of their patient's occupational performance and to designing and implementing an appropriate clinical intervention.

Occupational Adaptation as a Construct: A Scoping Review of Literature

“…Occupational adaptation was identified as a mechanism to manage and respond to the occupational environment (Brayman, 1996;Spencer, Davidson & White, 1996) and as a manner of receiving validation from the environment (Taylor et al, 2003). From a therapeutic perspective, occupational adaptation was applied and defined as the process of adapting the self and the environment to provide holistic care or intervention (Dale et al, 2002).…”

Organisational Change and Occupational Therapy

“…therapist and client and subverting the ethical foundation of the relationship. In the USA, Brayman (1996) conducted a series of focus groups at a university teaching hospital to understand the demands that the work environment placed on occupational therapists during a period of rapid change. The therapists were concerned about the relationship between the organisation and its employees, the pace of change, and the changing nature of the work itself and its effect on practice.…”

A congruent model for health promotion in occupational therapy

“…For current American consumers of occupational therapy services, managed care restricts access somewhat (VanLeit, 1997;Varela-Burstein et al, 1997), is plagued with bureaucratic hassles, and strips the citizens-stakeholders of their input in health care planning and delivery when they are insufficiently well to strongly advocate for themselves (VanLeit, 1997). For occupational therapists, managed care also poses ethical problems: when money overrides other considerations, health promotion and occupational therapy core values of caring and holism come into conflict with front line notions of cost-recovery and productivity (Brayman, 1996;Lohman and Brown, 1997).…”