Abstract
Surrounded by changes and opportunities, the profession of occupational therapy finds itself at a tipping point. We all have the power to make a difference. What bold action can you take to create meaningful change?
Amy J. Lamb, OTD, OT/L, FAOTA
When I crossed the stage to receive my bachelor’s degree in occupational therapy more than two decades ago, I was filled with enthusiasm for what lay ahead. It was a good time for the profession. Occupational therapy was on virtually all the Top 10 lists for careers, and the job market was plentiful for new graduates.
If someone had told me that day that in 20 years, I’d be president of the American Occupational Therapy Association (AOTA), I would not have believed it. I did not set out to find leadership roles. But as the old saying goes, life is what happens while you’re busy making other plans.
My leadership story was the direct result of the Balanced Budget Act of 1997. I was one of many occupational therapy professionals who lost their job as the industry worked to understand how to deliver services in the new prospective payment model. I was frustrated that patients were no longer getting services they needed, and I was no longer able to put my degree to use and earn an income.
It was in connecting with AOTA that I learned more about the policy changes themselves, as well as what the association was doing to meet these changes head on. I decided to channel my frustration into helping this effort.
I passed on what I learned from AOTA to other occupational therapy professionals to understand why these changes were happening and what we could do to ensure that people would still be able to access our services. I listened to the challenges that my colleagues were experiencing, offered my perspective when it was different, and, above all, made sure I collaborated with and supported my peers as we navigated this new system.
It was there, in the hospitals and clinics, that my leadership journey began. This leadership was anchored not with job titles, but with action—from taking risks to sometimes going against the grain, while working to keep the greater good front and center at every corner.
Why do I reflect on this now? Because today, we are all facing ups and downs within our profession and trying to navigate where to go from here. Major payment changes are on the horizon once again. As individual practitioners and as a profession, we have to determine what risks to take, when to play it safe, and when to be bold.
A Reflection on the Profession
In 2016, I asked you all, the AOTA membership, to revisit what brought you to the profession of occupational therapy (Lamb, 2016). Over the past 3 years, you’ve told me. You want to make a difference in the lives of others. You want to help your organizations do better and be better. You want to make your corner of the world better when you leave it than when you arrived.
You’ll notice a common theme in these ambitions. It’s not about us. For occupational therapy professionals, it’s always been about those we serve. For more than 100 years, we’ve been proud to be people that our communities can lean on.
In 2017, we celebrated our profession’s centennial by honoring our past and embracing the future. We explored opportunities as we thought ahead to Vision 2025 (AOTA, 2017; Lamb, 2017). We asked ourselves, What do we want our future to be? Here are my takeaways from hearing thousands of you answer that question.
We want to be an inclusive profession that respects diversity in all its forms. We want to meet people where they are, listening to them to really hear what they need and want from us. We want to transform practice in current settings and expand our reach in communities as people engage in their everyday lives.
We want to have joy in our work. We want to recognize that we cannot sit and wait for an invitation to the table; we need to pull up a chair and help others understand the full scope of occupational therapy and the value we have to add to what they do.
I believed two decades ago, and continue to believe today, that it is time to stop following the trail of reimbursement. If we continue to go where reimbursement leads us, our value will be diminished, access to services will be limited, and opportunity will be missed. It becomes all about the money and compensation—while the people who need our services get lost.
Years ago, I worked for a company whose motto was, “Take care of the clients, and the money will follow.” Client needs come first. Isn’t that why we came into the profession, to make a difference in the lives of others? Our energies, experience, and creativity are better spent generating new ideas and methods to meet society’s occupational needs. We have it within us. Demonstrate your value, and the money will follow. People are counting on us to do so. It is not about the number of minutes; it is about the quality of the interaction.
To do this, we have to work around or sometimes run right at and, often, right through barriers that threaten our progress. Take, for example, how we position the profession for the future. Five years ago, we began the dialogue about occupational therapy’s distinct value. We knew that as the systems in which occupational therapy occurs continued to change, it would be critical to articulate the distinct way in which occupational therapy enhances quality and provides value. We did just that! We developed the following distinct value statement, approved by the AOTA Board of Directors in 2015:
Occupational therapy’s distinct value is to improve health and quality of life through facilitating participation and engagement in occupations, the meaningful, necessary, and familiar activities of everyday life. Occupational therapy is client-centered, achieves positive outcomes, and is cost-effective. (AOTA, 2015, para. 6)
That gave us our legs, so to speak, to move beyond the words to demonstrate occupational therapy’s distinct value in practice. Interestingly, it is in the articulation and demonstration of our distinct value that the occupational therapy profession will be well positioned for payment shifts, such as the volume-to-value shift we are entering now. So, on the heels of our Centennial Celebration in 2018, we explored how the limitations we face may indeed be the spark for our creativity that ultimately creates new paths for our profession (Lamb, 2018). A consistent message I have worked to share with members and nonmembers alike over the past few years is the importance of being true to occupation, the power of everyday life, and the innate ability each of us holds to be an influencer of change, whatever shape that takes.
Reflection can be a powerful tool we can use as we plan our path forward. Through reflection, we can better understand what went wrong and how to prevent making the same mistakes in the future. We can gain perspective and the power to focus our efforts more intentionally.
I reflect on how my advocacy efforts have evolved over time. When I first started as an occupational therapy advocate, I was determined to share as much of what I knew as I could with someone in whatever time was allotted to me. I was focused on the volume [of information] and hoped something resonated with them.
Today, I prefer a much more focused approach. Before I walk into a meeting, I want to understand the context that surrounds the person I’m talking with and those they serve. The message is tailored to fill a gap and to focus on the value we bring to the team. What is it that this person cares about (whether an elected official, a school administrator, or a health care provider), and how can I connect what I know as an occupational therapy professional to make the pain points they are experiencing a bit less painful? In helping to relieve some of their pressures, we are opening a door for them to seek us out again to find out what more we can offer.
Through the course of my travels, I have met with occupational therapy professionals and students alike. I’m energized by the great work I see happening at all levels and in diverse settings. As those close to me can attest, after each state conference I came back excited to share about someone I met and the great work they were doing. I would leave asking myself, How is it possible that we didn’t know they were doing that? How can we shine a light on this outstanding work?
In addition, we have reached beyond the walls of the occupational therapy profession to explore collaborations, partnerships, and networks that can help us be recognized for the value we can bring in other sectors. I’ve heard from administrators who are hungry for someone to tackle sleep issues among older adults in assisted living and skilled nursing environments. From principals and superintendents searching for someone on the team to address the mental health needs of children and teens in a real and meaningful way. And from CEOs working to create avenues for wellness and prevention with their employees.
It can be frustrating—to hear the need, know you can make a difference, and not have a clear route to make that happen. Yet if we wait for the path to be perfectly smooth, the opportunity will have passed us by.
But as clichéd as it may sound, with great challenge comes great opportunity. I believe that we are about to embark on an occupational therapy revolution and that the challenges around us will spark the creativity we talked about last year. The constraint will lead to innovation. And as we have always done, we will use the occupational therapy skill set to meet the needs of people, populations, and communities in the meaningful ways they are seeking.
We need a game plan.
Listen to Understand
In my view, we must listen. As an occupational therapy practitioner, I believe that if we listen to our clients, they will tell us what they need. As an academic, I believe that if we listen to our students, they will tell us what they need. As a leader within our association, I believe that if we listen to our members, they will tell us what they need.
A few years ago, I was representing AOTA at a large political event at a park in central Cleveland, where I passed by someone holding a sign that offered up “Free Listening.” My initial thought was, “Seriously?” But I was interested to see whether anyone took him up on the offer. One after another, they did. I sat on a nearby bench and watched people come to this man and share their perspectives on a wide number of social issues, obviously with a multitude of opinions. What I observed was truly fascinating: People were finding peace from the simple act of being heard.
Later that night I searched to find out more about this “Free Listening” project. Turns out, it was a social project designed by a group called Urban Confessional (https://urbanconfessional.org/) to engage with strangers by lending an ear. Urban Confessional is a free listening movement about inspiring people to get out there and listen. Each week, members of the group take a sign to the street that says “Free Listening.” They invite people to approach them, and they have one simple goal: to listen to anyone who wants to talk, without passing judgment or offering advice. Listening is a way to engage each other, inspire others, and make other people feel that they matter.
I thought to myself, Wow! What if we did this tomorrow? What would we hear? How might we use it to inform what we do? Listening, I mean really listening, is vital to broaden our understanding of situations, people, motivations, and more.
At AOTA, we realized that we needed to do a better job of listening—and that led to the national conversation around the entry-level point for our profession. I am grateful to have had the opportunity to listen to what people had to say. I hope you felt heard. Your opinions matter.
Now please, raise your hand if you know who Stephen Covey is. Stephen Covey’s (2004) classic work, The 7 Habits of Highly Effective People, takes us to something else we must do. Habit 5 is to seek first to understand, then be understood. We all sit here today with a multitude of our own perspectives, informed by what we know, our experiences, and our situations. But other people’s opinions are as valid and real as our own. Our differences make us stronger. We build relationships by appreciating the perspective of another, a point of view different from our own. It is through perspective taking that we can be mindful in our approach to leading meaningful change.
Build a Movement
Next, you have to find people to join your movement. In Seth Godin’s (2008) book Tribes, he says,
We live in a connection economy. It is easier and faster to connect people today than it has ever been. So if you care about something, don’t wait for someone in charge to organize everyone else who cares about it. Tribes build sideways. (p. 139)
So my call to action to you is, “Go build your tribe.” The AOTA networking platform CommunOT (https://communot.aota.org/home) is a great way to do that. Say, for example, a member has great ideas for occupational therapy in women’s health. CommunOT provides a forum where the member can put these ideas out there, connect, network, and build momentum in this area. You don’t have to wait. You can start something today! It’s a grassroots approach to driving change, whether within your organization, the profession, or the association. Some movements will grow; others will not. But first, you have to try.
Finally, we can’t wait for opportunities to drop in our collective lap. Primary care physicians are likely not going to come knocking on our door to discuss their challenges addressing chronic pain. We must push in and articulate what occupational therapy can offer in managing chronic pain that is distinctly different from what these physicians might currently be doing. And of course, we must bring the evidence to back it up.
We can’t wait for permission to engage. I wonder, have you ever looked at a job description and thought it described occupational therapy, even though the job title was something else entirely? I have. This is an opportunity for us, and we must step forward. I say, apply for the position. Use your application, cover letter, and résumé as a vehicle to translate your skill set and reinforce all the ways an organization would benefit from hiring an occupational therapist or occupational therapy assistant. Show them how occupational therapy can fill the gaps. Use the opportunity to expand the reach of occupational therapy and perhaps step outside of your comfort zone to spark that joy you seek to have in your work.
Confront Risk
We are faced with choices each and every day and, from them, experience ups and downs, successes and failures. We can choose to put ourselves out there and take a bit of a risk, or we can play it safe and keep our ideas to ourselves.
I’m sure many of you, at one point or another, has been told no. What did you do? Did you give up? Or maybe put the idea on hold? We can hear no and close the door, or we can take the feedback, make the idea better, and find a window. I learned early on that a no to a new idea is not no forever. It means “not right now.”
AOTA member Ariana Gonzalez has been told no quite a few times in her rather short career. But she didn’t let any of those nos stop her. She finds windows on every wall. In a video, she shows us how persistence pays off. 1 Ariana had big ideas and made them happen, and she is just getting started.
Technology has expanded our ability to reach one another. AOTA member Alondra Ammanon is passionate about cultural diversity and inclusion within the occupational therapy profession. She knew she had value to add in this space. She stepped outside her comfort zone and jumped in feet first to inspire students and practitioners and promote inclusion in the occupational therapy profession. Watch a bit about her experiences [in the supplemental video available online]. We rise by lifting others! Thank you, Alondra, for taking action to create the change you want to see.
Now, for all the students in the audience who think you need to put your head down, get some experience under your belt, and then try and do your thing, let me tell you, it doesn’t always work that way. And that’s a good thing.
I’d like you to meet two occupational therapy assistants, Holly Masters and Ali Izzo—the founders of Purpose: The Therapeutic Subscription Box (https://ecenterlindenpointe.com/project/purpose-the-therapeutic-subscription-box-llc/). Their vision came to them when working on a class project in their occupational therapy assistant program. They wanted to decrease sadness and loneliness in the older adult population by designing and distributing boxes that contain products that older adults can use to sustain their memory or stay connected to their families, thereby improving their positivity and quality of life. When these two visionaries graduated, they put their plan into motion and became entrepreneurs. Hear more about their story [in the supplemental video available online]. I love their program. And I love that it was occupational therapy assistants who made it happen. We really do have an entrepreneurial spirit that cannot be denied!
Let me introduce you to another individual who didn’t wait for permission to change what wasn’t working. Rob Ferguson found himself wanting to be an occupational therapist after having a not-so-good experience with one. After an injury in the military, Rob was referred to occupational therapy. The services he received were minimal, at best. He was told he would heal in time and given some exercises to do at home. He was left to figure out how to adapt his daily activities on his own. He turned his frustration into fuel and later became an occupational therapist himself.
In a recent conversation with Rob while visiting our Michigan delegation on Capitol Hill, he showcased occupational therapy’s distinct value in a way that perked up the ears of the 20-something staffer sitting with us. It went like this: “So, what do fruit ninja, virtual reality, occupational therapy, and opioids have in common?” Let Rob tell us himself [in the supplemental video available online].
These are inspiring examples of our colleagues who have taken their ideas and put them into action. The first step was undoubtedly the hardest but proved to be a difference maker. Today they are reaching people in new and different ways because they weren’t afraid to be bold. And of equal importance: They are energized by their work!
Look to the Future
AOTA’s history as an organization is not unlike these individual stories of perseverance. We have had a century to figure out that change is not easy or fast. It does not happen overnight. The larger our organization becomes, the harder can be. Just as a large ship takes a while to change course, so, too, do large organizations take time to adjust their course for steady progress. It doesn’t mean nothing is happening; it means we are deliberate and strategic, because the changes we make affect so many. Within this construct, I strongly believe it is so important to celebrate the so-called small successes we experience in our course corrections. They make a difference.
So let’s look forward for a moment. Change is happening in AOTA! We are taking action to better engage you, our members, as we work to create the association for the future. We want it to be focused on what’s ahead, agile, and proactive, and we want all of you to feel that you have a positive and enhanced member experience. There are three things I’m particularly proud of and looking forward to.
First, AOTA is leveraging the knowledge gained during the payment change 20 years ago to better position the profession for upcoming changes. As Seth Godin (2012) wrote, “Change is not a threat, it’s an opportunity. Survival is not the goal, transformative success is” (p. 22). AOTA is stepping up to the challenge in shifting from volume- to value-based care. We are meeting with industry leaders at the association and corporate levels and with clinical management to drive meaningful change. Simultaneously, we are getting information to frontline practitioners so you are equipped with tools and strategies for practice in a value-based world. These efforts are to support all of you! Our grassroots efforts are designed to empower you, the occupational therapy practitioners, to use the full scope of occupational therapy to meet the real needs of patients and enhance their quality of life while improving the system at the same time. This is our opportunity to transform a system for the better!
Second, we need occupational therapy professionals who are ready to lead where they are at, regardless of title or setting. To do that, we can build on the success of existing leadership development programs at AOTA as a firm foundation to expand our reach and build capacity. Leadership skills are important to the occupational therapy profession broadly, from early practitioners to seasoned professionals. Therefore, AOTA is launching a multifaceted leadership development initiative as a part of its professional development programs. Access will not be limited to a few—it will be open to all. You decide when you’re ready, you identify the path, and AOTA will be here to support you in making it a reality!
Third, diversity and inclusion have been a struggle for the occupational therapy profession and for other professions as well. I’m excited by the changes we have made in this space in the past year. We heard loud and clear that we, AOTA, needed to do better. We started in October 2018 by modifying Vision 2025 to state, “As an inclusive profession, occupational therapy maximizes health, well-being, and quality of life for all people, populations, and communities through effective solutions that facilitate participation in everyday living” (AOTA, 2018). We continued the dialogue at our February board meeting, building out a pillar of equity, inclusion, and diversity, affirming that as a profession “we are intentionally inclusive and equitable and embrace diversity in all its forms” (AOTA, 2019, para. 6). At the national office, we are taking intentional action to support this mind-set throughout our association at all levels.
Be Bold
Now that we’ve looked back, and forward, let’s discuss the here and now. As the program tells you, my theme today is Be Bold. I hope that has come through here today. I chose it because I firmly believe that the future of the occupational therapy profession is in our hands.
AOTA is the professional association for the occupational therapy profession. AOTA is not the elected volunteer leaders. It is not the paid staff at our national office. AOTA is every occupational therapy practitioner and student, all elected volunteer leaders, and staff working together to advance the profession. Whether you look to the person on your left, right, or those commenting in the online chat connected to the livestream—We are all AOTA.
Together we can shape our own destiny. There is no doubt we will face challenges; let’s go meet them together. Because I know that together we will find opportunity in our changing world to better meet the evolving needs of all people, populations, and communities.
This is our moment in time. Each and every one of you has ideas, something you’d like to do, something to make a difference in the lives of others, something that will bring joy to your work. Why not take a chance? Why not be bold?
Conclusion
Now for a quick activity before you go. Reach into your bag. Grab a pen and a piece of paper or notebook. Pull them out and write one thing you can intentionally do today to make tomorrow better. Maybe it is heading into the expo hall to learn more about advanced credentials you’ve been eyeing from a distance. Maybe it is going up and introducing yourself to a presenter of a conference session and letting them know their message resonated with you and you intend to use it in your practice. Maybe it is sitting down with a few colleagues and sketching out some ideas that have been percolating but need some grounding. Maybe it is simply writing a statement acknowledging that you need to spend some time taking care of you each day. We cannot pour from an empty cup, after all, and the therapeutic process can take a lot out of us. We must invest in ourselves.
Monday, when you head back to work, I challenge you to show up like you’d want someone to show up for you. Focus on quality interactions:
Imagine you are a student. How would you want someone to walk into your classroom? How would you want someone to ask you a question or present an idea?
Imagine you are in the hospital. How would you want someone to walk into your room?
Imagine you are living in a skilled nursing facility. How would you want someone to approach you in the morning? What would they say, and how would they say it?
The goal on Monday is to touch someone’s heart and let them know you care about them. Show up with generosity. Treat them how you would want to be treated. When you do that with one person, it fills your cup, and you’ll be able to pay it forward to another and another and another.
As you consider your future, where you have been, where you are, and where you want to be, immerse yourself in the different perspectives. Pinpoint the opportunities for occupational therapy to be a part of the solution. Find your tribe, and take that critical first step together.
Change is inevitable; progress is not. Pull up a chair or, if you have to, build a chair. Build the entire table. But be a part of the conversation.
Be bold!
Footnotes
This and the other videos described in this article are available as supplemental materials; navigate to the top of the article online, and click on “supplemental.”
This article is an adaptation of the Farewell Presidential Address presented at the 2019 AOTA Annual Conference & Expo, New Orleans, LA.