The Power of Authenticity

Amy J. Lamb

doi:10.5014/ajot.2016.706002

Abstract

Occupational therapy practitioners can embrace the distinct value of occupational therapy by harnessing the power of authenticity in our daily practice. Practitioners, educators, students, and researchers being true to our core values, as well as the historical roots of the profession, will demonstrate how occupational therapy enhances clients' quality of life and positively affects their everyday lives. By harnessing the power of authenticity, we can drive the profession of occupational therapy into the future as practitioners with influence to meet the dynamic needs of health care and education systems.

Amy J. Lamb, OTD, OT/L, FAOTA

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I am deeply honored and humbled to stand before you today as the 30th president of the American Occupational Therapy Association (AOTA). I am grateful for the opportunity to have served with Ginny Stoffel for the past 4 years, first as your vice president and now as president-elect. Ginny and I have collaboratively led efforts to build leadership capacity for AOTA members in practice, in policy, in education, and in research. I will proudly continue this effort with the AOTA Board of Directors. Please join me in thanking Ginny for her heartfelt leadership as our AOTA president.

I would also like to acknowledge my family with me here today, especially my husband Nathan and our children Gabby and Josh. I am grateful for their continued love and support because without it, I would not be standing here in front of you today.

Why Authenticity?

After spending time last summer reading and writing in search of inspiration for the theme of my inaugural address, there were several topics that I wanted to discuss, yet I was looking for that common thread to tie them together. The inspiration came to me in August, as I was sitting with the most recent cohort of emerging leaders around the table at AOTA headquarters. At the end of the training, we were each asked to share a word that described what we experienced during our 2½ days together. The emerging leaders used words such as passion, empowering, grateful, and more.

The word I selected that best described my own experience among these emerging leaders was authentic. I purposefully chose this word because each person fearlessly shared their authentic self with the group. They brought their true selves to the table, stepped outside of their comfort zones to speak up, and were open to all aspects of this transformational opportunity. It was with these emerging leaders that I found the inspiration I was seeking. As I flew home that night, I drafted the outline of this address on a napkin; as we all know, some of the very best ideas started on a cocktail napkin.

One of my favorite quotes is by the famous poet Rumi (1995) : “Let the beauty we love be what we do” (p. 36). These words are engraved on one of my favorite pieces of jewelry I’ve worn for years and serve as a daily inspiration for my personal and professional work. We spend so much of our precious time working. The U.S. Bureau of Labor Statistics (2015) reported that during the workweek, adults spend an average of 8.9 hours a day in work-related activities, 2.5 hours in leisure and sports, and 7.7 hours sleeping. This leaves us roughly 5 hours for our family and friends.

I cherish my time with family, yet as for other Americans, work responsibilities take up a large percentage of my time. Therefore, I must find a sense of purpose in my work and crave opportunities to be a part of something bigger. I have always believed that most people want to wake up excited to go to work. They want to come home feeling fulfilled by what was accomplished that day. For some of us, that search for inspiration and fulfillment led us to the occupational therapy profession. It is in living this sense of purpose in our daily work where our authentic selves can not only live, but thrive.

Why Occupational Therapy?

Many of us have been asked, Why did you choose occupational therapy? Recently, this question was posed to me. I was originally a psychology major, and although I enjoyed my classes, I felt there was something missing. I wanted to do more than listen and talk about problems people might be experiencing. I wanted to do something. I explored options in the health and social sciences and in that process was drawn to occupational therapy. Occupational therapy was about doing and went a step further, to doing what is meaningful.

I came to choose occupational therapy because it filled that sense of greater purpose I sought to have in my professional life; it had a depth of meaning that inspired me. Occupational therapy is not about just talking, it is not about rote exercise, and it is not about merely doing something to someone else. Occupational therapy provided me with the opportunity to engage with people at a deeper level, to find out what matters to them, to facilitate participation in the things they need to do and want to do, to engage them in meaningful activities, and to improve their overall quality of life. The doing of occupational therapy inspired me then and still inspires me today.

During the past several months, I have been reflecting and preparing to serve as your president. At the same time, I was engaged in the efforts to draft Vision 2025 (AOTA, 2016), the next step after our centennial celebration in 2017. As I’ve reflected on what drew me to the occupational therapy profession, examined the opportunities that exist for the profession in the future, and reflected on my role as your leader on this path, the power of authenticity has been around every corner. Today, I’d like to share pieces of this journey with you and invite you to join me as we work to demonstrate the value of occupational therapy.

Revisiting Occupational Therapy’s Core Values

The root of occupational therapy is distinct, with the profession founded on the use of occupation as a therapeutic method. Our philosophical base (AOTA, 2011) is built on the premise that through occupational therapy and engagement in meaningful occupations, we support clients’ participation in everyday life. Our core values (AOTA, 2015b) are defined beliefs in which all occupational therapy professionals find their purpose and commitment to the profession, and these values serve as a guide to our daily work. When we examine the evolution of the occupational therapy profession, we clearly see the impact of leaders along the way who have cast bold visions and the committed professionals who have embraced the vision of those leaders and brought it to life in their daily work.

Today’s demands on occupational therapy practitioners, educators, researchers, and leaders are great. Although the context has certainly changed over the past century, every generation has felt their own set of pressures. As we prepare for our future, we must consider ways to meet the shifting demands of the systems in which we practice. We must continue to produce evidence that supports occupation as a therapeutic medium and its value in health care and education delivery systems and further the translation of that evidence into our daily practice. In addition to producing evidence, our career scientists and practitioners must collaborate to translate this knowledge and implement it in our daily practice. Finally, we must explore innovation in the ways we prepare future occupational therapy professionals to meet the dynamic needs of systems, people, populations, and communities.

Our health care system is shifting from simply treating acute illness and injury to prioritizing prevention and the overall health of all Americans. In 2007, the Institute for Healthcare Improvement, led by Donald Berwick, released what is referred to as the “Triple Aim” of health care to serve as a platform for reform efforts (Berwick, Nolan, & Whittington, 2008). The goals of the Triple Aim are (1) to enhance the quality of health care, thereby improving the health of Americans; (2) to improve the efficiency of the system, leading to an enhanced patient care experience; and (3) to decrease health care costs. These three dimensions of performance are guiding health care organizations, which are actively seeking health care professionals to help them meet these goals. Similarly, in education systems, we see changes in policy and practice that emphasize similar priorities, including the need to reduce costs, to enhance quality, and to be efficient with limited resources. It is essential that we advocate for occupational therapy and show the value we bring to enhancing the quality of life of those we serve.

Doors are opening to new delivery models that position occupational therapy better than ever to meet society’s occupational needs. Significant change is ahead with delivery models’ focus on interprofessional primary health care, new payment models, and emphasis on value demonstrated through improved outcomes, all in an effort to enhance quality health care for Americans. When we demonstrate the value of occupational therapy in our daily practice through improved outcomes, those we serve experience the true benefit of occupational therapy, and we are reimbursed for our services.

It is this emphasis on quality and value that I believe serves as our greatest opportunity and perhaps our greatest threat. To be relevant to the systems in which we work, we must anticipate needs; evolve our education, practice, and research to meet those needs; and collectively work to demonstrate the value of occupational therapy in new and innovative ways.

These transitions create instability in our work environments. When we get distracted by the chaos that surrounds our daily work, it is easy to get off track from applying our personal core values and to forget why we chose the profession of occupational therapy. We begin investing time, resources, and energy in things that are not of value to us personally or to those we serve. The solution to this instability lies in authentic occupational therapy practice. To help us adapt successfully, it is essential that we return to our original purpose as a profession. It is through our focus on occupation that we will be well positioned to seize the opportunities that surround us.

As Simon Sinek (2011) stated in his book Start With Why, people do not buy what we do, they buy why we do it. I believe that occupational therapy’s why is what systems, organizations, populations, and individuals seek today. I believe that everything we do in occupational therapy is focused on maximizing quality of life. The way we maximize quality of life is by using occupation, the meaningful, familiar activities of everyday life, to facilitate engagement and participation. The why of occupational therapy is clear: The practice of authentic occupational therapy—anchored in the use of occupation in our daily work to enable participation in everyday life and to promote health, well-being, and quality of life—is powerful.

Occupational therapy is more than a job; for many, it is a calling. We felt drawn to it. What’s your why? What led you to occupational therapy? Why did you choose to give your time and service to this profession? When we take the time to reflect on why we chose occupational therapy as a profession, it can become a spark that energizes our daily work during these times of incredible transition.

In addition to reflecting on why we chose the profession, we can also benefit from focusing on our personal core values. Each of us has core values that are our highest priority and ultimately govern every aspect of our lives.

In our AOTA leadership development programs, facilitator Nancy Stanford Blair guides participants through the process of identifying their core values. Participants are given cards with core values and brief descriptions on them. They are asked to place these core values in a hierarchy of always valued to least valued. No more than three core values can be placed into the always valued category. This is not an easy exercise. Participants often find this process to be transformational because they reflect on the identification of their core values and give these values the attention and reflection they deserve. My always valued core values include family, integrity, and personal growth.

This exercise is now available to all AOTA members. I invite you to invest in yourself and participate in AOTA’s new online leadership development program, the Mindful Path to Leadership, which will allow us to empower every member to be a leader in his or her daily work. With your values identified and prioritized, you often find inspiration and opportunity in your daily work that helps you feel fulfilled when you go home each day, knowing you made a difference in the lives of those you served.

Distinct Value of Occupational Therapy

In 2012, while serving as vice president of AOTA, I first shared ideas regarding occupational therapy’s distinct value at the New Mexico Occupational Therapy Association’s annual conference. I believed that we could not let the limited understanding of occupational therapy by others limit the potential of occupational therapy moving forward. This presentation was followed by many others and sparked a dialogue within the AOTA membership and association leadership that led to the development of a video titled Distinct Value of Occupational Therapy (AOTA, 2014b), the prioritization of the distinct value in strategic planning, and ultimately the following statement on the distinct value approved by the AOTA Board of Directors in April 2015: “Occupational therapy’s distinct value is to improve health and quality of life through facilitating participation and engagement in occupation, the meaningful, necessary, and familiar activities of everyday life. Occupational therapy is client-centered, achieves positive outcomes, and is cost-effective” (AOTA, 2015a, para. 6).

These words are important for the profession. However, it is not a definition of occupational therapy. It is not a new vision or brand. It is instead a foundation for a consistent message that broadly captures the distinct value of occupational therapy across all areas of practice for members to use with those outside the profession to help them understand the value of occupational therapy. To further provide support to the profession, under the leadership of AOTA’s vice president Dr. Shawn Phipps, we have spent the past year developing collateral materials for members to use as they articulate the distinct value of occupational therapy in their daily work across the six broad areas of practice.

The words within the distinct value statement are a foundation or a platform for each of us. The words are only the beginning. It is action that will create change. It is in demonstrating our distinct value and bringing these words to life in our daily practice that the power will emerge. This authenticity in our practice links to quality of practice and ultimately maximizes the quality of life for those we serve.

Harnessing Opportunities

Some of you may be asking, Why now? What we are experiencing today is the perfect storm of opportunity. Occupational therapy’s use of meaningful and familiar activity to facilitate participation in everyday life, combined with policy advancement and shifting reimbursement systems, has opened up opportunities. Doors are opening and reimbursement streams are flowing for emerging areas of practice such as wellness and prevention, primary health care, and increased attention to the mental health needs of Americans.

These new and innovative models provide opportunities for occupational therapy professionals to demonstrate our distinct value in settings where we are able to blend community-based practice with medicine to meet the occupational needs of society. The new models provide occupational therapy professionals with the opportunity to practice to the full extent of our education and training instead of spending time doing things that could be done effectively by others. Today, as these models are developing, it is essential that occupational therapy professionals find their place at the table to articulate occupational therapy’s distinct value and advocate for our inclusion in health care teams.

An excellent example of new opportunities is efforts to address the impact of chronic conditions on individuals, populations, and systems. Chronic conditions such as heart disease, cancer, obesity, arthritis, and diabetes are commonly seen in acute hospitalizations. In 2015, the Centers for Disease Control and Prevention reported that chronic conditions accounted for 86% of all health care costs. As occupational therapy professionals, we have a distinct value to contribute to the sustainability of the quality of life of people with chronic conditions. I believe that occupational therapy intervention anchored in habits and routines has value in self-management of chronic conditions and decreasing health risk. Occupational therapy can help people have quality of life regardless of these conditions and can play a role in reducing the cost of chronic conditions to the U.S. health care system.

The conditions for change have never been more perfectly aligned than they are today. In February 2016, the AOTA Board of Directors unveiled Vision 2025: “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, 2016, para. 5). Occupational therapy’s time is now. The health care and education industries are valuing what we believe now and have believed for 99 years. Quality of life is essential and a right of all those we serve.

Occupational therapy’s future in health care is not only about getting people back to their everyday life after illness or injury. As a profession, we must not sit idle. We must demonstrate the value of occupation as our method to produce positive outcomes and maximize quality of life for those with chronic health conditions, in primary health care delivery models, and in wellness and prevention efforts. We must take action. If now is not the time, then when? If not us, then who? The opportunities in front of us today require each and every one of us to take action.

Leadership in Action

Demonstrating occupational therapy’s distinct value in practice requires leadership to step forward and perhaps break out of status quo patterns in our daily work. This leadership is not about titles. In fact, we can lead from any position within our organizations. Leadership is simply a process of influencing others to achieve a shared goal.

Occupational therapy professionals can be powerful influencers of change. In your workplace, look for signs of the shifting priorities of the systems in which you work. Look for opportunities to showcase the distinct value of occupational therapy in your organization’s efforts to enhance quality, improve efficiency, and increase cost-effectiveness. I believe that if within our organizations we articulate how occupational therapy’s distinct value is a cost-effective means of enhancing quality and improving efficiency, we will find even more doors to open. With the smallest opportunity, by putting the distinct value of occupational therapy into practice, we will become change agents for our clients, organizations, and profession.

The Challenge

With great opportunity comes great responsibility. This responsibility does not lie just with me as the incoming president of AOTA, or with the AOTA Board of Directors, or with our AOTA volunteer leadership at large. Instead, the responsibility lies with each one of you to take to your practice, your classrooms, and your research endeavors. This must be a collective effort.

I believe that words may inspire, but only action creates change. Today, I am issuing a challenge to each and every one of you. I challenge each of you to be an influencer of change.

Challenge to Scientists and Researchers

To our career scientists and researchers, I’m challenging you to be an influencer of change and generate evidence on the cost-effectiveness and impact of occupational therapy in the systems in which we work. Natalie Leland is an assistant professor with a joint appointment at the University of Southern California (USC) Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy and the USC Davis School of Gerontology. She is a career scientist and influencer of change. Leland’s research is focused on understanding and improving postacute care quality for older adults, with a particular interest in how occupational therapy can contribute to fall prevention.

Leland is an expert in secondary data analysis and evaluation of the impact of health services on quality of care. She was the first occupational therapist published in Health Affairs, a leading peer-reviewed health policy journal. She and her coauthor examined nationwide facility-level nursing home data on outcomes for long-stay residents, resulting in evidence to support increases in Medicaid payment rates to support better care for these residents (Lepore & Leland, 2015). As we continue to build the science of occupational therapy, it is of vital importance that we design studies like Leland’s to give us the ability to demonstrate our value and engage in systematic quality improvement in the clinical setting to optimize patient outcomes.

Challenge to Educators

To our educators, I’m challenging you to be an influencer of change and reach out to your fieldwork educators and local occupational therapy community to identify ways we can amplify our support for the inclusion of occupation-based practice across all areas of practice. The University of Pittsburgh, University of New Mexico, Touro University Nevada, and Thomas Jefferson University occupational therapy programs and the Cincinnati State College occupational therapy assistant program are all influencers of change in their efforts to

Empower students as change agents for occupation-based practice,
Develop occupation-based partners at organizations within their local community,
Have faculty work in clinical practice each week across a variety of practice settings,
Work together with existing programs to create and manage culture change that is supportive of occupation-based practice, and
Support local clinicians with embedded opportunities to build up their spirit, reignite their passion, and foster attitudes that drive meaningful change in their practice and for those they serve.

These are just a few examples of how these programs, like others, are working to bridge gaps between academia and practice. There is great power in reaching out and going into our local organizations, listening to their successes and challenges, and identifying ways our academic programs can give back to them and support their practice.

Challenge to Students

To our students, I’m challenging you to be an influencer of change by keeping occupation central to your practice and role modeling the power of occupation to those around you. Rachel Goeser is a new occupational therapy practitioner with Rehabvisions in Valentine, Nebraska. She purposefully chose to work in a rural setting because of the diversity of practice it offered her. Within her position, Goeser practices in a critical access hospital in inpatient rehabilitation, outpatient rehabilitation, and skilled nursing facilities. She uses occupation as a means in her practice to facilitate participation and get clients back to the things they need to do, want to do, and have to do.

This underserved area did not have access to occupational therapy services until Goeser arrived. She didn’t seek to fit in; she sought to stand out. She stepped outside of her comfort zone and reached out to physicians, nurses, and nursing home administrators, educating them on the value of occupational therapy with their clients. In her first 7 months in practice, Goeser was an influencer of change as she worked to bring access to occupational therapy to this community and enhance the quality of life of those she serves.

Challenge to Practitioners

To our practitioners, some of you are being pressured to make decisions that do not align with the reasons you chose occupational therapy, with your personal core values, or at times with the core values of the profession. I believe that the majority of occupational therapy professionals came into the profession for more than a job and instead came for the opportunity to make a difference in the lives of people for the better. So today, I’m challenging occupational therapy practitioners to be influencers of change and put occupation back into your daily practice. For those of you who are already occupation based, I ask you to reach out to colleagues you can mentor to do the same.

Carol Conway.

Carol Conway is a school-based occupational therapist who is an influencer of change in Hudson City Schools and for the larger occupational therapy community in Ohio. Conway is part of the Every Moment Counts program, applying a public health approach to mental health in schools. Her daily practice is collaborative, focused on the whole child, and centered around occupation.

Every Moment Counts has changed the model of how occupational therapy is integrated into schools. The program uses a push-in model to serve kids in their natural setting; therapists go into the classroom, into art class, and into physical education classes. Students practice the skills they need in their natural learning environments. Therapists work collaboratively throughout the building with all staff members and embed themselves in all corners of the school.

It was through the mentoring of Carol Conway and her occupational therapy team that the teachers learned strategies they can use to support students’ success. In addition to providing individualized intervention, the program has developed model programs and tool kits emphasizing embedded strategies to help all children and youth enjoy participation throughout the day in the classroom, in the cafeteria, at recess, and after school and to cope with challenges that may arise.

Conway and her team faced challenges along the way. For example, school-based therapists don't often talk about addressing mental health, yet they address such issues all the time, so the team developed a community of practice and educated more than 200 school-based practitioners while also educating administrators, teachers, and parents on the value of this program and what occupational therapy can do within their schools. Conway and her team are influencers of change who actively engage in changing the model of how students access their community and make true friendships.

Shelly Hefner.

Shelly Hefner is an occupational therapist with 6 years of experience working in a skilled nursing facility in Iowa. She is an influencer of change as the primary occupational therapist in her facility and an active participant in an interprofessional team working to provide quality care to clients. Occupation is the focus of Hefner’s daily practice; she prioritizes the occupations that her clients need to be able to complete rather than solely working on preparatory methods. Hefner has found more success with clients when focusing on meaningful occupations and grading them as appropriate to facilitate progress toward goals.

Hefner promotes occupational therapy throughout the facility with staff and with clients and their families. She regularly attends nursing meetings and provides education regarding what occupational therapy is, how it can help the facility’s residents, and what signs staff should look for in residents that may indicate a need for occupational therapy.

Hefner also has had challenges along the way. With a relatively small therapy space, she has learned to be very creative and to use all areas of the facility to provide client-centered, occupation-based therapy sessions. Hefner is an influencer of change who uses AOTA’s evidence-based practice resources and good working relationships with her colleagues to provide quality care to clients and help them achieve better outcomes.

Krista Covell.

Krista Covell has been an occupational therapist for 15 years and is the owner of Covell Care and Rehabilitation in Colorado. Covell is an influencer of change, with her entrepreneurial approach to meeting the needs of older adults in her community. Covell Care is set up so that any occupational therapist, physical therapist, or speech–language pathologist can run a private practice through Covell’s. Her organization handles the administration and marketing, freeing up the therapists to practice.

Covell Care’s occupational therapy team takes pride in focusing on occupation-based practice. They see clients in the clients’ own homes and communities. Covell recognizes the importance of promoting occupational therapy as a part of her private practice, doing weekly talks with older adult groups to educate them on what occupational therapy can do for them and attending home care agency meetings to increase home health practitioners’ understanding of how occupational therapy benefits their patients.

Covell’s path has not always been easy; she has cited not letting fear get in the way and learning how to do things differently as essential. In Covell’s words, “We have to continuously educate people that we can do things in a different way. We have to educate insurers on our value while encouraging and helping practitioners to not be afraid of insurers.” Covell credits the support of interprofessional mentors in encouraging her to challenge herself to do things differently as she developed Covell Care’s innovative model.

My Commitment to the Challenge

I am committed to supporting each and every member in this journey, and I will be soliciting the participation of the AOTA Board of Directors. We will be hosting monthly virtual exchange sessions with other volunteer leaders to discuss successes, challenges, and strategies to help every member who accepts this challenge be supported on his or her journey. Forums will be created to support the journey of our occupational therapy change leaders and to highlight their successes.

As occupational therapy professionals, we understand context and the importance of the environment in ways that other professions do not. I have heard your concerns and believe we cannot ignore the current context surrounding practice, which includes the productivity pressures that practitioners are facing and the impact of these pressures on the quality of care. Although AOTA does not have jurisdiction over issues such as productivity, I believe we can make an impact. We have been engaged in open dialogue regarding productivity concerns with the American Speech, Language, and Hearing Association; the American Physical Therapy Association; and the National Association for the Support of Long Term Care. We have created documents such as the Consensus Statement on Clinical Judgment in Health Care Settings (AOTA, 2014a) and the Ethics Commission’s Advisory Opinion on Ethical Considerations for Productivity, Billing, and Reimbursement (AOTA, 2014c) to support practitioners in advocating for appropriate productivity standards that do not jeopardize quality of care.

At AOTA, we continue to build on these efforts. I am actively working with other AOTA leaders and staff to develop a multifaceted strategy to engage industry leaders, the Tri-alliance, employers, managers, and practitioners to address this issue. I cannot guarantee rapid change, but I can pledge that I will work to be an influencer of change as we create a practice environment that will promote quality occupational therapy practice.

Conclusion

I invite you to reconnect with why you chose the profession of occupational therapy and let that purpose inspire you. I ask you to demonstrate the distinct value of occupational therapy in your daily work. Seek out opportunities within your organization where occupational therapy can stand out.

In occupational therapy, we believe that everything we do is focused on maximizing quality of life. Occupational therapy professionals do this by facilitating participation and engagement in the meaningful, necessary, and familiar activities of everyday life. This is the distinct value occupational therapy brings to the clients and populations we serve daily, to the teams we are a part of, to the organizations we work within, and to the health care and education systems. This is authentic occupational therapy and the basis for each and every one of us to be an influencer of change for the future of occupational therapy.

See the opportunity. Be authentic. Lead the change.

References

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American Occupational Therapy Association. (2014b). Distinct value of occupational therapy [video]. Retrieved from https://www.youtube.com/watch?v=TreCtf5Nm28

American Occupational Therapy Association. (2014c). Ethical considerations for productivity, billing and reimbursement [Advisory Opinion]. Retrieved from http://www.aota.org/-/media/Corporate/Files/Practice/Ethics/Advisory/reimbursement-productivity.PDF

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