Standardized referral form: Restricting client-centered practice?

Abstract

Background: To increase homecare efficiency, the Ministry of Health and Social Services in Québec, Canada, encourages standardization of practices, including those of community occupational therapists (COTs). The impact of standardization is not known and might reduce client-centeredness. Aim/objectives. To explore the content and use of a referral form to standardize COTs’ practice. Material/methods. An institutional ethnography inquiry was conducted through observations of work and interviews with 10 COTs working in three homecare programs. Secondary informants were also interviewed and documents collected. Data were analyzed using institutional ethnography procedures. Findings. The referral form, completed by the COTs’ colleagues, includes categories primarily related to safety or autonomy in personal care and mobility. The form organizes COTs’ work, including information collection and interactions with clients and caregivers. Seen as consultants, COTs assess needs and make recommendations to keep clients at home safely for as long as possible, an important element of the homecare discourse. Conclusion/significance. The impact on COTs’ potential to be truly client-centered revealed by these findings merits serious consideration by other health professionals. Concerted efforts by professionals to question and act upon contextual barriers to client-centeredness are needed.

Key words:

• standardization
• quality
• practice context
• patient-centered practice
• occupational therapy
• needs assessment
• institutional ethnography
• home care services
• efficiency
• documentation
• community services

Acknowledgements

The authors wish to thank all the occupational therapists as well as their colleagues, managers and clients who generously participated in this study. For their helpful comments and advice on methodological aspects of this research, the authors are also indebted to: Profs. Annick Bourget, Chantal Camden, and Frances Gallagher (Université de Sherbrooke), Prof. Carl Lacharité (Université du Québec à Trois-Rivières), Prof. Paul Lamarche (Université de Montréal), Prof. Em. Dorothy E. Smith (University of Toronto), Prof. Em. Elizabeth A. Townsend (University of Dalhousie), and Dr Susan M. Turner (University of Toronto). Annie Carrier is a Canadian Institutes of Health Research (#250281), Fonds de recherche du Québec - Santé (#22754) and Canadian Occupational Therapy Foundation scholarship doctoral student. Mélanie Levasseur is a Fonds de recherche du Québec – Santé (#26815) junior 1 researcher.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.