STARTING /
RUNNING
A
DEPARTMENT
Setting up a Primary Health Care Occupational Therapy Service
By : Jennie McAdam
Acknowledgements : Sue Dacre
: Megan Sundgren
: Desiree van der Vyver
: Shireen Omar
: Christa Meyer
: Hilda Franzsen
: Brenda Reddy
.
. Revised : December 2002
Background
There have been enormous changes within the public health sector since 1994, with the focus having been shifted towards Primary Health Care (PHC). It is within this context that occupational therapists working in this sector have increasingly had the opportunity to develop and deliver community based services at a primary level of care.
Although this change has been long awaited within the profession, it has nonetheless created enormous challenges for clinicians. This is largely due to the fact that OT post structures within the PHC setting have made little or no provision for appropriate supervision, often resulting in new graduates being faced with the daunting task of setting up a new district service single-handedly, from scratch.
Purpose
This document has thus been compiled for the National Forum of Occupational Therapists in the Public Sector in order to assist O.T.’s in the setting up of services within the primary health care context. It is envisaged that this document serves as a baseline and it is hoped that it will be continually developed with the growth of the community-based field of practice.
As it is essential that the district or community O.T. provides services at various delivery points, the document has been divided accordingly into setting up a service at a district hospital, and setting up a service within the community, including at community health centres, clinics, home visits and projects for disabled clients.
1. SETTING UP A DISTRICT HOSPITAL O.T. SERVICE
When faced with setting up a district hospital O.T. service from scratch, the following factors should be taken into account:-
A. Administrative and Managerial Tasks
1. Getting started
The following points apply to approximately the first month of establishing a new service:-
Establish communication channels with superintendent and district manager.
¨ Arrange an initial meeting, particularly if they didn’t interview you.
¨ Do initial marketing / raise initial, basic needs.
¨ Discuss channels for regular meetings, particularly for the first few months.
¨ Clarify who is direct supervisor and explain re professional support by an OT who is possibly from another district.
Establish an interpersonal relationship with someone who has been at the hospital for a length of time and thus is familiar with procedures etc.
¨ Hospital or district, depending where actually based.
¨ Identify person/s who can take you on a “guided tours”, to orientate you to the environment.
¨ Identify someone who can provide you with ongoing guidance, orientation end explanations.
Establish a link with head office, especially with regard to policies etc.
¨ Feel free to phone the provincial rehab deputy director directly, but preferably contact the provincial O.T. coordinator first if it is strictly an OT issue.
¨ If appropriate, explain to district management and superintendent about OT and Rehabilitation structures.
¨ NB to obtain policy documents so can cope with Management meetings etc.
Establish a link with other therapists in the province.
¨ Clarify who is your “supervisor” / support OT in the province - NB for regular contact, either telephonic or face to face.
¨ Make contact with OT resource therapists in the province when necessary
¨ Make social contact and establish a support system.
¨ Find out when regional and provincial Occupational Therapy meetings occur
Establish an interpersonal relationship with someone who could provide support, and company etc for lunches and teas!
¨ Major risk factor is burn-out, exacerbated by isolation, particularly if you are alone in a district.
¨ NB to look after your own basic needs for belonging etc.
¨ Take time to settle in and establish basic procedures before starting to treat clients.
¨ Make it clear you will not start treating patients immediately.
¨ Take 2- 4 weeks before starting patient treatment.
Conduct a situational analysis.
¨ Screen wards and out-patient clinics for a pilot period - 2-3 months (a screening form can be used)
¨ Data collection can also be retrospective i.e. consult hospital records / stats in terms of patient statistics for a previous period.
¨ Consult Doctor’s, nurses, super, DPO’S etc in terms of their needs and perceptions of what the
OT service should be.
Obtain a suitable work space.
¨ Look around hospital and decide on some options.
¨ Make it clear to superintendent / district manager that some space for service delivery for patient treatment is essential.
¨ Basic requirements: accessible for clients, water, central in hospital, plug points etc.
Obtain essential furniture.
¨ Table, desk, stationery cupboards for storage of equipment and materials, filing cabinet, telephone, shelves.
¨ Extra chairs for patients, bench for waiting patients, table for treatment.
2. Marketing
One of the most essential elements in developing a new service is marketing, and this needs to be undertaken on an active and ongoing basis. It should include educating others with regard to the role of the O.T., the type of Occupational Therapy services offered, systems and how to access the O.T. service. Most importantly, it must involve convincing others of the validity and essential nature of your service in terms of government priorities, because if your service isn’t well-known and valued, it may be overlooked in terms of budget and resource allocation. The following points should thus be addressed:-
Maintain communication channels with NB management personnel and ensure involvement in management activities.
¨ Establish access to hospital/district management meetings.
¨ If not personally attending, find out if an Allied Health Professional attends, + if you are thus represented + if representation can rotate.
¨ You won’t make any progress if you are not represented at management level.
Meet with hospital doctors.
¨ Establish when/if Doctor’s meetings and/or training sessions take place.
¨ Organize to be invited to a meeting + do basic marketing.
¨ Use marketing document / put posters in Doctor’s tearoom etc.
¨ Explain the initial service you can offer + explain reasons for your decisions.
¨ Request discharge via OT for prioritized cases.
Meet with nursing personnel.
¨ NNB to establish good relationship with hospital matron + ward sisters.
¨ Meet with nursing management + nursing attendants regularly.
¨ Establish how overall referral patterns / access to OT service will function.
¨ Discuss any specific ward procedures e.g. with burns cases etc
Put up posters.
¨ In wards i.e. which patients need to be referred from that ward e.g. which paediatric cases etc.
¨ Put directions to department around hospital.
Establish interpersonal relationships with ward staff e.g. clerks.
¨ Implement discharge via OT.
¨ If you have good iprs with them + value of your service is achieved, they will help you with screening + referral.
Establish and reinforce a referral system.
¨ Ensure there are green cards in wards.
¨ Make it clear what you want referred, telephone extension, days available etc (this information can be put onto the abovementioned posters in each ward).
¨ Establish a diary for bookings.
Draw up/use existing marketing documents
¨ Orientation document for Doctor’s, posters, visitor’s orientation document.
¨ Invite visitors to department e.g. trainee nurses.
¨ Have an “open day” and invite hospital staff.
¨
3. Departmental Procedures
In order to deliver an effective service, it is imperative to establish basic departmental administrative procedures. These may differ slightly from institution to institution, so it is of value to spend time finding out the specifics for your hospital and to record them in a departmental “orientation” or “operational procedures” document. The procedures established should include the following:-
Ordering of stock i.e. consumables e.g.
- Stationery - pens, pencils, stapler, appointment cards, note pads, treatment materials etc.
- Surgical stores - POP, bandages, neck collars etc.
- Pharmacy - acetone, tongue, depressors etc.
- Kitchen - food for patient treatment etc.
- Works department - making equipment e.g. frames, plinth etc
- Cleaning department - cleaning materials.
¨ Note: Find out what you can obtain from various sources in the hospital:- cardboard boxes, old x-rays, sponges, pill empties, paper and cardboard off cuts, A4 paper - boxes, x-rays - boxes.
Telephone use
¨ Keep record of all calls made.
¨ Try to get an open line.
¨ Find out policy re booking call etc.
¨ Get hold of list of extensions etc.
¨ Use speed dials where possible.
Minor works
¨ Needed for minor changes in department e.g. add or remove a door.
¨ Repairs etc.
¨ Need works order book.
Photostatting
¨ Find out procedure.
¨ Make photostatting file with your name on it, to submit your documents in.
Faxing
¨ Find out procedure.
¨ Make file (as for photostatting).
¨ Get original fax form + make copies for department.
Typing
¨ Ensure access to typing pool.
¨ Make typing file (as for photostatting).
¨ Some departments have their own computers, but try to get administrative personnel to do most of the administrative support work, so that you can focus on O.T. - specific tasks.
Circulars
¨ If there is more than one staff member in the section, organize a system where all staff are sure to receive and read important circulars
Statistics
¨ Try to do daily, according to statistics instruction document.
¨ Submit monthly to hospital + provincial OT coordinator.
¨ Analyze and change service as necessary.
Personnel matters
¨ Establish to whom leave forms etc must be handed.
Filing system
Your filing system should include the following:-
¨ Hospital administrative e.g. minutes of Management meetings, circulars etc.
¨ Statistics - keep copies of your own.
¨ Patient records - per year, alphabetically. ? For 5 years. Keep current pts in separate place ie on your desk but in such a way that confidentiality can be maintained.
¨ Rehab issues - e.g. minutes, year plans etc.
¨ Assistive devices - record of orders, those issued etc.
¨ Personal file - keep your own + for subordinates - duty statement etc.
¨ Resource documents - Management, clinical, textbooks, catalogues, etc.
¨ Orders - copies of everything ordered + received.
¨ NB admin forms e.g. leave, claims, transport, order forms etc.
¨ Assessment forms (either develop own or obtain others).
¨ Reportable incident form.
Inventory / stock control (assuming you have stock!)
¨ Box with cardex system.
¨ Record everything taken in / issued etc.
¨ Inventory list (ensure that inventory clerk conducts inventory 6 monthly).
Patient register
¨ Record all new patients for every month, and (include name, diagnosis, address, location seen etc).
¨ Give each patient an OT number.
Staff register
¨ Recent circular which states that all sections need to have one.
¨ Obtain from personnel department / stationery.
¨ Record when signing in andout; taking leave, time off etc
Departmental safety
¨ Enquire about safely plan.
¨ Ensure safe equipment etc + appropriate area.
¨ Ensure that storage areas are lockable.
4. Financial Management
Although a great deal can be achieved with minimal financial resources, the ultimate ongoing development of the service will depend upon the availability of a budget. In order to obtain a budget, the following points should be considered:-
Refer to O.T. funding document which is available from all provincial O.T. Coordinators
¨ Ensure involvement in hospital / district management activities.
¨ If you are involved in Management meetings, you will be up to date in terms of budget developments etc.
¨ Hand in a realistic budget timeously. Find out what codes refer to rehabilitation equipment etc e.g., there are 3 relevant codes i.e. :-
(1) Therapy needs (consumables) - (incl. Splinting material, activity material etc)
(2) Equipment for the physically handicapped - (assistive devices)
(3) Wheelchairs.
¨ Try to obtain a budget for initial equipment - this is a separate budget item
NB for a new department to motivate for initial essential equipment (see proposal document on essential O.T. equipment).
¨ To order new equipment for your department:
Þ Familiarize yourself with the tendering and motivation procedure + order equipment well in advance.
Þ Familiarize yourself with the condemning + replacement procedure, as this is a way in which you can sometimes get equipment more speedily get equipment if there is no budget for new equipment.
¨ Follow -up budget issues
¨ Keep following up + if you get a budget, SPEND IT ASAP!
5. Basic Management Survival Tips
Utilize written communication in addition to verbal communication.
¨ If you don’t have it in writing, you won’t have a leg to stand on if a problem arises.
Write strong motivations.
¨ To whom it may concern
¨ Re:
¨ Background + details of request
¨ Effect if request is successful.
¨ Back up with stats, use policy + appropriate jargon.
)
Keep copies of all originals, order forms and NB documents.
¨ This will keep you out of trouble, in case documents go missing.
Consult other role-players.
¨ E.g. rehab colleagues, Management, consumers etc.
¨ Try not to make unilateral decisions.
Use assertive skills.
¨ Request meetings, state your case, using well backed-up arguments
¨ Use assertiveness techniques e.g. fogging.
Consider SWOT analysis technique.
¨ Examine strengths, weakness, opportunities, threats of an issue when problem solving.
Approach management with suggested solutions, not only problems
¨ More likely to listen to you / take you seriously if you make an appropriate suggestion to solve a problem.
¨ Be reasonable in your requests.
¨ hold regular staff meetings if there is more than one staff member. This keeps up morale + encourages team spirit and ensures an effective working environment. Consider setting up a peer review system to facilitate professional growth.