Living tensions: reconstructing notions of professionalism in occupational therapy

Reform of health organisations has brought significant changes to healthcare systems with attendant consequences for the definition and practice of professionalism. Occupational therapists must continually strive to provide excellent patient care, delivering positive patient outcomes whilst responding effectively to increasing fiscal constraint and changing organisational paradigms. This paper explores the experiences of occupational therapists as they reconstruct professionalism as a consequence of health care reform in England.

Fourteen occupational therapists were interviewed over 12 months across five National Health Service organisations in England. Each participant was interviewed three times and was asked to keep a monthly diary of critical incidents. A process of narrative analysis was developed to analyse these data.

Findings suggest that changes have occurred in the National Health Service which affects notions of professional values, expertise, status and accountability. However, far from seeing themselves as mere responders to stimuli, occupational therapists tell of mediating policies, of responding, experimenting and redefining choices whilst struggling to reconstruct professionalism.

It is suggested that professionalism can be conceived as a reflexive ethical concept in that it is through the process of reflecting on the discursive and behavioural options and values available that occupational therapists come to understand, and define their professional selves.