Institutional context: What elements shape how community occupational therapists think about their clients' care?

Area of Science:

• Occupational Therapy
• Health Services Research
• Sociology of Health

Background:

• Clinical reasoning (CR) is crucial for effective therapist interventions and client care quality.
• CR operates within an institutional context, influencing therapist decision-making.
• The specific impact of this institutional context on community therapists' CR is not well understood.

Purpose of the Study:

• To describe the elements of the institutional context that influence community therapists' clinical reasoning.
• To understand how these contextual elements shape the CR process in practice.

Main Methods:

• An institutional ethnography (IE) inquiry was conducted in three Québec Health and Social Services Centres.
• Data collection involved observations, semi-structured interviews with 10 occupational therapists and 12 key informants, and analysis of 50 administrative documents.
• Data were analyzed using the established IE process.

Main Results:

• Thirteen elements of the institutional context were identified as potentially influencing CR.
• Four elements were found to be almost constantly involved: institutional procedures, the organization's service offerings, occupational therapists' mandates, and service wait times.
• These four elements restrictively shape CR, leading therapists to limit their understanding of client situations and potential solutions.

Conclusions:

• Community therapists' CR is significantly shaped by specific institutional contextual elements, leading to restricted practice.
• Therapists must be aware of how their institutional context influences their CR and potentially limits their interventions.
• The findings have implications for professional roles, population health, and well-being, relevant to clinicians, educators, researchers, and regulatory bodies.