Case Study Staying Strong | Planning for a Better Future for Injured Workers

When a worker is injured, it's in everyone's best interest to get them rehabilitated and back at work in the best way possible. Key to this rehabilitation is the role of the occupational therapist, who conducts a "functional assessment" of injured workers, assessing their physical and functional capacity to work. But one occupational therapist, Susan Strong, suspected that the way that functional assessments were being done in southern Ontario probably left a lot to be desired. She set out to learn more, and her planning skills swung into action.

Strong, a clinical professor and research associate with the School of Rehabilitation Science at McMaster University in Hamilton, Ontario, had good reason to believe that there were inconsistencies in how occupational therapists in southern Ontario were conducting functional assessments for injured workers. Strong and her research team believed that there was a considerable difference of opinion, along with limited information, regarding the various tools and approaches occupational therapists were using. Change was needed, but it could not be based on speculation. They needed evidence to confirm what their anecdotal reports suggested.

For the next two years, they conducted research and verified that indeed there was widespread variability in such areas as staff training and support, approach, protocols, reporting practices, and costs. The issues they found were systemic, resulting from a lack of guidelines and practice standards. It was a serious situation. The conclusions that an occupational therapist might arrive at could have questionable validity or limited use. Public safety, professional accountability, and quality of service were at risk. But how could the researchers change an entire system of practice? They knew more people had to become aware of their findings if change was to be made, but how? The team wondered how they could disseminate their results in the quickest way possible, to everyone involved in the whole rehabilitation system, while getting sufficient buyin from such a diversified group who seldom, if ever, spoke and had differing views of how the challenges were defined, let alone how they should be addressed.

Future Search Conference

Through a colleague, Strong and her research team learned about a planning technique that might accomplish their goals. It was a bold methodology first developed in the 1960s designed to get large groups of people to cooperate and plan their future together. Three elements framed it. To be successful, anyone affected by a proposed change must be represented in the room and the focus must be on the future, not on problems or conflicts. Second, everyone must be guided to talk about the same "world," and those participating must manage their own learning. And last, everyone must be committed to democratic ideals of participation and dialogue.

The framers of the methodology called it a "future search conference."

A future search conference is a planning meeting that helps people act quickly to establish change. It is taskfocused and designed to bring together large groups of people (60 to 80 or more) in one room. It relies on mutual learning among stakeholders as a catalyst for voluntary action and followup.

After researching its merits and shortcomings, Strong and her team formed a design team that would develop the process, decide on the participants, invite them, follow up and support the facilitators during the conference, and support the action subgroups after the conference. Strong applied for a grant and secured funding. The fun was about to begin. They hired a veteran facilitator experienced in facilitating future search conferences and, with him, they created a design that represented stakeholders who were involved in every aspect of functional assessment practices: members of the provincial Workplace Safety and Insurance Board, injured workers, insurers, worker representatives, occupational therapists, legal representatives, family physicians, physiotherapists, nurse case managers, human resources professionals, and so on. They planned for eight and a half months, and then the day arrived when 87 invited participants and stakeholders started filling the meeting room at McMaster, ready to address their challenge for the next two and a half days. The conference was called "Functional Assessment: A Time for Consensus, A Time for Change."

The Conference Goals

The goals of the conference were clear:

to develop a common understanding of the issues related to functional assessment practice,

to develop an awareness of the evidence that relates to functional assessment issues, and

to develop strategies for facilitating an evidencebased functional assessment practice that provides excellence and accountability.

The participants came with the understanding that everyone would engage fully and equally. The conference was dynamically structured into different groupings of interactivity: as a whole group, in mixed groups, and in homogeneous groups. In the morning of Day 1 they analyzed the past, reflecting on milestones and key trends. In the afternoon they analyzed the present, looking at how current trends were having an impact on them and the way functional assessments were being conducted. On Day 2 they clustered into stakeholder groups, where they explored what they were currently doing and what they needed and wanted to do better. At this intersection, Susan Strong gave a description of her study that documented the variable state of affairs in southern Ontario to help provide an indepth understanding of the situation and generate dialogue.

In stakeholder groups, they discussed and reported back their "prouds" and "sorrys"what participants are proud of and what they feel sorry aboutand did so without blame but rather with acceptance as a basis for future change. Then they went back to mixed groups to reflect on the kind of future they wanteda future about which they could feel passionate and for which they could take responsibility.

On Day 3 the whole group came together to establish common ground. They posted themes and explored the meaning of those themes. The facilitator asked the participants to seek consensus on how the themes fit into the group's overall vision that they had previously distilled. They arrived at seven themes: research, systematic process, prevention, collaborative approach, education, whole person, and assessor competency.

The Moment of Truth

Participants were asked to go back to their "theme" groups and discuss goals and potential actions and list a date and time for accountabilities. This is the point where good intentions can languish. However, Susan Strong and her team reassured participants that the team's role would be to support the subgroups of people who could volunteer to carry the plans forward. They would act as a catalyst and a base to work from, bridge silos, educate, reduce barriers, create milestones, and link with others. A date was set to meet again in six months as a followup and to assess progress.

Eventually, the College of Occupational Therapists of Ontario published the "Standards for Occupational Therapy Assessments" for Ontario, drawing substantially on the work of Strong and her team and the pioneering planning participants at the future search conference.

Question: Problem Solving: Future search is known as a participatory planning method that can facilitate voluntary implementation of change. Why might people be more committed to implement change when they are involved in the planning?