Running head: LEADERSHIP FINAL QUESTION I 1

Leadership Final Question I

Gretchen Kempf
The University of Scranton













LEADERSHIP FINAL QUESTION I 2
What is the problem? What are the facts of the situation?
My Level II Physical Rehabilitation fieldwork took place at Pine Run Health Center
(Pine Run), an acute rehabilitation facility in Doylestown Pennsylvania. Although I enjoyed
many aspects of this fieldwork experience, I cannot envision working there as a licensed
occupational therapist due to the observed practice of occupational therapy (OT) therapists
misrepresenting the nature of OT to patients and failing to utilize occupation-based treatments on
a routine basis.
Each patient was assigned a certain amount of minutes for therapy each morning and an
OT therapist was expected to meet with the patient only for the required number of minutes. The
length of the therapy session was often quite short (e.g., a fifteen minute session) and this caused
the therapists to work under extreme time pressures. The short length of these sessions also made
it difficult for occupation-based practice to be integrated into treatment. In a typical short
session, the patient performed rote exercises rather than an occupation-based activity. This
approach did not help the patient to increase their independence or to understand the difference
between OT and physical therapy (PT). The OT therapists and PT therapists often were utilizing
the same type of treatment interventions and I overheard some OT therapists telling patients that
OT involved caring for the upper body whereas PT took care of the lower body. Each time a
patient was, for example, placed on an arm bike for a short OT treatment session, this
misinformed and dreadfully incorrect definition of OT was reinforced in the patients mind. The
therapists also did not act as advocates for OT.
Who are the interested parties? What is the nature of their interest? Why is this problem?
See APPENDIX A, attached hereto.
Is there an ethical issue? Does it violate a professional code of ethics?
LEADERSHIP FINAL QUESTION I 3
Sections of the AOTA Code of Ethics, Ethics Standards and AOTA Standards of
Practice that were violated at Pine Run include the standards of beneficence, social justice,
procedural justice, and veracity, as outlined below (American Occupational Therapy
Association, 2010).
Beneficence. Standard was violated when therapists failed to demonstrate concern
for the well-being, safety, and health of their patients by implementing treatment
plans that did not benefit their patients.
Social Justice. Standard was violated when certain patients were assigned 15-
minute treatment sessions which prevented therapists from utilizing beneficial
therapy techniques and tools that could be utilized with patients who were
assigned longer treatment sessions. The result is that OT therapists were not
providing treatment in a fair and equitable manner to all patients.
Procedural Justice. Standard was violated when OT therapists did not integrate
occupation-based interventions into treatment, which demonstrated a lack of
regard for AOTA documents governing the profession of OT.
Veracity. Standard was violated when therapists misrepresented the nature and
mission of OT to patients and failed to act in a manner which would differentiate
them from other health professionals.

According to Standard I of OT professional standing and responsibilities the therapists at
Pine Run were accountable for the safety and effectiveness of the services delivered (American
Occupational Therapy Association, 2010). By delivering ineffective, non-customized services,
this standard was clearly violated. Standard II: Intervention also was violated in that the
intervention process was not based on collaboration between the client and the therapist
(American Occupational Therapy Association, 2010).
Does it violate moral, social, or religious values?
The approach taken by OT therapists at Pine Run clearly violates both moral and social
values. Patients were denied the best possible practice they deserved and no effort was made to
increase their independence in their activities of daily living or to prepare them to reintegrate
safely into their community. An argument also can be made that the approach taken by the
LEADERSHIP FINAL QUESTION I 4
therapists violates a guiding principle of many major religions (Kornblau & Burkhardt, 2012), in
that they did not treat others in a manner in which they would want to be treated.
Is there a legal issue? Practice act/licensure law and regulations? Which sections?
Although there does not appear to be a legal issue per se, the actions taken, or not taken, by
therapists at Pine Run may be the basis for malpractice lawsuit to be brought against the
therapists since they failed to provide care that met the professional standards of their profession.
A review of the CELIBATE checklist indicates that patients were not getting the care that would
be most appropriate and beneficial. An argument also can be made that the therapists engaged in
insurance fraud each time they filled out paperwork that enabled an insurer to be billed for OT
services when no OT services (as defined by the profession) were provided.
Do I need more information?
The supervisor at Pine Run should be given a chance to explain why no occupation-based
interventions were used and how this is justified in view of the ethical and responsibility
standards of the profession. It also is important to find out the party responsible for the short
treatment sessions that prevented the utilization of an occupation-based practice.
Perhaps when the supervisor is questioned he will cite a justifying policy, procedure, law,
regulation or document with which I am not familiar and direct me to a copy.
Do I need to consult with a mentor, an expert in this area, and/or a lawyer?
It would be helpful to compare and contrast my experience with that of practicing,
licensed OTs and ask for suggestions on how to handle the situation.
What possible action steps can be taken? How do those action steps hold up to analysis?
Some possible action steps that I could have taken would be to talk to other occupational
therapists to see how they were implementing occupation-based treatments into 15 minute
LEADERSHIP FINAL QUESTION I 5
treatment sessions, talk to the clients about activities they would like to be able to engage in,
make occupation-based task boxes that included all necessary material for an activity (such as
medicine management, gardening, knitting, money management, or the like), ignore my
supervisors lead and implement occupation into sessions, phone my fieldwork supervisor for
advice, contact fellow classmates to solicit their suggestions, write a proposal to my supervisor
setting forth how the treatments violate the code of ethics, and/or talk to a facility manager.
In analyzing these choices, I would first eliminate all the choices that were unprofessional or
difficult to implement. This would eliminate writing a proposal to my supervisor since that
might be considered unprofessional. The remaining alternatives appear to stand up to analysis
since they will positively affect my patients, other interested parties, and me, they do not violate
the applicable code of ethics or the applicable practice act and regulations, and they are
consistent with my moral, religious, and social beliefs.
What course of action would I ultimately choose?
If I could redo this fieldwork, I would like to be a strong advocate for OT and request
permission from my supervisor to create premade occupation-based bins, based on input from
patients, to enable beneficial interventions during short treatment sessions. I also would make an
effort to educate patients during sessions as to the true nature of OT. This course of action holds
up when applying the Rotary Four-Way Test since it is a fair and beneficial win-win situation for
all concerned, builds goodwill and better friendships and makes me feel good because it could
increase patient independence, identify OT as a needed service, and differentiate OT from PT.
What type of ethical system and leadership style is needed to resolve the situation?
An ethical system is a set of interrelated values concerning preferable modes of
conduct (Hitt, 1990, pp. 98). For this particular situation, I would use the personalistic ethical
LEADERSHIP FINAL QUESTION I 6
system since my course of action is based on my own personal convictions and what my
conscience is telling me to do. According to Hitt (1990), in a personalistic ethical system, the
moral rightness of an action is determined by ones conscience. In the situation at hand, my
conscience is telling me to improve patient care. I believe that every individual deserves
appropriate and beneficial therapy no matter how short the session allowed. Providing
occupation-based treatment in a convenient and quick manner may help OT therapists to provide
the best possible treatment. Personalistic ethics also entails being an active member of your
group and standing up for what is right (Hitt). I knew that these patients were not getting
appropriate treatment but I felt it was not my place as a student to speak up. Unfortunately, my
silence enabled the facility to continue to treat patients in an inappropriate manner and did
nothing to remind therapists of the roots of OT.
The most appropriate leadership style for this particular situation would be that of a
transforming leader. I should have led by example. Such a leadership style is based on lifting
followers to their better selves (Hitt, 1990). Transforming leaders take pleasure in the growth
and self-actualization of others (Hitt). This type of leadership style would have enabled OT
therapists at Pine Run to see that occupation-based practice is possible in a short treatment
session. Assuming the role of a leader, however, might be a difficult in light of my position as a
student. I would have to enlist the support of my supervisor in a tactful manner before
implementing this course of action which is designed to increase the skills of the OT therapists
and to benefit patients. It is my hope that tactful and proper use of a personalistic ethical system
and a transforming leadership style would inspire other OT therapists to become leaders.


LEADERSHIP FINAL QUESTION I 7
Appendix A


Professional Personal Business Economic Societal
Facility
Want to be a well-
known, well-regarded
professional
rehabilitation hospital

Want to draw in as
many potential
clients as possible
to increase
business and to
increase reputation
Want to get as many
patients at an ultra
high RUG level in
order to produce the
most profit for the
facility as possible
Want to maintain
reputation of
excellence; want to
maintain proper
standards of
competency and ethics
Patients
Need individualized
treatment plans that
are designed to meet
their needs rather
than what meets the
time requirement.
Want to be
discharged with
increased
independence and
ability to perform
activities of daily
living.
Want ability to earn
an income or
participate in tasks
that generate or
support an income
stream.
Want to be able to
participate in the
community when
discharged.
OT Therapists
Want other therapists to
follow time requirement
so that they are able to
stay on schedule.
-Want the facility to
maintain good
reputation because their
personal job depends
upon it.
Seeing other
therapists fail to use
occupation based
practices may make
them feel
uncomfortable or
cause them to
follow suit.
Do not want anything
to compromise the
economic health of
facility since job
depends upon it.
Want to be viewed as
working at a clinically
excellent and ethical
facility
Patients
Family
Member(s) or
Caregiver(s)


- Want safe and
competent care for
their loved ones and
want loved one to
be discharged with
as much
independent as
possible to reduce
caregiver burden.
Will not suggest
this hospital to
other family or
friends if excellent
standard of care is
not received.

Might not be willing
to spend their money
at a place that their
loved one will not be
getting best possible
practice.

Payers (i.e.
health insurers,
Medicare,
Medicaid)
Payers will only pay the
facility based on
minutes spent with each
patient.
Documented time
spent with patient
may not be 100%
truthful; therefore
payers may not be
paying for
appropriate
treatment.
Do not want to be
paying for OT
treatment that is not,
in fact, occupation-
based and does not
meet the immediate
needs of the patient
with regard to
increasing
independence in
activities of daily
living.
Patients may be using
up their therapy
insurance allowance on
treatment that will not
help to reintegrate
them safely into the
community and may
need to seek further
treatment which will
not then be covered by
the payer.
LEADERSHIP FINAL QUESTION I 8
References
American Occupational Therapy Association. (2010). Occupational Therapy Code of Ethics and
Ethics Standards retrieved on: December 2, 2013 from:
http://www.aota.org/Practitioners/Ethics/Docs/Standards/38527.aspx
Hitt, W. D. (1990). Ethics and leadership: Putting theory into practice. Columbus, OH: Battelle
Press.
Kornblau, B. L. & Burkhardt, A. (2012). Ethics in rehabilitation: A clinical perspective.
Thorofare, NJ: SLACK Incorporated.