Effective Delegation: Enhancing Collaboration Between Occupational Therapists and Rehabilitation Support Workers

Occupational therapists (OTs) play a crucial role as leaders, in ensuring collaboration and fostering working relationships, when delegating tasks to rehabilitation support workers. Although occupational therapists may not directly supervise these workers, they can significantly improve task delegation, by applying a few key principles. Using a structured delegation model is key to enhancing the effectiveness of this process. This is particularly true in situations where the rehabilitation support worker operates independently, either through a community or private agency.

One such delegation model is the 5 Rights of Delegation, developed by the American Nurses Association and the National Council of State Boards of Nursing. This comprehensive framework ensures that tasks are delegated appropriately and effectively. This model emphasises five key elements that are crucial for successful task management:

Right Task

The task assigned is appropriate for the rehabilitation support worker’s skills and scope of practice.

Right Circumstance

Right Person

Right Communication

Right Supervision

Supervision - Effective Delegation: Enhancing Collaboration Between Occupational Therapists and Rehabilitation Support Workers (The Occupational Therapy Hub)

To put this into practice, consider a specific case:

Mr. Johnson is a 78-year-old client who is hemi-paretic, hemi-negligent, and experiences dysarthria and dysphagia, following a recent stroke. He has been assessed by his occupational therapist, but requires ongoing collaboration from a rehabilitation support worker - in order to achieve his goal of returning to independence, particularly with tasks at home, such as meal preparation.

The occupational therapist can adopt a guideline that focuses on fostering a collaborative relationship with the independent rehabilitation support worker, to facilitate the care of this client. This approach begins with:

1) Providing Clear and Detailed Instructions

Effective delegation begins with clear and detailed instructions. Occupational therapists should outline precisely what needs to be done, including any specific procedures, standards, or requirements that must be followed. For example, in the above case, a rehabilitation support worker is tasked with assisting a client with meal preparation. The occupational therapist should provide step-by-step guidance on the activity, including safety protocols related to Mr. Johnson’s particular needs. Expected outcomes of the task would also be important to review, in planning for any potential deviation from the norm. Clear instructions help ensure that the rehabilitation support worker fully understands the task and can execute it correctly.

2) Ensuring Access to Resources and Support

Ensure that rehabilitation support workers have access to the necessary resources and tools required to complete their tasks. This includes providing training materials, information or equipment. For instance, height-adjustable workstations or adapted kitchen utensils for the hemi-paretic client may be required. If a task requires specialised equipment, the occupational therapist should confirm that the rehabilitation support worker has access to it and understands how to use it. Providing additional support, such as training sessions, joint sessions, or informational resources, can also aid in task completion and professional growth.

Supporting staff - Effective Delegation: Enhancing Collaboration Between Occupational Therapists and Rehabilitation Support Workers (The Occupational Therapy Hub)

3) Delegating Authority and Autonomy

To empower rehabilitation support workers, occupational therapists should give them the authority to make decisions related to the task and allow them the autonomy to manage it within established parameters. In our case example, decisions left to the support worker may relate to the appropriate length of time spent on the task, as it relates to subjective and objective signs of fatigue, pain, or endurance. Autonomy builds confidence and allows rehabilitation support workers to adapt effectively to changing circumstances or challenges.

4) Setting Realistic Timelines and Deadlines

Set a realistic timeline and deadlines for the task. Occupational therapists should clearly communicate the timeframe for task completion and any interim milestones. For example, if sessions with Mr. Johnston require weekly progress reports, the occupational therapist should specify the due dates for these reports. Providing a clear schedule helps rehabilitation support workers manage their time effectively and ensures timely task completion.

5) Establishing Clear Lines of Communication

Effective communication is vital for successful delegation. Occupational therapists should establish clear lines of communication, so rehabilitation support workers can easily reach them or others for questions, clarification, or updates. If Mr. Johnston plateaus in his meal preparation skills, or repeatedly encounters safety concerns, maintaining a direct and regular communication channel is crucial. Offer regular check-ins, feedback, address any issues and make necessary adjustments to the task or approach. This helps rehabilitation support workers stay aligned with the client’s evolving needs and maintains high-quality care.

Autonomy - Effective Delegation: Enhancing Collaboration Between Occupational Therapists and Rehabilitation Support Workers (The Occupational Therapy Hub)

6) Using SMART Goals with Rehabilitation Support Workers

Incorporate SMART (Specific, Measurable, Achievable, Relevant, Time-bound) goals into the delegation process, to set clear and actionable objectives for rehabilitation support workers. Occupational therapists should work with rehabilitation support workers to define SMART goals that align with the client’s needs and the rehabilitation support worker’s responsibilities. For example, a SMART goal for Mr. Johnston may include the exact placement of his mobility device during the task, the number of minutes remaining in his wheelchair and the timeframe for achieving independence with meal preparation. SMART goals provide clarity and direction, helping rehabilitation support workers focus their efforts and track progress effectively.

7) Monitoring Progress and Providing Continuous Feedback

Monitor progress periodically and provide continuous feedback for successful delegation. Occupational therapists should regularly review progress notes and offer constructive feedback on the rehabilitation support worker’s performance. This feedback loop addresses issues promptly, keeps tasks on track, and allows for necessary adjustments. Continuous feedback also helps rehabilitation support workers refine their skills and improve their approach, maintaining high standards of care, even during repetitive tasks.

8) Evaluating and Reviewing the Task

After completing the task, review and evaluate the results. Discuss what went well and what could be improved, to gain insights for future delegations. This evaluation process helps occupational therapists refine their delegation practices and enhance the overall effectiveness of task management.

9) Acknowledging and Rewarding Efforts

Recognising and rewarding the rehabilitation support worker’s efforts and accomplishments is crucial for motivation and continued high performance. Acknowledgment of their hard work not only boosts morale, but also encourages ongoing commitment and excellence. Celebrating successes reinforces positive behaviour and contributes to a supportive work environment.

People in meeting - Effective Delegation: Enhancing Collaboration Between Occupational Therapists and Rehabilitation Support Workers (The Occupational Therapy Hub)

Conclusion

Although occupational therapists may not directly supervise some rehabilitation support workers or implement specific delegation strategies, they play a critical role in optimising the delegation process. By...

providing clear instructions
ensuring access to resources
granting autonomy
setting realistic timelines
maintaining open communication
using SMART goals
monitoring progress
and recognising efforts

...occupational therapists enhance the effectiveness of independent rehabilitation support workers. This comprehensive approach ensures that all professionals involved are well-equipped to deliver high-quality care.

References

American Nurses Association (2012) ANA’s Principles for Delegation. Available online: https://www.nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/principlesofdelegation.pdf.

Barrow, J.M. and Sharma, S. (2023) Five Rights of Nursing Delegation. 2023 Jul 24. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30137804.

College of Registered Nurses of British Columbia (2013) Assigning and delegating to unregulated care providers. Available from: https://cnps.ca/wp-content/uploads/2020/03/AssigningDelegatingUCPs.pdf.

National Council of State Boards of Nursing (2016) National Guidelines for Nursing Delegation. In Journal of Nursing Regulation (Vol. 7, Issue1). Available from: https://www.ncsbn.org/public-files/NCSBN_Delegation_Guidelines.pdf.