Ev Innes, BAppSc(OT), MHPEd, Lecturer

School of Occupational Therapy

Faculty of Health Sciences

The University of Sydney

P.O. Box 140

LIDCOMBE, N.S.W., 2141

[This is based on a paper presented at the Canadian Association of Occupational Therapy/OT Atlantic Conference, held in St John's, Newfoundland, Canada, June/july, 1992.]

Occupational health and occupational rehabilitation are areas of clinical practice which many occupational therapists have entered over the last 5 to 10 years in Australia (Innes, 1988). Internationally, particularly in North America, this is a similar trend.

When considered within the Occupational Performance Model (Chapparo & Ranka, 1992), it is logical for the profession to be involved in this area of practice. Occupational therapists are concerned with individuals achieving self-identified occupational roles to their level of satisfaction within their own context and environment. Productivity, self-maintenance, leisure and rest are viewed as the major occupational task areas in which an individual engages. Productivity is also identified by most people as a major life role. It is reasonable, therefore, for occupational therapists to be actively engaged in the rehabilitation of injured or ill people, enabling them to return to their major life roles in productivity. This emphasis on the return to a positive productivity role is the essence of occupational rehabilitation.

Within industrial and corporate organisations, as with individuals, there are many factors which contribute to their overall performance. In many cases the performance of an organisation is seen in terms of productivity or profitability. For managers and employers the aim is to improve an organisation’s performance through improvements in both productivity and profitability.

One of the factors which can have a detrimental effect on this performance is less than optimal employee or worker performance as a result of work-related injuries and disease, along with sub-optimal working conditions. An increasing awareness of this situation has resulted in a greater emphasis on occupational rehabilitation, and also occupational health and safety.

Occupational health can, therefore, be viewed as the proactive step of occupational rehabilitation, where potential problems and hazards are identified within a workplace. These problems are them remediated before the individual workers are affected, and their performance of their productivity roles compromised. Occupational therapy involvement in occupational health, therefore, attempts to maximise individuals’ satisfaction in their productivity roles within an optimal environment through the identification and remediation of potential problems.

This paper presents an adaptation of the Occupational Performance Model (Chapparo & Ranka, 1992) and Hunt’s (1972) Model of Organisations, as a framework for occupational therapy practice in the area of occupational health and safety. This framework is consistent with the profession’s view of individuals and applies this to organisations.

Hunt (1972) sees the performance of an organisation as being the result of the interplay between four main factors which exist within an external environment. These variables arepeople or the individual variable (those individuals within an organisation), technical or hardware (which includes aspects such as equipment, physical layout, and space),formalstructure (the rules and regulations within a company), and informal structure (encompassing the informal channels of communication, informal hierarchies of control and power) (Figure 1).

In a similar way occupational therapists perceive an individual’s occupational performance in terms of his or her occupationalrole, which is fulfilled by engagement inperformance areas (self maintenance, productivity, leisure and sleep/rest). The ability to carry out activities from these performance areas is the result of the interplay betweenperformance components (biomechanical, sensory-

motor, cognitive, interpersonal and intrapersonal). All components are necessary in varying degrees in order to carry out any occupationaltask and all interact with each other. This performance is seen within the context of an individual’s environment (physical, social, and cultural) (Figure 2).

If we are to then compare these two models, one focussed on organisation and the other on the individual, some analogies can be drawn. Whilst Hunt (1972) only considers variables operating within an environmental context, aspects such as an organisation’s mission statement and the various departments which comprise an organisation will also be considered. It is felt that, without due consideration to these aspects of an organisation, it is not possible to see the intimate links which occur throughout the system.

The occupational role of an organisation could be defined by it mission statement (Figure 3). It is the mission statement which guides an organisation’s overall focus and function, defining it’s purpose and being used to set future goals. In the same way, an individual’s occupational role defines the purpose for being and performing a wide range of activities which make up the successful performance of that role.

The performance areas of self-maintenance, productivity , leisure and rest, can be equated with the various departments within an organisation, such as Human Resources, Administration, and Production/Service Provision, which interact to enable the organisation’s mission and goals to be achieved (Figure 3). Each department performs a specific function, such as marketing the goods/services to customers. Performed in isolation, the department would be operating in a vacuum with no ultimate purpose of goal. Similarly, an individual performing occupational tasks, such as dressing or driving a car, without an ultimate purpose (e.g. satisfactorily carrying out the role of a worker), is functioning in a vacuum.

The component areas which enable successful performance of occupational tasks are equated with the four organisational variables presented by Hunt (1972) (Figure 3):

Biomechanical & Sensory-motor= Technical/Hardware

Cognitive =Formal Structure

Interpersonal = Informal Structure

Intrapersonal= People/Individual

The following describes the organisational variables (Hunt, 1992) and compares them with the component areas of the Occupational Performance Model (Chapparo & Ranka, 1992).

Hardware/TechnicalSystem: The technical and physical system includes such things as equipment, machinery, furniture, layout of offices, the buildings, the physical arrangement of employees, lighting and air conditioning.

With the individual, this aspect may be equated with the biomechanical and sensory-motor component areas.

Biomechanical - level, quality &/or degree of joint motion, muscle strength and tone, endurance, functional use of limbs and body, and gross and fine motor skills (Pedretti & Pasquinelli, 1990; Reed & Sanderson, 1983)

Sensory-motor - level, quality &/or degree of “body scheme, posture, body integration, reflex and sensory functions, visual perception & sensory-motor integration” (Pedretti & Pasquinelli, 1990).

The physical features of an organisation, therefore, are equated with the physical abilities/attributes of an individual.

FormalStructure: Within any organisation there is the need to co-ordinate and control activities between people within that organisation. There tends to be within any organisation the development of structures, hierarchies and controls. In large organisations there are more controls, rules, regulations.

This formal control and structure within an organisation is similar to the cognitive component within an individual.

Cognitive - level, quality and/or degree of comprehension, written and verbal communication, concentration, problem solving, time management, conceptualisation, integration of learning, judgement and time-place-person orientation (Pedretti & Pasquinelli, 1990; Reed & Sanderson, 1983).

The cognitive component, therefore, structures and organises. It is aware of and creates hierarchies, and rules to deal with the world.

InformalStructure: Hunt described this as a “complex network of relationships among different members who are attracted to one another for non-formal reasons. Work, similar interests, friendship, education, age and sex are only some of the reasons for the formation of such interpersonal relationships… Attitudes about friendship, about social and leisure activities and about common problems produce a much looser structure of informal, interpersonal ties which are based on face-to-

face communications” (Hunt, 1972, p.14). The office “grapevine” is part of this informal structure and especially important.

The interaction and communication at this informal level results in interpersonal relationships within an organisation, which is similar to the interpersonal component of an individual’s occupational performance.

Interpersonal - level, quality &/or degree of dyadic (relationships to peers, subordinates and authority figures; demonstrating trust, respect and engaging and sustaining interdependent relationships; communicating feelings) and group interaction (abilities in performing tasks in the presence of others; sharing tasks with others; cooperating and competing with others; fulfilling a variety of group membership roles; exercising leadership skills; perceiving and responding to the needs of group members) skills (Reed & Sanderson, 1983).

The similarity between the informal structure and the interpersonal component is relatively self-evident in terms of the focus on relationships between people.

IndividualVariable/People: The individual variable of people is an integral part of all organisations. Without them organisations would simply not exist. We must therefore recognise that all other variables are dependent on this one. It is also necessary to also recognise that each individual has a multitude of needs. It may include characteristics of individuals (psychological and physical factors, health behaviours, attitudes, beliefs, sociodemographic factors) (Sloan & Gruman, 1988).

Within each individual this is the unique personality that each of us possesses which makes us different. This is reflected in the intrapersonal component.

Intrapersonal - level, quality and/or degree of self-identity, self-concept, coping behaviours, defence mechanisms, emotional states and feelings (Pedretti & Pasquinelli, 1990; Reed & Sanderson, 1983).

ExternalPressures/Environment: Organisations and individuals do not exist in a vacuum. They are part of a larger social system. Society and the structures within it also have an effect on performance. For example, the laws governing Occupational Health and Safety and Workers’ Compensation may influence the type of policies, programs and approaches to health many organisations adopt, or economic pressures may influence the speed of production. Individuals in turn are influenced by their physical, social and cultural environments, which may include some of these environmental factors affecting organisations.

Perhaps the clearest way of explaining these models is through the use of an example:

Company X had an unacceptably high level of work-related back pain and overuse injuries. The company introduced a lifting and handling education program to deal with the back injury problem and new ergonomically designed furniture for the overuse injury problem. Unfortunately, although there was some initial improvement, there was no apparent sustained, long-

term benefit. The question asked by management was “What went wrong?”

Unfortunately this scenario has an all too familiar ring to it. Nothing may have gone wrong, but perhaps Company X did not consider ALL the factors which contribute to the overall performance of an organisation, and their interaction and interplay.

The components or variables which affect performance in the individual or the organisation are interdependent and interact with one another. A change in any one component may produce changes in another. For example, educating an individual about correct body mechanics and fitness [cognitive] may result in a decrease in pain levels and improvement in posture [sensory-motor], an increase in range of motion and endurance [biomechanical], an improvement in self-esteem and coping behaviours [intrapersonal] and a resultant improvement in personal relationships within the family [interpersonal]. This may be hoped for, but we are aware that this outcome is more the exception than the rule.

The converse is probably a more realistic situation, where treating only one aspect of an individual will not necessarily result in overall improvement in performance. For this reason most occupational therapy interventions are necessarily multi-

faceted.

The occupational therapist may provide education [cognitive] regarding correct body mechanics and fitness, develop a work conditioning program to increase strength and endurance [biomechanical], incorporate the use of biofeedback and relaxation training for pain management [sensory-motor] and to instil a sense of personal control for the individual [intrapersonal], AND involve the family in the treatment to reinforce positive health behaviours at home [interpersonal]. Perhaps this scenario sounds more familiar?

It is highly unlikely that only one performance component would be addressed without consideration also being given to these other factors.

It is necessary to consider all performance component areas and how these aspects inter-relate. This is not a new concept to most, however, it is important to take into account all aspects of the individual to ensure that the all aspects are considered. What may be new or different is to apply this concept to organisations in the area of occupational health.

By considering organisations in a similar way in which we view individuals, it is possible to become aware of the interplay between variables. It is vital to understand this interplay and inter-relationship if an effective overall intervention program is to be developed. It is not possible to focus on any one variable without recognising the effect that change may have on other variables, or the influence that other factors may have on a single component.

Going back to Company X, sustained improvement may have occurred if consideration had been given to a comprehensive program encompassing all variables. Some examples of other variables which may have been considered by Company X are:

FormalStructure:

*A policy stipulating the maximum weight of packaged products produced in this factory is less than 15 kgs. Where this is not possible, mechanical lifting equipment will be provided.

*A policy which acknowledges that employees who return to work following a prolonged absence (more than 4 weeks) will be permitted to upgrade to their pre-leave level of performance over a period of x day/weeks.

InformalStructure:

*Discussion of health and safety issues with staff representatives, selected by their peers, not only managers, supervisors and union representatives [formal].

*Identification of informal power brokers and attitudes to problems or proposed changes.

Technical/Hardware:

*Provision of equipment and an environment which promotes health and safety – e.g. lifting devices, benches at appropriate heights, adequate lighting, noise reduction, etc. These tend to be aspects which are readily identified and focussed on as the only areas requiring change or intervention.

IndividualVariable:

*Determining the level of knowledge and skill individuals possess; level of language skills (including literacy in spoken and written english and/or other languages); level of training and education required by individual employees.

A criticism of this approach is that it is not possible to make all these changes – access to all necessary avenues of influence may be limited. By the same token, this criticism could also be levelled at consideration of all performance components within the individual. Occupational therapists recognise that there may be aspects within some of our clients where little, if any influence may occur, but this does not negate the fact that this aspect is taken into consideration when planning a treatment program or intervention strategy. Similarly, it may not be possible to implement an occupational rehabilitation or occupational health and safety program within an organisation which encompasses ALL the variables in the detail outlined, however, it should not stop the therapist questioning these areas and determining how they may impact on the overall intervention.

Hunt’s (1972) model of an organisation’s performance has been compared with the Occupational Performance Model (Chapparo & Ranka, 1992) and adaptation made to provide a framework for practice for occupational therapy in the area of occupational health and safety. If the variables which affect an organisation’s performance are considered in the same way in which an individual’s performance is perceived, it is possible to use this framework for practice in both occupational rehabilitation [productivity for individuals] and occupational health [prevention of injuries within organisations]. By doing so, occupational therapists will be able to provide a high quality, comprehensive service within an organisation which is acceptable to management and which reflects the basic premises and tenets of the profession.

References:

Chapparo, C. & Ranka, J. (1992).The model of occupationalperformance. [Handout available from the School of Occupational Therapy, Faculty of Health Sciences, The University of Sydney, Lidcombe, N.S.W., 2141, Australia.]

Hunt, J.W. (1972).The restless organisation. Sydney: John Wiley & Sons.

Innes, E. (1988). Occupational therapy: Still at work.AustralianOccupational Therapy Journal, 35(4), 173-180.

Pedretti, L.W. & Pasquinelli, S. (1990). A frame of reference for occupational therapy in physical dysfunction. In L.W. Pedretti & B. Zoltan (Eds.), Occupational therapy: Practice skills forphysical dysfunction (3rd ed.) (pp.1-

17). St Louis: C.V. Mosby.

Reed, K.L. & Sanderson, S.R. (1983).Concepts of occupationaltherapy (2nd ed.). Baltimore: Williams & Wilkins.

Sloan, R.P. & Gruman, J.G. (1988). Participation in workplace health promotion programs: The contribution of health and organisational factors. Health Education Quarterly, 15(3), 269-288.