Nurture the Leader Inside: Making an Impact as Occupational Therapy Professionals

OT and Leadership

I am excited to talk to you today about leadership. Occupational therapy professionals do not always connect with that term. Still, I hope that after today, you feel a little bit more tethered to leadership and the potential leadership skills you have inside of you. I believe that we all are leaders, and we can work on being stronger leaders every single day.

I also want to share a little bit about my story. I have been an occupational therapist for 20 years. Even at this stage in my career, I would not define myself as a leader. However, I have started a private practice and have been a rehab manager. These may be areas that are thought of as leadership positions. When I say occupational therapists, I want you to know that I am referring to OTs, assistants, and even OT students. OT professionals, in general, can benefit from this conversation on the whole.

Typically, when we go to occupational therapy school, our primary focus is becoming a therapist to provide OT services to people in need. We are hands-on with patients helping them reach independent goals. We gain exposure and information about leadership, but it is not always a big focus for our curriculum outside of patient care.

We also hear about our national and state organizations and even student organizations in school, but we are not really nudged into leadership roles. It is not really in the OT culture to be big leaders in the field or healthcare.

There is also a division between what we think a leader looks like and how we can actually show up and be a leader in our everyday lives. This is especially true in our professional lives. To be honest, most of us are hoping to enter the profession and not feel like a total imposter. We want to be solid clinicians and do a good job. In fact, when we start our careers and leave our universities behind, we probably have fewer conversations about leadership. We need to start bringing those conversations with us. As OTs, most of us have exceptional leadership qualities and can impact many ways in healthcare and other industries. We need to embrace that when we leave school.

We need to embrace current leaders as well to protect our profession. We have to consider all of the leaders that came before us and their work, like protecting our licenses. For example, in Colorado, we did not have licensure for a long time. We also need to have leadership to protect the public. This is funny to think about, but we need to protect people in our communities because we know that people benefit from occupational therapy. Research supports this, and we need to use our voices to support our role in patients' and their caregivers' lives. This is not only just to have access to occupational therapy but also to have quality care. A third reason we want to talk about leadership is that we need to advocate for ourselves and our own health at work regarding topics such as productivity standards and compensation. OT leaders have a role in stepping back to take a bird's eye view of healthcare and see where we can show up. For example, we may not all agree on politics or policy, especially right now, but many of us can agree that our healthcare system has many cracks. Occupational therapists can help with this, and we need a seat at the table to be part of those discussions. We need to represent our unique roles and how we can help clients. This advocacy can be done in tiny or big ways.

I often think there is a disconnect when we start talking about huge leadership roles, and we are going to talk about that more today. I hope when you walk away from this presentation that you realize what leadership looks like. It can be represented in a lot of different ways. It does not have just to be big leadership roles. Sometimes, it is just a perception change, which can be a good thing.

What Stands in the Way of OT Professionals Becoming Leaders?

Let's talk now about why we do not identify as leaders. What is getting in the way of OT professionals becoming leaders?

Figure 1. Barriers to OT leadership.

One of those first things is that we do not always identify as leaders. The word leader is a funny term for occupational therapy professionals. What are we leading? Another thing is that we often downplay what we offer.  Perhaps, the problems seem too big. For example, if there is payment reform in Washington (a little later--we are going to talk about a therapist that went through that), you might think, "What could you possibly do to change that?" However, leadership might be as simple as writing one letter to a representative. Sometimes, we think that stepping in as a leader might lead to more work, stress, and less compensation. That can be true, and people may shy away from leadership roles as their plates are really full. And lastly, there may not be a good work environment. There may not be good support from a manager. Again, thinking about productivity, adding one more thing to a schedule may not be possible. So that can get in the way too. These are some of the answers given by OT professionals regarding why they are not in leadership roles. Some of you may identify with these responses.

Defining Leadership for OT Professionals

• “Leadership is the art or practice of motivating a group of people in order to achieve a common goal. Leadership derives from social influence rather than strict hierarchy or seniority. Anyone with the right skills, regardless of their position in a company or organization, can be a leader.”

This is a quote that comes from an online leadership masterclass. I have a reference to that in the end if you want to look into that. This helps to get that preconceived notion of leadership out of our minds. 

• "The time has come for a silent revolution. Leadership is everyone's business, and leadership knowledge, skills, and ways of thinking must be recognized as legitimate professional development activities for all practitioners."

This next quote comes from an article written by two British occupational therapists in an article called "Embracing the Leadership Potential of Occupational Therapy in the Social Age, Time for a Silent Revolution."

Bravo and kudos to all taking this course. Part of being a good leader is being a solid OT professional. And, it is not just our clinical skills. We need to embrace the fact that we are all leaders and contribute to the fields we work in. We can help our clients, our future as a profession, and the delivery of healthcare. Thus, as we learn about leadership, you will also learn about how what you do as a practitioner also helps in the leadership role. There are skill sets that need to be learned to do that. 

Qualities of a Leader

• Ability to influence others
• Transparency
• Encourage risk-taking and innovation 
• Value ethics and integrity 
• Act decisively 
• Balance hard truths with optimism

According to Harvard Business School, these are the qualities of a leader. Remember, you can search online and see various lists about what types of qualities make a good leader. In some cases, organizations may have their own list of skills they want to see for leadership roles. You can pick and choose what you want, but I think this is an excellent overall list.

The first is the ability to influence others. This is pretty obvious. The next one is transparency. We want our leaders to be relatable, but a good leader also has to demonstrate good discretion regarding how much they share. For example, a rehab manager might not share if they were having a bad day or had a run-in with a director. They would not want to share those emotional pieces with their staff. The people that you are leading are not going to be your support system.

Leaders encourage risk-taking and innovation. Experimentation is critical to keep an advantage with change. Leaders need to help others through that process to develop new creative solutions, weighing out risks, and deciding when to make a change.

Leaders have to have strong ethics and integrity. This is often ranked as the number one attribute of a good leader. People you admire and look up to most likely have strong ethics and integrity.

Leaders have to be decisive and act decisively. If a leader wavers on decisions or is wishy-washy, this breaks down the leadership process and the ability to reach goals. This does not mean that a leader cannot change their mind, but we have to know when to change course and not be on the fence about certain things.

Leaders also have to know how to balance hard truths with optimism. This can be really tough sometimes. We cannot avoid hard truths. If you are leading a team or a project and you make a mistake, that is okay. You just have to be responsible and own up to your role in the process. Always maintain optimism and hope. It is important to be hopeful and focused on creating new plans of action. People are going to look to leaders for that.

Qualities for Leadership in Healthcare

• An understanding of costs, reimbursements, and the bottom line
• Conflict management and resolution skills
• Organizational change management
• A concerted focus on patient safety

George Washington University provides qualities of leadership in health care. Not only can you think of people you look to for leadership and see these qualities that I have listed, but you can also start looking at some of your own characteristics to identify some of your strengths and weaknesses. If you notice some weaknesses, you can then do a deeper dive for leadership development. Leaders in health care have to understand costs, reimbursements, and the bottom line of a system. If they do not understand those things, it is nearly impossible to develop good and effective ideas. I have met many therapists and social workers who do not have a great handle on how costs, reimbursements, and the bottom line affect their job. This can get in the way if/when they do speak up about a problem and to be taken seriously.

Conflict management and resolution skills are also critical. If you have worked in healthcare for any amount of time, you have probably experienced some conflicts. Again, it could be something like productivity. This is a hot button item for a lot of therapists. Therapists can feel a lot of push from corporate liaisons and administrators. There may be conflicts with a manager or nursing staff. Conflict management is so important in these examples. 

Healthcare can move quickly in some ways while at a snail's pace in other ways. Leaders have to be able to move through those changes and understand them. We are never going to stop seeing change. This is a good thing for the most part, as we want to see a progression of new ideas and research. However, organizational change can be really hard. A manager/leader is going to be able to shift and pivot through those changes. For example, there is going to be a payment reform based on outcomes. To get better reimbursement, we have better patient outcomes. To be successful, we have to have some strategy around that. During COVID-19, we had to make a big shift from doing a lot of face-to-face inpatient care to telehealth. We had to move quickly to put effective change into place and still serve our patients. 

Then, leaders have to have a concerted focus on patient safety. This is no big surprise in healthcare. No matter what area (the ER, ICU, or outpatient), patient safety has to be the focus. Interestingly, George Washington University shared that between 250,000 to 400,000 people die every year in our country from preventable errors in hospitals. Depending on what these errors are, should an OT participate in systemic change to help with that? They certainly could. If we think about things like falls, are these safety concerns that an OT could participate in? Possibly. If you work in an organization with big safety concerns like this, could an OT offer to participate in a focus group? "Would you mind if I looked at the way that we do things? I might have some feedback to give." 

Where Are OT's Leadership Strengths and Weaknesses?

• Strengths:
  • Communication
  • Respect
  • Responding to constructive criticism
• Weaknesses:
  • Seeking out resources to drive the action for change
  • Taking risks by sharing new approaches
  • Taking on leadership roles

Some research talks about how OTs are strong and not so strong in leadership, and I encourage you to talk about this with your peers. This information was gathered from fieldwork educators about their perception of leadership qualities in their OT students. They reported that students were effective communicators, showed respect for the fellow employees, and responded to constructive criticism.

Areas that needed improvement included seeking out resources to drive change, taking risks by sharing new approaches, and taking on leadership roles by implementing new protocols. Knowing this, we can assume that students/therapists are showing up in their fieldworks and the workforce with the same weaknesses. These weaknesses are not really areas that we focus on when we first start. If we start looking at these qualities initially (as a student or a new clinician), we can develop these early on.

Another study provided insight into students' perception of leadership abilities and highlighted areas for focus on leadership. It determined that as a whole, the profession needs to hone leadership skills. This means students, practitioners, all of us. AOTA is trying to develop a curriculum to offer to occupational therapists on how to be good leaders at the beginning of our careers. That is a fascinating thing. 

Figure 2 shows some of the therapists they brought together in Bethesda, Maryland, before the world shut down to develop some of that curriculum. 

Figure 2. OT leaders.

They pulled everybody from assistants, therapists, and new grads. Some people had been in the field for 30 years. It was fascinating. I have high hopes that we will see a lot more leadership support from our national organization. It is not that occupational therapists do not want to be leaders, as people say that they want to, but we are not great at it.

Where Do OTs Want to Make a Difference?

• In the lives of others 
• By helping our organizations do better and be better 
• Making our corner of the world better when we leave it than when we arrived 
• Through being an inclusive profession that respects diversity in every form 
• Experiencing joy in our work 

Many have said that they want to show up in the world to impact others' lives. We want to be able to help our organizations do better and be better. We want to show up as leaders and make our corners of the world better than when they arrived. We also want to have a very inclusive profession and support and respect diversity in every form. We also want to show up as a leader to have joy in our own work. Leaders will tell you that they did not know their leadership style or now what their skills were. And, many did not even consider leadership as a focus at first. Sometimes, we find a cause that we are excited about and step forward in that. However, if we take the time to think about leadership and self-assess, we can be more impactful when it comes to change and better results.

Leadership Styles

• Democratic
• Autocratic
• Laissez-Faire
• Transactional
• Charismatic
• Transformational
• Servant 
• Bureaucratic 

Let's start talking about leadership styles. You will probably identify with some of these styles or know someone who embodies them. You can also pull from different traits of each and have blended styles.

Democratic

The democratic leadership style involves a leader soliciting input from each of the team members. It considers each person's point of view before making a decision and allows everybody to engage in the decision-making process. This is really good for boosting morale, job satisfaction, and engagement.

Autocratic

The autocratic leader is the opposite of a democratic style. They are going to make decisions unilaterally without consulting any of the other group members. It feels very authoritarian, but it can be helpful though when quick decisions need to be made. Occupational therapists tend to be lovey-dovey type of people. We think autocratic, and we think that sounds terrible. However, sometimes we do need to make decisions quickly and may need to use this leadership style.

Laissez-Faire

Laissez-Faire is a hands-off leadership style that involves a manager delegating responsibility and decision-making with minimal interference and supervision. You may be thinking, "How effective can that be?" It can be beneficial if you work with people that are pretty self-motivated. It helps them engage in their own passions and their own interests, which can be positive.

Transactional

Transactional leadership involves offering incentives for effective performance and penalties or disciplinary action for poor performance. It can be a strategic leadership approach when you want to achieve specific performance-related benchmarks.

Charismatic

Charismatic is how it sounds. People rely on their charm and personality to communicate goals and encourage performance. These leaders are adept at inspiring team members to accomplish a shared objective.

Transformational

Transformational leadership is where a leader's desire is to improve upon or transform a business or company. This is their number one goal. They prioritize the organization's growth above all else. People with this type of management tend to focus on big picture goals rather than the minutia of management or smaller pieces.

Servant

Servant leadership is placing the satisfaction of the employees above everything else. This style believes that team members' professional and personal fulfillment will result in a higher quality of work. Servant leaders place others' needs above their own, which lends itself to calling it servant leadership.

Bureaucratic

The last one on the list is bureaucratic. These leaders strictly abide by company policy and tradition. They have clear expectations for team members, and it is very stabilized and systemized. This can be effective in a highly regulated department.

These leadership styles can be used in a workplace or be transferred to other settings like volunteer groups. These are some of the qualities we value as OTs.

Leadership Skills

• Exceptional emotional awareness
• Diplomacy 
• Empathetic approach 
• Self-awareness and accountability
• Understanding that change can happen from the bottom up 

When OTs were asked, these were some of the leadership skills that were reported. One thing we want to see in our leaders is exceptional emotional awareness. We want to know that people have good emotional regulation control and have been through some things in life but can still manage their own emotions. We want to see people that are diplomatic with an empathetic approach. Leaders need good self-awareness and accountability. Accountability looks at integrity that is important for a strong leader. Leaders also need to understand that change can happen from the bottom up. For example, a brand new OT could come up with a wonderful idea that will positively impact the entire system. It does not have to be an administrator, the CEO, a corporate liaison, or an insurance company. Anybody can step into a leadership role. We want to embrace the staff's leadership skills, no matter where they are on the totem pole. Now that we have spent time talking about leadership skills and a good leader's qualities, how do we cultivate the skills?

Cultivating Leadership Skills

• Map our own knowledge, skills, and mindset 
• Create opportunities to advance our understanding of leadership 
• Mentor, supervise, create communities to support everyone’s leadership potential 
• Engage in honest conversations 
• Share our leadership stories 

This is information from the British Journal of Occupational Therapy. It shares with us some ideas on how OTs can do this. Whenever I teach a course, I always like to have a few golden nuggets that you can take away as action items. I thought they had a great bullet point list that I would like to share with you.

The first thing they talk about is mapping out our own knowledge, skills, and mindset regarding leadership principles. This helps us to see our strengths and where we need to improve.

Another is creating opportunities. I love this one as OTs are really creative and tend to be really good at investigating ways to up-level our skills. We can do this through education like you are doing today, conversations, research, reading books, and all different kinds of activities to advance our understanding of leadership.

Mentoring, supervising, and creating communities to support everyone's leadership potential is another way to cultivate leadership skills. We know that leaders help others become leaders. For example, we are starting a pediatric focus at the private practice that I run, and we have some powerful pediatric therapists. We are also opening up some opportunities to bring other therapists into the mix that want to step into the pediatric world. This is elevating our ability to practice as pediatric and adult therapists. This also supports everybody's ability to be a good leader.

Another thing is engaging in honest conversations. We should talk about what is holding us back professionally and personally from identifying as leaders. Bring this topic up with colleagues and see what feedback you get.

Lastly, it is important to share leadership stories. If we share our leadership stories or hear from others about their leadership stories, this will probably elevate our ability to lead. You can do that with just your spouse, on social media, in a community, with your friends, sitting at dinner, et cetera. 

Self-Assessment Examples

• Reflective journaling
• Checklists and surveys
• 360-degree feedback
• Self-observation
• Harvard Business School Self-Assessments
  • The Emotional and Social Competency Inventory
  • Personal Values Questionnaire

I wanted to give you a few tangible ways to map your strengths and weaknesses. I am sure there are plenty more that you could add, but these are some examples of how to expand our awareness of our skills.

Reflective Journaling

One thing you can try is reflective journaling. You may have done this, or maybe you have talked to your patients about doing this, but it gives you time to look back on experiences and mindfully reflect on them. You can even ask, "How did I do yesterday? How was I in yesterday's meeting? How did I do with that difficult family?" You can also talk about what you were happy with and what you were not. This journaling helps you to develop a plan to move forward.

If you are interested in reflective journaling, there are many great websites out there that can walk you through it. There are even downloadable sheets that are free. You can use this in practice or your personal life. I have twin toddlers. How did I do managing some of their breakdowns yesterday? This can help you to figure out how to do things better in all aspects of your life, not just leadership. It will also help you see how you manage your stress at work, a difficult colleague, or time.

Checklists and Surveys

This tool can support the process of self-assessment and be customized to skills that you want to grow, like emotional competencies, relationship skills, and enthusiasm at work. It can also include involvement, conflict resolution, and clarity of direction. The survey stage may even come after you do a little bit of reflective journaling. You can gather some skills that you want to work on and then create a checklist of things you want to accomplish and develop as a leader. A checklist is a great way to show personal growth as a leader and help with accountability. For example, I am working on a few skills that I want to develop over the course of this year. I have a checklist, and I go through that every morning to make sure that I am working on different tasks. Checklists can help you stay on top of your leadership development skills.

360-Degree Feedback

This approach is comprehensive and requires a little bit of vulnerability. You ask for feedback about strengths and weaknesses as a leader, and it is usually completed through an anonymous survey by your peers and superiors. You can certainly set this up on your own, but if you are working in a team, you could suggest this to your supervisor, or if you are a supervisor, you could suggest this to your team and ask them to review you as well. I have done this with previous employers as a staff OT. I found it to be really insightful. I got really great information on what I could improve. You can also sit down though and have these conversations with close friends. I had a friend who, when she turned 35, brought together her closest friends, had a big dinner party, and told us what she wanted to accomplish in her life. She then asked everyone to give her feedback on these goals.

Self-Observation

This looks at mindfulness and awareness of how you are doing things. You can also videotape or record your voice. If you are giving training to the CNAs you work with, you could do it in the mirror before that. Self-observation goes a long way. When I was in social work school, they had us pretend that we were interviewing patients. They videotaped us to see how we delivered things. You could pinpoint areas like repeating the same statement, nodding your head a lot, or never making eye contact with somebody. Those self-observation moments can be key to pinpoint areas to work on.

Harvard Business School Self-Assessments

I included The Emotional and Social Competency Inventory and Personal Values Questionnaire as things you can look up online in this area. The Harvard Business School provides these self-assessments and encourages the use of them. I also included these in the resources. 

Leadership Self-Assessment

I also included the Leadership Self-Assessment from Purdue University. It is fun to do. You could also provide that to your team. It is composed of questions to help you define your current leadership competencies. You can rate yourself with either do not do well, do somewhat well, or do well. Once you complete it, you can go back and place a checkmark next to the categories you want to include in your personal development plan. The advice with this assessment is to try to stretch yourself 10%. Then, you can come back and use the assessment again to see if you have made any improvements.

Effecting Change Through OT on Various Scales

• Staff meetings 
• Lead by example 
• Going the extra mile
• Doing continued education regularly
• Seeking out ways to make a difference 
• Volunteering 
• Self-control

When we talk about effecting change, we can look at that on various scales. You can literally show up every day and be a leader in your own profession. You can do this through simple daily activities. The key is being consistent in your performance and being intentional. It is important to remember that leadership does not always look like owning a big company, standing on the floor of your state's capital and speaking about policy change, or having a title of manager/director. You can start making changes in your daily life as an OT today.

Staff Meetings

An opportunity might happen at a staff meeting. I have mentioned this a couple of times. Perhaps, you do not speak up a lot. You could start by coming prepared and on time. You also want to stay engaged and do not do your notes during a meeting. Give people good eye contact. If people see you doing that, they are more likely to do that too.

Lead By Example

This leads to the next point of leading by example. Do a good job, get things done on time, stay up to date on policy change, and share it with your team. Bring articles that you read and share them with your team.

Going the Extra Mile

You can also go the extra mile. You can plan great treatment plans. Be there for your peers. Organize a fundraiser or be part of one. For example, we had a colleague that was an activity assistant at a skilled nursing facility that was diagnosed with breast cancer. We organized an incredible fundraiser for her. We had a band and donations. Everybody was in tears by the end of it. 

Doing Continuing Education Regularly

You want to educate others on what you learn. If you are one of those who do many webinars, you can share it with other people. You can have really wonderful and insightful conversations about all different kinds of topics.

Seek Out Ways to Make a Difference

Seek out ways to make a difference. Is there something that you can improve? If you are an OT assistant and want to have a better relationship with your OTR, how will you accomplish that? You could suggest some changes with your team. Could you collaborate with other departments on program development? I talked to a skilled nursing OT the other day which was really passionate about incontinence. She went to the wound care team at her skilled nursing facility and developed a program on incontinence management.

Volunteering

It is always a good idea to show up as a leader. You could offer your services at work, organize an event, or help at your state conference. People are always looking for volunteers. You can even go the extra mile and volunteer to serve on your state's board. You will learn a lot if you do that.

Self-control

If you work on a team or are in a place where things are stressful and strained, how can you stay in control and take a stand on things? Another huge thing in this area is being a good listener. It is having exceptional self-awareness and keeping cool under pressure. I love this quote.

• “Self-leadership is the greatest leadership challenge we face.” Andy Stanley

We have to be good leaders of ourselves and how we move through the world. While we can look at people within occupational therapy, it is also okay to look at people outside of occupational therapy and find encouragement. You can look at their skills that you appreciate and figure out how to cultivate some of them. Figure 3 shows some leaders that I admire.

Figure 3. Leaders that the author admires.

The top left shows two occupational therapists, Lisa and Jill, from our state conference a few years ago. Jill was a Creighton OT student, and Lisa was a Creighton grad. She took Jill under her wing, and I just admired her so much in this leadership role. It made me want to be a better leader with students as well. You can learn by observing and bring in some of those skills yourself. On the top right, I am standing with Jane, a physical therapist who owns a private practice, and Tiffany, an OT. They both helped me to become biofeedback certified so that I can treat pelvic muscle dysfunction. I enjoyed learning from them as they came together and collaborated. It is rare for people to do that. They both work with incontinence and pelvic health, and one lives in Texas and the other in Vermont. They came up with this whole curriculum on how to treat pelvic muscle dysfunction.

I also encourage you to read books, like on the bottom left. This is the guy that started the shoe company called Toms. The bottom middle picture is an article about women doing great things in their communities. This might inspire you to step up and volunteer. The bottom right picture is a picture of three women that I admire. One works in non-medical home care, one is a physical therapist, and one is a nurse practitioner. The PT and NP work at the hospital. They have made some significant changes with fall prevention and the patient experience at the hospital. In fact, they started speaking in front of large crowds of people about the topic. It started with an idea, collaboration, and good listening skills. Lastly, the top middle picture is Oprah Winfrey.

Look at people that you want to emulate with leadership because there may not be enough leaders in occupational therapy for you to have a whole picture.

OT Leaders

I wanted to show you some occupational therapy leaders in our field to get your juices flowing.

Barbara Ingram-Rice, OT, LMT, CLT, CHC

• Licensed massage therapist
• Certified lymphedema therapist 
• Certified health coach 
• Extensive service in her state organization
  • President 4 years 
  • Government Affairs for 3 different terms 
  • Vice President 
  • Chair of the AOTA ASAP (Affiliated State Association Presidents) Committee 

This is Barbara Ingram-Rice in Figure 4.

Figure 4. Barbara Ingram-Rice.

She is a licensed massage therapist, a certified lymphedema therapist, and a health coach. She has provided extensive service in her state organization, where she served as president for four years. She has been in government affairs for three different terms and has served as vice-president and as the chair of OTA's ASAP Committee (Affiliated State Association Presidents). Barbara has many credentials behind her name and has many years of experience. It is all about putting your hat into the ring and starting somewhere. Barbara did that, and look where she is at now.

Josie Jarvis, MA, OTR/L

• Joined the legislative committee for her state board as a student and helped develop trainings for her state’s annual lobby day 
• Served on the WOTA board as secretary 
• Her plan is to be involved in establishing OT’s presence academically, politically, and practically as service providers for young adults around the nation  

This is Josie Jarvis in Figure 5.

Figure 5. Josie Jarvis.

Josie is an occupational therapist that joined her state board legislative committee as a student and helped develop trainings for her state's annual lobby day. She had some background in politics and was able to be influential there. Think about the skill sets that you have and what you can bring to the table. She also served on her state board as secretary. Many students feel nervous about getting involved. Again, it is about just showing up and participating. Her goal is to help OTs have a presence academically, politically, and as service providers for young adults around the nation. She has some big goals, but of course, it just starts with what she is doing now.

Debra Battistella, MS, OTR/L

• FW Coordinator in an OTA program 
• Started providing services on their college campus doing ergonomic assessments and working with the student access center 
• Focus areas include resiliency and social connections 
• Moving towards hosting an OT capstone student this year 

In Figure 6, this is Debra Battistella. She is a fieldwork coordinator for an OTA program.

Figure 6. Debra Battistella.

She started by providing services at a local college campus doing ergonomic assessments and working with the student access center. She has taken a leadership role and stepped out a little bit in academia and doing things a little bit differently. Her focus areas include resiliency and social connection. She is currently moving towards hosting an OT capstone student this year. She is doing awesome work there.

Sarah Putt, MA, OTR/L

• Founder & Clinical Director of Sarah Bryan Therapy, an occupational therapy private practice that provides early intervention services to clients in Los Angeles, CA
• Host & Creator of OT 4 Lyfe, a podcast and website dedicated to connecting and inspiring OT practitioners and students across the globe and advancing the profession of occupational therapy

Here is Sarah Putt in Figure 7.

Figure 7. Sarah Putt.

Sarah is definitely expanding the scope of OT. If somebody is not doing something and you think that it needs to be done, this might be the calling for you. She has a huge passion for connecting occupational therapy professionals around the globe. She has given presentations for therapists and students in Iceland, Portugal, and Estonia. She has also volunteered as an OT in Peru, Ecuador, Honduras, and Cambodia. She has developed a podcast called OT 4 Lyfe, and she offers podcast consulting. We definitely need that as OTs and do not have a lot of that going on in our industry. 

Kathryn Wise, OTD

• Started her leadership journey networking with other health professionals, took a clinal coordinator role and started a private practice
• Led a large team of healthcare professionals and learned how to share the value of OT across disciplines 
• Built the “Leadership in Healthcare Organizations” course for McMaster University in Canada
• Mentored and taught leadership around the world 
• Started the OT Leadership Lab Facebook group 
• Hopes to expand to a global group in 2021 to coach OT’s and other healthcare professionals on leadership

Kathryn Wise started her leadership journey networking with other health professionals and eventually took a clinical coordinator role and started a private practice (Figure 8).

Figure 8. Kathryn Wise.

She built a leadership and healthcare organizations course for McMaster University in Canada. If you are interested in leadership or have been a leader, it might be time for you to return the favor to people coming up behind you that also want to do something similar. She started the OT leadership lab Facebook group and hopes to expand to a global group in 2021 to coach OTs and other healthcare professionals on leadership. She has done a lot of really great work educating others on the role and the importance of occupational therapy. This requires powerful leadership skills.

My point in sharing these stories is that they all started somewhere and did not come out of school to be the secretary for their state association. They did not have a private practice right when they started. We all have to start somewhere, and we have to start with small changes.

Amy Lamb, OTD, OTR/L, FAOTA, Former President of AOTA

• “It was there, in the hospitals and clinics, that my leadership journey began. This leadership was not with job titles but with action—from taking risks to sometimes going against the grain while working to keep the greater good front and center at every corner. “ Amy Lamb OTD, OTR/L, FAOTA

And lastly, this is Amy Lamb in Figure 9.

Figure 9. Amy Lamb.

Amy Lamb is a former AOTA president and someone that many people look up to, including me. In her presidential address at the end of her AOTA presidency, she shared her leadership story. She said that her leadership story was the direct result of the Balanced Budget act of 1997. Anyone working when the Balanced Budget act came out, you have been in the field for a while. It was a huge industry change for all of us. She went on to say that she was one of the many occupational therapy professionals who lost their job at that time as the industry worked to understand how to deliver services in the new prospective payment model. "I was frustrated with patients that were no longer getting services they needed, and I no longer was able to put my degree to use and earn an income. It was in connecting with AOTA that I learned more about the policy changes themselves." She pursued the information to make a change. "I decided to channel my frustration into helping with this effort." This is putting this information forward. "I passed on what I learned from AOTA to other occupational therapy professionals to understand why these changes were happening and what we could do to ensure that people would still be able to access our services. I listened to the challenges (active listening) and made sure I collaborated with and supported my peers as we navigated the new system." This is an example of a leader supporting leaders. This leadership was anchored not with job titles but with action. She took risks and went against the grain to work for the greater good,

"Why do I reflect on this now? Today, we're all facing ups and downs within our profession, trying to navigate where to go from here. Major payment changes are here on the horizon once again. As individual practitioners and as a profession, we have to determine what risks to take, when to play it safe, and when to be bold." Leaders need to learn how to pivot and change. If you feel uncomfortable with any of those things, those are places to focus on as far as leadership. This course is really intended for people interested in growing what they are already doing as a leader or stepping into a leadership role. I hope this gives you the confidence and the guideposts to do a little bit more of a deep dive into what you can create in your own profession right now and in your story.

Growing Your Leadership Toolbox

Leadership Toolbox Checklist

As you grow your leadership toolbox with skills, we want to look at some tangible takeaways. I have provided a toolbox checklist as a download. 

Figure 10. Leadership checklist.

Some of the things that are on there are small. You could join an online OT chat group. If you are already part of a chat group, put something into the chat. Sometimes that is the hardest part. We lurk around on social media, but maybe we do not participate. As a leader, it is excellent to get out there and start talking. Establish a mentor or coach. You could hire a coach, or you could talk to somebody about being your mentor. Speak up about your needs. One part of great leadership skills is asking for help. As we discussed, speak up in meetings or offer to help a new team member. If there are people that you want to learn about, read some books or articles about them. Take classes on leadership. Find some weaknesses in your own profile. For example, if public speaking is a weakness, put that on your learning agenda. Do not just focus on clinical skills. Attend your local or National Hill Day to find out more about policy. Share compliments with coworkers. Make a goal that every day in whatever month that you are going to say something kind about a coworker or somebody else.

Attend a Ted circle meeting. If you do not know what that is, I encourage you to look that up. At our OT association conference in Colorado, a presenter talked about Ted circle meetings. I did not know what it was, so I looked it up. It is awesome and a great way to engage with others.

Improve your documentation. That can be a leadership skill. Then, you can coach others on documentation. OT month is right around the corner in April. Start thinking about fun and educational opportunities that you can take advantage of for that month. You could educate the nurses, dietary, and other people on the role of occupational therapy. Make it fun and engaging and take a leadership role in that.

This checklist is intended to give you ideas and track some of the things that you are doing. You could even look at this checklist and pick 10 things to accomplish. Again, leadership shows up in all different ways.

Setting Goals in Leadership

• Make it a priority 
• Complete the self-assessment
• Identify areas of growth
• Action items

And of course, we have to talk about goals. We are OTs and write goals every day for others. However, we do not always write them for ourselves. This can be a disservice. Be sure that you set a goal on how often you will revisit your leadership journey so that you have that in your calendar. Also, how are you going to track that? Are you going to take a class? Are you going to read a book? Are you going to speak up at work? How will you track that and make it measurable, just like we do for our patients? Always put the self-assessment in setting your goals, so that gives you good tangible information.

Resources for Leadership Development

• AOTA 
• Your state OT Association
• APTA Private Practice Section 
• Harvard online leadership courses
• Howard Schultz Business Leadership Masterclass
• Recommended books:     
  • Dare to Lead: Brene Brown
  • Leaders Eat Last: Simon Sinek  
  • Shoe Dog: Phil Knight 
  • Good to Great: Jim Collins 
  • The 7 Habits of Highly Effective People: Stephen Covey 
• Pursue the OTA leadership kit 
  • https://www.aota.org/Practice/OT-Assistants/OTA-Leadership.aspx
• Take an online class on leadership 
  • ​20Q: Leadership Reflections From a College Dean
• Leadership and Advocacy for the OTA 
  • https://www.occupationaltherapy.com/ot-ceus/course/leadership-and-advocacy-for-ota-2743

I have included this resource page for you. We have talked about AOTA and state organizations. They can be great resources. You may even want to look to other industries for support. The American Physical Therapy Association has a private practice section. I have done a conference with them and was blown away by it. If you are interested in private practice, I would use that as a resource. I have also listed some books that I recommend. Additionally, the Harvard online leadership courses are free if you want to do a deep dive. There is also an OTA leadership kit on the AOT website. There is a leadership class on occupationaltherapy.com that I also listed.

Summary

Finally, I will end with this quote. This is from the same final presidential address from Amy Lamb. I really like it because it ties up many of my points today, and I think she can say it better than I can.

• “Together we can shape our own destiny. There is no doubt we will face challenges; let’s meet them together. Because I know that together we will find opportunity in our changing world to meet better the evolving needs of all people, populations, and communities. This is our moment in time. Every one of you has ideas, something you’d like to do, something to make a difference in others' lives, something that will bring joy to your work. Why not take a chance? Why not be bold?” (Former AOTA President, Amy Lamb)

This is what our leaders do. They take a chance and an opportunity to be bold. Sometimes it takes some self-assessment, learning some new skills, doing a deep dive into leadership, and then pushing that a little bit. In the self-assessment that I gave you from Purdue, the challenge is to stretch yourself 10%. How can you stretch yourself 10% as a leader? Maybe it is just figuring out your leadership quality or style. There are many things that you can do.

I'd love to hear from you. Feel free to reach out to me.

Questions and Answers

How can a leader monitor people's performance without turning that into micromanagement?

This is a great question. Nobody wants to be a micromanager. I would encourage you to look at those leadership styles and then also determine what type of team you have and all of the personalities that are at play. Figure out the best way that you can empower them. Some people may need more micromanagement and systems in place. The other thing you can do is look at that more democratic leadership style. I would recommend bringing everybody together and asking them, "I really want to lead you, but I do not want to be your micromanager. We have these objectives that we have to meet, and how can we do it together?" I do that with my team all the time. Sometimes they come up with stuff that is so helpful and good.

Which post-graduate degrees will improve an individual leadership management skills?

This is an excellent question. I think any post-graduate degree could help to put you into a leadership role. I think it also depends on where you want to work. I think anything that you can do to expand your education will help with leadership if you apply what you learn to what you are doing every day.

What about transdisciplinary teams? Sometimes it is hard to find a leadership role within a team and get paid for it. I usually designed program handouts on my own time.

This is always a challenge because we all come from a different lens. I encourage you to find some commonality, be positive, and bring people together in conversation. If you can figure out how to communicate correctly, that can be helpful. "This is how I see it as an occupational therapist. I'd really love to hear how you look at this. If we overlap at all or have disagreements, could we talk about that?" If you phrase things like that, people are more receptive, and you get more quality conversation out of that. It is also important to recap what you hear. This is that active listening piece. "This is what's going to work well for you. This has worked well for us. Am I hearing you right?" Reflecting is always really important. I would recommend that. I also know exactly what you mean about doing things on your own time. Sometimes, that is a sacrifice that a leader has to make. You can always have a conversation with your manager to reduce your productivity requirement or some other type of reimbursement for that.

What was your favorite organization or project?

I would not say that this was my favorite, but one of the most beneficial things I ever did was volunteer for my state board. I was approached to be the president of the board for Colorado. I did not seek that out, but I took the opportunity when it came. I learned more about occupational therapy and the systems behind it than I did in my whole 20 years combined.

References

Available in the handout.