Implementation of an Occupation-Based Practice Strategy in a Metropolitan Health Service: A Case Study

Abstract

Background

Occupation-Based Practice (OBP) is fundamental to occupational therapy, enhancing consumer engagement and outcomes, yet implementation is challenging due to local environments and dominance of impairment-based interventions.

Aim

To investigate implementation of a service-wide OBP strategy in a large metropolitan tertiary health service over 6 years; understand its influence on occupational therapists; identify barriers and facilitators; and observe changes in clinician perceptions supporting sustainability.

Methods

Qualitative case study at two time points. Participants were occupational therapists and allied health assistants (n = 95 in 2017; n = 39 in 2023). Data was collected through focus groups (n = 8 in 2017; n = 3 in 2023) and multiple documents. Descriptive thematic analysis identified themes and sub-themes.

Results

Strategic leadership cultivated an OBP culture. Barriers included resource limitations and systemic pressures; facilitators included interdisciplinary support and professional development. Over time, perceptions shifted from conceptual understanding to practical application as OBP became integrated into service culture.

Conclusion

A service-wide OBP strategy was effectively used in practice. Implementation depended on consistent application, a supportive service culture, and responsive systems. Although COVID-19 negatively impacted OBP, commitment to the strategy supported re-establishment, demonstrating sustainability.

Significance

A service-wide OBP strategy increases OBP and can be sustained in a tertiary healthcare setting.

Introduction

Occupational therapy works with people and communities to enhance their ability to engage in the occupations they want to do, need to do, or are expected to do [1]. They achieve this through Occupation-Based Practice (OBP), which provides the foundation of occupational therapy [2] and yields positive health outcomes across various populations [3]. Occupational therapy in many countries has shifted away from impairment-focused approaches. However, the adoption of OBP has varied across local and national contexts [4–6].

Terminology around OBP in occupational therapy literature varies, with alternatives such as occupation-centred and occupation-focused also used to describe this concept. A scoping review of 35 papers by Ford et al. [7] confirmed these terms are used inconsistently, and while OBP is the most common, it is defined in several different ways. In this study, OBP refers to the use of occupation as the foundation of occupational therapy assessment, intervention and evaluation [8].

Occupation-Based Practice in Occupational Therapy

Many occupational therapists struggle to put their aspirations around OBP into practice [9], to the detriment of the profession, the individual clinician and the consumer. The literature consistently describes the profound impact that practice environments have on the implementation of OBP. In a study by Di Tomasso et al. [9], which included 8 occupational therapists from various settings, the impact of workplace culture and educational gaps on OBP implementation was emphasised, often leading to a “paradigm-practice” gap.

A subsequent study by Di Tomasso et al. [10] with 18 new graduates found that the value of OBP was well recognised, but service efficiency pressures and the dominance of impairment-based interventions were common barriers. These contextual factors often produce tension between the ideal of OBP and the realities of practice [11, 12]. Occupational therapists perceive OBP as a fundamental aspect of their professional identity [11, 13]. When they are unable to fully implement it in practice, role ambiguity and reduced professional confidence can result [4, 14].

Implementing and sustaining OBP in the diverse practice settings of occupational therapy is therefore an extremely challenging proposition [3, 11]. As noted by Gillen and Greber [4], while some settings readily adapt to OBP, others face significant barriers due to logistical limitations, interdisciplinary role expectations, and legislative restrictions. International literature points out that the scarcity of occupation-based assessment tools and limited evidence supporting occupation-based interventions are significant barriers to implementing occupation-based practice [5, 6, 15].

Conversely, sustained and accessible OBP-focused professional development is consistently recommended as a facilitator [15]. New graduates are reported to lack confidence in their occupation-focused skills [10], and the integration of OBP into supervision by senior occupational therapists has been recommended to address this issue [11]. More broadly, mutual support and collegiality among occupational therapists have also been recommended to promote professional development and continuous engagement with evidence that enables OBP [4].

Occupation-Based Practice Within Health Services

In the Australian context, most metropolitan health services are publicly funded, multi-site integrated health services that provide a continuum of care across acute tertiary hospital services, subacute care, ambulatory programs, and community-based rehabilitation services for a defined geographic region [16]. In this paper, the term “tertiary health service” refers to the broader integrated metropolitan health service within which these occupational therapy services were provided. These healthcare settings can be particularly challenging environments for OBP implementation [3, 17], because biomedical models of care and reductionistic approaches often shape how services are structured and delivered.

Multiple studies of occupational therapists in tertiary health services have found they value OBP as a key part of their professional identity and an important contributor to better outcomes for clients [2, 12, 18–22]. OBP was also seen as a tool for promoting the value of occupational therapy within these services; however, its influence on role identity for occupational therapists may be positive or negative depending on the workplace context [19]. OBP barriers identified specific to tertiary health settings include time and caseload pressures, prioritisation of acuity over rehabilitation, a lack of resources and therapy space, understaffing, organisational policies, and poor recognition by funding schemes [3, 19, 22]. Acute/tertiary occupational therapy practice is also often strongly shaped by health system priorities related to discharge efficiency, readmission reduction, and value-based care models [23]

Potential facilitators for OBP in tertiary services were identified in a qualitative study of occupation-based hand therapy in the USA [20]. Amongst other themes, their content analysis highlighted the role OBP plays in tailoring treatment to individual needs, goal setting as an important mediator between the medical model and occupation, integration of OBP alongside non-occupation-based interventions, and how experience improves therapist skill and capacity for OBP. In addition, Robinson et al. [12] recommended the use of occupational therapy theoretical and practice models to support a balanced approach to OBP and non-occupation-based interventions in hand therapy, which acknowledges the wholesale adoption of OBP may not be feasible in some areas of practice.

Rationale for This Study

Much of the current research focuses on the perceptions and experiences of occupational therapists in these services, rather than the process of implementation itself. With the influence of contextual factors so clearly emerging from these studies, research embedded in and engaging with real-life clinical environments is needed to build the evidence base that several authors have called for. To date, there are few studies exploring OBP in the specific context of tertiary health services or which look at implementation at the organisational level. This study addresses the identified need for service-wide strategies that support OBP [20]. Such approaches may help occupational therapists provide more consistent occupation-based care across the consumer journey.

Commencing in 2011, the metropolitan health service implemented a multi-dimensional OBP strategy designed to support clinicians to consistently embed occupation-based approaches into practice [24]. The strategy included profession-specific education, occupation-based documentation resources, supervision approaches, professional development activities, communities of practice, and service-wide communication strategies intended to strengthen occupational therapy culture and identity. Practical tools and examples were developed to support occupation-based language, goal setting, intervention planning, and evaluation across different service settings. The strategy also included annual OBP forums that provided opportunities for shared learning, showcasing practice examples, reflection, and reinforcement of occupation-based approaches across the workforce. One author (JW) was directly involved in the development and implementation of this strategy [24]. Two (JW, CB) facilitated the 2023 focus groups, and one (DH) scribed one of these focus groups.

The aim of this case study was to describe the experience and impact of an OBP strategy implemented over a 6-year period across a large metropolitan integrated health service. Its objectives were to (1) gain insight into occupational therapist understandings of OBP and their perceptions of its influence on clinicians, consumers and the broader organisation, (2) identify barriers and facilitators to delivering OBP in occupational therapy services within a large tertiary health service, and (3) identify changes over time in clinician perceptions and factors which contributed to the sustainability of the strategy implemented.

Method

Case study methodology is particularly appropriate for in-depth exploration of complex phenomena within their real-life context [25], due to its capacity for providing rich, context-specific insights required for further service development [26]. The study received ethics approval from the health service in 2017 (QA2017.07) and 2023 (QA 2022.85), and the same procedures were replicated at both time points. A Clinical trial number was not applicable. Reporting of this qualitative case study aligns with the Consolidated criteria for reporting qualitative research (COREQ) to ensure rigour and accessibility [27].

Case Selection

The case was purposefully selected due to the development and implementation of a workforce-wide OBP strategy by the occupational therapy department. This strategy was initially developed in 2011, with elements being progressively rolled out between 2011 and 2018. The setting was a large metropolitan publicly funded integrated health service which included acute tertiary hospital services, subacute services, ambulatory programs, and community-based rehabilitation services. The service is the major healthcare provider for a rapidly growing, culturally and linguistically diverse population.

The Occupational Therapy department included staff working across the service areas. Working groups within the department oversaw governance, education, culture and innovation of the department. The culture working group, led by the department manager, identified gaps between practice and the overarching paradigm of practice congruent with OBP that resulted in the development of a strategy to seek cultural change in line with professional convictions and identity. This strategy sought sustainable change that hinged on four critical factors: vision, leadership, ownership and structural tools [24].

Case selection aimed to capture workforce diversity across service streams. This supported understanding of how the OBP strategy had been sustained across the health service over time. As a result, the study methodology was designed to maximise participation by all sections of the workforce, including decisions related to data collection burden and timing. Resources to manage the resulting dataset were also planned to ensure the feasibility and rigorous conduct of the study.

The research team included occupational therapists with experience in clinical practice, leadership, workforce development, and qualitative research. Researchers involved in data collection and analysis had varying levels of prior involvement with the OBP strategy and the health service. Reflexive discussions occurred throughout analysis to consider how these experiences and assumptions may have influenced interpretation of the data.

Participants and Recruitment

A purposive sample of occupational therapy department staff were recruited for this study. All full- and part-time occupational therapists and allied health assistants employed at the service when data was collected in 2017 and 2023 were eligible to participate. The small number of casual staff employed by the service were excluded given the short-term and inconsistent nature of their employment.

Potential participants received an email invitation from a researcher with no direct relationship to their area of the service, including a plain language statement that provided additional information about the study. All participants provided explicit written consent for their participation. In 2017, the focus groups followed but were distinct from a department-wide planning session, making it easier for clinicians to break from clinical demands. In 2023, focus groups were scheduled at a time which followed on from the regular staff cohort meetings to maximise convenience. These cohort meetings include clinicians from diverse service settings, grade levels and levels of experience. Participants were free to leave the focus group at any time.

Data Collection and Procedures

A bespoke prompt schedule was developed for these focus groups, based on both an extensive literature review and the professional experiences of the research team. All focus groups were led by an experienced clinician researcher, and the discussion was facilitated to enable participation by all attendees. Focus groups lasted for approximately 45–60 min. All data was non-identifiable, with no person-specific information collected from participants. In 2017, eight focus groups consisting of 8–13 participants (n = 95) were facilitated in person. Participant notes were recorded on flip charts and sticky notes by a group delegate and then transcribed by the research lead (JW) to an additional Word document. In 2023, three focus groups consisting of 9–15 participants (n = 39) were facilitated online using a cloud-based videoconferencing meeting.

Participant discussion was recorded by a designated scribe who captured summary concepts, key participant phrases, selected verbatim quotations, and meta-cognitive observations in response to other participant responses. This data collection approach was intended to support study feasibility and quality by producing a large but manageable data set, optimising active participation, encouraging higher rates of participation, and aligning with cultural practices adapted through the COVID-19 pandemic. The research team also decided not to audio record the discussion to avoid privileging verbal responses over the data collected on flip charts and sticky notes.

Data Analysis

All data was analysed using descriptive thematic analysis, which sought to identify and critically analyse patterns within the data [28, 29]. All documentation from the focus groups was gathered and transcribed into Word documents, before being read and re-read by the researchers for familiarisation. In both 2017 and 2023, the research team members (2017 JW & DH, 2023 JW & CB) followed the same process, utilizing Braun and Clark’s [29] six steps for descriptive analysis. Researchers independently generated open codes that reflected their interpretation of the key concepts within the data. These codes were then collated into preliminary themes separately for each time point and collaboratively reviewed by the coders. The research team then returned to the data to test and refine the themes and select illustrative examples from the documentation.

Finally, the research team defined the identified themes and completed a critical analysis of all data assigned to each to produce the findings below. Reports were generated to define and name the themes derived from both studies prior to a comparison of themes being conducted. Themes were then compared against the OBP strategy [24] and between the two time points to understand where organisational efforts had produced sustained impact to summarise key themes and subthemes. This enabled a comprehensive analysis of the data that considered the horizontal (i.e. strategy impact across different service areas) and transversal (i.e. change over time) axes of comparison within this case study [30].

Trustworthiness was supported by a range of strategies to maximise the rigour of the study [31]. The contextually embedded nature of case study methodology supports credibility by providing a detailed and realistic description of the phenomenon of interest. The bespoke focus group prompts also ensured all discussions were focused and relevant to the research aim. While this study did not aim for transferability, information about the content and context of the OBP strategy implemented at the service will enable readers to assess the applicability of the findings to their own circumstances. The practices of independent coding, collaborative theme generation and iterative approaches to the data all support the principles of dependability and confirmability. The production of a detailed audit trail for this study also enabled the research team to reflect on the progress of the study and how their analysis evolved over time.

Results

Sample

There were 95 participants in 2017 across 9 cohorts (Aged Care Assessment Service, Acute, Hand Therapy, Geriatric Evaluation and Management, Community Based Rehabilitation, Transitional Care Program, Inpatient Rehabilitation, Paediatrics, Emergency Department Care-Coordination). The 2023 sample included 39 participants across 5 cohorts (Acute, Geriatric Evaluation and Management, Community Based Rehabilitation, Inpatient Rehabilitation, Emergency Department Care-Coordination and outreach service).

As shown below in Fig. 1, three overarching themes were identified in the data along with 10 sub-themes.

Fig. 1.

Factors that influence OBP implementation and sustainability

Organisational Leadership and Culture

The role of leadership for OBP was identified at both time points. Participants conveyed their appreciation of occupational therapy leaders within the service who personified OBP in their practice, by encouraging reflective practice and providing opportunities for professional and interprofessional development; “[OT manager] is a big driver of OBP, which filters across all staff and departments” (2017). Clinical supervisors were also identified as role models for OBP, and participants recognised they also needed to “model this for students” (2023). These visible examples of OBP were viewed as tangible expressions of the service’s commitment to professional development and occupational therapy culture.

OBP leadership enabled a professional culture in which participants felt supported and that they had “back up” (2023). Data from 2017 placed greater emphasis on organisational culture change, as the service-wide strategy and more concerted efforts to promote OBP had been implemented relatively recently at that time. Participants particularly noticed greater multidisciplinary use of occupation-based language, which they associated with inter-disciplinary education and communication strategies implemented as part of the organisational framework. One participant described a “decreased use of ADLs” (2017) terminology, reflecting a broader shift away from narrowly task-focused language towards discussion of meaningful occupations, participation, routines, and goals across contexts. By 2023, participants described a stronger sense that OBP was firmly embedded within the culture of the service, leading to a more consistent approach to practice. One participant stated that “Occupational therapy champions OBP [at the service] and this helps everyone understand what each other does. [It is] embedded in the mutual learning approach” (2023). Another reflected that “The department and team culture – I notice it since returning to [the service]” (2023), suggesting that OBP had become embedded within the professional identity of the service.

An important aspect of this culture discussed at both time points was the deliberate and explicit use of occupation-based language. The use of occupation-based language was primarily identified with the promotion of occupational therapy, being used with both multidisciplinary colleagues and “when introducing my role and purpose of [my] session with the patient” (2017). Participants described occupation-based language as a confident expression of professional identity. One participant explained that “being proud of what we do stops others pigeonholing us” (2023). Occupation-based language was employed verbally and also in written documentation like “referrals, handovers and progress notes” (2023), demonstrating that the communication of OBP required attention to multiple forms of communication with diverse audiences.

However, COVID-19 was recognised as negatively impacting the occupational therapy team’s ability to sustain their OBP culture. Participants described losing elements of the professional identity the strategy had cultivated because of the extreme disruption caused by the pandemic. One participant reflected that “it’s harder to be OBP when you’re using telehealth” (2023), highlighting the challenges associated with rapid practice change and resource constraints. Participants also described how lockdown restrictions altered opportunities for occupation-based interventions, with one noting that “occupations weren’t practiced in a ‘normal’ setting and socialising was severely limited” (2023). As restrictions eased, participants described renewed opportunities to support occupation-based engagement through being able to again “share resources and spaces” (2023) and “go to the café or pharmacy to engage in other occupations” (2023). Despite these disruptions, participants remained optimistic that the organisational framework and strategies supporting OBP would enable a return to higher quality occupation-based practice.

Occupation Based Occupational Therapy Practice

Perceptions of implementation issues for OBP changed over time. In 2017, participants discussed frequently having to clarify their role with multidisciplinary team members, which they felt was assisted by recently introduced “standards, policies and example on how to use occupation-based language”. They also identified the use of SMART (specific, measurable, achievable, realistic, timed) goals [32] in case conferences as a key strategy to embed OBP in their inter-disciplinary work. They also believed their OBP was instrumental in “giving patients the confidence and skills to engage in occupations, which improves their satisfaction, relieves anxiety about returning home to their routine and re-engaging in occupations”.

By 2023, “goal based and meaningful tasks” were seen as the foundation of OBP and the core focus of their work as occupational therapists. Task analysis was considered the key implementation strategy, because it directed occupation-based “progress, achievement, adaptation and support”. OBP was now perceived as “both a means and an end”. Effective communication for collaboration was a much stronger theme in the 2023 focus groups and had become a highly valued element of their OBP. Some of these partnerships were inter-disciplinary, as the occupational therapists held “joint sessions with other disciplines to provide an opportunity for occupational therapy to demonstrate its value and provide education [to colleagues]”. Participants felt confident to contribute their unique professional perspective to multidisciplinary treatment planning, and to also partner with external services: “accessing other [OT] services to make sure occupation-based goals are reached even if they aren’t possible in acute”.

Access to resources and infrastructure was a consistent theme across both time points, and referred to both physical objects and environments. Funding for assistive technology for consumers was often difficult to obtain and needed to be “available for both trial and hire” (2017). A sense of consistent availability was also conveyed in observation that “environments (simulated or actual) provide the context for service provision across the continuum of care” (2023). However, there was “not always the space or resources to replicate home”, and participants emphasised that resources to support OBP had to be accessible and “inviting” (2023).

Another consistent theme at both time points was the role of professional development in developing and sustaining the organisational strategy. OBP was embedded into occupational therapy professional development activities and reinforced through annual OBP forums that showcased occupation-based initiatives, shared learning, and clinical examples across the service. One participant described these forums as “mind-blowing to attend for the first time, but it shouldn’t have been” (2023), reflecting the impact of seeing OBP approaches explicitly valued and demonstrated across diverse practice settings.

Participants also describe individually focused elements of OBP professional development such as “increased and protected time for research” (2017) and support for “affiliations with universities, community providers and special interest groups” (2017). Participants at both time points linked these opportunities directly to their workplace quality of life, and believed it contributed to “job satisfaction being high, resulting in good retention” (2017). This led to the participants viewing their workplace as “motivating, refreshing, rewards passion and aids career progression” (2023). Overall, participants enjoyed being encouraged to have “an inquiring mind” (2017) when it came to OBP.

Several other influences on OBP were consistently identified by participants, all of which existed at the organisational level. Time pressures were ever present and encompassed factors such as “length of stay, caseload demands and [balancing] non-clinical and clinical duties” (2017). Participants’ opportunities to work with consumers were often “dictated by the medical model” (2023), and did not provide enough time to “create the right environment” (2023) to implement OBP. The regular turnover of staff in public health services also posed a challenge for OBP, due to the need to “orient new staff and rotating grade ones and students to OBP” (2017). Other workforce issues like “holding vacancies and leave” (2023) also have a disruptive impact on the organisational strategy and cohesiveness of the occupational therapy department as a whole.

Present and Future Impact

Participants at both time points perceived OBP as having a pervasive and positive impact on the consumers they serve. The department-wide commitment to OBP was believed to result in “more engaged and better therapeutic relationships [which enables] quicker improvement and gains” (2023). Participants also believed the OBP approach supported “autonomy and the dignity of risk” (2023) by “Giving patients choices and encouraging them to guide therapy which empowers patients” (2017) for their consumers, which aligns closely with the values of occupational therapy. As mentioned previously, the OBP strategy was also believed to have a positive impact on perceptions of the occupational therapy profession and workforce satisfaction and retention.

In 2017, participants were primarily calling for more education about the role of occupational therapists and the importance of OBP for multidisciplinary colleagues to ensure the sustainability of the organisational strategy. They also recognised the need to embed more occupation-based outcome measures into their usual practice, which were considered an important strategy for communicating with executives and other service leaders “why we are [uniquely] important”. However, by 2023 OBP had been successfully integrated into multiple aspects of the service, and there was less emphasis on having to prove its value. This mature version of the organisational strategies for OBP has multiple benefits within the complex system of healthcare; “People understand my role better now – that keeps me in the profession longer because I feel there’s more of a why behind what I’m doing…”. The evolution of the organisational strategy over time suggests there is now a more integrated approach to OBP, which has succeeded in “normalising OBP so [it is] less impacted by busy times” (2023).

Discussion

This case study aimed to articulate the experiences and impacts of an OBP strategy implemented over a 6-year period within a large metropolitan health service. Three key themes important to the strategy at this service were identified: organisational leadership and culture, occupation-based occupational therapy practice, and present and future impact. Despite the challenges of the COVID-19 pandemic, the study found increasing integration and normalisation of OBP within the service, reflecting an evolving strategy less impacted by operational pressures and more aligned with occupational therapy values. These findings are similar to existing research [3, 33] which consistently describe tensions between OBP ideals and environmental constraints, and evolving clinician confidence and practices over time.

Participants recognised the role of occupational therapy leaders and clinical supervisors in embodying and promoting OBP at both timepoints. The importance of support from occupational therapy department managers, supervisors and educators was also identified in previous research about both OBP [4, 11, 24] and occupational therapy in acute services [34], indicating that OBP in this setting must be role modelled “from the top” [3]. When dealing with systems constraints, leadership and cultural alignment are crucial elements to embed OBP within an organisation [21]. The strategy acknowledged the profession’s distinct practice approaches while also addressing known implementation challenges [33]. This appeared to support a more consistent approach to OBP. Furthermore, Di Tommaso et al. [10] previously highlighted the influence of workplace culture to support young clinicians adopting OBP.

OBP had become more embedded in organisational culture over time, suggesting that consistent application of the strategy led to a progressively stronger sense of professional identity. However, it was also striking how multi-disciplinary many of the perceptions and experiences were, which was in turn experienced as a highly valued element of the strategy, suggesting that OBP is shared across multiple disciplines rather than solely the remit of occupational therapy. The implementation of OBP at this service was clearly not just about occupational therapy but involved building better multidisciplinary communication and collaboration, which in turn was experienced as a highly valued element of the strategy. This extends existing literature by illustrating how these factors operate at both the individual clinician level and across entire service systems over time.

Organisational culture is often invisible and implicit, but a tangible aspect of the OBP strategy implemented here was the explicit use of occupation-based language as both a means of communication and a representation of the service’s commitment to OBP [24]. Over time, the strategy evolved from introducing standards, policies, and examples to build clinician capability towards greater clinician confidence in delivering OBP. Participants described feeling more able to communicate the purpose and value of occupational therapy to both consumers and colleagues through occupation-based language and practice [3, 7, 15, 21, 22, 33].

While some of the barriers and facilitators to OBP identified in this case study (e.g. time pressures, acute efficiency pressures, resources constraints and alignment with biomedical models) have been widely reported [3, 19, 22, 23], these findings also reflect emerging conceptual frameworks for OBP implementation, including the Dynamic Model of Occupation-Based Practice, which address the interactions between environmental constraints and clinician capability [33]. Service-wide strategies may enhance workplace support for occupational therapists [9]. They may also create opportunities to develop OBP skills across different career stages [11]. This emphasises professional development as an important mechanism for translating OBP into everyday practice within complex systems. Overall, this case study suggests that sustainable OBP requires alignment and collaboration between leadership, culture and practical implementation supports across multiple organisational levels.

Strengths and Limitations

Along from its contextual depth, the longitudinal data collection in this case study is another area of strength. Case studies are often cross-sectional, but change over time is an important aspect of OBP given that clinical practice is always evolving. While not intentional, the study also offers an insight into OBP prior to and during the COVID-19 pandemic, which has been a system-wide transformative event for healthcare. The relatively large qualitative sample across 11 focus groups supported broad representation from multiple clinical streams, grade levels, and practice settings within the service. This in turn supported a richer understanding of how the organisational strategy operated across contexts. However, the size of the dataset and use of summary documentation rather than full transcripts may have reduced analytical depth for individual participant experiences and prevented the collection of extended verbatim participant quotations.

However, there are also limitations to the study design which reduce its potential transferability to other settings. Few other occupational therapy services have organisation-wide OBP strategies, and the first data collection timepoint in this case study occurred approximately 6 years after the initial strategies were implemented. Experience of its very initial stages of implementation is therefore absent. The lack of audio recording in the focus groups may have led to the omission of some nuanced verbal data, and their knowledge that the groups were part of a research project may have influenced some participants’ responses. The community within which the service is set has a high degree of cultural diversity and is growing rapidly; distinctive characteristics which will have influenced the findings.

Conclusion

This case study provides a detailed description of the implementation of an OBP strategy at a metropolitan health service over a 6-year period. Strong and consistent leadership are pivotal to embedding OBP in the organisation culture and enable a progressively stronger sense of professional identity for occupational therapists. While OBP is valued for its potential to enhance consumer outcomes and therapist satisfaction, there are many barriers to its implementation into metropolitan and tertiary service settings. Occupational therapy services should adopt strategies that adapt to the evolving nature of OBP and provide ongoing professional development to support their workforce. Despite the challenges, there was an observable shift towards a more integrated and normalised approach to OBP within the service over time, suggesting that sustained efforts supported by explicit policies, procedures and practice tools can result in greater uptake of OBP in alignment with core occupational therapy values.

Key Findings

• Strengthen leadership training to champion occupation-based practice

• Integrate ongoing occupational-based practice focused professional development to build and maintain capacity

• Develop policies to enhance resource access for sustainable occupation-based practice implementation

Author Contributions

All authors contributed to study conceptions, ethics application, recruitment, data collection and analysis and final version of this manuscript. JW and DH contributed to the draft versions of the manuscript.

Funding

Open Access funding enabled and organized by CAUL and its Member Institutions.

Data Availability

Data are available from the authors upon reasonable request and with permission of Western Health and Deakin University.

Declarations

Ethics Approval

Ethics was obtained through the Western Health Low Risk Human Research Ethics Panel, approval numbers QA2017.07 and QA2022.85.

Informed Consent

Informed consent obtained.

Competing Interests

The authors declare no competing interests.