A six-year case study from a large metropolitan health service suggests that occupational therapy can shift from an impairment-focused model toward occupation-based practice when the change is supported across an entire organisation. The research, conducted at Western Health in Melbourne, Australia, examined how a service-wide strategy was introduced, maintained and adapted in a tertiary healthcare setting. Rather than evaluating a single treatment or patient outcome, the study investigated how clinicians understood and used a practice philosophy that places people’s everyday activities, roles and routines at the centre of care. The findings indicate that implementation was not achieved through a one-time policy or training session. It depended on leadership, professional development, interdisciplinary support and systems capable of reinforcing the approach during routine clinical work.
Occupation-Based Practice, or OBP, is closely aligned with the purpose of occupational therapy: helping people participate in meaningful activities despite illness, injury, disability or changes in their circumstances. In practical terms, this can mean working with a person on dressing, preparing food, returning to employment, caring for family members or resuming community activities, rather than concentrating only on isolated physical or cognitive impairments. Impairment-based interventions remain clinically relevant, but OBP connects those interventions to the occupations that matter in a person’s life. That connection can make therapy more personally relevant and potentially strengthen engagement. The researchers note, however, that translating the principle into everyday hospital practice is difficult, particularly in environments shaped by time pressure, limited resources and established routines.
The investigators used a qualitative case-study design, collecting information at two points in the implementation process. In 2017, 95 occupational therapists and allied health assistants contributed to the research, while 39 participants took part in 2023. The data included eight focus groups in 2017 and three in 2023, together with multiple organisational documents. Researchers used descriptive thematic analysis to identify recurring ideas and patterns in how staff experienced the strategy. This approach did not produce a numerical estimate of treatment effectiveness. Instead, it allowed the team to examine changes in professional perceptions, the conditions that helped the strategy take hold and the pressures that made occupation-based work harder to sustain. Comparing the two time points also provided a view of implementation beyond the initial launch.
The analysis found that strategic leadership helped cultivate a culture in which OBP could become part of professional practice rather than remain an abstract concept. Leadership can influence implementation by establishing shared expectations, allocating attention to the strategy and signalling that occupation-centred care is a service priority. In this case, the strategy was supported by a broader organisational culture, allowing clinicians to encounter consistent messages about the value of OBP across their work environment. Such cultural reinforcement is important because clinical behaviour is shaped not only by individual knowledge but also by documentation systems, team communication, workload, supervision and the priorities visible in day-to-day decision-making. The case study therefore presents implementation as a systems problem, not simply as a question of whether therapists understand the underlying philosophy.
Professional development was identified as another important facilitator. Training and learning opportunities can help clinicians move from knowing what OBP means to recognising how it should influence assessment, goal-setting, intervention and review. An occupation-based assessment may explore what a person needs or wants to do, the context in which the activity occurs and the barriers that limit participation. Therapists can then use clinical reasoning to connect specific interventions with those real-world goals. For example, strengthening, cognitive strategies or environmental modifications become more meaningful when they are explicitly tied to a person’s ability to complete a valued task. The study indicates that, over time, staff perceptions shifted from conceptual understanding toward practical application, suggesting that repeated exposure and organisational support helped embed the approach in clinical reasoning.
Interdisciplinary support also helped the strategy develop. Occupational therapists work within teams that may include nurses, physicians, physiotherapists, speech pathologists, social workers and allied health assistants. When colleagues understand the purpose of occupation-based goals, they can reinforce them during discharge planning, rehabilitation and daily care. This can improve continuity between therapy sessions and the rest of a patient’s hospital experience. It also reduces the risk that occupation-focused work will be treated as an optional addition to medical care. The study does not claim that the strategy produced a specific improvement in patient outcomes, and its qualitative design cannot establish such an effect. Its contribution is different: it shows how shared professional values and cooperation across disciplines can create conditions in which an established therapeutic approach is more likely to be used consistently.
The researchers also identified substantial barriers. Resource limitations and systemic pressures can narrow the time available for detailed conversations about routines, roles and participation. Acute and tertiary services often prioritise immediate clinical needs, rapid turnover and measurable impairment changes, all of which can make occupation-based goals harder to articulate or document. Even when therapists support OBP, systems may encourage fragmented care or place greater visibility on tasks that are easier to standardise. These pressures do not necessarily reflect opposition to occupation-centred practice; they can arise from the structure of healthcare delivery. The findings suggest that implementation efforts must therefore address practical conditions, including staffing, workflows, documentation and communication, rather than relying on clinicians to compensate for system-level constraints through individual effort alone.
COVID-19 negatively affected occupation-based practice, according to the study, disrupting services and creating new demands across healthcare. The pandemic placed pressure on staffing, clinical routines and the ways professionals could interact with patients and colleagues. Those disruptions tested whether OBP had become sufficiently embedded to survive a major change in operating conditions. The researchers found that commitment to the strategy supported its re-establishment after the disruption. This recovery is significant because sustainability is more demanding than initial adoption. A practice can appear successful during a focused implementation period but fade when leadership attention changes or exceptional circumstances arise. In this case, the return toward occupation-based work indicated that the strategy had become part of the service culture, even though it remained vulnerable to broader operational pressures.
The case study offers a detailed example of how a health service can make a practice philosophy more durable, while also showing the limits of evidence from one setting. The participants were drawn from a large metropolitan tertiary service, so the findings may not transfer directly to smaller hospitals, community organisations or health systems with different resources and structures. The number of participants also differed between the two time points, and the study focused on staff experiences rather than directly measuring patient outcomes. Nevertheless, the six-year perspective provides evidence that implementation can progress from shared ideas to routine application when leadership, education, teamwork and responsive systems work together. For occupational therapy services seeking to strengthen OBP, the central lesson is that sustainability is built collectively: clinicians need practical support, teams need a common language and organisations need systems that make meaningful occupation a visible part of care.
The study is particularly useful for understanding implementation as an evolving organisational process. By examining the service at two time points six years apart, the researchers could consider whether occupation-based practice remained visible after the initial period of change. The later findings suggest that implementation involved more than introducing new terminology: clinicians increasingly described how the approach informed practical work. This distinction matters because a service may endorse a philosophy in policy documents without incorporating it into clinical reasoning, team discussions or routine decisions. The movement from conceptual endorsement toward application therefore provides an indication of cultural integration, even though it is not a numerical measure of fidelity or effectiveness.
The evidence was assembled from several qualitative sources, including focus groups and organisational documents. Using more than one source can help researchers compare staff accounts with the formal record of a strategy and its implementation. At the same time, the unequal participation across the two periods—95 participants in 2017 and 39 in 2023—means that the results should not be interpreted as a direct before-and-after measurement of the same group. The study is better understood as a comparison of perspectives within one service at different stages. Descriptive thematic analysis can reveal recurring experiences and implementation conditions, but it cannot determine how often particular behaviours occurred or establish that the strategy itself caused changes in practice.
These methodological features place the findings alongside, rather than above, other forms of evidence. The study does not test whether occupation-based interventions improve a defined clinical outcome, reduce length of stay or produce greater participation after discharge. Instead, it addresses a preceding question: what organisational circumstances make a practice approach feasible and durable? That question is important because outcome research may have limited influence when clinicians lack the time, tools or team support needed to deliver the model being evaluated. Future work could build on this case by linking implementation measures with patient-reported participation, goal attainment or other outcomes, while also examining whether similar strategies function in rural, community or differently resourced services.
The account also highlights why sustainability should be treated as an adaptive process rather than permanent completion. A strategy may need to be re-established after disruption, refined as clinical demands change and continually connected to the service’s operational systems. The reported recovery following COVID-19 suggests that shared commitment can help preserve a practice identity during upheaval, but it does not imply that occupation-based care is protected from future pressures. Ongoing leadership attention, learning opportunities and interdisciplinary communication may be needed to keep the approach active. For service managers, the implication is to monitor not only whether OBP appears in policy, but also whether everyday systems continue to make occupation-centred reasoning possible and visible.
Subject of Research: Implementation and sustainability of occupation-based practice in a metropolitan tertiary health service
Article Title: Implementation of an Occupation-Based Practice Strategy in a Metropolitan Health Service: A Case Study
Article References: Wort, J., Hitch, D., & Baxter, C. (2026). Implementation of an Occupation-Based Practice Strategy in a Metropolitan Health Service: A Case Study. Scandinavian Journal of Occupational Therapy. https://doi.org/10.1007/s44474-026-00004-4
Image Credits: AI Generated
DOI: 10.1007/s44474-026-00004-4
Keywords: occupation-based practice, occupational therapy, health service implementation, tertiary healthcare, clinical leadership, professional development, interdisciplinary care, practice sustainability, Implementation, Occupation-Based, Practice, Strategy
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Scienmag. (August 29, 2026). How Hospitals Can Make Occupation-Based Therapy Part of Everyday Care. https://scienmag.com/how-hospitals-can-make-occupation-based-therapy-part-of-everyday-care/
Scienmag. “How Hospitals Can Make Occupation-Based Therapy Part of Everyday Care.” Scienmag, 29 August 2026, https://scienmag.com/how-hospitals-can-make-occupation-based-therapy-part-of-everyday-care/. Accessed 29 August 2026.
Scienmag. “How Hospitals Can Make Occupation-Based Therapy Part of Everyday Care.” Scienmag. August 29, 2026. https://scienmag.com/how-hospitals-can-make-occupation-based-therapy-part-of-everyday-care/
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