Occupational therapy is a very established profession in many areas of rehabilitation: Paediatric, neurological, orthopaedic, professional, to name some examples. I think that most Occupational Therapists (OTs), throughout their professional trajectory, experience many areas, until the moment when they can choose one to call their 'specialty'.
It happened to me and many colleagues. I started my career attending to people with burns-related injuries, because of a great internship at my college. But, to tell the truth, there are not many places to work as a specialist in burns rehabilitation in the city I live. So I decided to go to a larger field of action and work with traumatic upper limb injuries. That's why I became a hand therapist. Nowadays, I work as an independent consultant in ergonomics and quality of life in workplaces. Of course, in this latter specialism, thinking about my quality of life was the predominant factor.
Without any doubt, I think that all these career changes were possible because I had options. I was able to try different approaches that I considered that I should do.
What was important, from my perspective, was to work with activities that had purpose and meaning to me; the area of work itself was less important.
I always thought that having purpose and meaning in my job, in my activities, would help me develop my skills as a professional and as a human being. But ultimately, I could do it because I was in an environment that allowed it.
Now I ask you to think about the context for general workers. Most of them, usually and unfortunately, do not have the option to make the kind of changes that I did, or even think about the purpose and meaning of their jobs. When working as ergonomists, we must be careful not to forget our prime focus as occupational therapists: the purpose and meaning of activities. How they can make us healthier and how they can help us to have a better quality of life.
As ergonomists, we have to adapt the work to the psychophysiological characteristics of the individual. Generally, when we make an ergonomic workplace assessment, we follow the norms and check all the parameters to identify risk factors. In these moments, we must breathe in and remember that, lamentably, most of the time, the standards emphasise only the physical hazard and leave the psychosocial risks aside. And we can do the same in our evaluations if we don't pay attention and listen to the worker.
Because of the coronavirus pandemic, many workers started to work from home. There was also more focus on the psychosocial risks and vulnerability at the workplace. Working from home made the boundaries between professional life and personal life disappear. Our house became our workplace. We could realise how all our activities are connected and how one interferes with another.
If I could point out one positive aspect resulting from the pandemic, it would be the attention to healthy habits and mental health - and the role of leadership in improving wellbeing and quality of life in workplaces.
Due to technology, it is possible to work from remote places; people don't need to be in person in the office. So 'where' leaves the headline and enters 'how': How is your work; how is the organisation of your job; how is the communication between you and your leader and your peers - and how long do you work per day? These - and many others - are questions that flood our assessment. But overall, we must ask: Does your activity make sense to you? It is a fundamental question to think about engagement and wellbeing in workplaces. And then, finally, we arrived at the culture of health.
It is relevant to create a parenthesis here to talk about the word 'health'. We must remember the five dimensions of health:
quality of life
reaching our full potential
When we use this approach (culture of health) in organisations, we must consider those five dimensions and apply them in four pillars: health consumer, health community, health environment and health worker. As occupational therapists, we cannot interfere directly in all posts. Even though they are not silos, they all are connected. Our priority always will be the worker's health.
There is more than one definition of the culture of health. One of the most commonly used is that developed by the Robert Wood Johnson Foundation. The Foundation defines a culture of health as:
"One where individuals and social entities - such as households and businesses - can make healthy life choices, within an environment that promotes options for health and wellbeing for everyone, and where the healthy choice becomes the valued and easy choice."
To achieve our goal, that is to create a healthy environment for workers, we must consider the following steps:
Eliminate working conditions that threaten safety, health and wellbeing;
Substitute or institute health-enhancing policies, programs and practices;
Redesign the work environment for safety, health and wellbeing;
Educate for healthy choices and safety;
Encourage personal changes.
I do not intend this article to become a to-do list. Thinking about the culture of health and our role as occupational therapists is something relatively new; as such, it is a work in progress. But there is a solid start: Prevention, which is the fundament of the culture of health. We must create an environment free of harm - both physical and mental. The atmosphere has to facilitate good communication, to avoid misunderstandings and be receptive to workers' needs. It must guarantee safety and wellbeing to achieve engagement.
Of course, there are plenty of topics related to the workplace we could talk about in this article. Yet it was never my purpose to exhaust this subject in only one text; remember, the journey of the culture of health has just begun.
Occupational therapists can promote healthy and humanised workplaces, where workers may find purpose and meaning in their jobs and lead them to do things for conscience and not by expectation (which would lead to frustration).
Antonovsky once said that health is about coherence - here understood as the feeling that life is understandable, manageable and meaningful. I agree with him and I think that is why it is so important to encourage personal changes when, despite all the adjusts in the environment, a person cannot achieve the purpose of his activity. We, occupational therapists, must show this person that there are options. Feeling stuck will not help this person reach his/her full potential and, consequently, be healthy and happy. We are mediators in realising the importance of meaningful occupations for good health and helping people find them out.
And that is our role in improving the culture of health in workplaces.
Antonovsky, A. Health, Stress and Coping. San Francisco: Jossey Bass; 1985.
Robert Wood Johnson Foundation. Available from: https://www.rwjf.org/en/cultureofhealth/about.html