089: Collaboration: Experiences & Attitudes (Part 2)

Show Notes:

Overview of Themes and Subthemes

1. Factors Influencing UD Implementation (Part 1)
   1. Lack of Demand/Interest
      1. Consumers
      2. Professionals
   2. Systemic Barriers
      1. Lack of standards 
      2. Incentivization of UD implementation 
      3. The need for personalization
      4. Cost and aesthetics
2. Dynamics and Challenges of Interprofessional Collaboration (Part 2)
   1. Belief in interprofessional collaboration
      1. Value in a team of professionals working together with specific expertise
      2. Value in ongoing collaboration
      3. Professional growth
      4. Motivation to work with other disciplines
   2. Disconnect between professionals
      1. Attitudes and stereotypes
      2. Language differences
      3. Differences in processes
   3. Payment
3. Relevance to Occupational Therapy (Part 3)
   1. Therapeutic use of self
   2. Challenges OTs can help solve
   3. Availability of work

Transcript:

Sarah: [00:00:00] You’re listening to Good Fit Poor Fit. Our podcast is part of The UD Project, a small business rooted in occupational therapy that looks at how the design of a home environment impacts how well people of different ages and abilities perform everyday activities. We chat about this unique perspective to boost your knowledge and help you consider what can be changed in communities like yours.

Learn more about our work at universaldesign.org.

Hello Good Fit Poor Fit listeners, Rebecca and I are back again with recently graduated Anisha Carr. She finished up her doctorate in occupational therapy at Towson University, and she is sharing the results of her valuable research within our podcast. You are joining us in part two of a three part series, discussing her research on the experiences and attitudes surrounding universal design in [00:01:00] interprofessional collaboration in the design of residential homes. If you haven’t listened to part one, you should go back and do so. We discussed two major Factors Influencing UD Implementation, which included the lack of demand and interest from consumers and professionals and systemic barriers to implementation, which included lack of UD standards, incentivization the need for personalization within the design and lastly costs and aesthetics. If you remember, she interviewed 16 leading professionals in the housing industry, including contractors, architects, interior designers, industrial designers, and OTs. And she wanted to discover how their attitudes and experiences of UD practitioners prevented effective collaboration and OT involvement.

These professionals spanned coast to coast from the east to the west of the U.S. and she even had a few people outside of the [00:02:00] U.S. as well. If you do want to follow along in the flow of her research and the themes, I’ve included those in the show notes.

Rebecca: I know I’m honored to be here with Anisha and you to hear all about the findings. Despite the growing interest in universal design, there’s a significant challenge that remains, and that is limited interprofessional collaboration. And that’s where Anisha’s research comes in. So let’s move on to the next theme, Anisha.

Anisha: Yeah, so this next theme is dynamics and challenges of interprofessional collaboration. Within this theme, there are 3 sub themes, including belief in interprofessional collaboration, disconnect between professionals, and payment. First, let’s start with belief in interprofessional collaboration. Themes emerged here that highlight the value of interprofessional collaboration through successful projects that contributed to their professional growth and motivation to work with other disciplines. First, professionals found value in a team of professionals working together with specific [00:03:00] expertise. Many participants found that they were able to recognize the importance of interprofessional collaboration through successful collaboration with their colleagues. They had knowledge gaps and found that others could fill these gaps.

Sarah: Yeah. An architect with extensive experience making recommendations for UD identifies certain areas where he lacks expertise and acknowledges the potential benefits of collaborating with another professional. Here’s their quote.

Oliver: Did you have a stroke on the left side or the right side?… Women are stronger in the butt, hips and legs, men are stronger in the chest and shoulders and biceps. And so that’s where I need more players with a different level of education and a different view on the angle of the story.

Anisha: This participant expresses a need for professionals of different backgrounds to address all aspects of health. This concept ties into a previous theme, which is the need for personalization in UD. This is an integral aspect of creating accessible environments and by utilizing professionals with expertise and understanding the functioning [00:04:00] of the human body and creating personalized recommendations, more holistic housing solutions can be created.

Rebecca: Conversely, this OT participant who has expertise in body mechanics and making personalized recommendations described why she needs the expertise of an individual with building expertise.

Louisa: I’m not a builder or G.C…. So, sometimes if it’s a really complex situation and the home structure is really old, and I’m not really 100% sure of what the environment is capable of… there has been times when I’ve gone out to the home and said…. “I can’t complete this scope of work until I do a second visit with a builder or G.C.”… I don’t wanna write recommendations for things that are not achievable, you know?

Anisha: Yeah, this professional acknowledges her own expertise in OT related realms as well as the additional areas in the home modifications process. However, she really recognizes the limitations of her expertise when it comes to understanding home structures and construction feasibility. The second topic [00:05:00] within this sub theme that I want to discuss is the value of ongoing collaboration. The emphasis on continuing collaboration throughout the entirety of the project highlights the perceived value of diverse professional insights in every phase of planning, execution and evaluation. It ties into the previous concept where many professionals express that they prefer to work on projects with professionals with a variety of expertise and find themselves needing input from other professionals throughout the entire project.

Sarah: I am glad to see this come out in your research too, Anisha, because I’ve personally experienced the need for all professionals to have that ongoing collaboration throughout the entire project. From first meeting a client and understanding their needs to figuring out the design together and implementing it as planned with the ability to collaborate together along the way, as things often change.

Rebecca: Yeah, I can really see where professionals recognize the value of interprofessional collaboration through successful projects and the importance of ongoing [00:06:00] collaboration throughout a project. I can only imagine this collaborative effort contributed to their professional growth and motivation to work with other disciplines.

Anisha: Yeah, and in regard to professional growth, I have a quote from an interior designer who recalls an experience working with a contractor where she recommended a specific appliance chosen for its accessibility features, and the contractor responded negatively. Here’s her quote.

Samantha: The building professional was just like, ‘That’s terrible. I wouldn’t do that.. the plumbers are going to hate you because they can’t fit their hands behind there to get the the water shut off.’ And so I felt like, like, he’s like throwing me under the bus here rather than working together… but then I thought more about it and I’m like, you know what, even those, like, grumpy responses… I’m learning from…I’m like, ‘You know, these are great.’

Sarah: Yeah, this quote demonstrates the interprofessional challenges encountered in collaboration as well as the opportunity for personal and professional growth within these dynamics. That was a really [00:07:00] interesting quote. Despite feeling undermined, she acknowledges the value in these scenarios and recognizes them as learning opportunities.

Anisha: So fourth and finally, the last topic within this sub theme is a motivation to collaborate with other disciplines. I expected to see relationships between the field of study and willingness to collaborate on UD projects, and the responses didn’t really reflect that. The passion for UD and accessibility as a whole appears to be the major factor impacting professionals willingness to collaborate, not their field of study.

Rebecca: Interesting. I can definitely see where the desire to work on something together with others who have a passion for the same concept of UD makes a big difference. It’s also really rewarding to work through that collaboration process to come out on the other end with an optimal outcome for a client. After all, getting people to believe in the idea of universal design and advocate for the value is half the battle. But I’m sure you also found some themes that discuss potential barriers in collaboration.

Anisha: [00:08:00] Yes, we definitely did, and that leads me to my second subtheme in this category, which is disconnect between professionals. There are three topics I want to discuss here, including attitudes and stereotypes, and language differences, and differences in processes, which played a significant role in shaping collaboration dynamics. One participant shared an experience where differences in how OTs and building professionals approached a specific project led to misunderstandings and inefficiencies. Here’s his quote.

Henry: The one thing that we’ve noticed with the way that some occupational therapist’s are trained in college and it’s not wrong, it’s just a different style of of of performing the work that you do… is they’ll list things like ‘Malachi’ loves video games and he really loves to video game out on his patio and that’s where his parents put a TV. So he can get sun and… vitamin D. Blah blah. So he needs a threshold ramp out to the back, out to the backyard, right? And the state looks at [00:09:00] it and says, ‘Well, that’s pleasure. That’s not a medical necessity. Declined.’ If you would have reworded that and said… ‘‘needs access to the backyard for a therapeutic swing that he has’, boom. Approved.

Anisha: This participant discusses how educational experience and training can vastly impact the process of proposing home modifications while conducting evaluations and making recommendations is certainly an OTs scope of practice, this participant suspects that their education often emphasizes impacts on quality of life rather than justifying recommendations in a way that strictly adheres to guidelines, such as those provided by Medicaid.

Rebecca: That is a fascinating, albeit not at all shocking, perspective about quality of life versus recommendations that adhere to funding guidelines. I think that this is a really classic clash that you can see in this world. The functional reality of what would really work for a person, versus what’s recommended and guidelines and in procedure, [00:10:00] that’s definitely a frustration. I imagine another frustration that you came across in your research can be found in the next theme, which is attitudes and stereotypes towards other professionals.

Anisha: Yes, definitely 8 out of the 16 participants reflected on experiences where attitudes held by other professionals impacted collaboration, efficiency or occurrence. A common theme among the quotes was essentially stated as many other professionals who I’ve worked with do not value my experience and don’t treat me with respect. Negative attitudes often stemmed from a lack of perceived respect or understanding for professionals from other disciplines, leading to friction and barriers in communication or collaboration. Negative attitudes can manifest in various ways, such as skepticism, dismissiveness, or direct resistance, as highlighted by many of the participants experiences. For example, some professionals, such as those in the fields of design, may undervalue the expertise of OTs, believing that their [00:11:00] focus on the individual over universal accessibility undermines their design recommendations. One OT participant referenced research that she and her colleagues have often referred to. The concept from the research that stuck with her the most was the attitudes fueled from misconceptions towards OTs, that were expressed by designers that were interviewed in the study. She said…

Nancy: Basically the the authors interviewed occupational therapists and interviewed designers and they said that occupational therapists often have a very narrow focus with one person one ability and they often don’t understand, like the whole concept of design’

Rebecca: While there may be instances where this concept holds true, based on the individual OT’s educational and clinical background, the notion that OTs lack the expertise to provide recommendations for a broader population can undermine collaboration efforts and lead to a lack of respect for their expertise.

Anisha: My participants also expressed that many professionals exhibit a slight resistance towards collaboration, assuming [00:12:00] superiority in their knowledge and dismissing suggestions. One OT expressed his experience working with contractors. He said:

Malcolm: They quite often are like, ‘Well, we know how to build and we know what we’re doing’…. It relates to like getting along and communicating and collaborating. And and you know, and especially when people are like, ‘Oh, I took a CAPS course. I’m an aging in place specialist’. I think it needs to go further than that in the educational realm.

Sarah: I could see where there might be some power struggle on who had the lead of the project and understanding the scope of one’s practice and knowledge. This resistance and failure to seek other knowledge through additional education or knowledge sharing through collaboration can hinder effective collaboration and lead to misunderstanding between professionals, which is just so unfortunate because there is so much value in collaborating when all of the pieces of the puzzle fit together well, because like we said earlier, positive attitudes also shaped interprofessional [00:13:00] collaboration, fostering mutual respect and appreciation for each other’s expertise, leading to knowledge sharing and successful collaboration.

What else was discussed in dynamics and value of interprofessional collaboration?

Anisha: So another topic in this sub-theme is the language differences. Well, an architect to builder and interior designer may not face a language barrier when communicating with each other due to their fields already being kind of intertwined. Other professionals, such as OTs or industrial designers, may not possess the language to successfully communicate with these professionals. Most participants express that they prioritize and respect collaboration with professionals from diverse disciplines, regardless of whether they share a common language or not. Despite seeing the value in collaboration and avoiding judgment towards others for their unfamiliarity with the specialized terminology used, they acknowledge that language remains a barrier to successful collaboration and emphasize the importance of being mindful of this factor when communicating. A contractor had this to [00:14:00] share about the importance of adjusting his language when collaborating with professionals of other disciplines, especially OTs, sometimes avoiding certain terminology. He said:

Robert: Really understanding that, you know, we can’t, you know, use certain language, because they’re not going to understand it… And sometimes I’m like ‘What? What did you say? What is that?’”

Anisha: Additionally, he acknowledges his own lack of understanding of OT terminology and the necessity to ask for clarification when needed. This quote highlights the mutual responsibility between professionals from different disciplines to be aware of the language differences when collaborating and make sure that they ask clarifying questions and make sure that they’re understanding each other. I also wanted to include a quote from an OT with experience learning about home modification through the lens of a contractor who leverages language and technical terminology as a tool for fostering rapport with fellow building professionals. She said:

Audrey: It’s interesting because when I’m working with a contractor for the first time and I start talking [00:15:00] and saying terms, like contractor terms, or talking their jargon… then all of a sudden… their tone changes… It starts clicking, because if if I don’t, if I don’t talk to them first, about my experience and, you know, my knowledge and experiences then… you can tell even when you’re talking on the phone, you can tell they’re still guarded a little bit or and then if I say something like oh, well, yeah. I mean the the clear width of that door is such and such… then you start using their terms, then they realize that you really are experienced, and then all of a sudden their whole tone changes.

Rebecca: Yeah, good on her for being able to quickly help show her value in that field. It sounds like this OT typically encounters initial skepticism from those who assume she lacks education in their field, but they often display receptiveness once they realize her familiarity with their realm. This is something that I can relate to as well, because when I first got into universal design, it was from the perspective of having been in [00:16:00] engineering, gone to engineering school and then becoming an occupational therapist.

And I felt like once they heard that I had a degree in engineering, a lot of people were a lot more interested in having these conversations with me, not to say that I know a one 100th of what a contractor or home builder knows about that kind of design. But just that one word engineer sometimes would help me get my foot in the door. It seems like there are two approaches here with one professional deciding not to use certain words, and another pushing in and trying to show the other professional they can speak their language. I think this is valuable information that there’s always a chance to learn from others. A mutual effort to bridge the language gap, among all disciplines, could improve interprofessional collaboration and create a smoother collaboration process.

Anisha: This also relates to differences in processes, which is a significant challenge in interprofessional collaboration, particularly when the OTs expertise is undervalued or not recognized by building professionals who may [00:17:00] prioritize more technical justifications. This mismatch in approaches can complicate the collaboration process and hinder the willingness of building professionals to work alongside professionals from outside their perceived field.

Sarah: Yeah, this is a biggie. We don’t have a lot of time to dig into this much today, but there is a growing set of literature that’s being explored on this one. We had a student last summer named Kaylee Clark, and she did her research on this and we talked about it in podcast episode number 82, if you’re interested in that, and she shares her specific research in combining processes of an interior designer and an OT, based on some literature. We can’t talk about professional differences without talking about money.

Anisha: Yeah, so the last sub-theme in this section is payment. These professionals expressed concerns about the ability to bill for their services when collaborating with others, which limited their willingness to engage in collaborative efforts. Additionally, some participants felt like they were [00:18:00] undervalued and underpaid for the work that they already performed, leading to a sense of disappointment. Others found that larger firms were hesitant to bring on additional professionals, deeming them unnecessary and preferring to maximize profits by minimizing the expense associated with hiring more people with a more wide variety of expertise.

An architect speaks about a project she worked on which hired a range of professionals to ensure good design and functionality within the space. The lead architect on the project insisted that these professionals would be necessary for completing the project successfully, despite the fact that many other professionals would have deemed these professionals unnecessary.

Tabitha: You take the risk of like losing the project at some point because… there is not enough money to continue doing this. You know, I think he took a risk in involving what would be called “unnecessary people”. But all of these things, they affect the results, and the process, and then what you are going to see as the final product.

Anisha: This quote demonstrates how [00:19:00] rare it is for professionals who are not typically deemed as essential for a project to be hired on for their expertise.

This situation talked about is very unique in that the lead professional was insisting on input from healthcare workers and other specialists. Because of the fact that this is so unique, I think it represents a broader issue, which is that professionals are not typically willing to bring on other professionals because of financials, even if the other professionals will improve the overall outcome of the project.

Sarah: I have experienced when different professionals try to get certifications to learn the knowledge about what they don’t know, to not have to include other professionals. This reminds me of the Hitch article I like to talk about with people, when the article states that people are trying to be amateurs at other professional scopes of practice to save money when we really should figure out how to make the payment work for all parties to put out a better product overall. There are a lot of other systems and medical related [00:20:00] payment details that make this topic even more complicated when it would just be easy if we could just collaborate and make a valuable impact.

Rebecca: Yeah, I absolutely agree with all of that. Unfortunately, similar to some of the other things we’ve discussed before, the financial piece is another just frustrating barrier that in an ideal world wouldn’t be the case and wouldn’t make it so difficult to actually create spaces that really work for people to thrive and do all of the things that they want and need to do.

Sarah: It’s very true. And Rebecca, looking ahead to our next episode, I know there’s talk of finances in that one, too. Thank you listeners for joining us in our discussion of the second theme of An isha’s research. Dynamics and challenges of interprofessional collaboration. We look forward to continuing the conversation, discuss her last theme, the relevance of occupational therapy in part [00:21:00] three of this series.

Hope you all have a good one.

Thanks for listening to Good Fit Poor Fit. If you want to learn more… first, find more episodes with transcripts and show notes at goodfitpoorfit.com. Don’t forget to subscribe! Second, check out our courses at go.universaldesign.org.

We cover housing topics like advocacy, collaboration, home modification, universal design and task adaptations. Lastly, if you have questions or topics you’d like us to discuss, email us at [email protected]. Thanks for fitting us into your day.