What Happens at the Intersection of Policy and Practice? Examining Role Conflict and Professional Alienation of Occupational Therapy Professionals in Complex Environments

Abstract

ABSTRACT To examine what happens at the intersection of policy and practice, this dissertation utilizes a three-article format to advance public administration scholarship and contribute to health system research about occupational therapy. This work creates bridging links between public administration scholarship in the areas of street-level bureaucracy and policy alienation and the occupational therapy profession. The articles combine to inform the occupational therapy community by providing empirical findings to validate role conflict and professional alienation experiences of practicing occupational therapy professionals when implementing policy in practice. The Article One thesis asserts that while policy content matters, it is vital to understand the context of policy, and by extension, the context of practice as a response to policy implementation. Drawing on institutional theory, this work offers an historical review of policy-specific critical junctures in occupational history and how policy has influenced occupational therapy practice. Article Two connects institutional theory, street-level bureaucracy scholarship, and policy alienation research to explain the experience of role conflict related to implementation of productivity standards for occupational therapy professionals. Article Three utilizes street-level bureaucracy theory and policy alienation scholarship to provide the foundation for introducing “professional alienation” as an extension of policy alienation constructs. The article examines the extent to which occupational therapy professionals feel pressured to alienate core professional values, such as client-centered care, in practice. Articles Two and Three present the empirical findings from this original research study, which employed online survey methodology to explore the relationship of professional profile characteristics and work context factors with the two dependent variables of interest – role conflict and professional alienation. T-tests and multiple regression analyses indicate that professional profile characteristics such as professional credential/status and direct treatment provider designation influence role conflict and professional alienation. Work context factors that contribute to role conflict and professional alienation appear related to practice parameters and policy expectations in specific practice environments such as long term care/skilled nursing facilities and pediatric practice settings. This study lends support for future research including frontline storytelling of occupational therapy professionals, exploration of context differences, and coping strategies of frontline workers.