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Why you should attend our Clinical Workshops 2018: Harsh Vardhan

Harsh Vardhan is President, Tangata Tiriti of OTNZ-WNA. He is employed as an occupational therapist and clinical coordinator at child development services, based at Hutt Valley District Health Board (HVDHB). He has recently undertaken work as a project manager on the Choosing Wisely initiative of HVDHB, and is currently doing a Masters of Management (Health Services) at Massey University.

Harsh won the 2014, Hutt Valley DHB Quality Award, for his commitment to quality improvement and was also placed among the top three in the 2016 Clinician’s Challenge, a joint initiative by the Ministry of Health and Health Informatics New Zealand (HiNZ). In 2017, he received the AIOTA occupational therapy achiever award. He is strong advocate of occupational therapy and has made several verbal submissions in parliament.

What does nurturing and enabling resilience mean to you?

The Oxford English Dictionary (OED) defines resilience as the capacity to recover quickly from difficulties; toughness; and elasticity. In my view nurturing resilience is not limited to its literal meaning, or psychological interpretation. Its practical implication for occupational therapists is a lot more pervasive and deeper.

Our inner strength gives us the ability to face external challenges (Pedlar et al 2004). Powerful individuals, make powerful teams, who have highly developed levels of addressing challenges and creating support. The ability of team members to push and challenge each other depends on high levels of security, support and vice versa.

I think resilience has wider implications for occupational therapists. To me resilience means having inner strength to face challenges; having good support systems and measures to cope with the demands or targets; showing authentic and motivational leadership; identifying a deeper sense of purpose to be at work; creating a learning environment; taking more risks; experimenting and trying new things; being less critical and more appreciative of other people’s efforts; encouraging people to run with ideas; learn from our mistakes; and embrace and promote innovative changes at all levels.

 In the current health environment, what is the significance of being resilient?

We are already aware that rate in which we are spending our health dollars is not sustainable. The Treasury (2013) points out that if we keep the tax revenue constant at 29 percent of GDP, then by the mid-2020s our revenue will become insufficient to cover health related expenses. At the current rate of expenditure, the government will need to borrow to meet these expenses, which can lead to government debt of 198.3 percent of GDP by 2060.  The Treasury identified health care and superannuation as the two most expensive sectors, so government has been trying to address this expenditure related pressure and find a more sustainable way of providing public services. Lean measures are being implemented to increase the overall cost effectiveness of health services, and in recent years there has been tremendous pressure to provide better health and education outcomes with limited resources.

A lot of changes are taking place to manage, and in some cases over manage resources and outcomes. Many organisations have stretched their strategies and resources to help meet these expectations.

I see it as both a challenging and exciting time for occupational therapists. There is a constant pressure to be more efficient, learn, and be innovate, all at the same time. I believe that in the current health environment, it is very important for occupational therapists to be resilient.

Do you think in the current health environment, health professionals get enough support to learn, innovate and develop resilience?

Support systems may vary depending on place and context. In my opinion, when I look at our current health strategy (Minister of Health 2016) I can see a lot around what is expected from health professionals. However, I cannot find any strategy or plan of action which explicitly talks about investing in the work force, building their capacity and capability, offering support, or facilitating their resilience to meet with the expectations. One of the strategic themes called “Smart Systems”, highlights the significance of sharing information and technology as an enabler. The strategic theme “Value and High Performance” includes plans to build a culture of performance and quality improvement. This sound great, but I think socio technical aspects needs more emphasis and understanding first.

As humans we are very different from machines. Human dynamics needs to be addressed to get the best out of us in a workplace environment. With my occupational lens I can relate to the significance of socio technical aspects like motivation, stress, and resilience in any task. I think a sustainable level of efficiency cannot be achieved without considering these factors. A healthy, happy, and resilient workforce is indispensable in achieving the desirable future of the New Zealand government of “All New Zealanders live well, stay well, get well”.

 What can be done to facilitate resilience and sustainability?

In my view facilitating resilience and sustainability needs a systematic approach. It cannot be obtained in a day through a course, or an event. We all have different roles to play, depending on our context and position in the system. Having resilience is much wider than stress management, embracing spirituality for peace and mastering other cognitive or behavioural strategies to cope with challenges.

In contemporary healthcare, employees are expected to demonstrate leadership and engage with others to set and achieve a common goal to achieve outcomes.  Many of us have mixed feeling about leadership. Perhaps partly because of our association of leadership with the actions of great and outstanding people (Pedlar et al 2004). We need to question this legacy because it holds us back. Leadership starts from within and leading ourselves is the first leadership practice. Leadership is about effective actions when we face challenges. It is about noticing them, choosing them, moving forwards with them, or away from them. I think resilience is about identifying and nurturing leadership.

Creating an environment of learning and innovation is very important. Reg Revan’s ecological formula L ≥ C suggests that learning (L) in any organism must be equal to or more than the rate of change (C), otherwise the organism will decline and fall behind with time. In recent times there has been huge pressures to deliver big performance goals, to cope with high levels of change, and to innovate – all the same time. The key is to have the performance culture, which is also a learning culture (Pedler, Burgoyne and Boydell, 1997). It is not that easy to achieve all these at the same time. One needs to be very careful that performance management does not lead to its downsides, like making people target obsessed, avoid risks and become closed and defensive.  For me resilience means having a balance between the ability to perform and learn. This balance in the long run can result in innovations, which in turn can increase efficiency and output.

Being innovative is not just about finding known solutions. In the current context it is not uncommon to get into situations where we have to deal with the unknowns.  The more resilient we are, the more prepared we are to take risks and explore the unknowns.

In finding a purpose in what we do, it is very important to be resilient and sustain a high level of commitment. People can often get confused between direction and purpose. Direction is the immediate intention or goal in a specific situation. However, a sense of purpose has a deeper pulse or internal compass (Pedler et al. 2004).

When I come into work, I know that we have a huge waiting list to deal with. Addressing this list can be seen as a goal, but it is not the only reason I come to work. I guess almost all occupational therapists have a deeper purpose to be at work, which can be linked to their core values. For example, for someone the purpose can be to bring positive changes in lives of people and make them as independent as possible. This is an era of targets and deadlines and they often get pushed as the principle means of motivation. This can make it challenging for occupational therapists to stay connected with their deeper sense of purpose.

From observations, it is not uncommon for clinicians to be asked to justify their therapy time. It is then natural for us to lose enthusiasm, get frustrated and stressed when we are made to follow directions which run against our sense of purpose. On the other hand, we become enthusiastic, productive and resilient when our sense of purpose gets aligned with our directions.

Networks are like webs rather than hierarchies of relationships. Networking gives connections, which is empowering and can promote resilience. These connections help in getting things done through the people you know and is a key enabler for learning and innovation. For example, better connected health professionals are more likely to adopt innovative practices, than those who are in silos (Rogers, 2003). Networks help in connecting people whose status depends more on their knowledge and access to resources, than on position. This means that such relationships may be valuable support when needed. Networks can help to develop a common sense of purpose. For example, if you know your line manager only as a boss, and not also as a fellow member of a project, or your professional association, your “bandwidth” with that person remains much narrower than it might otherwise. I think that better connected occupational therapists, who develop the most effective lateral relationships can be more resilient and productive.

As an occupational therapist, why would the 2018 clinical workshops be valuable to attend? What would you say to other occupational therapists who were thinking about attending the clinical workshops?

I am looking forward to attending the clinical workshops in Napier. I find OTNZ-WNA clinical workshops and conferences a great opportunity to reach out to other occupational therapists, learn from each other, have fun, and celebrate our journey with the treaty relationship model. This year I am especially excited about the theme “Ko ngā tapuwae tukuiho, ko te huarahi manawapou: Nurturing and Enabling Resilience and Sustainable” as it is so fitting for the time.

I would encourage everyone to attend this year’s clinical workshops. Use it as a platform to share stories; develop networks; embrace and promote leadership; spread a culture of learning and innovation; and develop understanding of each other’s sense of purpose. It is a great opportunity for us as occupational therapists to explore a wider perspective of resilience and sustainability, and discover how to be more efficient, learn, and innovate, all at the same time.

Harsh Vardhan’s views as expressed in this article should not be taken as representing those of Hutt Valley District Health Board.