The Influence of Environment on Clinical Practice: Unspoken Rules

Abstract

Purpose: The purpose of this study was to explore organisational social processes as an environmental contributor to the professional culture of practice. Occupational therapy practitioners are expected to be adaptable, responding to ever-changing demands of health care organisations. Occupational therapy students are expected to integrate into multiple settings during their practice education; however, the distinctive culture of organisations is often unspoken, making acculturation difficult. Method: This study examined four representative practice settings in the United States through institutional ethnography. Findings: Analysis revealed complex, interlaced, poorly documented social processes at immediate, local and external organisational levels. Occupational therapy practitioners revealed that these social processes influenced the ways in which they provide health services, perceive change and respond to change. They also revealed that newcomers, including practitioners and students, must learn to fit in by the sink-or-swim method. Conclusion: The findings of the study suggest possible changes in didactic, practical and continuing education to facilitate adaptation to increasingly complex health care systems. Further research is recommended to determine practitioner and student perceptions of hierarchical social processes, commonalities and differences of practice environments, the influence of different environments on practice, and strategies of adaptation.