When your treatment fails: Handling the aftermath with the client
Overview: If your treatment “fails” (e.g., client doesn’t get back much movement in their arm after a stroke), it’s important to figure out how your client/patient/consumer views treatment failure so that you can navigate accordingly.
Failing the Consumer (Link to PDF of my paper thoroughly reviewing this article)
Have you ever felt you failed a consumer/client/patient? Have you ever felt the consumer blamed you for the failure? I recently read an article by Zaynes, Otnes, and Fischer (2014) called “The nature and implications of consumers’ experiential framings of failure in high-risk service contexts.” It wasn’t written by occupational therapists, but is quite relevant. While occupational therapists are not typically sued, I think an understanding of how consumers frame failure is an important way to avoid legal issues after a “failure,” where a consumer fails to get better, whether it’s truly your fault or an unrealistic consumer perception.
Based on interviews with people who have undergone failed fertility treatments (“high risk” of failure), the investigators found that consumers viewed treatment failure in one of four ways: 1) “failure as a route to success” 2) “failure as a mobilizing frustration” 3) “failure as a cue to re-evaluate” 4) “failure as fated” (Zayer, Otnes, & Fischer, 2014, p. 4).
Essentially, consumers came into fertility treatment with a particular view, and after failure of intervention (in an OT case, perhaps the consumer doesn’t get better after stroke treatment), the consumers navigated the failure path differently. Some understood it as just a likely possibility, some saw it as inappropriate/wrong/provider failure, some saw it as a reason to look at other possibilities, and some saw it as destiny. The most challenging group to handle after failure are those who see failure as unacceptable, and blame the provider, regardless of fairness or not.
In the case of OTs, we are pretty intuitive, and I think by the end of evaluation, especially with this knowledge in mind, we could see what “frame” the consumer operates within, and adjust our intervention accordingly. With those in that challenging group of “failure as mobilizing frustration” or failure as unacceptable, I recommend lots of clear communication as to probability, as well as extra careful documentation for future legal action. Please see the linked paper above for more information on navigating the aftermath of failure for the other three groups.
The paper linked at the top of this post is one I wrote for one of my post-professional OTD classes within the Administration and Practice Management track, exploring consumer desires. If you work in a “high-risk” arena, which can include hand therapy, catastrophic trauma, etc, I recommend you look into this article (or read my paper), to see how you can start to navigate the possibility of failure from Day 1! Good luck!
Zayer, L., Otnes, C., & Fischer, E. (2014). The nature and implications of consumers’ experiential framings of failure in high-risk service contexts. Journal of Service Research, 1094670514559187 doi:10.1177/1094670514559187