AOTA member spotlight: Natalie Leland, PhD, OTR/L, FAOTA, FGSA

Natalie Leland, PhD, OTR/L, FAOTA, FGSA, is a Professor in the Department of Occupational Therapy at the University of Pittsburgh.  She spoke to Jamar Haggans, MS, OTR/L, Director of Quality at AOTA about her current position and how she became interested in quality.

Jamar Haggans: What is your current position?

Natalie Leland: I am a Professor at the University of Pittsburgh in the Department of Occupational Therapy.

Jamar Haggans: How did you become interested in quality?

Natalie Leland: It started when I was a clinician working in skilled nursing. I saw a disconnect between what we knew was best practice and what was happening in the clinic. The more I learned over time and was exposed to practice in other facilities, I continued to see the variation in the care that was being provided.

I then began to explore what quality was and how we think about quality improvement. At that time, there weren’t a lot of occupational therapy practitioners (OTPs) talking about quality and quality improvement that I was aware of. For context, this occurred soon after the Prospective Payment System (PPS) was implemented in post-acute care. I started attending continuing education to learn about quality improvement, and eventually pursued a master’s degree. It was in my master’s degree program where I really began to understand the policies that were informing my care as a clinician.

I continued to dive into healthcare policies for the aging population while pursuing my PhD in Gerontology. I understood the policy process better. However, I had more questions such as, “where is our evidence?” There was information about specific interventions, but we didn’t have evidence that spoke to our effect on populations, which is necessary for informing policy.

Jamar Haggans: How has your interest in quality influenced your research?

Natalie Leland: My clinical background of working with older adults and seeing the effect of evolving policies influenced my research.

Working with the clinical community to develop evidence, inform policy, and demonstrate the quality and value of OT as part of an interdisciplinary team is very important. While I don’t get to treat patients on a daily basis anymore, I’ve stayed connected to the clinical community. All of my research projects are done with individuals from the clinical community to make sure the research is addressing clinical priorities. The end goal is making sure that the patients we care for get the care they need, at the right time, so that they can achieve the outcomes that they desire.

Jamar Haggans: What can occupational therapy practitioners do to prepare for a future where quality is at the forefront of payment?

Natalie Leland: I believe it is important to have an understanding of insurance- and policy-level perspectives. We need to show how we are an essential part of the care team regardless of the setting in which you practice. We should constantly evaluate the quality of the care that we're providing as an individual and health profession in alignment with national initiatives focused on the delivery of highly effective, low-cost care that produces good outcomes. I would also encourage clinicians to collaborate with researchers. Through these partnerships we can ensure our research is clinically meaningful and accelerate the translation of evidence into practice.

Jamar Haggans: What advice would you give to anyone interested in quality or research?

Natalie Leland: Reach out to people you know and ask questions. Regardless of what your current job role is, it never hurts to build on your networks to learn from other people.

For students, always asking questions and exploring different options.

If you’re interested in research but and you’re not sure about going back to school, it never hurts to reach out to researchers and learn more about what they do. Look for people who are doing work in the area you're interested in. It may not happen overnight but there could be opportunities for future collaborations.

There are lots of opportunities for OTPs to learn more about quality improvement. When OTPs are embedded in quality improvement initiatives, we bring a valuable perspective to the team because of our occupational therapy perspective. Even if the topic isn’t OT focused, we look at things differently than other disciplines, so we can often make contributions to that team, regardless of what the clinical dilemma is.

The advice I give to all researchers is to build ongoing collaborations with the clinical community regardless of the type of work you're doing, even if it is in the early stages of the translational continuum. If you have members of the clinical community providing insights and advice on the conceptualization, feasibility, or implementation it will help accelerate the translation of those practices to the clinic.

We know that there's a 17-year evidence-to-practice gap. As researchers, the sooner we engage the communities we're working with into the idea development, or even the prioritization of research topics to evaluate, we can really improve the pipeline for developing evidence and getting it into the hands of the clinicians to impact the patients that we all care about.