The American Occupational Therapy Association’s 93 rd Annual Conference & Expo APRIL 25–28, 2013

1. The American Occupational Therapy Association’s 93rd Annual Conference & Expo APRIL 25–28, 2013 SAN DIEGO, CALIFORNIA from heartfelt leadership to compassionate care

2. Assembly of Student Delegates: Power & Leadership Florence Clark PhD, OTR/L, FAOTA, AOTA President

3. Components of My Talk

4. The Centennial Vision We envision that occupational therapy is apowerful, widely recognized,science-driven, andevidence-based professionwith a globally connectedand diverse workforcemeeting society’s occupational needs.

5. America’s elite boarding schools Preparing for Power

6. Preparing for Power:America’s Elite Boarding Schools • Socialization for power • Insular community of “American aristocracy” • Discourage individuality in order to form collective class identity • Exclusive: “You go there to be separated from ordinary people” (p. 53). • Academically rigorous & highly competitive • “Privilege must appear to be earned, because the only real justification for inequality is that it is deserved.” (p. 125) Cookson, P.W. & Persell, C.H. (1985). Preparing for power: America’s elite boarding schools. New York: Basic Books.

7. The Boarding School Classroom “At the center of an Exeter education is the Harkness classroom—twelve to fourteen students and a teacher seated around a table for the purpose of forming and expressing ideas rather than dispensing and receiving information, a classroom in the Socratic manner where maximum participation is encouraged, pretense and careless preparation readily perceived.” (p. 96) “Students who haven’t read the day’s assignment have little hope of escaping detection. There is no back row at prep school, as almost everyone sits around a table or in a circle.” (p. 98) Cookson, P.W. & Persell, C.H. (1985). Preparing for power: America’s elite boarding schools. New York: Basic Books.

8. Life After Prep School • Significantly higher acceptance rate into Ivy League Colleges • Graduates make up high proportion of leaders in business, law, politics, and corporate boards • “Nearly 90% of all U.S. cabinet officers between 1897-1973 were members of either the business or the social elite.” (p. 200) • Influence on media • “Inner-circle business leaders go out of their way to be available to the press, to communicate ‘the private enterprise perspective on a variety of critical issues’.” (p. 202) • Involvement in the arts, museums • Volunteerism Cookson, P.W. & Persell, C.H. (1985). Preparing for power: America’s elite boarding schools. New York: Basic Books.

9. The Chosen Ones “With none of the other American children I have worked with have I heard such a continuous and strong emphasis put on the “self.” In fact, other children rarely if ever think about themselves in the way children of well-to-do and rich parents do—with insistence, regularity, and, not least, out of a learned sense of obligation. These privileged ones are children who live in homes with many mirrors. They have mirrors in their rooms, large mirrors in adjoining bathrooms. When they were three or four they were taught to use them; taught to wash their faces, brush their teeth, comb their hair. Personal appearance matters and becomes a central objective for such children.” (p. 55) • Cookson, P.W. & Persell, C.H. (1985). Preparing for power: America’s elite boarding schools. New York: Basic Books.

10. The Chosen Ones: Prep Poise • “The first step on the road to ‘being somebody’ is to ‘act like somebody,’ even if you are not quite sure who that somebody is.” (p. 56) Groton Video: http://www.groton.org/academic/academic_experience?rc=0 • Cookson, P.W. & Persell, C.H. (1985). Preparing for power: America’s elite boarding schools. New York: Basic Books.

11. Occupational Therapy’s Relationship with power

12. Power vs. Leadership Power: Ability to achieve one’s goals VS. • Leadership: Process of influence to achieve a goal

13. Types of Power (French & Raven, 1959)

14. Occupational Therapy’s Relationship with Power • Historically, OTs have not been comfortable with being powerful • Why the unease? • Opposite of caring • Masculine attribute • Association with domination

15. Getting Comfortable With the Idea of Being Powerful • Power is neither good nor bad • The ethics of power lie in its use

16. Power Ability to do or act; capability of doing or accomplishing something Natural strength Political control in the government of a country, state, etc.

17. Powerless • Unable to produce an effect • Lacking power to act; helpless

18. Powerful vs. Powerless Professionals

19. History of OT Power In Health Care • OT was constrained in establishing market control due to: • Our difficulty in defining our commodity • Our decision to shy away from licensureuntil the early 1970’s • Our lack of political presence in Washington DCuntil Medicare’s establishment • As a result • When Medicare laws were passed in 1965,OT was not made eligible to access Medicareas a primary provider (Gritzer & Arluke, 1989)

20. Ways of understanding power

21. Critical Social Theory • Emphasis on Power Structure • Privileged and disenfranchised • Bases of power are prestige, status, social class, etc. • Political struggle is path to power for oppressed group. • Emancipation: women winning the right to vote • The influence of labor unions • (Bradbury-Jones, Sambrook, & Irvine, 2008)

22. Organizational/Management Theory • Emphasis on Context/Environment • Focus on hierarchical organization structures (particularly top/down) • Power is the ability to get things done • Control over: • Access to resources • Access to support and decision making • Information • Opportunity for advancement or opportunity beyond one’s job description • Where you are on the organizational chart (Bradbury-Jones, et al., 2008; Kanter, 1993; Laschinger& Havens, 1996; Manojlovich, 2007)

23. Social Psychological Theories • Emphasis on Individuals’ Personalities • No matter the environment, a few “hardy” individuals do whatever it takes to achieve their aims • Manipulate the few empowering structures they find • Personal efficacy; determination; vigilance; self-confidence; etc. • Work between cracks • Sniff out potential power opportunities like a bloodhound on the hunt (Manojlovich, 2007; Spreitzer, 1995; Quinn & Spreitzer, 1997; Kuokkanen & Leino-Kilpi, 2000)

24. Post-structural Theories • Emphasis on Local Situations • Power is not distributed top-down. It also works bottom-up and laterally. • Capillary form: “reaches into the very grain of individuals, touches their bodies, influences their every action, their words, their everyday lives in everyday context.” (Foucault,1980, p. 39) • Power is negotiated continually in everyday contexts (Kondo, 1990) • Consumer alliances (Foucault, 1995; Bradbury-Jones, 2007)

25. Defining professional power

26. Defining “Professions” • “Exclusive occupational groups applying somewhat abstract knowledge to particular cases” • Control of knowledge and skill • Abstract system of knowledge: Problems and task can be redefined and defended • Strong professional association (Abbot, 1998)

27. The Medical Power Continuum Stratification by: • Area of Medical Practice • Degree of Independence • Rank in remaining hierarchy • Academic Credentials (Gloubermann, 2002)

28. Professional Power • “Ability to retain jurisdiction when system forces imply that a profession ought to have lost it” • “Interprofessional force” • Dominating conflicts and preventing conflicts from arising • Need abstract knowledge (Abbott, 1998, p. 136)

29. Abraham Lincoln A Powerful Leader

30. Lincoln’s Legacy • Lincoln’s Leadership Qualities • Resilience • Forbearance • Emotional intelligence • Consideration of all sides of an argument “Listening, always being present and authenticity are essential leadership qualities whether one is leading a country in wartime or a company during a period of transformation” –Howard Schultz, CEO of Starbucks (Kohen, 2013)

31. Careful Listening • Listened to those inside and outside his sphere of influence • Gathered advice - even from those who didn’t agree with him • Traveled to the battlefields and held open “office” hours in the White House (Kohen, 2013)

32. Resilience • Experienced many obstacles: the growing toll of the war, defeat in battle, pressures from abolitionists, personal loss • Lincoln was able to experience a range of emotions without acting on them rashly or compromising his larger goals. • He used emotional intelligence and a deep faith in his vision to navigate difficult terrain. (Kohen, 2013)

33. The Emancipation Proclamation “Things had gone on from bad to worse, until I felt that we had reached the end of our rope on the plan of operations we had been pursuing; that we had about played our last card and must change our tactics or lose the game” – Abraham Lincoln • Lincoln went on to draft the Emancipation Proclamation – A way of communicating his commitment to a larger purpose • He was able to shift tactics to meet changing circumstances without abandoning his larger goal. (Kohen, 2013)

34. Cultivating power

35. Characteristics of Empowered People • Empowered people have a sense of • Self-determination • Meaning • Competence • Impact • Empowerment “not something that management does to employees, but rather a mind-set that employees have about their role in the organization” (p. 41). (Quinn & Spreitzer, 1997)

36. Facilitating Empowerment • Four levers • Clear vision and challenge • Openness and teamwork • Discipline and control • Support and sense of security • Leaders must be empowered in order to empower others! (Quinn & Spreitzer, 1997)

37. Barriers to Empowerment • Bureaucratic culture • Emphasizes status quo • Strong top-down tradition • Multi-level conflict • Divisions between departments • Conflict among peers • Personal time constraints • Downsizing • Stressful conditions • “Conform, don’t rock the boat!” (p. 43). • Failure to develop “voice” (Quinn & Spreitzer, 1997)

38. Cultivating Your Power • Presentpapers at interdisciplinary meetings at which no one discipline dominates (e.g. GSA) • Build relationships with senior, well-respected administrators with whom you have overlapping interests who are not occupational therapists/occupational scientists • Publish! Publish! Publish! • Network! Network! Network! • Develop your voiceand ability to speak incisively and concisely

39. Cultivating Your Power • Ensure the strategic use of your successes to give publicity to the services you provide • Invest time in public relations as a source of power that will enable you to do more of what you are good at • Build alliances with the clients that you work with Pollard, Sakellariou, & Kronenberg, 2008)

40. References Abbott, A. (1998). The system of professions: An essay on the division of expert labor. Chicago, IL: University of Chicago Press. Bradbury-Jones, C., Sambrook, S., & Irvine, F. (2008). Power and empowerment in nursing: A fourth theoretical approach. Journal of Advanced Nursing, 62(2), 258-266. Cookson, P.W. & Persell, C.H. (1985). Preparing for power: America’s elite boarding schools. New York: Basic Books. French, J. R. P., & Raven, B. (1959). The bases of social power. In D. Cartwright & A. Zander, Group Dynamics (pp. 150-167). New York: Harper & Row. Foucault, M. (1995). Discipline and Punish: The Birth of Prison. Translated by A. Sheridan. New York: Vintage Books. Gloubermann, S. (2002). Structures, power, and respect: The nurse’s dilemma. North York, Ontario, Canada: Canadian Nursing Advisory Committee. Retrieved from http://www.healthandeverything.org/files/Nursing_Paper.pdf (pp. 13-14). Gritzer, G. & Arluke, A. (1989). The making of rehabilitation: A political economy of medical specialization, 1890-1980. Berkeley and Los Angeles: The University of California Press. Kanter R.M. (1993) Men and Women of the Corporation, 2nd edn. Basic Books, New York. Kohen, N.S.(2013, January 27). Lincoln’s school of management: Resilience and careful listening, as learned in 1862. The New York Times, ppYBU1 –YBU7. Kuokkanen, L. & Leino-Kilpi, H. (2000). Power and empowerment in nursing: Three theoretical approaches. Journal of Advanced Nursing, 31(1), 235-241. Laschinger, H.K.S. & Havens, D.S. (2006). Staff nurse work empowerment and perceived control over nursing practice: Conditions for work effectiveness. Journal of Nursing Administration, 26(9), 27-35. Manojlovich, M. (2007). Power and empowerment in nursing: Looking backward to inform the future. OJIN: The Online Journal of Issues in Nursing, 12(1). Pollard, N., Sakellariou, D. & Kronenberg, F., eds. (2008). The political practice of occupational therapy. Edinburgh: Elsevier. Quinn, R. & Spreitzer, G.M. (1997). The road to empowerment: Seven questions every leader should consider. Organizational Dynamics, 26(2), 37-49. Spreitzer, G. (1995). Psychological empowerment in the workplace: Dimension, measurement, and validation. Academy of Management Journal, 38(5), 1442-1465.

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