Implementation of an Occupation-Based Practice Strategy in a Metropolitan Health Service: A Case Study

Occupation-Based Practice (OBP) is fundamental to occupational therapy, enhancing consumer engagement and outcomes, yet implementation is challenging due to local environments and dominance of impairment-based interventions. To investigate implementation of a service-wide OBP strategy in a large metropolitan tertiary health service over 6 years; understand its influence on occupational therapists; identify barriers and facilitators; and observe changes in clinician perceptions supporting sustainability. Qualitative case study at two time points. Participants were occupational therapists and allied health assistants ( n = 95 in 2017; n = 39 in 2023). Data was collected through focus groups ( n = 8 in 2017; n = 3 in 2023) and multiple documents. Descriptive thematic analysis identified themes and sub-themes. Strategic leadership cultivated an OBP culture. Barriers included resource limitations and systemic pressures; facilitators included interdisciplinary support and professional development. Over time, perceptions shifted from conceptual understanding to practical application as OBP became integrated into service culture. A service-wide OBP strategy was effectively used in practice. Implementation depended on consistent application, a supportive service culture, and responsive systems. Although COVID-19 negatively impacted OBP, commitment to the strategy supported re-establishment, demonstrating sustainability. A service-wide OBP strategy increases OBP and can be sustained in a tertiary healthcare setting.