Guest blog by Lisa Harrison, Occupational Therapist, Rehab Jigsaw
When I explain the value occupational therapy offers to employers, managers, and sometimes even other healthcare professionals, I often find myself saying the same phrase: "We don't just ask whether someone can work. We ask how they work."
As an occupational therapist specialising in vocational rehabilitation and occupational health, I have spent many years supporting people with physical, cognitive, neurological, and mental health conditions to remain in work or return to work successfully. A diagnosis alone rarely tells us what someone can actually do in the workplace. Two people with the same condition can have very different levels of function. One may manage a full-time role with minor adjustments, while another may struggle to sustain essential job demands. Understanding that difference is where occupational therapists add value.
Function is the missing piece
Occupational therapists are trained to understand the relationship between a person's health condition, their environment, and the activities they need or want to perform. In workplace assessments, my focus is not primarily on the medical diagnosis. Instead, I explore:
- What tasks does the role require?
- What cognitive, physical, sensory, or emotional demands does the job place on the individual?
- How does the person's health condition affect their ability to perform those tasks?
- What strategies, adjustments, or interventions could bridge the gap?
- What impact does the environment have on the ability to perform work?
This functional approach helps move conversations towards practical solutions. For example, a referral may tell me that an employee has multiple sclerosis, chronic pain, anxiety, or a brain injury. Those diagnoses are important, but they do not tell me whether that person can concentrate for prolonged periods, manage competing demands, tolerate fatigue, safely operate equipment, or sustain a full working day.
The workplace is my assessment space
When undertaking workplace assessments, it can be easy to rely on what individuals state that they can do. While self-report is valuable, I have frequently seen that people often underestimate or overestimate their abilities. During an assessment, I combine information from multiple sources. This may include:
- Detailed interviews
- Observation of work tasks
- Functional assessment
- Workplace observations
- Discussions with managers
- Review of job demands.
- Assessment of equipment and environment
Seeing somebody perform real work tasks often provides insights that would never emerge from a clinic-based conversation.
I remember assessing an employee who reported that they were managing well following a being diagnosed with a neurological condition. During workplace observation, however, subtle difficulties with memory, organisation, and task sequencing became apparent. These issues were largely invisible to colleagues but had a significant impact on productivity and confidence. Once identified, we were able to implement practical strategies that supported both the employee and employer.
Assessing capacity, not incapacity
One of the biggest beliefs about workplace assessments is that they are designed to identify what people cannot do - my experience is quite the opposite. Occupational therapists seek to identify strengths, capabilities, and opportunities for participation. We assess what someone can do now, what they could do with adjustments, and what barriers may be preventing success. This strength-based approach is particularly important for individuals with long-term health conditions. Good work can support health and wellbeing, but only when the demands of the role are compatible with the individual's functional capacity. The challenge is often finding the right balance.
Turning recommendations into reality
Another lesson I have learned is that recommendations only have value if they can be implemented. Lengthy reports packed with clinical detail are not always easy for managers to translate into day-to-day practice. I aim to provide recommendations that are clear, practical, and achievable. Whatever type of reasonable adjustments being considered such as changes to workload, assistive technology, flexible working arrangements, or phased return-to-work plans, the goal is always the same: helping individuals’ function at their best in the workplace.
Why function matters
In occupational health, there is an understandable focus on diagnosis, risk, and fitness for work. Occupational therapists bring an additional perspective. We specialise in understanding function and participation in real-world environments. By examining the interaction between health, work demands, and workplace context, we can provide a more detailed picture of how someone works, not simply whether they can. For me, that remains one of the most rewarding aspects of occupational therapy. Every assessment is an opportunity to look beyond the diagnosis and identify practical ways to help people remain engaged in meaningful work. Work matters. Understanding function is often the key to making it possible.