Ep #113: Leading Care Without Carrying It All: The Day-to-Day of Team-Based Practice

Welcome to Clinicians Creating Impact, a show for physical therapists, occupational therapists, and speech-language pathologists looking to take the next step in their careers and make a real difference in the lives of their clients. If you’re looking to improve the lives of neurodiverse children and families with neurological-based challenges, grow your own business, or simply show up to help clients, this is the show for you. 

I’m Heather Branscombe, Therapist, Certified Coach, Clinical Director and Owner of Abilities Neurological Rehabilitation. I have over 25 years of experience in both the public and private sectors, and I’m here to help you become the therapist you want to be, supporting people to work towards their dreams and live their best lives. You ready to dive in? Let’s go.

Hi there, friend. Welcome back to Clinicians Creating Impact. In this episode, which is now episode 113, it’s also episode four in an ongoing series where I’m talking through how we work with rehabilitation assistants in a way that’s sustainable, ethical, and genuinely supportive for both clinicians and clients. Today I want to talk about the day-to-day workflow of team-based care, what it actually looks like to lead care without carrying it all.

If you’re listening to this in real time and thinking, “Hmm, I might have missed a few steps,” you’re absolutely welcome to go back and listen to the earlier episodes in this series. In episode one, The Heart of Integration: Why Rehab Assistants Change Everything, we talked about the why behind team-based care. And then in episode two, How Clear Roles Turn a Team into a Rhythm, we explored why clarity really makes it all possible. And then in episode three, The Art of Delegation, we focused on the when and how to involve a rehabilitation assistant in a way that builds confidence rather than stress. Obviously, you don’t have to listen to them in order, but together, they create a foundation for today’s conversation.

So whether you’re brand new to working with rehabilitation assistants, just starting to explore team-based care, or you’ve been doing this for a while and you want to feel lighter, today’s episode is about how leadership can show up in your day-to-day work without becoming exhausting. One of the biggest misconceptions about leadership in clinical work is that it means carrying more. And to be fair, I’ve seen it, I’ve felt it, and in some organizations, that is actually true. Many clinicians work in systems that are designed around compliance and control, systems that ask you to manage more clients, more complexity, and more responsibility without any meaningful change to your income, your impact, or your autonomy. And so, of course, in those environments, leadership really does mean carrying more because the system is designed that way.

Often, you’re not given a choice about if, when, or how you use your rehabilitation assistants. Decisions are made far above you, sometimes by people who aren’t even clinicians at all. So I just want to acknowledge if that’s your reality, I want to name it and note that tension is real. And even there, I still believe there are ways to empower yourself within the system you’re in, and so this episode may be helpful for that. But at the same time, I want to be transparent. At Abilities, we have the privilege of being in private practice. We’re able to design our systems from the ground up, guided primarily by our college standards, which actually support authorship, professional judgment, and impact when they’re used well.

So today, no matter where you work, I want to talk about how to lead care day-to-day without carrying it all. I want to talk about why that matters to you, your clients, for rehabilitation assistants, and ultimately for the future of our profession. Because what I’ve seen over and over again is that clinicians don’t burn out because they don’t care. They burn out because they care so much about what they’re doing, they carry things they were never meant to carry alone.

So let’s talk about what I see leadership actually is and what it isn’t. Because especially as therapists, many of us are drawn into this profession because we already demonstrated leadership in some form. So it’s easy to assume we all mean the same thing when we say leadership. But I think it helps to be explicit. From my point of view, leadership is not doing more. It’s not about being the backup for everything. It’s not about holding every detail in your head, and it’s not about being the emotional container for the entire system. What I see leadership is, is leadership is direction. It’s authorship, it’s clarity, it’s stewardship. So leadership is designing care in a way that works even when you step back.

Now, our health colleges already support this. They define scopes, roles, and responsibilities. Where we have an opportunity to grow in our professions is moving beyond minimum standards into intentional design. And no matter where you work, there is always some room for movement. I’ve seen it, I’ve worked in a variety of systems. Even small shifts in how you structure your own work can move you from compliance towards authorship and from control towards a deeper impact. And that’s where I believe leadership truly lives.

I definitely didn’t know that about 20 years ago when I started Abilities, what I actually know now, because I didn’t have the language of authorship or stewardship. And truthfully, we had no framework for leadership like we do now. I had no framework for leadership like we do now. We had nothing but myself and a desire to build something better.

Now, again, many of you, I’ve always loved leadership. Not leadership as a burden, but leadership as freedom, freedom for myself and freedom for others. And I knew I didn’t want leadership to mean heroics or hustle. I also knew that rehabilitation assistants would be part of the solution, or at least I instinctively thought they could be. They are literally the first people I hired beyond myself. And what has followed has been almost two decades of experimenting, learning, getting things wrong, refining, and listening.

And what we’ve learned collectively together is simple but powerful: structure should support humans, all of the humans. That includes clients, obviously, caregivers, the rehabilitation assistants we work with, and you as the clinician. And I think when structure does that well, leadership stops feeling heavy.

So what does that look like in real life? First, leadership, I believe, is about direction, not constant presence. So it’s easy to assume that if you’re physically there in the same room, things will go better. And in my experience, that’s actually not necessarily true. Presence is not a substitute for clear plans, clear goals, and clear expectations. So strong direction actually matters more than constant proximity. So at Abilities, for example, we use clear supervision standards, including remote supervision where appropriate. We define when clinician input is required and why, and that allows leadership without hovering.

Strong direction reduces anxiety for everyone in the system. And that doesn’t mean that you can predict everything in advance. Of course you can’t. It means you’ve named what right looks like, what off looks like, and what to do when things change. So secondly, I think you should decide once, not every time. What requires clinician input? What does not? What can the rehabilitation assistant decide independently, and what should escalate back to you? Because when everything is a question, everybody gets tired. Clear defaults reduce decision fatigue for both the clinician and the rehabilitation assistant.

Third, I would say, use communication as a design tool. Communication doesn’t have to be just reactive; it can be something that you design. So you think about the methods that you use when you communicate, whether that’s in person, email, texting, messaging platforms, formal meetings, thinking about urgency, thinking about response times, and naming your preferences early. When communication is intentional and layered appropriately, it becomes supportive instead of stressful.

So let’s talk about this for a moment from what I like to think of as a caseload stewardship lens or a caseload leadership lens. This is where leadership maturity really shows up. At Abilities, our caseload stewardship framework starts with stewardship of self, and that foundation actually matters. So here’s a few concrete questions you can ask yourself, especially if you’re newer to working with rehabilitation assistants. What about using a rehabilitation assistant with this client feels either energizing or engaging? What about it feels challenging? And then ask yourself why. Where might the rehabilitation assistant be unclear? Where might the client be unclear? And where might I be unclear? Am I acting as the system right now, or am I designing the system?

So these questions aren’t about carrying less; it’s about carrying well and carrying sustainably. These are questions that you can continue to ask, and we at Abilities continue to ask on a daily basis. When this foundation is in place, everyone wins. The clinician will experience less mental load and more focus. The rehabilitation assistant will gain clarity, confidence, and a meaningful contribution. And then the client benefits from consistency, continuity, and a regulated support team.

So in closing, here’s the question that I’ll leave you with: Where in your day-to-day work are you carrying something yourself that could be led instead? And what might be possible if you let leadership rather than effort hold that piece? If we want a sustainable future in rehabilitation, leadership cannot keep meaning exhaustion. It has to mean impact, clarity, and care that lasts.

So with that, in the next episode, we’re going to continue this conversation by talking about feedback loops and how to guide and support others without micromanaging. Thank you again so much for listening. And until next time, keep creating the impact in a way that supports both your clients and yourself.

Thanks for joining me this week on the Clinicians Creating Impact podcast. Want to learn more about the work I’m doing with Abilities Rehabilitation? Head on over to abilitiesrehabilitation.com. See you next week.