Development and evaluation of a new model for person-centred goal setting using practice development and appreciative inquiry approaches in a rehabilitation unit

Background: This article explores the use of a mixed-methods participatory approach to bring about transformative change to goal setting in an 18-bed, subacute rehabilitation unit in New South Wales. Aim: To use a blended approach underpinned by practice development and appreciative inquiry approaches, to develop and evaluate a model of person-centred goal setting for rehabilitation clients. Methods: Evaluative methods were co-designed and co-agreed by members of the rehabilitation team, based on what the team hoped to achieve in terms of establishing goals for clients in their care and what this meant to clients and each other. Data sources included team discussions, semi-structured interviews with individual team members and clients, a survey and stories using emotional touchpoints. Interpretation of the data involved content analysis for generation of themes and the use of Statistical Package for Social Science software for analysis of the survey. Results: Nine themes emerged. Clients highlighted: barriers to goal achievement; incorporation of goals into daily care; goal achievement; and a sense of purpose. The rehabilitation team highlighted: becoming person-centred; their role in goal setting; and barriers to establishing goals. The survey responses showed the team used person-centred approaches to achieve person-centred goals. Conclusion: Changes to goal setting allowed staff to feel person-centred in their care delivery and gave them the satisfaction of knowing they were doing something meaningful for those in their care. There was strong agreement that a unified team approach to goal setting was key to client satisfaction and achievement of the goals. Clients felt valued and included in making decisions surrounding their care. Implications for practice: • Using the practice development principle of developing collaborative partnerships among healthcare teams leads to greater involvement of clients in their care • Involving clients in goal setting leads to greater success and improved client satisfaction • Appreciative inquiry and practice development approaches are effective in developing partnerships between team members • Staff who treat clients with dignity and respect improve participation in goal setting by the clients • Creating a space in which the emotional needs of clients can be heard and acted on is crucial for success in goal achievement • Appreciative inquiry generates a greater appreciation and understanding of how to deliver person-centred care

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HEALTHCARE PROVIDERS’ EXPERIENCES IN CARING FOR OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS

Innovation in Aging ◽

10.1093/geroni/igz038.1160 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

pp. S317-S318

Author(s):

Jenny Ploeg ◽

Marie-Lee Yous ◽

Kimberly Fraser ◽

Sinéad Dufour ◽

Sharon Kaasalainen ◽

...

Keyword(s):

Older Adults ◽

Primary Care ◽

Home Care ◽

Family Caregivers ◽

Chronic Conditions ◽

Care Delivery ◽

Healthcare Providers ◽

Multiple Chronic Conditions ◽

Team Approach ◽

Personal Support

Abstract The management of multiple chronic conditions (MCC) in older adults living in the community is complex. Little is known about the experiences of interdisciplinary primary care and home providers who care for this vulnerable group. The aim of this study was to explore the experiences of healthcare providers in managing the care of community-living older adults with MCC and to highlight their recommendations for improving care delivery for this group. A qualitative interpretive description design was used. A total of 42 healthcare providers from two provinces in Canada participated in semi-structured interviews. Participants represented diverse disciplines (e.g., physicians, nurses, social workers, personal support workers) and settings (e.g., primary care and home care). Thematic analysis was used to analyze interview data. The experiences of healthcare providers managing care for older adults with MCC were organized into six major themes: (1) managing complexity associated with MCC, (2) implementing person-centred care, (3), involving and supporting family caregivers, (4) using a team approach for holistic care delivery, (5) encountering rewards and challenges in caring for older adults with MCC, and (6) recommending ways to address the challenges of the healthcare system. Healthcare providers highlighted the need for a more comprehensive integrated system of care to improve care management for older adults with MCC and their family caregivers. Specifically, they suggested increased care coordination, more comprehensive primary care visits with an interprofessional team, and increased home care support.

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GOAL-SETTING, GOAL ACHIEVEMENT AND VOLITIONAL REGULATION

Sibirskiy psikhologicheskiy zhurnal ◽

10.17223/17267080/64/1 ◽

2017 ◽

pp. 6-23

Author(s):

Yury T. Glazunov ◽

◽

Konstantin R. Sidorov ◽

Keyword(s):

Goal Setting ◽

Goal Achievement

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What Matters to Us: Impact of Telemedicine During the Pandemic in the Care of Patients With Sarcoma Across Scotland

JCO Global Oncology ◽

10.1200/go.20.00599 ◽

2021 ◽

pp. 1067-1073

Author(s):

Holly M. McCabe ◽

Alannah Smrke ◽

Fiona Cowie ◽

Jeff White ◽

Peter Chong ◽

...

Keyword(s):

Care Delivery ◽

Mixed System ◽

Specialist Care ◽

Team Members ◽

Delivery Of Care ◽

Face To Face ◽

Patients With Cancer ◽

Rapid Changes ◽

Regular Practice ◽

Survey Questionnaires

PURPOSE In Scotland, approximately 350 sarcoma cases are diagnosed per year and treated in one of the five specialist centers. Many patients are required to travel long distances to access specialist care. The COVID-19 pandemic brought a number of rapid changes into the care for patients with cancer, with increasing utilization of telemedicine. We aimed to evaluate how the utilization of telemedicine affects professionals and patients across Scotland and care delivery, at the Beatson West of Scotland Cancer Centre Sarcoma Unit. METHODS Between June 8 and August 25, 2020, we invited patients and professional sarcoma multidisciplinary team members to participate in separate online anonymous survey questionnaires, to assess their attitudes toward telemedicine. Data were extracted, and descriptive statistics were performed. RESULTS Patient satisfaction (n = 64) with telemedicine was high (mean = 9.4/10) and comparable with traditional face-to-face appointments (mean = 9.5/10). Patients were receptive to the use of telemedicine in certain situations, with patients strongly opposed to being told bad news via telemedicine (88%). Providers recommended the use of telemedicine in certain patient populations and reported largely equivalent workloads when compared with traditional consultations. Providers reported that telemedicine should be integrated into regular practice (66%), with patients echoing this indicating a preference for a majority of telemedicine appointments (57%). CONCLUSION Telemedicine in sarcoma care is favorable from both clinician and patient perspectives. Utilization of telemedicine for patients with rare cancers such as sarcomas is an innovative approach to the delivery of care, especially considering the time and financial pressures on patients who often live a distance away from specialist centers. Patients and providers are keen to move toward a more flexible, mixed system of care.

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Abstract T P278: HASTe: A Team Approach to Improving Pre-Hospital and ED Delays in Stroke Care

Stroke ◽

10.1161/str.45.suppl_1.tp278 ◽

2014 ◽

Vol 45 (suppl_1) ◽

Author(s):

Melissa Dofredo ◽

Angela West

Keyword(s):

Medical Record ◽

Performance Improvement ◽

Care Delivery ◽

Stroke Care ◽

Individual Case ◽

Delivery Systems ◽

Team Approach ◽

Improvement Project ◽

Transfer Processes

Background: Despite an array of available guidelines and research, many organizations continue to seek innovative ways to decrease time delays and enhance their stroke care delivery systems. After dissecting the case of an acute ischemic stroke (AIS) patient cared for in our facility, many delays were noted from onset of symptoms until admission to ED. Purpose: The purpose of the HASTe (Hyper Acute Stroke Team) initiative is to utilize a case-study approach to discover pre-hospital and ED delays, and offer quality improvement project ideas that can be used to enhance stroke-care delivery systems. Methods: With leadership from the Stroke Program Director, 15 neuro-critical care nurses formed the HASTe to ameliorate delays noted in AIS care. A case-study review of an AIS patient led to a schematic timeline map which demonstrated minutes lost at each area of delay. Identified areas of delay included lack of community knowledge on stroke, preventative delays in Emergency Medical System (EMS) on-scene time, lack of updated AHA/ASA guideline knowledge at an outside facility ED, inefficient transfer processes to our facility for endovascular intervention, and technical delays in electronic medical record entry. All of these factors contributed to time lost for reperfusion therapy. Results: Pre-hospital and ED delays contributed to approximately 120 minutes lost. After analyzing these delays, the HASTe initiated several performance improvement projects to address the delays. Community and EMS presentations covering the urgency of stroke were created. Connections were made with outside facility ED educators to offer in-services on AHA/ASA updates. Improved transfer processes were coordinated with local EMS administration and private ambulances. A pre-admitted “John Doe-Stroke” medical record was created for potential stroke patients coming in to our ED. Conclusions: A team approach such as the HASTe is an innovative way to integrate knowledge gleaned from individual case studies to induce coordinated performance improvement projects that affect the community, EMS, and ED. Further case study reviews can reveal other areas in which the HASTe can positively affect change in the continuum of stroke care.

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Abstract WP442: Process Improvement for Stroke/Cardiovascular Risk Factor Screening

Stroke ◽

10.1161/str.51.suppl_1.wp442 ◽

2020 ◽

Vol 51 (Suppl_1) ◽

Author(s):

Margie Campbell ◽

Jessica Lee ◽

Tammy Watts

Keyword(s):

Risk Factor ◽

Process Improvement ◽

Team Approach ◽

Heart Team ◽

Factor Screening ◽

Team Members ◽

Heart Institute ◽

Risk Factor Screening ◽

Stroke Team ◽

Institute Staff

Background and Purpose: Despite advances in the acute treatment of stroke, many patients are delayed in seeking care. While many factors contribute to delays, the principle factor continues to be a lack of public knowledge regarding stroke signs and symptoms. For several years, our Comprehensive Stroke team had been completing community stroke screenings independent of our CV team partners. As the risk factors for Stroke and myocardial infarction (MI) are very similar, we explored the possibility of combining our resources with our Neurological Institute staff and the Heart Institute staff. The purpose behind our process improvement project was to improve collaboration, enhance utilization of resources, and provide more comprehensive risk factor assessment and risk factor education for our participants. An additional goal included teaching the participants the signs/symptoms of Stroke and MI and the importance of calling 911 immediately. Methods: The first step was to create a team that included Neurological Institute and Heart Institute team members. We developed educational materials to be used during the events, including a comprehensive Stroke and Cardiovascular disease booklet, a Risk Factor Scorecard and other visual aids. As the project progressed, additional team members were added to meet the expanded needs identified during the screenings completed. Physician referral was incorporated for appropriate patients. Results: In 2017, the Stroke team completed 3 events and screened 180 participants with a total of 14 volunteers. In 2018, the Neurological/Heart teams completed 5 events with 180 participants screened by 57 volunteers. Thus far in 2019, the Neurological/Heart team has completed 5 events with 333 participants screened and 38 volunteers participating. Conclusions: An interdisciplinary team approach resulted in more comprehensive risk factor screening for participants, increased number of events and greater community outreach. In addition, 4 participants were referred for Cardiology appointments.

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Managing the multiply injured patient: the impact of multidisciplinary teams

British Journal of Hospital Medicine ◽

10.12968/hmed.2019.80.12.703 ◽

2019 ◽

Vol 80 (12) ◽

pp. 703-706

Author(s):

Jonathan French ◽

Lewis M Agius ◽

Nemandra A Sandiford

Keyword(s):

Trauma Care ◽

Care Delivery ◽

National Level ◽

Injured Patient ◽

Improve Patient Care ◽

Multidisciplinary Teams ◽

Team Approach ◽

Trauma Service ◽

Multiply Injured Patient ◽

The Impact

Management of trauma has been tackled at a national level to improve patient care and mortality. Decision making through a multidisciplinary team approach has resulted in improved patient outcomes through a complex combination of changes. While the focus of trauma care delivery has been towards establishing an effective multidisciplinary trauma service, there are still improvements which can be made. This article reviews the history of trauma care in the UK, and the impact that multidisciplinary teams have had on the management of the multiply injured patient.

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Use of the functional independence measure in Japanese rehabilitation team interaction

Discourse Studies ◽

10.1177/1461445619866981 ◽

2019 ◽

Vol 21 (6) ◽

pp. 660-689

Author(s):

Hiroaki Izumi

Keyword(s):

Clinical Decision Making ◽

Collaborative Work ◽

Functional Independence Measure ◽

Clinical Decision ◽

Functional Independence ◽

Disabled Persons ◽

Rehabilitation Team ◽

Team Members ◽

Team Interaction ◽

Team Meetings

The functional independence measure (FIM) is a clinical scale which is used to evaluate the amount of assistance disabled persons need to conduct their daily living activities. Drawing on 65 video-recorded rehabilitation team meetings and medical records collected from a Japanese hospital, this article utilizes ethnomethodology and conversation analysis to uncover how Japanese rehabilitation team members use the FIM to track changes in the functional status of patients and decide the length of stay in ongoing interactional sequences. Analysis shows that a series of the FIM scores assembled and arranged in situ provide a sequential framework for members to understand the progress of rehabilitation and predict the plateau phase. Moreover, a particular expert is asked about patients’ capacity for further improvements and his or her opinions are treated as a basis for clinical decisions. In this way, diagnostic and clinical decision-making is produced through the ongoing collaborative work of various specialists.

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Care Coordination

10.1093/med/9780190493097.003.0015 ◽

2017 ◽

Author(s):

Joy H. Kang ◽

Peter A. Selwyn

Keyword(s):

Chronic Disease Management ◽

Interdisciplinary Team ◽

Hiv Care ◽

Team Approach ◽

Service Needs ◽

Coordination Of Care ◽

Successful Management ◽

Team Members ◽

Hiv Continuum Of Care ◽

Multiple Health

Patients infected with HIV are now living longer, and there is a growing prevalence of HIV-related and/or non-HIV-related comorbidities, often with an increasing need for chronic disease management beyond the treatment of HIV infection. The barriers to each of the steps in the HIV continuum of care need to be identified, anticipated, and addressed. Comprehensive HIV care requires the coordination of many providers. Successful management of referrals, communication between team members, and the challenges of an aging HIV-infected population are reviewed. The interdisciplinary team approach is essential to effective coordination of care for patients with multiple health and service needs.

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Real-life outcomes in spasticity management: features affecting goal achievement

BMJ Neurology Open ◽

10.1136/bmjno-2019-000015 ◽

2020 ◽

Vol 2 (1) ◽

pp. e000015

Author(s):

Rajiv Singh ◽

Alison Clarke

Keyword(s):

Goal Setting ◽

Outcome Prediction ◽

Real Life ◽

Goal Achievement ◽

Successful Outcome ◽

Life Outcomes ◽

Real World Data ◽

Independent Variables ◽

Patient Demographics ◽

Independent Variable

Background/objectiveSpasticity is a complex and common condition but there is a lack of ‘real-world’ data on goal setting and spasticity treatment, as well as identifying those features that might be associated with goal achievement. Our aim was to provide such data.MethodsProspective attenders at a multi-disciplinary spasticity clinic over 2 years followed for consecutive appointments. Patient demographics and doses of botulinum toxin injected were documented. Main outcome was achievement of a primary goal but secondary goals were also recorded. Independent variables were examined for association to the outcome.ResultsA total of 606 goals were set in 224 patients. The majority (75.2%) were achieved with similar levels across active (72.5%), passive (75.7%) and pain (78.6%) goals. However, in terms of the primary goal, active primary goals were achieved less frequently (59.7%) than non-active primary goal (74.2%). A logistic regression confirmed that this was the only independent variable associated with primary goal achievement. The majority of patients (61.6%) required changes to their treatment between appointments, irrespective of time since diagnosis, age or aetiology.ConclusionsMost goals set in spasticity clinic can be achieved irrespective of type of goal. However, active goals may be harder to accomplish when they are set as a primary goal. This may reflect the desire of individuals to prioritise a desirable goal rather than one that is achievable. While goal setting is important in the management of spasticity patients, very few patient or treatment factors are associated with outcome prediction. Further work needs to identify features that may predict successful outcome.

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Client Satisfaction among the clients attending tertiary care centers in Mangalore, South India

Journal of Health and Allied Sciences NU ◽

10.1055/s-0040-1708716 ◽

2017 ◽

Vol 07 (03) ◽

pp. 003-006

Author(s):

Usha Rani S. P. ◽

Rashmi Kundapur ◽

Anusha Rashmi ◽

Harsha Acharya

Keyword(s):

Health Care ◽

Sample Size ◽

Waiting Time ◽

Client Satisfaction ◽

Care Delivery ◽

Tertiary Care ◽

Teaching Hospitals ◽

Cross Sectional ◽

Tertiary Care Centers

Abstract Background: Provision of services in line with the wishes and needs of patients is central to a human health care system .The hospital market has today as changed from a seller's market to a buyer's market and there is a need to improve the quality in the health care delivery. Client satisfaction is a key determinant of quality of care provided in health care centers. Objectives: To determine the client satisfaction among the patients attending tertiary care centers in Mangalore. Materials and Methodology: The study was a cross sectional study which was conducted among the clients attending five teaching hospitals in Mangalore. With 60% of client satisfaction obtained in our pilot study, the sample size was 384 and adding 20% for dropouts the total sample size came up to 462.The clients were selected randomly from each hospital. A pretested Proforma was used outside the hospital with strict confidentiality. Results: In our study we found that,87.6% of the clients felt that the clinic hours at health facility were adequate,79.3% felt health care was easily accessible,89.2% were happy with hygiene and comfort of waiting area. Average waiting time was 116mins.Only 45.4% could meet the same service provider in follow up visit and only 51.5% availed similar services as in the first visit in the follow up. Satisfaction with provider's skill and ability was seen in 82.5% of the clients. Only 69.2% of the clients were satisfied with the cost of services available. Conclusion: Our study revealed that waiting time was a major concern for the client's satisfaction.

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