Abstract
Background: Implementing a patient-centred, interdisciplinary approach to shared decision-making in goal setting is essential in rehabilitation, aligning care with patient needs, fostering safer environments, and boosting motivation. At the National Rehabilitation Hospital, Ireland (NRH), a new goal-setting process was introduced to improve care in specialised rehabilitation services, supported by a framework of system-wide governance and leadership. This study aimed to examine managers’ perspectives on the process one year post-implementation, specifically focusing on how their support and leadership strategies, within a broader organisational governance context, facilitated or impeded the integration of the process into routine rehabilitation patient care.
Approach: Semi-structured interviews with managers across units and disciplines provided insights into challenges faced, as well as the leadership’s role in aligning staff with this new, patient-centred rehabilitation goal setting process. Thematic analysis was used to identify how governance structures and leadership strategies influenced both engagement and barriers to the implementation.
Results: Nine managers participated, with an average age of 43.38 years (SD = 6.91) and 17.17 years (SD = 8.75) of experience at NRH. Both managers and staff demonstrated willingness to adopt the new process, yet described barriers to full implementation into daily rehabilitation routine care. Managers often expressed a sense of isolation, positioned between clinical staff and the interdisciplinary team advocating for the process. They highlighted the lack of clear authority or organisational support to enforce new goals, which limited their leadership capacity and created a passive role in implementation. While staff supported the patient-centred focus, they raised concerns over unrealistic patient expectations and time constraints, which managers were unable to address effectively due to limited systemic mechanisms. Despite these obstacles, managers valued the long-term potential of this patient-centred goal setting process, recognising the importance of sustained governance support to fully embed the process.
Implications: This study examined the role of leadership and governance in embedding patient-centred process within healthcare settings, with a particular focus on rehabilitation. Findings suggest that while managers recognise the benefits of interdisciplinary, patient-focused approaches, the long-term success of these initiatives depends on supportive governance structures, clear authority, and continuous leadership development. Insights from this study will inform ongoing quality improvement strategies at the NRH, supporting the development of governance frameworks that foster interdisciplinary teamwork in rehabilitation settings. These findings are also valuable for other rehabilitation providers, offering the strategies toward enhancing patient-centred quality improvements in other rehabilitation settings.