Abstract
Background: Research has demonstrated the importance of a patient-centred, interdisciplinary approach to shared decision-making in goal setting within rehabilitation, enhancing personalised care, reducing risks, and aligning treatment with patients’ needs. This approach promotes safer healthcare environments, increases patient motivation, and improves rehabilitation outcomes. The National Rehabilitation Hospital implemented a new goal-setting process to optimise patient care in specialised rehabilitation services in 2023. This study aimed to examine staff perceptions of the process, comparing differences between its initiation (T1) and one year post-implementation (T2), to assess its impact on care delivery and outcomes.
Approach: This study employed a mixed methods approach to explore staff experiences and perspectives on the implementation of a new patient-centred goal-setting process at its initiation (T1) and one year post-implementation (T2). Quantitative data were collected to assess staff attitudes, interdisciplinary collaboration, and evaluate the integration of the new process into routine practice. In addition, in-depth interviews were conducted to gain further insights into staff-perceived enablers, barriers, and the impact of the goal-setting process on patient care and teamwork across various rehabilitation specialties. Quantitative data were analysed using t-tests, while qualitative data were analysed using thematic analysis.
Results: In T1, 56 staff completed the survey, with 61 participating in T2. Results showed a slight increase in staff confidence and optimism between T1 and T2, alongside a significant decrease in team inclusion (from 87.5% to 75.4%, p < .05). Staff considered the process sustainable at both time points, with sense-making scores rising from 3.40 to 3.73. For the qualitative study, 15 staff members were interviewed in both T1 and T2, revealing mixed findings: at T1, staff viewed the process as positive and collaborative, though some felt it added to their workload and pressure. By T2, staff remained motivated, recognising the process’s benefits for patient care, though concerns about resources and team adaptation persisted.
Implications: Implementing quality improvement activity in a healthcare organisation, even though the participants see its value, is a difficult undertaking. The study identified staff experience of the implementation journey of this new goal setting process. Results illuminate challenges and strategies to implementing changes to goal setting within rehabilitation context. Findings will be used to inform implementation of other quality improvement activities within the hospital and further contribute to knowledge for rehabilitation practice.