Clinicians’ actions associated with the successful patient care process: a content analysis of interviews with paediatric occupational therapists

Abstract

Purpose: Clinicians’ actions impact the patient care process and pathway. This study identified clinicians’ actions associated with successful care processes in one community healthcare setting, children’s occupational therapy. Method: A secondary analysis in a form of a quantitative content analysis was conducted of 47 interview transcripts, describing outcomes and therapists’ (n = 25) self-reported actions in 25 “successful” and 22 “unsuccessful” care processes. The successful processes were those with positive outcomes (clear and coherent process with easy discharge; achieved patient goals and positive patient–clinician relationships). The transcripts were coded for presence of therapists’ actions and non-actions using content analysis; and actions associated with success of the process were identified by Pearson Chi-square test. Results: In total 207 actions were identified. These clustered around six areas: assessment, setting goals and planning actions, treatment, review, discharging, and managing processes and relationships. The key actions associated with successful processes were: gather perspectives from others at assessment (χ² = 6.65, p < 0.01); identify therapy goals (13.16, p < 0.01); agree/communicate plans, roles and responsibilities (9.10, p < 0.01); involve the child and parents in treatment (6.36, p = 0.01); adapt physical environment (6.01, p = 0.01) and make comparisons between the baseline, current and target levels when reviewing progress (6.36, p = 0.01). Conclusions: The actions identified are congruent with literatures about patient involvement and goal achievement. Specific hypotheses about the mechanisms by which the identified actions may relate to care process are presented.

Implications for Rehabilitation

• Clinicians’ specific actions are related to success in the patient care process.

• Identifying, agreeing and using goals to direct the care is related to success.

• Actively involving patients and their family – especially in goal setting, action planning and treatment – is also related to success.

Keywords::

• Care pathway
• children
• goal setting
• occupational therapists
• professionals’ practice
• quality of care

Acknowledgements

The authors would like to thank the therapists who had provided the data in the primary study; Dr Justin Presseau for double coding a proportion of the transcripts; and Occupational Therapists Jo Thomas and Alison Elder for providing further insights by commenting on the coding structure.

Declaration of Interest: The authors report no conflicts of interest. The study was funded by the Scottish Government Chief Scientist Office (ref: CZF/1/38). The authors accept full responsibility for the manuscript. Funders were not involved in the conduct of the study or preparation of the manuscript.