Integrating an approach to personalised self-management support in stroke and neurorehabilitation service contexts: People1st – a quality improvement initiative

Abstract

Purpose

People living with stroke and neurological conditions access rehabilitation at different times but self-management is often viewed as what happens post-discharge. Personalised models that integrate self-management support within everyday care are now advocated but this may require practitioners to change their behaviour to adopt and sustain new ways of working. The People1st project evaluated integration of an existing Supported Self-Management programme (“Bridges”) across varied stroke and neurorehabilitation service contexts.

Materials and methods

Mixed-method evaluation of training for groups of healthcare practitioners across 24 UK National Health Service (NHS) Trusts, exploring how learning from Bridges was assimilated and enacted in practice, on an individual and collective basis.

Results

Staff growth in confidence and skill around supported self-management was demonstrated. Transformations to practice included changes to: the structure of, and language used in, patient interactions; induction/training processes to increase potential for sustainability; and sharing of successes. Bridges helped practitioners make changes that brought them closer to their professional ideals. Engaged leadership was considered important for successful integration.

Conclusions

Bridges was successfully integrated within a wide range of stroke and neurorehabilitation service contexts, enabled by an approach in line with practitioners’ values-based motivations. Further work is required to explore sustainability and impact on service users.

Implications for rehabilitation

• Personalised models of care and support for self-management are advocated for people living with stroke and neurological conditions; this requires practitioners to be supported to change behaviour and practices to adopt and sustain new ways of working.

• Staff from a wide variety of backgrounds in neurorehabilitation and stroke can learn collaboratively about self-management practices via the Bridges programme and can integrate those practices into their service contexts.

• Bridges can take practitioners closer to their professional ideals of caring and making a difference and empowers them to initiate change.

• Organisational commitment and engaged leadership are required to facilitate a culture of support for self-management in practice.

Keywords:

• Supported self-management
• rehabilitation
• interprofessional training
• neurorehabilitation
• stroke
• personalised care
• long-term conditions

Acknowledgements

We wish to thank all practitioners, service leads, and relevant NHS trust governance teams for their support for this initiative. We would like to acknowledge the team at HEE not only for funding this work, but for ongoing support throughout the project.

Disclosure statement

Professor Fiona Jones is the founder and CEO of Bridges Self-Management a social enterprise run in partnership with St Georges University of London and Kingston University. Dr Nicola Hancock and Julie Houghton have no competing interests to declare.

Additional information

Funding

This work was funded by Health Education England, HEE.