Implementing a tailored, co-designed goal-setting implementation package in rehabilitation services: a process evaluation

Abstract

Purpose

This study aims to evaluate the process of implementing an evidence-based goal-setting package into five rehabilitation services across the continuum of rehabilitation.

Materials and methods

This study used a mixed methods approach guided by Medical Research Council (MRC) recommendations for conducting process evaluations, the RE-AIM framework, and the Theoretical Domains Framework (TDF). This study will evaluate the reach, adoption, implementation, and maintenance of the goal-setting package over six months.

Results

Environmental context and resources, the clinician’s social and professional role and identity, social influences and clinician beliefs about goal-setting consequences and individuals’ capabilities were all identified as barriers or enablers throughout the implementation process. Community rehabilitation services faced challenges implementing paper-based resources, whilst inpatient rehabilitation sites faced challenges engaging nursing staff in the interdisciplinary approach to goal-setting. Social influences were an enabler in two sites that used the case conference format to facilitate setting common goals. Clinicians in all sites continued to express difficulties implementing shared decision-making with people who had cognitive impairments or were no longer progressing in their rehabilitation.

Conclusions

A team-based approach to implementing the goal-setting interventions centred around the case conference format appeared to be the most successful mode for implementing interdisciplinary person-centred goal-setting.

IMPLICATIONS FOR REHABILITATION

• The rehabilitation case conference forum can be used to facilitate teams to set interdisciplinary common goals.

• Rehabilitation teams should add further consideration to how they can involve clients as a member of the rehabilitation team throughout the rehabilitation process.

• Embedding changes into existing process and using structured templates and tools can enhance the process of goal-setting in rehabilitation.

• Strong leadership, dedicated facilitation, audit and feedback can enhance team’s success in implementing elements of the goal-setting implementation package.

Keywords:

• Decision making shared
• goals
• implementation
• occupational therapy
• physical therapy
• rehabilitation

Acknowledgements

The authors acknowledge the Queensland Statewide Rehabilitation Clinical Network for funding this research project and the goal-setting working group for their clinical advice and guidance. NAL is supported by the National Heart Foundation of Australia Future Leader Fellowship (102055).

Disclosure statement

The authors report that there are no competing interests to declare.

Additional information

Funding

This work was supported by Clinical Excellence Queensland.