Goal-setting in Rehabilitation Services

Initiative Type
Service Improvement
Status
Deliver
Added
13 December 2018
Last updated
12 June 2019

Summary

Goal-setting is fundamental to rehabilitation practice and optimal patient outcomes. The National Stroke Foundation (NSF) guidelines recommend that clients should have the opportunity to participate in goal-setting processes. Whilst there are many goal-setting tools available to clinicians, choices and implementation standards have varied significantly. The National Safety and Quality Health Service (NSQHS) Standards focuses on ensuring that organisations use shared decision-making tools to help clients make decisions about their health and care and additionally use communication strategies that are tailored to the needs and preferences of the client.

Client centeredness has been shown to improve patient care experiences and create value for public services, through increasing quality and safety of health care and decreasing costs.

Hospital pressures to facilitate discharge and decrease length of stay have been identified by staff as barriers to implementing patient-centred goal-setting practice (Parsons et al). This has resulted in goal-setting often being hospital driven rather than patient driven. Furthermore, in a recent study by Rosewilliam et al (2016) “staff expressed a lack of knowledge of strategies or tools to implement patient-centred principles in care processes such as goal-setting”. There is a need to enable rehabilitation services to improve goal-setting models and client engagement in health care related goals and decisions.

Phase 1

The first phase of this project investigated current methods and tools used in adult rehabilitation settings to facilitate goal-setting. This was done through evaluation and review of the existing literature and completion of a scoping review of goal-setting methods currently being implemented across rehabilitation services within Queensland.

Phase 2

Moving forward from this, the project facilitated the development of goal-setting models, resources and implementation toolkits to support goal-setting in rehabilitation services across Queensland. These were developed through the use of co-design workshops with local staff and consumer feedback.

logan-rehabilitation-unit.jpg

Phase 3

A proof of concept trial has been carried out within selected hospital and health services to inform the ongoing development and refinement of the resources and contemporary rehabilitation goal-setting practices.

Phase 4

Alongside the proof of concept trial a process evaluation is being undertaken to inform future implementation of the goal-setting resources and strategies beyond the trial sites.

Phase 5

An evaluation of the outcome of the goal-setting resources and strategies will be undertaken in each site with longer term follow up to determine the sustainability of the goal-setting interventions.

Key dates
May 2017
Jun 2019
Implementation sites
Three sub-acute inpatient rehabilitation units and two community rehabilitation units have participated in this project.
Partnerships
This project is guided by the SRbCN Goal Setting Working Group and supported by researchers from Griffith University and La Trobe University.

Aim

The project will explore goal-setting methods identified within the literature as well as current goal-setting practices in Queensland rehabilitation services. This information will inform the development of resources to support and enable rehabilitation clinicians and services to embed innovative, best practice goal-setting processes as an integral component of contemporary rehabilitation practice.

Benefits

  • Improvement in person-centred, interdisciplinary goal-setting in rehabilitation.
  • Improved client engagement and experience in rehabilitation services.
  • Potential for improved rehabilitation outcomes

Background

In 2015 the Statewide Rehabilitation Clinical Network (SRbCN) Steering Committee consulted with the broader rehab network to identify key priorities for future development within Queensland Health rehabilitation services. After extensive feedback through forum workshops and surveys, “the use of goal-setting in rehabilitation” was identified as a key priority area for further exploration and development within the network.

In 2016 a working group was established to steer the activity of the network towards achieving its objectives related to goal-setting and subsequently goal-setting practice was one of the key topics on the agenda at the February 2017 Statewide Rehabilitation Clinical Network Forum. The goal-setting presentation and workshops were well received by the clinicians in attendance and anecdotally feedback suggested that further work was needed to support clinicians to implement the latest goal-setting practices within Queensland rehabilitation services. 

The primary goal of the project is to explore, develop and pilot new evidence based resources for person-centred, interdisciplinary goal-setting practice in rehabilitation services within Queensland Health. To date, this work has not been undertaken in Queensland and there appear scant "local" resources to support rehabilitation goal-setting in practice.

Solutions Implemented

The resources currently being developed and trialled within the project include:

  • Consumer videos informing clients about rehabilitation and goal-setting
  • Consumer held goal-setting record
  • Rehabilitation services brochures
  • Staff training modules
  • Meeting templates
  • Goal boards and action plans
  • Implementation toolkit
  • Talking Mats (below)

talking-mats-patients.jpg

Evaluation and Results

Results from the state-wide survey of goal setting practice in rehabilitation were presented as a poster at the 2018 AOCPMR conference in New Zealand.

Results of the project outcomes are currently being collated and will include perspectives of both staff and consumers in the evaluation.

Lessons Learnt

A process evaluation is being undertaken and the implementation toolkit being developed as part of the suite of resources will highlight barriers and enablers to implementing person-centred goal-setting practices moving forward. This will be available for sites to support rollout in other areas.

References

Australian Commission on Safety and Quality in health Care. Safety and Quality Improvement Guide Standard 2: Partnering with Consumers. (October 2012. Sydney. ACQSHC 2012.
Holliday, R. C., Antoun, M., & Playford, E. D. (2005). A survey of goal-setting methods used in rehabilitation. Neurorehabil Neural Repair, 19(3), 227-231. doi:10.1177/1545968305279206
Holliday, R. C., Ballinger, C., & Playford, E. D. (2007). Goal-setting in neurological rehabilitation: patients' perspectives. Disability & Rehabilitation, 29(5), 389-394. 
Holliday, R. C., Cano, S., Freeman, J. A., & Playford, E. D. (2007). Should patients participate in clinical decision making? An optimised balance block design controlled study of goal-setting in a rehabilitation unit. J Neurol Neurosurg Psychiatry, 78(6), 576-580. doi:10.1136/jnnp.2006.102509
Leach, E., Cornwell, P., Fleming, J., & Haines, T. (2010). Patient centered goal-setting in a subacute rehabilitation setting. Disability & Rehabilitation, 32(2), 159-172. doi:10.3109/09638280903036605
Levack, W. M., Weatherall, M., Hay-Smith, E. J., Dean, S. G., McPherson, K., & Siegert, R. J. (2015). Goal-setting and strategies to enhance goal pursuit for adults with acquired disability participating in rehabilitation. Cochrane Database Syst Rev(7), CD009727. doi:10.1002/14651858.CD009727.pub2
National Stroke Foundation. Clinical Guidelines for Stroke Management. 2010. Melbourne Australia
Prescott, S., Fleming, J., & Doig, E. (2015). Goal-setting approaches and principles used in rehabilitation for people with acquired brain injury: A systematic scoping review. Brain Inj, 29(13-14), 1515-1529. doi:10.3109/02699052.2015.1075152
Rose, A., Rosewilliam, S., & Soundy, A. (2017). Shared decision making within goal-setting in rehabilitation settings: A systematic review. Patient Educ Couns, 100(1), 65-75. doi:10.1016/j.pec.2016.07.030
Seigert R, Levack W (2015) Rehabilitation Goal-setting: Theory, Practice and Evidence. CRC Press, Taylor & Francis Group. 
Scobbie, L., Duncan, E. A., Brady, M. C., & Wyke, S. (2015). Goal-setting practice in services delivering community-based stroke rehabilitation: a United Kingdom (UK) wide survey. Disabil Rehabil, 37(14), 1291-1298. doi:10.3109/09638288.2014.961652
Scobbie, L., Wyke, S., Dixon, D., Brady, M., & Duncan, E. (2015). Theory-Based Approach to Goal-setting. Physikalische Medizin, Rehabilitationsmedizin, Kurortmedizin, 25(03). doi:10.1055/s-0035-1554826

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Key contact

Rachel Olorenshaw
Rehabilitation Network Coordinator
Healthcare Improvement Unit
(07) 3328 9124
Statewide_Rehab_Network@health.qld.gov.au