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.
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.
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.
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.
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.
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.