Implementation of best practice goal-setting in five rehabilitation services: A mixed-methods evaluation study

Abstract

Objective: This implementation study aimed to enhance the key elements of clinical practice goal-setting across 5 rehabilitation services. Design: This study followed a participatory action research approach guided by the Knowledge to Action framework. Methods: Medical record audits and structured client interviews were conducted prior to and following 12 weeks of implementation, in order to evaluate the success of the goal-setting implementation package. Results: Medical record audits and interviews conducted pre-implementation (audits n = 132, interviews n = 64), post-implementation (audits n = 130, interviews n = 56) and at 3-month follow-up (audits n = 30) demonstrated varied success across sites. Following implementation 2 sites significantly improved their common goal focus (site 1 p ≤ 0.001, site 2 p = 0.005), these sites also demonstrated a significant increase in clients reporting that they received copies of their rehabilitation goals (site 1 p ≤ 0.001, site 2 p ≤ 0.001). Four sites improved client action planning, feedback and review, and 3 sites enhanced their specificity of goal-setting. At 3-month follow-up 4 sites had continued to improve their common goal focus; however, all sites decreased the specificity of their goal-setting. Conclusion: Elements of the implementation package were successful at enhancing the goal-setting process; however, how the package is implemented within the team may impact outcomes. LAY ABSTRACT There are 4 important elements of goal-setting in rehabilitation: including the client; having a team focus on common goals; setting specific and meaningful goals; and including action planning feedback and review of goals. A goal-setting package was developed to assist healthcare workers to complete all important elements of goal-setting. This study aimed to evaluate the use of the goal-setting package in 5 rehabilitation services. Client medical records were reviewed and interviews with clients were undertaken to evaluate the success of the goal-setting package. In 2 sites, using the goal-setting package resulted in a significant increase in establishing common goals among the client and team and providing written information to clients about their goals. More action plans were developed to assist clients to work towards goals at 4 sites, whilst 3 sites improved in terms of setting more specific goals.

Keywords

• behaviour change
• shared decision-making
• goals
• implementation science
• stroke rehabilitation