Implementation of a new goal-planning process in an intermediate neuro-rehabilitation unit

Purpose

It was recognised that the neuro-rehabilitation unit had a length of stay above the national average of 80 days. A new multidisciplinary goal planning process was implemented on the unit with the following aims; reduce length of stay to the national average; reduce the waiting list to 1 week; to consistently achieve greater than 70% patient and family/carer satisfaction.  The impact on the FIM/FAM outcome measure was monitored to ensure there were no adverse effects on patient outcome as a result of implementing the new process.

Approach

The new goal planning process was determined through liaison with the multi-disciplinary team. Regular meetings were held to maintain communication and information sharing to ensure the most appropriate process was determined and to ensure it was implemented as effectively and efficiently as possible. The process involved creation of new documentation, changes to the meeting frequency, format, timings and staff representation at these meetings.

A SWOT and team roles analysis was carried out to ensure the team were actively engaged in the new process and took ownership of it to ensure its success and effectiveness.

Outcomes

The project ensured a smooth integration of the new goal planning process whilst taking into account individual and team traits.

Regular and consistent communication ensured that the new goal planning process had been effectively implemented into practice.  It also ensured staff felt valued and engaged in the change process. 

Implications

Goal planning is recognised as an integral part of neuro-rehabilitation with multiple guidelines recommending its implementation within this area due to the increased effectiveness it produces on neuro-rehabilitation units. This new process will enable a more coordinated approach to rehabilitation maximising the unit´s effectiveness and efficiency and patient and family/carer satisfaction.

Following the implementation of this goal planning process alongside other changes such as the employment of a specialist rehabilitation nurse, length of stay has reduced to 75 days with patients waiting an average of 10 days to be admitted to the unit. Delayed discharges have reduced to 30 days and the overall number of patient episodes on the unit has increased by 51% per year.

Top three learning points

  1. The importance of forward planning and good communication with all involved when implementing a new process.
  2. The value a robust goal planning process can have on the efficiency and effectiveness of a neuro rehab unit.
  3. The importance of evaluating a new process following its implementation to ascertain if any adaptations are required and whether it is achieving its intended purpose.

Fund acknowledgements

Manchester University Hospitals NHS Foundation Trust University of Salford

Additional notes

This work was presented at Physiotherapy UK 2018 and was updated in December 2019.