Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention in children's occupational therapy
AuthorKolehmainen, N; MacLennan, G; Ternent, L; Duncan, EAS; Duncan, EM; Ryan, SB; McKee, L; Francis, JJ
Source TitleImplementation Science
PublisherBIOMED CENTRAL LTD
University of Melbourne Author/sFrancis, Jillian
AffiliationMelbourne School of Health Sciences
Document TypeJournal Article
CitationsKolehmainen, N., MacLennan, G., Ternent, L., Duncan, E. A. S., Duncan, E. M., Ryan, S. B., McKee, L. & Francis, J. J. (2012). Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention in children's occupational therapy. IMPLEMENTATION SCIENCE, 7 (1), https://doi.org/10.1186/1748-5908-7-76.
Access StatusOpen Access
BACKGROUND: Access and equity in children's therapy services may be improved by directing clinicians' use of resources toward specific goals that are important to patients. A practice-change intervention (titled 'Good Goals') was designed to achieve this. This study investigated uptake, adoption, and possible effects of that intervention in children's occupational therapy services. METHODS: Mixed methods case studies (n = 3 services, including 46 therapists and 558 children) were conducted. The intervention was delivered over 25 weeks through face-to-face training, team workbooks, and 'tools for change'. Data were collected before, during, and after the intervention on a range of factors using interviews, a focus group, case note analysis, routine data, document analysis, and researchers' observations. RESULTS: Factors related to uptake and adoptions were: mode of intervention delivery, competing demands on therapists' time, and leadership by service manager. Service managers and therapists reported that the intervention: helped therapists establish a shared rationale for clinical decisions; increased clarity in service provision; and improved interactions with families and schools. During the study period, therapists' behaviours changed: identifying goals, odds ratio 2.4 (95% CI 1.5 to 3.8); agreeing goals, 3.5 (2.4 to 5.1); evaluating progress, 2.0 (1.1 to 3.5). Children's LoT decreased by two months [95% CI -8 to +4 months] across the services. Cost per therapist trained ranged from £1,003 to £1,277, depending upon service size and therapists' salary bands. CONCLUSIONS: Good Goals is a promising quality improvement intervention that can be delivered and adopted in practice and may have benefits. Further research is required to evaluate its: (i) impact on patient outcomes, effectiveness, cost-effectiveness, and (ii) transferability to other clinical contexts.
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