Interdisciplinary Teamwork: A Mixed Methods Approach to Patient-Centred Goal Orientated Care

Research has promoted the value of person-orientated care & interdisciplinary teamworking (IDT), yet they are not consistently implemented in clinical practice. Patients involved in their own goal setting experience greater improvements in functioning, and they prefer a shared decision-making approach to goal setting. This fosters a culture that supports knowledge translation and change management by enhancing patient communication & individualized care planning. Introduction of an IDT process comes as most goal setting in rehab care is multidisciplinary in nature, therefore this shift represents the blurring of disciplinary boundaries to develop joint service plans and complete shared goals. Introducing a new interdisciplinary, person-centred goal setting to a rehabilitation service offers an opportunity to gain insight into the barriers of implementing and normalising this process in complex services. Researchers used a mixed-methods approach to capture patient and staff experiences and perspectives of a new goal setting process. Staff data was collected via self-report measures at 3 time-points; pre, during, and post implementation process, and through interviews at the final stage. The staff surveys included the Interprofessional Socialisation and Valuing Scale ISVS-9B, measuring interprofessional socialisation and readiness to function in teams, and the NoMAD (Normalisation Measure Development Questionnaire), which measures the normalisation of complex healthcare interventions. Patient data was collected after their goal setting meeting. A semi-structured interview followed midway through their admission in the hospital. The patient survey included the C-Cogs (Client-Centredness of Goal Setting), measuring client-centredness of goal planning, and CollaboRATE, measuring the shared decision-making patients experienced following their goal planning meeting.In total, 133 participants took part in the surveys. 121 staff members completed the survey at least once. At Time 1, 76.9% of staff reported feeling part of the unit team, while at Time 3, this rose to 86.7%. Interviews with 15 staff revealed they viewed the new process as an opportunity for change, and to learn from and work with other disciplines to enhance their ability to deliver patient-centred care. Contrastingly, some felt the burden of a changed process on an increasingly stressed team that continued to face staff shortages & annual leaves. Six patients took part in the interview, and 12 in the survey. There was an overwhelmingly positive response from patients regarding their goal setting experience. Patients noted that they felt grateful for their opportunity to be treated in the hospital. Staff were a source of support which helped patients grow in their beliefs that they could achieve future goals they set for themselves. Goals were discussed regularly, patients felt listened to and included in the process, and empowered to continue in their rehab by their team who provided guidance and reassurance. The study aims to represent a holistic view of the patient and staff experience of the goal setting process. Results illuminate challenges and potential solutions to implementing changes to goal setting within this context. Findings will be used to inform implementation within the hospital and further contribute to knowledge for rehabilitation practice around developing IDT person centred goal-oriented care.