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It's a challenge clinicians everywhere face: setting goals so patients are engaged and driving the process while all members of the care team are clear on what is trying to be achieved.
Mandy McGlynn, an advanced practice leader and physiotherapy practitioner, and 10 others from the the Toronto Rehab Musculoskeletal (MSK) inpatient unit, recently participated in a rapid improvement event (RIE) through Lean Process Improvement aimed at finding a solution to that problem.
They realized very quickly that everyone on the health-care team – physiotherapists, occupational therapists, therapy assistants, social workers, doctors and nurses – talked about goals. But no one used the official goal-setting form, which had been in place for a long time. So, they ripped it up.
"The most significant thing we did was challenging that form," said McGlynn. "Staff had been saying it didn't work for years, but it was so firmly entrenched in the way we operated that it was never challenged. Lean allowed us to start fresh and we came up with something that doesn't exist anywhere else. We went in with a clear goal and we achieved it. And, it's patient focused!"
Making it big
The team also realized that patients knew what their goal was, but most couldn't connect it back to the exercises they did with their therapists. The solution was to make that connection big and visible.
"Every piece of research says patients need to set goals," said McGlynn. "When they do, they're more engaged, they can connect difficult rehab exercises back to their goal and day-to-day tasks are more meaningful. We replaced the form with a poster and put it right at the end of their bed. It's easy for anyone to understand no matter their language, background or mental capacity."
"One of the nurses using the poster told me she
loved it,'" said McGlynn. "I'd never heard of that before, and it was a little thrilling. The new poster doesn't just work for providers; it works for the patients too. It's simple and valuable and it's not a load of extra work. I've never heard of anything like that before!"
Patients started using the form two days after the event ended and the feedback has been positive.
"I look at the poster every morning, not to remind myself what my goal is because I know I want to go home," said Jake Reynolds, an inpatient at Toronto Rehab. "I look at it to remind myself about the steps I need to take to get home and it helps me connect the exercises I'm doing back to my goal. I noticed my nurses have started using it to see what I'm working on too, which helps keep me motivated."