Using shared goal setting to improve access and equity

a mixed methods study of the Good Goals intervention in children's occupational therapy

Niina Kolehmainen, Graeme Maclennan, Laura Ternent, Edward A S Duncan, Eilidh M Duncan, Stephen B Ryan, Lorna McKee, Jill Francis

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Abstract

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 at 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.
Original languageEnglish
Article number76
Number of pages11
JournalImplementation Science
Volume7
DOIs
Publication statusPublished - 16 Aug 2012

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Occupational Therapy
Salaries and Fringe Benefits
Quality Improvement
Focus Groups
Cost-Benefit Analysis
Odds Ratio
Research Personnel
Interviews
Costs and Cost Analysis
Research

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Using shared goal setting to improve access and equity : a mixed methods study of the Good Goals intervention in children's occupational therapy. / Kolehmainen, Niina; Maclennan, Graeme; Ternent, Laura; Duncan, Edward A S; Duncan, Eilidh M; Ryan, Stephen B; McKee, Lorna; Francis, Jill.

In: Implementation Science, Vol. 7, 76, 16.08.2012.

Research output: Contribution to journalArticle

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