Implementing a 6-day physiotherapy service in rehabilitation: exploring staff perceptions
Erin L. Caruana A B D , Suzanne S. Kuys C , Jane Clarke C and Sandra G. Brauer AA School of Health and Rehabilitation Sciences, University of Queensland, St Lucia, Qld, 4072, Australia. Email: s.brauer@uq.edu.au
B St Andrew’s War Memorial Hospital, Physiotherapy Department, 457 Wickham Terrace, Spring Hill, Qld, 4001, Australia.
C School of Physiotherapy, Australian Catholic University, 1100 Nudgee Rd, Banyo, QLD, 4014, Australia. Email: suzanne.kuys@acu.edu.au; jane.clarke@acu.edu.au
D Corresponding author. Email: e.caruana@uq.edu.au
Australian Health Review 43(1) 29-35 https://doi.org/10.1071/AH17107
Submitted: 11 August 2016 Accepted: 28 September 2017 Published: 20 November 2017
Abstract
Objective Australian weekend rehabilitation therapy provision is increasing. Staff engagement optimises service delivery. The present mixed-methods process evaluation explored staff perceptions regarding implementation of a 6-day physiotherapy service in a private rehabilitation unit.
Methods All multidisciplinary staff working in the rehabilitation unit were surveyed regarding barriers, facilitators and perceptions of the effect of a 6-day physiotherapy service on length of stay (LOS) and patient goal attainment at three time points: before and after implementation, as well as after modification of a 6-day physiotherapy service. Descriptive statistics and thematic analysis was used to analyse the data.
Results Fifty-one staff (50%) responded. Before implementation, all staff identified barriers, the most common being staffing (62%) and patient selection (29%). After implementation, only 30% of staff identified barriers, which differed to those identified before implementation, and included staff rostering and experience (20%), timing of therapy (10%) and increasing the allocation of patients (5%). Over time, staff perceptions changed from being unsure to being positive about the effect of the 6-day service on LOS and patient goal attainment.
Conclusion Staff perceived a large number of barriers before implementation of a 6-day rehabilitation service, but these did not eventuate following implementation. Staff perceived improved LOS and patient goal attainment after implementation of a 6-day rehabilitation service incorporating staff feedback.
What is known about this topic? Rehabilitation weekend services improve patient quality of life and functional independence while reducing LOS.
What does this study add? Staff feedback during implementation and modification of new services is important to address potential barriers and ensure staff satisfaction and support.
What are the implications for practitioners? Staff engagement and open communication are important to successfully implement a new service in rehabilitation.
Additional keywords: process evaluation, staff perspectives, weekend physiotherapy.
References
[1] McCluskey A, Vratsistas-Curto A, Schurr K. Barriers and enablers to implementing multiple stroke guideline recommendations: a qualitative study. BMC Health Serv Res 2013; 13 323–35.| Barriers and enablers to implementing multiple stroke guideline recommendations: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
[2] Wong Shee A, Phillips B, Hill K, Dodd K. Feasibility and acceptability of a volunteer-mediated diversional therapy program for older patients with cognitive impairment. Geriatr Nurs 2014; 35 300–5.
| Feasibility and acceptability of a volunteer-mediated diversional therapy program for older patients with cognitive impairment.Crossref | GoogleScholarGoogle Scholar |
[3] Melton HL, Hartline MD. Customer and frontline employee influence on new service development performance. J Serv Res 2010; 13 411–25.
| Customer and frontline employee influence on new service development performance.Crossref | GoogleScholarGoogle Scholar |
[4] Yang Y, Lee PKC, Cheng TCE. Continuous improvement competence, employee creativity, and new service development performance: a frontline employee perspective. Int J Prod Econ 2016; 171 275–88.
| Continuous improvement competence, employee creativity, and new service development performance: a frontline employee perspective.Crossref | GoogleScholarGoogle Scholar |
[5] Donaldson A, Finch CF. Planning for implementation and translation: seek first to understand the end-user’s perspective. Br J Sports Med 2012; 46 306–7.
| Planning for implementation and translation: seek first to understand the end-user’s perspective.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BC38zmsF2gsA%3D%3D&md5=2398f943d6a40df9ed84a0d837192bd9CAS |
[6] Kotter JP, Schlesinger LA. Choosing strategies for change. Harv Bus Rev 1979; 57 106–14.
| 1:STN:280:DyaE1M7gvVemsQ%3D%3D&md5=0c4ff1f1abb3785729749ade90ac8955CAS |
[7] Ellard DR, Thorogood M, Underwood M, Seale C, Taylor SJC. Whole home exercise intervention for depression in older care home residents (the OPERA study): a process evaluation. BMC Med 2014; 12 1
| Whole home exercise intervention for depression in older care home residents (the OPERA study): a process evaluation.Crossref | GoogleScholarGoogle Scholar |
[8] Peiris CL, Shields N, Brusco NK, Watts JJ, Taylor NF. Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomised controlled trial [published erratum appears in BMC Med 2013; 11: 262]. BMC Med 2013; 11 198–208.
| Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomised controlled trial [published erratum appears in BMC Med 2013; 11: 262].Crossref | GoogleScholarGoogle Scholar |
[9] Peiris CL, Taylor NF, Shields N. Additional Saturday allied health services increase habitual physical activity among patients receiving inpatient rehabilitation for lower limb orthopaedic conditions: a randomised control trial. Arch Phys Med Rehabil 2012; 93 1365–70.
| Additional Saturday allied health services increase habitual physical activity among patients receiving inpatient rehabilitation for lower limb orthopaedic conditions: a randomised control trial.Crossref | GoogleScholarGoogle Scholar |
[10] DiSotto-Monastero M, Chen X, Fisch S, Donaghy S, Gomez M. Efficacy of 7 day per week inpatient admissions and rehabilitation therapy. Arch Phys Med Rehabil 2012; 93 2165–9.
| Efficacy of 7 day per week inpatient admissions and rehabilitation therapy.Crossref | GoogleScholarGoogle Scholar |
[11] Brusco NK, Shields N, Taylor NF, Paratz J. A Saturday physiotherapy service may decrease length of stay in patients undergoing rehabilitation in hospital: a randomised control trial. Aust J Physiother 2007; 53 75–81.
| A Saturday physiotherapy service may decrease length of stay in patients undergoing rehabilitation in hospital: a randomised control trial.Crossref | GoogleScholarGoogle Scholar |
[12] Moore G, Audrey S, Barker M, Bond L, Bonell C, Cooper C, Hardeman W, Moore L, O’Cathain A, Tinati T, Wight D, Baird J. Process evaluation in complex public health intervention studies: the need for guidance. J Epidemiol Community Health 2014; 68 101–2.
| Process evaluation in complex public health intervention studies: the need for guidance.Crossref | GoogleScholarGoogle Scholar |
[13] Munro A, Bloor M. Process evaluation: the new miracle ingredient in public health research? Qual Res 2010; 10 699–713.
| Process evaluation: the new miracle ingredient in public health research?Crossref | GoogleScholarGoogle Scholar |
[14] Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, Moore L, O’Cathain A, Tinati T, Wight D, Baird J. Process evaluation of complex interventions: Medical Research Council guidelines. BMJ 2015; 350 h1258
| Process evaluation of complex interventions: Medical Research Council guidelines.Crossref | GoogleScholarGoogle Scholar |
[15] Caruana EL, Kuys SS, Clarke J, Brauer SG. A pragmatic implementation of a 6-day physiotherapy service in a mixed inpatient rehabilitation unit. Disabil Rehabil 2017; 39 1738–43.
| A pragmatic implementation of a 6-day physiotherapy service in a mixed inpatient rehabilitation unit.Crossref | GoogleScholarGoogle Scholar |
[16] McCluskey A, Cusick A. Strategies for introducing evidence-based practice and changing clinical behaviour: a manager’s toolbox. Aust Occup Ther J 2002; 49 63–70.
| Strategies for introducing evidence-based practice and changing clinical behaviour: a manager’s toolbox.Crossref | GoogleScholarGoogle Scholar |
[17] Waddell D, Sohal AS. Resistance: a constructive tool for change management. Manage Decis 1998; 36 543–8.
| Resistance: a constructive tool for change management.Crossref | GoogleScholarGoogle Scholar |
[18] Hayward KS, Kuys SS, Barker RN, Brauer SG. Clinically important improvements in motor function are achievable during inpatient rehabilitation by stroke patients with severe motor disability: a prospective observational study. NeuroRehabilitation 2014; 34 773–9.
[19] Reistetter TA, Graham JE, Deutsch A, Granger CV, Markello S, Ottenbacher KJ. Utility of functional status for classifying community versus institutional discharges after inpatient rehabilitation for stroke. Arch Phys Med Rehabil 2010; 91 345–50.
| Utility of functional status for classifying community versus institutional discharges after inpatient rehabilitation for stroke.Crossref | GoogleScholarGoogle Scholar |
[20] Heinemann AW, Linacre JM, Wright BD, Hamilton BB, Granger C. Prediction of rehabilitation outcomes with disability measures. Arch Phys Med Rehabil 1994; 75 133–43.
| 1:STN:280:DyaK2c7ksFejtQ%3D%3D&md5=507385592010cde0bc7651c6ce89e970CAS |
[21] Kuys SS, Burgess K, Fleming J, Varghese P, McPhail SM. Evidence of improved efficiency in functional gains during subacute inpatient rehabilitation. Am J Phys Med Rehabil 2016; 95 800–8.
| Evidence of improved efficiency in functional gains during subacute inpatient rehabilitation.Crossref | GoogleScholarGoogle Scholar |
[22] Brusco NK, Watts JJ, Shields N, Taylor N. Are weekend inpatient rehabilitation services value for money? An economic evaluation alongside a randomized controlled trial with a 30 day follow up. BMC Med 2014; 12 89–99.
| Are weekend inpatient rehabilitation services value for money? An economic evaluation alongside a randomized controlled trial with a 30 day follow up.Crossref | GoogleScholarGoogle Scholar |
[23] Fontaine P, Jacques J, Gillian D, Sermeus W, Kolh P, Gillet P. Assessing the causes inducing lengthening of hospital stays by means of the Appropriateness Evaluation Protocol. Health Policy 2011; 99 66–71.
| Assessing the causes inducing lengthening of hospital stays by means of the Appropriateness Evaluation Protocol.Crossref | GoogleScholarGoogle Scholar |
[24] McDonagh MS, Smith DH, Goddard M. Measuring appropriate use of acute beds: a systematic review of methods and results. Health Policy 2000; 53 157–84.
| Measuring appropriate use of acute beds: a systematic review of methods and results.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M%2Fgslylug%3D%3D&md5=3e7656d410b0eddc9196c8f2c8802503CAS |
[25] Gonçalves-Bradley DC, Lannin NA, Clemson LM, Cameron ID, Shepperd S. Discharge planning from hospital. Cochrane Database Syst Rev 2016; CD000313
| Discharge planning from hospital.Crossref | GoogleScholarGoogle Scholar |
[26] Baruch Y. Response rates in academic studies: a comparative analysis. Hum Relat 1999; 52 421–38.
| Response rates in academic studies: a comparative analysis.Crossref | GoogleScholarGoogle Scholar |
[27] Cook C, Heath F, Thompson RL. A meta-analysis of response rates in web- or Internet-based surveys. Educ Psychol Meas 2000; 60 821–36.
| A meta-analysis of response rates in web- or Internet-based surveys.Crossref | GoogleScholarGoogle Scholar |
[28] Porter SR. Raising response rates: what works? New Dir Institutional Res 2004; 2004 5–21.
| Raising response rates: what works?Crossref | GoogleScholarGoogle Scholar |
