Download presentation
Presentation is loading. Please wait.
Published byDaniella Sutton Modified over 6 years ago
1
Bridges through the stroke pathway The Bridges Kingston Project
06/12/2018 Bridges through the stroke pathway The Bridges Kingston Project Nicki Bailey Project Coordinator – Bridges Kingston Project
2
What is Bridges? A quick reminder…
06/12/2018 What is Bridges? A quick reminder… Workshops for practitioners Stroke workbook given to clients Individualised self-management programme Would imagine everyone knows this already…. By the fact they are here… so probably don’t need to go through it… just a quick reminder Individualised self-management programme for stroke survivors Aims to provide stroke survivors with opportunity to develop their self-management skills Originally conceived by Dr Fiona Jones, 2005. Preliminary testing showed significant change in self efficacy, improved activity, participation and mood in all participants Developed, ongoing evaluation since then. Used to be called Stepping Out 2 main components: 2 workshops for practitioners – 1 introduction, 1 follow-up. Learn skills, theory and research relevant to stroke management Practice and discuss how to use Bridges approach one-to-one with stroke survivors in practice Stroke workbook, given to clients Client-held, personalised, interactive workbook, which practitioners can use to work with stroke survivors to support their self-management Includes stories and strategies of other stroke survivors, and also a place for the person you are working with to record their personal targets and successes Workbook designed and tested in consultation with stroke survivors Now on the 4th version – continually revised
3
The Bridges Kingston Project
06/12/2018 The Bridges Kingston Project South-West London Academic Health and Social Care System Pilot: First time social care practitioners included Training members of different teams in mixed workshops Objectives: Enable greater focus on promoting self-management throughout the stroke pathway Improve continuity of care for stroke survivors in Kingston Improve knowledge sharing and cross team working between teams on Kingston stroke pathway Conduct an evaluation of the project Funded by SWL AHSN Wanted to fund a project straddling health and social care. Also to bring Bridges training to Kingston (as staff in surrounding boroughs already been trained) First time social care practitioners joining in the training – previously just health professionals Also one of the first times trained members of different teams working along the stroke pathway in the same workshop OBJECTIVES Greater focus on self-management throughout pathway Improve continuity of care – particularly by including social care and voluntary sector teams Improve knowledge sharing and cross team working – by mixing teams together for training workshops, and including an exercise on using Bridges throughout the stroke pathway Project also includes an evaluation of how well project has met its objectives Evaluation Objectives of evaluation: Evaluate change in staff beliefs and attitudes to self-management Evaluate staff and patients’ experiences of using the Bridges programme Evaluate change in cross-team working and knowledge sharing throughout Kingston stroke pathway Evaluate social care practitioners experience of the programme, and identify adaptations required to better meet the needs of their service users Data collection methods: Contextual mapping of teams involved in stroke pathway in Kingston Short interviews with team members before and after workshops, about cross-team working and knowledge sharing in Kingston Questionnaires completed before and after workshops, evaluating participants’ change in beliefs, knowledge and practice of self-management Case reflections undertaken by staff of their experiences using the workbook with patients Participants asking patients about their experiences of using Bridges Make use of any patient satisfaction mechanisms already in place
4
Context Mapping & Preparations
06/12/2018 Context Mapping & Preparations Project steering group Interviews with teams Role of service Current goal-setting practices Approaches to self-management Cross-team working within pathway Adaptations to training Kingston pathway specific ‘Pathway’ exercise Awareness raising of the project HASU St Georges (20 beds) STROKE UNIT Kingston Hospital (20 beds) Home with Community Rehab: ICT, Richmond CNRT Home with no support required In-patient Rehab eg Cedars Unit, QMH Community Resources RBK Social work input/ care package/ individual budget Input from RBK Stroke Co- coordinator Input from voluntary organisations and/ private organisations Steering group – head of each team working on stroke in Kingston pathway. Agreed on project and evaluation objectives before going ahead. Interviews with teams: Garnered info from services about self-management, goal setting etc. (To use as a baseline and to make adaptations to training) Adaptations: Used info to adapt workshops to make them Kingston pathway specific, and added in exercise to get participants to think about how they might use Bridges throughout the pathway Gave various presentations, and sat in on meetings - Awareness raising about the training and evaluation
5
The Kingston Stroke Pathway
06/12/2018 The Kingston Stroke Pathway QMH and Richmond CNRT – not part of Royal Borough of Kingston Richmond CNRT have been trained. Voluntary orgs: Dyscover; Stroke Association Crescent Resource Centre = part of RBK
6
Who participated? 54 participants completed intro & follow up
06/12/2018 Who participated? 54 participants completed intro & follow up Mix of teams and professions BUT social care restructure Executive session for GPs and managers 4 workshops, tried to have a quota system, so certain number of practitioners from each team were sent 66 participants attended initial workshops; 54 completed the follow up as well For the most part, managed to get a mix of professions and teams in each workshop BUT social care going through a restructure so couldn’t attend workshops when initially planned. Luckily SWLAHSCN funded a fourth workshop, but this was mostly SCWs, and there weren’t many SCWs in first 3 workshops. Less mixing than intended. Graphs show mix of professions and mix of teams. Decided to hold a 2 hour session for managers and local GPs, who didn’t have time to attend training, and were unlikely to be using workbook hands on with patients, but important to get their buy in. GPs very positive about it.
7
Results: Change in Practice
06/12/2018 Results: Change in Practice Overall change in beliefs and attitude towards self-management 53% thought their practice had changed 28% used workbook “It’s like a refresher. It reminds us about giving people hope, listening to people’s goals” “I think it’s ended up this new thing, rather than just chatting to patients about goals, actually putting it down to make it a more visual tool” Questionnaire results showed change in beliefs and attitudes towards self-management – point system. Most notable change amongst rehab assistants and then physios. Team-wise: reablement team, then voluntary sector. 53% thought their practice had changed. Highest reported change amongst Cedar Unit (83%), lowest in ICT (33%). Participants talked about Bridges being a refresher – reminding them of principles they already knew. Also talked about the workbook being a tool they could use for goal setting 15 participants (28%) reported using the workbook between intro and follow up workshops. 11 of these were physios and OTs. Team with most usage was the acute team, which is interesting as a recent study of 60 case reflections from other workshops suggested that practitioners often felt it was too early to use Bridges in the acute setting. However, maybe because have most stroke patients of all the teams interviewed.
8
Results: Barriers to using Bridges
06/12/2018 Results: Barriers to using Bridges Not enough time Difficult when patient has communication difficulties Not enough stroke patients Environment wasn’t right (eg. Acute, short stay) 55% experienced barriers to using Bridges. The top 4 : Due to heavy workload, not enough time allocated to each patient Didn’t feel it was appropriate to use workbook with patients with communication difficulties Didn’t see enough stroke patients Environment wasn’t right (eg. Short stay, acute
9
Results: Cross team training
06/12/2018 Results: Cross team training 99% said workshops enabled meeting people from other teams 19% felt team better connected (49% not sure) “I think it’s that connection having met them – oh yeah, you were on the training – on the telephone I just feel there is more of a connection there now” “It’s actually opened my eyes a bit to the pathway and how it all links together” HOWEVER “It was interesting to meet people from other teams. But I don’t think there’ll be a lasting link.” Only 19% felt teams were better connected. Reasons given for why not, were that teams were already well connected, and participants hadn’t YET seen much evidence of Bridges having been used throughout the pathway. In qualitative interviews, all participants felt it was beneficial to mix the teams, and some would have liked to have seen more of a mix Positive comments were: However, there was a question about sustainability of the links which were created
10
Results: Bridges within the stroke pathway
06/12/2018 Results: Bridges within the stroke pathway 78% thought could be used successfully throughout pathway Potential to improve continuity of care for patients in 3 ways: Shared ethos Provides practitioners in all teams with “some kind of shared ethos or philosophy to dip into” Continuity of goals “The patient isn’t going to have to start the whole goal setting process again, but has got a record, of ‘I’ve been working on this, I’ve achieved this.” Strengthened connections “It’s helped in liaising with the referrers...if they are referring from the Hospital we’ve mentioned oh what about the Bridges workbook... it’s a tool to help with that process of linking in.” 78% thought could be used successfully throughout pathway because: - Facilitate consistency as all working towards self-management (better handovers with workbook, consistency in approach to goal-setting, more continuous support for patients) - Improve communication between teams Interviewed participants enthusiastic about Bridges potential to improve continuity of care along the stroke pathway. Three main reasons were given for this. Shared ethos: even for those who knew, refreshed their principles, reminded them. And put everyone on the same page about self-management. Continuity of goals: Patient held handbook means that patients have a record of goals they have set, they have decided on. They have therefore more control over what they work towards, and their goals do not change with every new practitioner. Strengthened connections between teams: As met people from different teams, hopefully better connection with these people, more familiar. And can always ask about Bridges when referring between teams – workbook as a patient-held link.
11
Results: Is Bridges relevant to social work?
06/12/2018 Results: Is Bridges relevant to social work? Bridges seen as “a good fit” with social work practice because: 1) Social workers already trained in ‘social model of disability’ “Responses were a lot more around empowerment and less risk averse” 2) Often stroke survivors have most difficulty once at home, outside of medical setting “He said ‘Actually things are more difficult than I’d hoped’... He’s using Bridges as a way of looking at how he can get back to activities he used to do before” 3) Bridges goal setting corresponds well with current social care practices (individual budgets, support plans) “Bridges can be part of that support plan, as it is looking at what are their long-term goals and steps to work towards that” Example given by observer of the workshop. Famous example of Jerry, who wants to be able to drive. Health care practitioners tended to say they would steer him away from unrealistic goal. SCWs would sit in the car with him and talk through how he’s going to do it. Possibly as further along process, so know what its like when people are back at home, and what’s available for them in the community. Actually at home for much longer, and that transition period can be difficult, and is a very relevant time to be using Bridges – to reflect on progress made and how might get back to what did before. Support plans and individual budgets – about looking at what the SS wants to achieve, how they want to spend their money. Fits in with Bridges – patient-led goal setting ethos.
12
What’s next? Investigating sustainability
06/12/2018 What’s next? Investigating sustainability ‘Based on Bridges’ – not just stroke Study continuity of care from stroke survivor’s point of view Sustainability of the intervention – continued momentum of using Bridges in teams and across the pathway, is key concern to participants in this study, and has come up frequently in evaluations. Recently acquired a small amount of funding from AHSCS to investigate what could help improve the sustainability of the training – what would encourage people to keep using the Bridges philosophy? Based on Bridges Not enough stroke survivors in a lot of these services. FJ recently been developing training focusing more on self-management techniques more broadly, taking the emphasis off stroke. Stroke survivors point of view This was evaluation, no ethics approval, so unable to interview stroke survivors, not a research project. Would be interesting to investigate this further.
13
Any Questions? Visit: http://bridges-stroke.org.uk
me:
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.