Strategy
We formed a key stakeholder working group to develop the intervention, run the project, and data collection and finally to evaluate and report our findings. Using the PDSA model as our template over three months we developed the following:
Month 1: develop a training intervention that was ward and patient group focused.
Working closely with our partners "The Performance Coach", we developed the "recovery coaching" concept highlighting key coaching techniques we could use in our ward setting. We designed the training around five key care areas that that we (as a team experienced in older people's rehabilitation) felt our older patients would need to be able to do independently and/or have a plan of how to manage before discharge. These were:
I. Be able to get in and out of bed safely
II. Be able to get in and out of a chair safely
III. Be able to wash and dress themselves
IV. Be able to feed themselves
V. Be able to go to the toilet.
Month 2: strategy to identify measureable outcomes from the patient participants.
Working with our academic partners at the psychology department at the University of Winchester, we identified the most suitable measures to assess changes in patient outcomes on the ward. Using a short PDSA cycle, the most suitable measures on the ward were identified as being the Barthel Daily Functioning Index and Elderly Mobility Scale (EMS).
In order to record the patient’s mood so that there were no differences between the pre/post intervention stages, the Hospital, Anxiety and Depression scale (HADs) was chosen as a measure and included in the ward doctor’s admission assessment. To measure the patients self confidence at discharge, the Modified Falls Self Efficacy (MFES) scale was added.
Finally, to record service improvement data, patients, care packages on admission and discharge were recorded, along with length of stay. All of these measures were taken at both the pre and post intervention stages of the project.
Month 3: strategy for implementation of research study.
The study was a pre/post intervention design to evaluate the impact of the recovery coaching training on patient and staff outcomes. Ethical approval was granted by The West Midlands (Solihull) NRES Committee. The appointment of a research practitioner rather than a project manager was a great asset as their input enabled the process to run relatively smoothly. Staff became increasingly engaged in the project due to their active involvement on the ward that promoted the buy-in and the enthusiasm of the team.
An inclusion/exclusion criterion was created and undertaken by the ward consultant and medical team. Inclusion was on the basis of medical fitness and capacity to participate. Patients who met our inclusion criteria for the study were invited to consent to be part of the project.
Training sessions were planned to take place halfway through the project timeline so that two distinct data collection stages were created, each lasting three months in length. Training was scheduled over a one month period and back-fill payments were arranged were necessary.
A group of staff were interviewed to allow evaluation of the training and discuss how it felt to use the recovery coaching approach. All analyses were performed by Winchester University to allow for robust and academic rigour in the analysis of the intervention that would be difficult to quantify otherwise.