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Implementing an integrated approach to self-management support in an acute major trauma therapy team: an improvement project
  1. Lucinda Hollinshead1,
  2. Fiona Jones2,
  3. Lucy Silvester3,
  4. Paul Marshall-Taylor4
  1. 1Bridges Self-Management, London, UK
  2. 2Centre for Health and Social Care Research, Faculty of Health, Social Care and Education, St Georges University of London and Kingston University, London, UK
  3. 3Department of Trauma and Orthopaedics, St. George's University Hospitals NHS Foundation Trust, London, UK
  4. 4Department of Trauma and Orthopaedics, St George's Hospitals and University Foundation Trust, London, UK
  1. Correspondence to Professor Fiona Jones; F.Jones{at}sgul.kingston.ac.uk

Abstract

More patients now survive multiple trauma injuries, but the level of long-term unmet needs is high. Evidence shows self-management support can improve patients ’ confidence to manage these needs but traditionally this support starts post-hospital. Starting self-management support early could prepare patients and families for successful transitions from hospital. The skills and commitment of clinicians have been shown to contribute to the success or failure of self-management approaches. The aim of this project was to explore the feasibility of integrating self-management support in an acute major trauma setting by evaluating the impact of an educational intervention on clinicians’ knowledge, attitudes and behaviours regarding self-management support and identifying any barriers and facilitators to integrating self-management into daily practice. Two improvement cycles were carried out over a 1-year period involving 18 allied health professionals (AHPs) in an acute major trauma centre in London, UK. An educational intervention, ‘Bridges Self-Management Programme’ was modified for the setting. The impact was evaluated using (1) a clinician questionnaire to evaluate knowledge and attitudes; (2) case reflection forms and (3) peer review to observe interactions to integrate self-management support. Questionnaire data were summarised and pre-training and post-training scores compared; the qualitative data from written case reflections, verbal and written feedback from training and group discussions was described and analysed thematically. The result of two improvement cycles has shown it was feasible to improve AHP’s knowledge, attitudes and change behaviours regarding self-management support in the acute trauma setting, but difficult to sustain change beyond 6 months. Key barriers such as the pressure to discharge patients and support within the wider multidisciplinary team (MDT) were identified. Facilitators included the introduction of a new key-worker, to enable shared team approaches and paperwork to involve patients and families in goal setting and treatment planning. The main learning was to ensure sustainability mechanisms from the outset, engage the wider MDT in training, and integrate self-management language and principles into team processes.

  • healthcare quality improvement
  • patient-centred care
  • self-care
  • critical care

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Contributors FJ and LH contributed to the project concept, design, acquisition of data, analysis of data and critical review of the manuscript. FJ is responsible for the overall content as guarantor. LS and PM-T contributed to the drafting and critical revision of the manuscript. All contributors reviewed the manuscript.

  • Funding St George's University Hospital, NHS Foundation Trust, London, UK, funded the project.

  • Competing interests FJ is the founder of the social enterprise Bridges Self-Management. She has not received any financial support for this work that could have influenced its outcome.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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