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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

Niina Kolehmainen1*, Graeme MacLennan1, Laura Ternent2, Edward AS Duncan3, Eilidh M Duncan4, Stephen B Ryan1, Lorna McKee1 and Jill J Francis4

Author Affiliations

1 Health Services Research Unit, University of Aberdeen, 3rd floor, HSB, Foresterhill, Aberdeen, AB25 2ZD, UK

2 Health Services Research Unit and Health Economics Research Unit, University of Aberdeen, 3rd floor, HSB, Foresterhill, Aberdeen, AB25 2ZD, UK

3 Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, FK9 4LA, UK

4 Health Services Research Unit and Aberdeen Health Psychology Group, University of Aberdeen, 2nd floor, HSB, Foresterhill, Aberdeen, AB25 2ZD, UK

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Implementation Science 2012, 7:76  doi:10.1186/1748-5908-7-76

Published: 16 August 2012

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 that 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.