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Kingston Project

Background

The ‘Bridges Kingston project’ was the first time social care and voluntary sector practitioners participated in Bridges training alongside their health colleagues. It was also the first time the use of the Bridges stroke self-management programme (SSMP) through a complete stroke pathway had been evaluated.

The project, funded by the South West London Academic Health and Social Care System, aimed to introduce the Bridges SSMP to all health and social care teams on the stroke pathway in Kingston, by holding mixed-team inter-professional workshops.

The stroke pathway in Kingston is known to be fairly complex, due to the number of teams working on it, and the fact that patients are often referred on to teams in surrounding boroughs. Stroke practitioners in most boroughs of SW London had already been trained on the Bridges SSMP in the past, but never in Kingston. For these reasons, it was decided Kingston would be a good place to pilot something new for Bridges.

The project

At the beginning, a steering group was set up, composed of team leads from each team working on the stroke pathway in Kingston - the Acute Stroke Unit (Kingston Hospital), the Cedar Unit for Inpatient Rehabilitation (Tolworth Hospital), the Intermediate Care Team, the Adult Social Care team and a representative from the Stroke Association.

The steering group agreed on the objectives of the project, which were to:
· 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 stroke teams in Kingston (by holding mixed-team workshops)

In the end, sixty-six professionals attended the Bridges workshops, from eight different teams on the stroke pathway in Kingston. The four workshops included participants from eleven different professions, and each workshop contained a mix of professionals from different teams.

An abridged two hour Bridges session was also held with team managers and GPs, to inform them about the programme and to garner their support.

Questionnaires were filled out by participants prior to the initial workshop and after the follow up workshop to evaluate participants change in beliefs, knowledge and practice of self-management, and their views on cross-team working in the stroke pathway.

Staff from each team were interviewed on their experiences of using Bridges in practice, and about its potential to improve continuity of care for patients. Participants were also asked to complete case reflections, analyzing their use of the programme with patients.

Key results

Key results from the data are as follows:

· Overall there was a change in knowledge and understanding about stroke self-management amongst participants. The biggest change was seen amongst health care/rehab assistants and physiotherapists. Team-wise, the biggest change was observed in the reablement team (part of adult social care).

· 99% of workshop participants thought the training enabled them to meet people working in different teams on the stroke pathway. Qualitative data suggested participants found this mixing beneficial, as it gave them an opportunity to meet colleagues face to face and learn about challenges faced by other teams. It also helped them to better understand the stroke pathway and their team’s place within it.

· Unfortunately, only 19% of participants thought their team was better connected to others on the stroke pathway since the training. The main reasons given were that they thought the connections were already good, and they hadn’t seen any evidence of Bridges being used with any stroke survivors throughout the pathway as yet. 47% of participants weren’t sure if their team was better connected or not).

· 71% of participants felt Bridges could be used successfully throughout the pathway. The main reasons given were:
- It facilitates consistency through the stroke pathway (particularly in goal setting, and referrals)
- It improves communication between services working in stroke care

· ‘Continuity of care’ was an important theme which emerged in the qualitative research, with participants reflecting that Bridges, and the training, could improve continuity of care for stroke survivors in the following ways:
- By providing practitioners in different teams with a shared philosophy to work with
-  The work book is a new tool for goal setting which can be used right along the pathway, meaning stroke patients don’t need to start goal setting from scratch every time they are referred to a different team. As the book is patient-held, it puts the stroke survivor in control of the goal-setting process.
- The training enabled practitioners from different teams to meet face to face, so now it feels there is a stronger connection between teams.

Conclusions

The biggest challenge faced during this project was the restructure of the Kingston social care department, which took place at the same time as the three planned introductory workshops in February 2011. This meant that the majority of social care practitioners could not attend these workshops alongside their health care colleagues.

Thanks to extra funding provided by the SWL AHSN, a fourth workshop was run for social care workers in June 2011. Although some health care workers from different teams attended this fourth workshop, and staff from the social services ‘reablement team’ and voluntary sector workers attended the three original workshops, the restructure meant there was less of a mix between health and social care professionals in the workshops than was originally anticipated.

Results from the semi-structured interviews undertaken as part of this evaluation highlight concerns amongst participants that the Bridges approach risks getting lost or forgotten about within the pathway if refresher training sessions or activities are not organised, for new staff joining the teams as well as reminders for staff who have already completed the training. As yet, little is known about the sustainability of the Bridges intervention, and further research will need to be undertaken into what activities encourage continued use of Bridges in practice and how the motivation to use Bridges within a team can be kept high.

In light of these results, a Bridges ‘Sustainability Scoping Study’ is currently underway in South West London. For more information about this study, please click here.

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