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Sustainability Scoping Study


During the evaluation of the Bridges Kingston project [click here for more information], practitioners raised concerns about the sustainability of the Bridges training intervention in their services. Barriers identified included things like staff turnover meaning not everyone was trained in Bridges, and communication problems between teams on the stroke pathway.

In light of these concerns, Bridges was supported by South London HIEC to undertake a further scoping study, to explore ways of making the programme more sustainable - to make sure Bridges continues to be used in teams and pathways long after the training has been completed.

The project

The first phase of the scoping study was to revisit evaluation data from the Bridges Kingston project, and record all results which were related to sustainability. Using this information, semi-structured interviews were conducted with practitioners from different teams on the Kingston stroke pathway, to explore their views and ideas about sustainability of Bridges within their services. A short online questionnaire was circulated to all participants of the Bridges Kingston workshops, to gauge their views on the Bridges programme one year post-training.

As well as this research, two free workshops were held this summer for any interested stroke practitioners working in South West London. As almost all Boroughs in SW London have received Bridges training, it was felt the workshops could be opened up to teams outside of Kingston in order to build better links between teams who use Bridges. The workshops were as follows:

1. Bridges ‘catch up’ training workshops for new staff, or for those who missed the first set of workshops, to ensure as many staff working on stroke in South West London are trained as possible.

2. A ‘master class’ workshop for interested staff to revisit key principles of Bridges and address ways of integrating the programme into their teams and pathway. The training focused on potential organisational, professional, and personal barriers, using feedback from the Kingston evaluation. It will also sought to create better links between ‘Bridges Champions’ in South West London to help keep momentum going for using Bridges in the area.


Sustainability scoping study
From the qualitative interviews with practitioners, the online survey and the revisiting of the evaluation data, the following results were found:

Barriers to sustainability of Bridges SSMP
The five main barriers to sustainability of the Bridges SSMP identified by practitioners were:
• “If staff don’t use it, they lose it, and never use it” – Practitioners felt the practice was essential, and once staff had used the workbook once, they were likely to keep using it.
• Not enough, or the “wrong kind” of stroke patient – A lot of teams felt they didn’t see enough stroke patients to use Bridges consistently in their work. Some practitioners felt the stroke patients they did see were too far post stroke.
• Staff turnover, and which staff should be trained – Practitioners felt a continuous training cycle was needed for new staff, but it was too expensive for teams to pay for this. There was also a question about the wrong staff being trained, and some practitioners felt staff who spend most time with patients (eg. rehabilitation assistants, volunteers) should be prioritised to receive the training.
• Training is too stroke specific – The survey showed that more people were still using the principles than the workbook, as they didn’t have many stroke patients in their caseload. Some practitioners thought if the training was broader than stroke, people would use it more frequently.
• Fragmentation of the stroke pathway – Loss of the stroke coordinator role means teams do not get feedback about how Bridges is being used at different points in the stroke pathway, leading to concerns that it is not be continued further down the line.

Things which are working well
Practitioners mentioned six strategies which they felt were encouraging the continued use of Bridges within their services:
• Bridges Champions – everyone felt champions were essential in keeping the momentum going around using Bridges. It was felt there needed to be more champions (at least one in every team), and they needed to be better connected between teams and pathways.
• Pathway feedback to keep practitioners motivated – Knowing the workbook continues to be used with service users further down the stroke pathway motivates practitioners, and makes them feel they don’t have to get through everything in their sessions alone.
• Making Bridges an official part of the referral process – Such as including a tick box on referral forms
• Support from managers and team leads encourages continued use - Supportive consultants and GPs were mentioned as a factor in increasing use of Bridges within teams and pathways
• Having a stable team with minimum staff turnover – so all staff have received the Bridges training
• Using Bridges creatively – Practitioners mentioned not feeling obliged to use the whole workbook each time, but introducing patients to parts which they felt were relevant.

Ideas of how Bridges could improve its sustainability
Practitioners came up with a few ideas of how they felt Bridges could improve the sustainability of the SSMP:
• Create a network of Bridges champions who could support each other, and share ideas and experiences
• Run frequent refresher sessions to keep practitioners motivated to use Bridges
• Create a Bridges volunteer force, with volunteers who could spend more time using the workbook with stroke survivors
• Train the trainer – to get over the problem of high staff turnover, train staff to train others within their team
• ‘Based on Bridges’ training – emphasise the use of self-management principles with all patients in the training, so practitioners who do not see many stroke patients will also use the principles in their practice

Bridges Masterclass
The first ever Bridges ‘Masterclass’ was held as a half day workshop on 26th June at St Georges University. Six stroke practitioners attended from teams in Kingston, Sutton and Merton and Wandsworth.

The workshop explored evidence around three key factors which could affect the effectiveness of a self-management programme in practice: individual context of a stroke survivor; practitioners’ attitudes to the SSMP; and organisational issues within a stroke pathway. An OT and physiotherapist from Barts and the London stroke pathway were invited to present on how they have integrated Bridges SSMP into their stroke pathway, and on the innovative ways they are using Bridges within their service. Participants had time to reflect on, and share, their experiences of using Bridges within their teams and pathways, and consider barriers and possible strategies to overcome these barriers in their practice.

Evaluation feedback from the workshop was very positive. Practitioners found it useful to hear how other teams were using it, and felt they would go back to their teams with some new ideas. They enjoyed the opportunity to network with other interested practitioners, and felt inspired and motivated to use reinvigorate use of Bridges within their services. The only complaint was that half a day did not leave enough time for discussion. Comments included:

• “It was seeing how different teams are working with Bridges and how it could work in our team”
• “Found idea of patient, professional and organisation very useful”
• “Good refresher – inspiring and useful to get feedback from different teams”
• “Timeframe of one year was useful as has given us time to consolidate our learning and reflect on how it has worked in the service so far”
• “This will hopefully help me to encourage others in my team to use Bridges more”
• “Really really helpful session. Do it again!”

If you would like to discuss the possibility of running a Bridges ‘Master Class’ for your team/pathway, please contact us on:

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