Clinicians' actions associated with the successful patient care process: a content analysis of interviews with paediatric occupational therapists.
OBJECTIVE
Clinicians' actions impact the patient care process and pathway. This study identified clinicians' actions associated with successful care processes in one community healthcare setting, children's occupational therapy.


METHODS
A secondary analysis in a form of a quantitative content analysis was conducted of 47 interview transcripts, describing outcomes and therapists' (n = 25) self-reported actions in 25 "successful" and 22 "unsuccessful" care processes. The successful processes were those with positive outcomes (clear and coherent process with easy discharge; achieved patient goals and positive patient-clinician relationships). The transcripts were coded for presence of therapists' actions and non-actions using content analysis; and actions associated with success of the process were identified by Pearson Chi-square test.


RESULTS
In total 207 actions were identified. These clustered around six areas: assessment, setting goals and planning actions, treatment, review, discharging, and managing processes and relationships. The key actions associated with successful processes were: gather perspectives from others at assessment (χ(2) = 6.65, p < 0.01); identify therapy goals (13.16, p < 0.01); agree/communicate plans, roles and responsibilities (9.10, p < 0.01); involve the child and parents in treatment (6.36, p = 0.01); adapt physical environment (6.01, p = 0.01) and make comparisons between the baseline, current and target levels when reviewing progress (6.36, p = 0.01).


CONCLUSIONS
The actions identified are congruent with literatures about patient involvement and goal achievement. Specific hypotheses about the mechanisms by which the identified actions may relate to care process are presented.
Health Services Research Unit and Aberdeen Health Psychology Group, University of Aberdeen, Aberdeen, UK. n.kolehmainen@abdn.ac.uk
Niina
N
Kolehmainen
Edward A S
EA
Duncan
Jill J
JJ
Francis
D002648:Child; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D009788:Occupational Therapy / Q000379:methods*; D010043:Outcome and Process Assessment, Health Care; D010290:Parents; D005791:Patient Care / Q000379:methods*; D010347:Patient Care Planning / Q000458:organization & administration*; D010372:Pediatrics; D011368:Professional-Family Relations; D011787:Quality of Health Care