Using shared goal setting to improve access and equity: a mixed methods study of the Good Goals intervention in children's occupational therapy.
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.
Health Services Research Unit, University of Aberdeen, 3rd floor, HSB, Foresterhill, Aberdeen AB25 2ZD, UK. n.kolehmainen@abdn.ac.uk
Niina
N
Kolehmainen
Graeme
G
MacLennan
Laura
L
Ternent
Edward A S
EA
Duncan
Eilidh M
EM
Duncan
Stephen B
SB
Ryan
Lorna
L
McKee
Jill J
JJ
Francis
D002648:Child; D019988:Children with Disabilities / Q000534:rehabilitation*; D006040:Goals; D015276:Health Care Rationing; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006801:Humans; D009788:Occupational Therapy / Q000193:education / Q000458:organization & administration; D019982:Organizational Case Studies; D009936:Organizational Innovation; D015397:Program Evaluation; D011446:Prospective Studies; D058996:Quality Improvement / Q000191:economics / Q000458:organization & administration; D013192:Staff Development / Q000191:economics / Q000379:methods* / Q000458:organization & administration; D006113:United Kingdom