title: Improving care for people after stroke: how change was actively facilitated.
abstract: OBJECTIVE
  This paper aims to report on the approach to change used in the development of a tool to assess patient status six months after stroke (the Greater Manchester Stroke Assessment Tool: GM-SAT).
  
  
  METHODS
  The overall approach to change is based on the Promoting Action on Research Implementation in Health Services (PARiHS) Framework, which involves extensive stakeholder engagement before implementation. A key feature was the use of a facilitator without previous clinical experience.
  
  
  RESULTS
  The active process of change involved a range of stakeholders--commissioners, patients and professionals--as well as review of published research evidence. The result of this process was the creation of the GM-SAT.
  
  
  CONCLUSIONS
  The details of the decision processes within the tool included a range of perspectives; the process of localisation led commissioners to identify gaps in care provision as well as learning from others in terms of how services might be provided and organised. The facilitator role was key at all stages in bringing together the wide range of perspectives; the relatively neutral perceived status of the facilitator enabled resistance to change to be minimised.
  
  
  CONCLUSIONS
  The output of this project, the GM-SAT, has the potential to significantly improve patients' physical, psychological and social outcomes and optimise their quality of life. This will be explored further in future phases of work.
  
  
  CONCLUSIONS
  A structured process of change which included multiple stakeholder involvement throughout, localisation of approaches and a dedicated independent facilitator role was effective in achieving the development of a useful tool (GM-SAT).
authors: The Business School, University of Huddersfield, Huddersfield, UK. David.Bamford@hud.ac.uk
authors: David
authors: D
authors: Bamford
authors: CLAHRC, Salford Royal NHS Foundation Trust, Salford, UK.
authors: Katy
authors: K
authors: Rothwell
authors: University of Manchester, Salford Royal NHS Foundation Trust, Salford, UK.
authors: Pippa
authors: P
authors: Tyrrell
authors: Manchester Business School, Manchester, UK.
authors: Ruth
authors: R
authors: Boaden
mesh_terms: D006302:Health Services Research / Q000379:methods; D006801:Humans; D008134:Long-Term Care / Q000191:economics / Q000458:organization & administration / Q000592:standards*; D017146:Models, Organizational; D019982:Organizational Case Studies; D016730:Program Development; D058996:Quality Improvement / Q000191:economics / Q000592:standards*; D011788:Quality of Life; D013222:State Medicine / Q000191:economics / Q000458:organization & administration / Q000592:standards; D020521:Stroke / Q000191:economics / Q000453:epidemiology; D000071939:Stroke Rehabilitation; D006113:United Kingdom / Q000453:epidemiology