Live well after stroke

Abstract

Background: Difficulties in meeting guidelines on the intensity of therapy for acute stroke patients is common internationally. Current UK guidelines recommend patients receive a daily minimum of 45 minutes of each required therapy. This article details practice development work in an acute stroke unit in a large teaching hospital in Ireland, where an audit of stroke patients discharged in one month found that only 27% had received what is deemed ‘sufficient’ physiotherapy, while 30% had physiotherapy on fewer than half of their days of admission. Aim: Based on the audit, we looked at how we could increase therapy intensity for patients and correspondingly improve the quality of their experience of care and that of their therapists. We broadened our scope beyond physiotherapy to include occupational and speech and language therapies. We aimed to increase patient treatment time from an average baseline of eight to 16 minutes per day to 45 minutes per day. Methods: We used a combination of Lean Six Sigma and person-centred improvement principles, in conjunction with appreciative inquiry to redesign the current approach to therapy time. Results: Following our work, patient therapy time increased cumulatively by 125% across all therapies on days when no group classes were held and by 164% on days with classes. The average time patients spent with no therapy interaction outside therapy hours fell from 5.34 hours to 2.3 hours. Conclusions: The combination of approaches brought under the banner of the ‘Live Well After Stroke’ initiative ensured the project catalysed a new and more sustainable way of working together. The use of appreciative inquiry in our practice development workshops worked well as a way of respecting people’s sense of purpose and their values, and working with these to articulate, and progress towards, a desired shared future state. Implications for practice: Our use of the improvement sciences of Lean Six Sigma and person-centredness combined with appreciative inquiry demonstrates the synergistic elements of these sciences that can be optimised for use in practice development Without a change in resources, ways of providing therapy for this population can be redesigned to increase intensity Addressing culture as a key component of a practice development project resulted in an improvement in team collaboration and communication