Ms Anitra Thomas1
1Hunter New England Local Health District, Newcastle, Australia
In response to the altered health landscape resultant from the National Disability Insurance Scheme (NDIS), Hunter Spinal Cord Injury Service (HSCIS) implemented a model of care to prioritize healthcare for people with recent (within 5 years) spinal cord injury. HSCIS sought to ensure 100% of rehabilitation clients had a goal deemed SMART and participatory within six weeks of admission.
Service eligibility was altered and promoted to clients and healthcare professionals. Multiple quality cycles were undertaken to improve clinical goal setting of the interdisciplinary team. Literature review to identify tools to assess goal quality was undertaken and tools trialed to assess goal quality.
Clinical hours allocated to recent spinal cord injury increased from 50% to 75%. A suitable tool to assess goal quality was not identified and so a tool was developed to provide a goal quality score scaled 0-15. Using the audit tool developed; inclusion of a social participation component in goals improved from 25% to 80%, the rate of goals deemed SMART improved from 1% to 93% and average SMART score increased from 5/15 to 12/15. Clinicians and clients reported positive effects of goal setting on rehabilitation.
Challenges to include a participation component in goals may be attributed to factors within the client cohort, an alternative approach may optimize rehabilitation for these clients. Despite widespread endorsement of client-centered SMART goals, there is scarcity of tools to objectively assess goal quality. Further study may inform the validity and reliability of tool developed in this project.
Anitra Thomas is a physiotherapist and service manager for Hunter Spinal Cord Injury Service. Anitra has worked in rehabilitation for 20 years specializing in chronic and complex case management.