Useless since these are guidelines with NO effective rehab protocols supporting them. Damn it all, start demanding results, NOT just guidelines, processes or targets. RESULTS!
How is the audit of therapy intensity influencing rehabilitation in inpatient stroke units in the UK? An ethnographic study
Abstract
Objectives
Occupational therapy, physiotherapy and speech and language therapy are
central to rehabilitation after a stroke. The UK has introduced an
audited performance target: that 45 min of each therapy(So the doctor involved does absolutely nothing and is totally useless?) should be
provided to patients deemed appropriate. We sought to understand how
this has influenced delivery of stroke unit therapy.
Design
Ethnographic study, including observation and interviews. The
theoretical framework drew on the work of Lipsky and Power, framing
therapists as ‘street level bureaucrats’ in an ‘audit society’.
Setting Stroke units in three English hospitals.
Participants Forty-three participants were interviewed, including patients, therapists and other staff.
Results
There was wide variation in how therapy time was recorded and in
decision-making regarding which patients were ‘appropriate for therapy’(I expect 100% recovery for all, don't cherry pick the less disabled patients. How would you feel if I told you were not good enough to get rehab? Or do you conveniently lie by omission?)
or auditable. Therapists interpreted their roles differently in each
stroke unit. Therapists doubted the validity of the audit results and
did not believe their results reflected the quality of services they
provided. Some assumed their audit results would inform commissioning
decisions. Senior therapy leaders shaped priorities and practices in
each therapy team. Patients were inactive outside therapy sessions.
Patients differed regarding the quantity of therapy they felt they
needed but consistently wanted to be more involved in decisions and
treated as individuals.
This
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