Exploring perspectives on the management of patients with complex care needs in stroke rehabilitation An interpretive description study

 

This is the whole problem in stroke enumerated in one word; 'care'; NOT RECOVERY!

YOU have to get involved and change this failure mindset of 'care' to 100% RECOVERY! Survivors want RECOVERY, NOT 'CARE'!

I see nothing here that states going for 100% recovery! You need to create EXACT PROTOCOLS FOR THAT!

ASK SURVIVORS WHAT THEY WANT, THEY'LL NEVER RESPOND 'CARE'! This tyranny of low expectations has to be completely rooted out of any stroke conversation! I wouldn't go there because of such incompetency as not having 100% recovery protocols!

RECOVERY IS THE ONLY GOAL IN STROKE! GET THERE!

Exploring perspectives on the management of patients with complex care needs in stroke rehabilitation

Indar, Alyssa; Nelson, Michelle; Berta, Whitney; Mylopoulos, Maria

Author Information

Health Care Management Review ():10.1097/HMR.0000000000000440, May 9, 2025. | DOI: 10.1097/HMR.0000000000000440

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Abstract

Background 

Exploring the “wicked” problem of improving care(NOT RECOVERY!) for patients with complex care(NOT RECOVERY!) needs could benefit a large swath of health system stakeholders given the breadth and depth of this issue. Patients with complex health and social needs often require customized care(NOT RECOVERY!) that deviates from expected care(NOT RECOVERY!) trajectories. At Canadian Stroke Distinction sites, clinicians provide care(NOT RECOVERY!) for a high proportion of patients with complex needs while adhering to best practice recommendations.

Methods 

We conducted an interpretive description study, which explored the perspectives of 16 stroke rehabilitation clinicians, four organizational key informants, and two health system key informants. We collected data via 45- to 60-minute virtual interviews and engaged in a hybrid inductive–deductive approach to analysis.

Results 

We constructed three main themes: (a) recognizing complexity is routine work for clinicians, (b) clinicians use workarounds to manage complexity, and (c) clinicians perceived and worked to bridge a difference between organizational processes and the realities of patient care(NOT RECOVERY!). When comparing clinician and key informant perspectives, we noted differences regarding their perceptions of the prevalence and nature of patient complexity. We developed the concept of “work-as-expected” as an intermediary to bridge the gap between the “work-as-imagined” and “work-as-done” framework.

Conclusion 

We describe the strategies used by expert clinicians to continually manage care(NOT RECOVERY!) for a high proportion of patients with complex care(NOT RECOVERY!) needs. Although expert clinicians have developed effective workarounds, they experience significant moral distress when these strategies are unable to compensate for health system limitations.

Practice Implications 

A better understanding of how clinicians manage the needs of patients with complex care(NOT RECOVERY!) needs could support policymakers and organizational leaders to consider macro- and meso-level strategies to support the adaptive practices of clinicians.