Bridges through the stroke pathwayThe Bridges Kingston Project

Nicki BaileyProject Coordinator – Bridges Kingston Project

What is Bridges? A quick reminder…

Workshops for

practitioners

Stroke workbook given to clients

Individualised self-

management programme

The Bridges Kingston Project

• South-West London Academic Health and Social Care System• Pilot: First time social care practitioners included• Training members of different teams in mixed workshops• Objectives:

• Enable greater focus on promoting self-management throughout the stroke pathway

• Improve continuity of care for stroke survivors in Kingston• Improve knowledge sharing and cross team working between

teams on Kingston stroke pathway

• Conduct an evaluation of the project

Context Mapping & Preparations

• Project steering group• Interviews with teams• Role of service• Current goal-setting practices• Approaches to self-management• Cross-team working within pathway

• Adaptations to training• Kingston pathway specific• ‘Pathway’ exercise

• Awareness raising of the project

The Kingston Stroke Pathway

Who participated?

• 54 participants completed intro & follow up• Mix of teams and professions BUT social care restructure• Executive session for GPs and managers

Results: Change in Practice

• Overall change in beliefs and attitude towards self-management• 53% thought their practice had changed• 28% used workbook

• “It’s like a refresher. It reminds us about giving people hope, listening to people’s goals”

• “I think it’s ended up this new thing, rather than just chatting to patients about goals, actually putting it down to make it a more visual tool”

Results: Barriers to using Bridges

55% experienced barriers to using Bridges. The top 4 :

Not enough time

Difficult when patient has communication difficulties

Not enough stroke patients

Environment wasn’t right (eg. Acute, short stay)

Results: Cross team training

• 99% said workshops enabled meeting people from other teams• 19% felt team better connected (49% not sure)

“I think it’s that connection having met them – oh yeah, you were on the training – on the telephone I just feel there is more of a connection there now”

“It’s actually opened my eyes a bit to the pathway and how it all links together”

HOWEVER

“It was interesting to meet people from other teams. But I don’t think there’ll be a lasting link.”

Results: Bridges within the stroke pathway

• 78% thought could be used successfully throughout pathway• Potential to improve continuity of care for patients in 3 ways:

Shared

ethos

• Provides practitioners in all teams with “some kind of shared ethos or philosophy to dip into”

Continuity

of goals

• “The patient isn’t going to have to start the whole goal setting process again, but has got a record, of ‘I’ve been working on this, I’ve achieved this.”

Strengthen

ed connectio

ns

• “It’s helped in liaising with the referrers...if they are referring from the Hospital we’ve mentioned oh what about the Bridges workbook... it’s a tool to help with that process of linking in.”

Results: Is Bridges relevant to social work?

1) Social workers already trained in ‘social model of disability’

• “Responses were a lot more around empowerment and less risk averse”

2) Often stroke survivors have most difficulty once at home, outside of medical setting• “He said ‘Actually things are more difficult than I’d hoped’... He’s using

Bridges as a way of looking at how he can get back to activities he used to do before”

3) Bridges goal setting corresponds well with current social care practices (individual budgets, support plans)

• “Bridges can be part of that support plan, as it is looking at what are their long-term goals and steps to work towards that”

Bridges seen as “a good fit” with social work practice because:

What’s next?

• Investigating sustainability

• ‘Based on Bridges’ – not just stroke

• Study continuity of care fromstroke survivor’s point of view

Any Questions?

Visit: http://bridges-stroke.org.ukEmail me: n.bailey@sgul.kingston.ac.uk