The influence of objective measurement tools on communication and clinical decision making in neurological rehabilitation

Tyson, S; Greenhalgh, J; Long, A; Flynn, R

Abstract

Rationale: routine collection of outcome measures is advocated to improve quality of care. However, there has been scant investigation of how measurement tools are used in clinical practice and what impact they may have. This paper compares two neurorehabilitation teams, one which routinely used standardized measurement tools and the
other which did not.We explore differences in communication and clinical decision making within multidisciplinary team (MDT) meetings to illuminate the influence measurement
tools could have on clinical practice.
Method: non-participant observation of MDT meetings in two neurological rehabilitation units in England. Semi-structured interviews were also carried out with at least one member of each profession in each team. Grounded theory techniques were used to analyse the data.
Results: differences in team members’ communication within MDT meetings underscored differences in the process of clinical decision making within the teams. Using measurement
tools provided a shared understanding to facilitate communication by focusing discussion on the patient’s abilities rather than individual professionals’ contributions. This led to differences in the way team members identified the nature and cause of patients’ problems, monitored their progress and planned for discharge. They provided a ‘neutral ground’ to
reach a shared perspective between professionals, thereby avoiding conflict. Externally, use
of the tools enabled objective discussion with patients and their families about their progress and was a vehicle to facilitate giving bad news.
Conclusion Using standardized measurement tools can promote a patient-focused approach to care, thus facilitating treatment planning and clinical decision making.

Citation

Tyson, S., Greenhalgh, J., Long, A., & Flynn, R. (2010). The influence of objective measurement tools on communication and clinical decision making in neurological rehabilitation. Journal of Evaluation in Clinical Practice, 17(3), https://doi.org/10.1111/j.1365-2753.2010.01555.x

• Journal Article Type: Article
• Publication Date: Sep 1, 2010
• Deposit Date: Jun 8, 2011
• Journal: Journal Of Evaluation In Clinical Practice
• Print ISSN: 1356-1294
• Publisher: Wiley
• Peer Reviewed: Peer Reviewed
• Volume: 17
• Issue: 3
• DOI: https://doi.org/10.1111/j.1365-2753.2010.01555.x
• Keywords: clinical decision making, communication, neurological rehabilitation, outcome measures
• Publisher URL: http://dx.doi.org/10.1111/j.1365-2753.2010.01555.x