Client-centred practices and work in inpatient rehabilitation teams: results from four case studies

Abstract

Purpose: To explore the relationship between client-centredness (CC) and work in teams in inpatient rehabilitation. Methods: Case study, mixed-method design, with strong qualitative component. Methods include ethnographic observations of team and clinical encounters for 6 months; healthcare professional (HCP) interviews. HCP n=45; Observations = 40 encounters & meetings. Results: Based on HCP perceptions, intra-team and organizational factors were identified that influence client-centred practice in rehabilitation. Team factors included relational and communication dimensions affecting work that can hinder or facilitate CC. These dimensions are presented in detail. HCP perceived organizational factors such as workload, schedules and hospital culture to influence their work on teams and with clients. Conclusion: CC is not a “one size fits all”. It is affected by similar factors that affect work in teams such as organizational policies, team characteristics and culture. CC can be seen as an outcome of team performance.Implications for RehabilitationClient-centred practice (CCP) is influenced by client, provider and organizational factors. CCP is not just about client–provider communication. How inter-professional teams work together is an important aspect of CCP.Shared knowledge, shared goals and mutual respect characterize the relationships among members in a team. These three dimensions influence, and are influenced by, the nature of team members’ communication and the organizational structures and culture in which they take place.Effective teamwork does not automatically lead to enhanced client-centredness. Strategies are needed that ensure teamwork does not merely perpetuate the health professionals’ control of the patient or that decisions are the “right” decisions from the health care professionals’ perspectives.