Measuring and learning in clinical practice

Abstract

ABSTRACT Within healthcare there is an increasing need to demonstrate the effectiveness and cost‐effectiveness of clinical intervention. This paper describes a model developed for speech and language therapy which takes as its starting point the proposition that finding out about clinical effectiveness is a continuous learning cycle. The model uses a database to enable therapists to record their goals, interventions and outcomes in a form which allows sophisticated analysis and learning to take place as a by‐product of clinical practice. The database enables therapists to create assessment and care protocols by use of dictionaries of standard terms. Protocols are then used to create individual care plans. Interventions carried out are recorded against the individual care plan and outcomes achieved recorded against targets set during the assessment process. Through a process of audit, therapists seek causal explanations for variances between actual and expected outcomes and use such explanations to refine the protocols. To cover the unusually wide range and complexity of speech and language therapy, the authors have developed the concept of ‘health benefits’ which particular programmes of care set out to deliver. The authors believe that health benefit is a clearer and wider construct than ‘outcome’ or ‘health gain’. Health benefits may be associated with named clients or with populations. The paper reports on the creation of a collaborative action research program within speech and language therapy as an efficient and effective way of developing robust research‐led practice models. The collaborative programme involves therapists at a number of sites joining a network or ‘clearing house’. Through their membership, therapists are able to propose new protocols and dictionary entries for the database and to share research data. Network members are also able to access support and training in the use of the model and to propose developments to the software. The creation of such a research community promotes a much faster development of research‐led practice than would be possible through individual efforts. The authors also believe that it creates a strong sense of a professional community which is of great importance when services are being fragmented and therapists isolated within their management units. The model is being extended to other professions and to multidisciplinary settings. It has attracted strong interest and support from purchasers and from providers. The paper addresses the relationship between this model and other initiatives, such as the development of Read Coding and integrated information systems for hospitals and community units. Therapists have found the model sufficiently flexible to accommodate the individuality of clients and the application of professional judgement in determining appropriate interventions. Therapists have found that the model enhances clinical effectiveness by offering a clear focus on outcomes and by enabling systematic evaluation of practice as a by‐product of their work. The collaborative research model is a potentially powerful tool in building the confidence of the profession in its own effectiveness and in creating a knowledge base for the practice of speech and language therapy.