Proceso de implementación de la tarea “Rally matemático”

It is perhaps worth noting at this point that the level at which we focused the outcomes in the OC was guided by the earlier outcomes research.2,3_{However, it was also important to focus outcomes at the level}

that best suited NRTs’practices. Focusing outcomes at the intermediate level meant that the constituent elements of higher-level outcomes would not be missed and also that NRTs and service users would still have the opportunity to discuss the lower-level outcomes during assessments. The research team also wanted to avoid the checklist replicating existing paperwork or becoming too long.

The content of the checklist was common across thefive NRTs and was based on the outcomes in the three domains outlined inChapter 5. However, the format and the way the teams used the checklist in practice could differ between teams to accommodate their different practices around assessment and service provision. We met with each team to discuss developing the outcomes into a checklist. We used a standard list of discussion points (seeAppendix 3) to explore how teams wanted the checklist to look, what additional functions they wanted (e.g. space to record comments or actions), if and how they wanted to record that they had discussed the outcome with the client, and whether they would prefer a paper or an electronic version.Table 18summarises each team’s preferences for how their checklist should‘look’.

As can be seen fromTable 18, the appearance and functions of the checklist were largely similar across all sites, but there were some minor differences. For example, sites B and C wanted to record referral

information in the form of a tick box, while site A wanted to record this information in the comments box. In line with the teams’specifications and preferences, checklists were drafted and sent to each team for further comments and amendments. At this point, only minor amendments to formatting were requested. The OCs were thenfinalised and copies sent to each team, along with guidance for use and the

parameters of each outcome (seeAppendix 4).

Teams were asked how they wanted to use the checklist. Several different approaches were identified. For example, some teams initially discussed using it as a one-off assessment checklist, while others thought they might use it repeatedly with the same client over time to assess outcomes as an episode of care

TABLE 18 Preferences for format of OC, by site

Team Client information Paper/electronic Functions Appearance

A (BI) The team use stickers containing client information that they attach to documents (name, date of birth and NHS number). A box where this sticker could be applied would be useful or, for when there are no stickers, a box where they can put this information

Prefer paper copies, but would like an electronic version

Three tick boxes to indicate whether or not the outcome is important to client (yes, no, not relevant at present–review later)

Would like the name of the team on checklist

Would like space to add details about referrals and when the outcome should be reviewed

Would like it to be in boxes or a grid that is consistent with their other documentation Would like three columns

to add in dates if and when the outcomes are reviewed

Would like it to be landscape

Do not want space to add in details about the outcome/need or actions taken as these are detailed in the assessment form Would like a space at the bottom to sign, initial and date each sheet

A (MS) Space to record name, NHS number and date of birth

Paper Would like a way of recording which outcomes are and are not important to client

Would like name of new team on checklist, with MS added to it Yes/no tick box to record

this–having an explicit no reduces ambiguity for anyone else looking at the notes

Would like it in similar format to existing documentation Would like space to

summarise discussion had with client. They might refer to another document where they detail the goals they have set with the clients

Possibly landscape

Would like a way of recording which outcomes are in the remit of the team and which will be referred–possibly as part of the free-form text box

Were interested in distinguishing by colour, but not green

Would like to record intended actions in free-form text box Text box should have prompts for referral details, outcome of discussion, action

CAN THESE OUTCOMES BE ASSESSED IN SERVICE DELIVERY?

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progressed. Some teams talked about using it simply as an aide memoire and others wanted to integrate it into their assessment processes. How this worked in practice is discussed later in this chapter.

The teams implemented the OC for a period of 6 to 10 months. We contacted them on a monthly basis to monitor the use of the checklist and to provide an opportunity for teams to report any difficulties they were having with checklist implementation. During this period, we also met with the teams to discuss progress and possible changes to the checklist to reflect NRTs’needs. In site B, the team requested that thefirst question on their checklist (Was the outcome discussed with the client?) be replaced with‘Is this outcome important to the client?’. In site C, the team requested that thefirst question on their checklist (Is this outcome important to the client?) be replaced with‘Is this outcome a particular issue for you at this time?’, with a corresponding yes/no/referred to other professional or service tick-box option. The review date box was also amended at their request to include a way to record whether or not the outcome had been achieved.

TABLE 18 Preferences for format of OC, by site (continued)

Team Client information Paper/electronic Functions Appearance

B Would like space for a label

Electronic template but paper version for use

Would like space for comments

Landscape Would like‘Does the client

want help with this outcome’as opposed to‘Is this outcome important to the client’; would like yes/ no tick box for indicating whether client wants help with outcome

Would like it in Ariel 11, on coloured paper

Would like a tick box for

‘referred on’

Would like space for signature, date and initials C Space to record name,

NHS number and date of birth

Paper Three tick boxes to indicate whether the outcome is important to client (yes, no, not relevant at

present–review later)

Landscape

Two columns for dates A space to write comments A tick box to indicate if a referral to another service is made

A box to write down a review date

Space to write name and designation of staff using checklist, and date of use

D This case site was recruited later in the research so we were able to show the team the checklists we had developed for the other teams. The NRT in site D chose the same format as that designed by the BI NRT in site A