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Research/Quality Practices

2002 First Place

Increasing our capacity to gather client feedback: A quality improvement opportunity

            The health system faces many challenges on a daily basis.  Expectations are increasing around the range and quality of services, and accountability while, at the same time, resources are being stretched further than before.  The current climate requires organizations to have a certain level of proficiency in performance management, and this includes measurement of client satisfaction.  Acquisition of the necessary skills and knowledge places additional strain on organizations’ resources.

While the literature provides much in the way of motivation to undertake client feedback exercises, and the anticipated outcomes of such exercises may make good sense, rationalizing the allocation of resources can still pose a challenge. And are there opportunities for the health sector to improve its capacity to gather client feedback and mitigate the costs associated with such activities?  Recent experiences of one health board in this province suggest that there are.

Rationalizing the cost of client satisfaction information 

In a user-pay system, such as in the United States, the immediate relevance of consumer satisfaction data lies in the competitive edge it gives practitioners and their respective organizations.  Quality improvement literature and practical experience tells us that the customer’s needs and expectations define quality and drive satisfaction.  In considering the pros and cons of conducting client feedback exercises, calculating the costs of software, consultants, staff time, etc., is usually the first thing that is considered.  However, equally important to consider are the costs incurred if an organization goes without client satisfaction information.

While in some rural areas of Canada there may not be an alternative service or practitioner to which the disgruntled consumer can turn, failure to meet clients’ needs and expectations can have economic, emotional and physical consequences.  If a client has a “bad” experience, she may choose to postpone accessing needed health services in the future, and end up receiving service only when her condition is much worse, much more costly to treat, and less likely to be successfully treated. 

Health organizations have other customers to satisfy as well: health workers.  The literature clearly indicates that failure to consider the needs and expectations of these clients can result in low morale, increased sick leave, lower productivity, higher staff turnover and lower quality of service for external customers.  As quality improvement guru, Jim Clemmer writes, “The internal or external service delivered by an individual or team tends to be no better or worse than they receive from the organization.”[1] 

            The Canadian Council on Health Services Accreditation emphasizes the importance of measurement and timely access to information about client needs and expectations in its Achieving Improved Measurement (AIM) Standards.  It also places great emphasis on the provision of a high quality of work life for all health employees, thus highlighting the need for timely feedback from internal clients; that is, from staff.[2]

A recent discussion paper, prepared by the Newfoundland and Labrador Provincial Human Resource Planning Steering Committee, summarized the literature and research on recruitment and retention issues in the health sector.  The report emphasized the importance of providing a high quality of work life as part of a comprehensive human resources strategy.[3]  If organizations are to be effective in fostering a high quality of work life, they will need to verify their success through feedback from staff.

The literature is supportive of improved information systems and measurement, especially as tools for improved service planning; however, the health sector is currently under-spending in this area.  Doug Balson, of the Ministry of Health Planning Patient Centered Research, in Victoria, British Columbia, quotes CIHI research that states that only 2% of health budgets are spent on information technology and that most of this is spent on the management of the bureaucracy, with very little being spent on consumer research.  He contrasts this with Canadian banks, which spend up to 12% of their budgets on infrastructure to help them understand customer experience and how their customers use and experience their services.  Mr. Balson contends that the health sector needs to improve its ability to measure and learn about its customers’ experiences and to incorporate this information into service planning.  Otherwise, health services will be limited to evaluating existing services instead of visualizing what will be needed in the future.[4]

Having access to timely client feedback also has implications in terms of accountability.  Healthcare organizations that have adopted the Balanced Scorecard[5] approach to reporting need information on their clients’ perspective in order to fulfill the model’s requirement for sound customer knowledge.  Although it originated in the private sector, the model is catching on in the public sector and within the health sector.  For example, the Ontario Hospital Association has sponsored a series of report cards that describe hospital performance on a provincial basis.[6]   

In Newfoundland and Labrador, the provincial government has introduced its new accountability framework, Achieving Excellence 2000: A Guidebook for the Improved Accountability of Public Bodies that, like the Balanced Scorecard approach, places greater emphasis on the non-financial aspects of results and performance.[7]  In order to fulfill the requirements of this new framework, public institutions will be required to become more sophisticated and efficient in measuring performance, and this will necessarily include measurement of client satisfaction.

            Having access to timely feedback from internal and external clients supports improved service responsiveness and quality of work life, quality reporting formats like the balanced scorecard, and compliance with the provincial governments new accountability framework. Clearly, while there are costs associated with undertaking client satisfaction feedback exercises, these are outweighed by the costs incurred by an organization if it chooses to remain uninformed about its clients’ perspectives. 

Options for building capacity: one organization’s experience

Grenfell Regional Health Services (GRHS) is an integrated health services board serving northern Newfoundland and southeast Labrador.  The organization subscribes to the standards established by the CCHSA and, internally, has chosen to implement a continuous quality improvement (CQI) philosophy.  GRHS recognized that in order to effectively implement a CQI approach it needed to build its capacity to gather, analyze and report client feedback.  With this in mind, the organization decided to plan and implement staff satisfaction and client satisfaction surveys.   Its Quality Council decided that a do-it-yourself approach, while perhaps less efficient and more costly than hiring a consultant, would better position the organization to repeat these exercises in the future and increase its skills and knowledge base.

The staff survey project began in May 2001.  The organization’s Quality Council authorized the formation of a team consisting of frontline, non-supervisory staff, to plan and implement the survey.  Commercial survey software options were investigated and a package was purchased.  The team researched its approach and began by conducting focus group sessions throughout the region to learn what were the most important work life issues facing staff.  The survey was designed, and tested during the fall and early winter of 2001/02, and was finally administered in March 2002.  As of July 2002, the survey team is preparing its report and recommendations for improving quality of work life.

The client satisfaction survey got a significant boost when the author (who is responsible for coordinating the project) became involved in a series of teleconferences exploring the possibility of a nation-wide patient satisfaction survey.[8] Through this opportunity to network with other individuals concerned with client satisfaction, GRHS became aware of an independent study which statistically identifies what drives client satisfaction with physicians, specialists, hospitals, other health care providers, and home care services. [9]  GRHS used this information to design its client satisfaction survey questions.  The pilot project aims to successfully contact a random sample of 75-100 households from throughout the region this summer.

These experiences have given GRHS some insight into the costs associated with carrying out client feedback activities.  Both projects have had the consistent support of the organization and both have been made a priority by the CQI office, which has provided technical and logistical support throughout.  Members of the staff survey project team have been very supportive although the project has lasted longer than originally anticipated. The learning curve has been incredibly steep and as that project continues, the more team members realize what they have yet to learn about conducting surveys.  The most significant costs have involved human resources.  Survey design and development, and the data entry of survey results were time-consuming.  Some economy was realized in the choice of survey software, which adapts well to both client and employee survey exercises.

Because the client satisfaction project was later starting, it has inadvertently benefited from some of the lessons learned by the staff survey project.  It has also benefited from a little old-fashioned good luck in terms of the information it acquired through a networking opportunity. 

When GRHS repeats these exercises in future, it is highly likely that a similar allocation of staffing resources will be required.  Of course, the organization will benefit from its current experiences and it is unlikely that the learning curve will be as steep or as costly next time. 

Mitigating the costs: A quality improvement opportunity

The do-it-yourself approach undertaken by GRHS has increased the organization’s knowledge and capacity to carry out client feedback exercises.  But how much unnecessary waste, rework and effort is incurred by health organizations, as they undertake these exercises, because they are unable to truly benefit from each other’s experiences in this area?  Are partnership opportunities missed that might help to mitigate cost or accelerate learning, because organizations consider feedback exercises to be private/internal concerns?  GRHS’s recent experiences suggest this may be so.

While GRHS made an attempt to discover what some other health boards in the province had done in the area of staff and client satisfaction, there seemed to be some reluctance to share much in terms of the details of those experiences.  And the author’s experience of the teleconference on the possibility of a nation-wide patient survey was that many organizations were leery of committing to any kind of partnership with the Ontario Hospital Association, regardless of how committed all participants were to the notion of client feedback. [10] 

Client feedback projects, like the ones described above, are exercises in self-evaluation, processes that can be uncomfortable at the best of times.  A certain amount of reluctance is understandable, but if we are to avoid duplication, rework and effort in the health system and to collectively become more sophisticated in gathering and analyzing client feedback, we need to overcome this reluctance and create forums where there can be open discussions about our experiences and what we have learned.  These exchanges need to go beyond polished, power point presentations delivered at annual events that gloss over the hard lessons learned along the way.  Health organizations need to share project work plans, communication plans and strategies, survey questions and formats, evaluations of commercial survey software packages and other resource materials, difficult issues that faced individual project teams and how these were overcome. 

We also need to be open to new opportunities to expand our skills and knowledge, such as partnering with other organizations to pool resources and gain economies of scale where possible.  While the Ontario Hospital Association’s attempt to stimulate interest in a national patient survey met with mixed enthusiasm and some skepticism, it did help to connect people with an interest in client satisfaction and fostered networking opportunities that might not have otherwise occurred. 

The health sector in this province is constantly looking for ways to support high service quality and accountability while, at the same time, eliminating waste, rework and effort.  There will always be some resource costs associated with conducting any kind of client feedback exercise; however, there are opportunities to decrease costs and improve outcomes through meaningful sharing of information and experiences, waiting to be explored.

GRHS welcomes inquiries from any other health board that is interested in moving forward in that direction.[11]

Author Bio:  Katherine Walters, B.A. (Hon.), is the Quality Improvement Coordinator with Grenfell Regional Health Services.  She is currently taking the Health Services Management Program through the Canadian Healthcare Association, and was this year’s winner of the Ronald J. McQueen Award (for first-year students in the program).

2002 Second Place

Home Care for Everyone

As an Occupational Therapist with the Mental Health Program with the Health Care Corporation of St. John's, I am frequently asked to assess an individual's ability to manage self-care activities. In one particular case, though, I found it quite ironic that the person I was seeing that day had just published an article in the "Slice of Life" section of The Telegram, highlighting how she felt that she had been successful in maintaining her apartment for the last 3 years.  When you read Janet's May 24 article in The Telegram, you can sense her justifiable pride.  Having suffered from schizophrenia for most of her adult life, she describes being bounced from bedsitter to boarding home to hospital, being denied suitably-sized, clean, safe and generally acceptable premises because she did not have children or was not pregnant.  The irony for me was that I was visiting Janet that day because she was having some difficulty with completing the housekeeping tasks associated with having an apartment and ultimately was at risk of losing her apartment.

Nobody, including any decision-making, policy-making, fiscally restrained health administrator or bureaucrat, will deny the fact that all individuals, including those who are seriously mentally ill, should have access to adequate housing.  It's a basic human right. Unfortunately, "adequate housing" is a relative term and for individuals with serious mental illness, the relativity is even less defined. There is no public argument that a person with multiple sclerosis should have home support to manage activities of daily living if it means that they will remain out of hospital but more importantly allow them to maintain their independence. The same is not so true for another individual who is stricken with long term, persistent chronic illness.

With the current climate of financial restraint, it is not surprising that my client from earlier on, is struggling to get funding for help with housekeeping.  Until it becomes a public health issue, in which case the client will either be involuntarily taken to hospital or the client herself will decide to voluntarily go to hospital out of desperation, the situation for her will not change.  With an average length of stay of 18 days at $500 a day, the cost of a psychiatric admission hovers around $9,000.  I estimate that my 4 bedroom house with 3 small children, a dog and a cat could use about 4 hours of housekeeping a week at $10 an hour for a total of $2,080 a year. I don't think it's unrealistic to think that a single person in a one-bedroom apartment could reasonably manage with help up to that same amount. Although I am not aware of any scientific empirical evidence that can demonstrate that providing housekeeping services to an individual with a serious mental illness will help reduce the number of admissions that they will have, I do know that it would provide them with cleaner living quarters, a weekly visit from someone, and someone from whom they could potentially learn those skills.

For many individuals suffering from a serious mental illness such as schizophrenia or bipolar disorder, organizing their daily routine in a way that will ensure that they get all the activities of daily living completed is not always an easy task in spite of having good symptom control with medications. Many have either not had the opportunity to learn the skills and/or have a reduced ability to learn the necessary skills of self-care, just as they have with other areas of occupational performance, such as productivity and even leisure.  Their deficits are often associated with deficits in the higher cognitive functions, such as their decreased ability to abstract, decreased ability to organize and plan behaviour, reduced concentration and attention span, and others.  This may or may not be compounded with negative symptoms such as avolition and anhedonia.  The stigma associated with serious mental illness continues to persist. If an individual with schizophrenia is living on his or her own in an apartment which is very unkempt and unclean, there is no hesitation to assume that this individual is lazy or a slob. Having said that, many will argue that if we lobby for publicly-funded home care for the seriously mentally ill, how do we differentiate between those who really need and those who just want free housekeeping services?

In a study that was published by the Canadian Mental Health Association in October 2000, which is titled "Home Care & People with Psychiatric Disabilities," several recommendations were made around national standards or guidelines that should be developed for meeting the needs of people with serious mental illness. It was determined by the study that these standards could be integrated into any standard developed for home care in Canada.  One of those "standards" highlights that individuals with a primary diagnosis of serious mental illness should have access to publicly-funded home care.  It also highlights the importance of accurately measuring those needs using a standardized tool. This would not only measure the needs of the clients consistently and accurately, but should also reflect that this population has unique needs, as do other populations such as seniors, individuals with Alzheimer's Disease, a spinal cord injured patient or a person with a developmental delay.

As an Occupational Therapist who has been assessing life skill abilities for the last 12 years, I know that we can, at least at this point in time, accurately measure a person's ability to perform various tasks of daily living using a variety of tools available. We can determine if they have the skills needed to prepare a simple meal, for example.  We can identify if they have the knowledge as to how to prepare a meal and will observe them actually preparing one. We can identify when they do not have the skills and/or the knowledge, and whether they have the potential to learn how to prepare a meal. The dilemma for me personally is in "discovering" these deficits specifically, but not having the means to appropriately remediate and perhaps having to watch individuals deteriorate over time as a result of not being able to maintain their independence. Unfortunately, for a person with a primary diagnosis of mental illness, there are few supports in the community for them around this area and even less for other activities of daily living, such as household management, medication management, budgeting, etc.  They typically have a choice of support in the form of supported housing, such as a boarding home situation, or no supports at all.  Very few of my clients can live in their own apartment unless they are completely independent in all aspects of daily living.  Those who are in independent living arrangements but have daily living challenges stand to lose this independence, unless they are lucky enough to have either a case manager or very involved family members and/or friends to help them out.

Although I remain optimistic that in the near future home care for individuals with serious mental illness will be publicly funded, as a health care professional who knows the difference it could make, I cringe at the thoughts of other "Norman Reids" suffering in the meantime.  Perhaps some individuals will refuse to have someone come into their home for home or respite care, but that is also their right. By not publicly funding home care services for individuals with serious mental illness, we have essentially taken away the right to choose.  We have denied them the opportunity to independence or even partial independence.  If home care for these individuals remains unfunded, then we have a long way to go in destigmatizing this population.

Biographical Sketch:  Kim Larouche, B.Sc, OT(c), is an Occupational Therapist in the Mental Health Program of the Waterford Hospital.  She graduated in 1988 from McGill University and has worked in various areas of practice including home care, injured workers and mental health.  She has also been involved in program development and evaluation in mental health Occupational Therapy.  Recently, she has been doing some private work in injury prevention and outcome measurement.  She has also been involved with the Occupational Therapy professional bodies, providing direction and input around standards of practice and professional practice monitoring.

2002 Third Place

Living Large on the Rock:  Obesity in Newfoundland

            Newfoundlanders are friendly folk, often stopping on the street to say hello to perfect strangers and always willing to lend a helping hand to another in need.  Having recently returned to the province myself, I have observed another characteristic about our people that, unfortunately, is not as pleasant.  In the mall, in the park, on the street:  what is it about Newfoundlanders that caught my eye?  My training as a Physiotherapist has made me a keen observer of the physical form of others; and here at home I notice that a greater percentage of Newfoundlanders seem to be overweight or obese when compared with other Canadians.  One has to look no further than the latest Health Canada statistics to support this fact.  At 39%, the Newfoundland obesity rate tops the Canadian standard by a whopping 10%.  Perhaps more startling is that when compared to data compiled just eight years ago, the provincial obesity rate has increased 3.4%.  While it is tempting to look out West and argue that Alberta exhibits the most rapid rise in obesity, we cannot deny the popularity of Alberta as a haven for Newfoundlanders.   Apparently, when we pack our bags and move out West, we take our unhealthy weights with us.  Clearly, obesity is a significant problem for Newfoundlanders at home and away.  This article endeavours to address the reasons why so many Newfoundlanders are obese and what we can do about it to ensure the health and well-being of our people for generations to come.

            Whether it be supersizing a drive-thru delight or sitting in front of the television for hours, most of us are guilty of taking part in activities we know to be unhealthy.  It is how we rationalize these behaviours that is disconcerting.  Instead of concentrating our worries on adverse effects such actions have on our health, we tend to focus on its impact on the size of waistlines.  Society has made obesity a cosmetic issue when in fact its effects go much further than skin deep.  Obesity is a major global health concern that the World Health Organization has identified as “one of the greatest neglected public health problems of our time.”  Being obese places people at an increased risk of diabetes, certain types of cancers, stroke, high blood pressure, heart disease, asthma, arthritis, urinary incontinence, back problems, thyroid disorders, repetitive strain injuries, hormonal disorders, sleep apnea, infertility and impaired immune function.  For Newfoundlanders, this has meant higher mortality rates due to cardiovascular disease, coronary heart disease and stroke.  Collectively, obese individuals are 50-100% more likely to die prematurely than those with healthy weights.  The chronic illnesses linked to obesity require intensive medical attention and produce unnecessary suffering to our people.  Obesity not only costs us our health, it creates a heavy financial burden as well.  Taken together, direct medical and indirect social and economic costs of obesity in Newfoundland can be estimated at $250 million annually.  Simply put, obesity is a condition we cannot afford.

            So, what is the good news in all this?  Well, obesity is completely preventable and reversible.  By identifying the causes of obesity, we can decrease its impact on our lives.  Undoubtedly there is a genetic component in Newfoundland but this reason alone cannot account for the dramatic increases realized in such a short span of time.  Higher rates of stress and overwork, poverty, nutritional illiteracy, and a junk food explosion are all factors contributing to the global obesity crisis.  Above all, obesity is caused by physical inactivity.  If you stop to think about it, you can complete banking transactions, pick up dinner and fill your gas tank without even stepping out of the car.  The Canadian Fitness and Lifestyle Research Institute has revealed that 61% of Newfoundlanders are sufficiently inactive for optimal health benefits.  If these levels continue, the rising obesity trend and associated health problems will skyrocket.  From the young to the elderly, the answer to obesity lives in increasing physical activity and promoting healthy lifestyles.  First and foremost, we need to lay the foundations of good health in our children and youth.  In Newfoundland, 57% of youth aged 12-19 are not active enough for optimal growth and development.  Physical education programs have been cut or dramatically reduced in our schools.  Children surf the Internet instead of playing sports.  Processed “fun foods” are staples in our children’s lunchboxes.  We know that obese children tend to grow into obese adults.  Researchers at the New England Medical Centre found that overweight teenagers were more likely to suffer from heart disease, colon cancer, arthritis or gout by age 70 than those teens with healthy weights.  Even if the obese youth reduced their body mass by adulthood, they remained plagued by poorer health later in life than those who had never been obese.  As a society, we have the responsibility to promote a healthier future for ourselves and our children.  This means investing in programs that focus on disease prevention and health promotion.  We must provide environments at work, school and in the community that support and foster physical activity.  All levels of government have an important role to play.  However, the onus of making healthy choices and becoming active lies with each and every one of us.

            So, what does it take to become more physically active?  Contrary to popular belief, getting active does not require the purchase of expensive equipment or fancy sneakers.  Nor does it require a huge time commitment.  Just three ten-minute periods of physical activity per day is sufficient for moderate health benefits.  Aside from promoting healthy body weight, physical activity has been shown to reduce stress, strengthen bones and muscles, improve posture and balance, increase energy levels, improve academic performance and lead to increased independence later in life.

            Right here in this beautiful province of ours, the options for active living are endless.  There are numerous activities to take part in year round, from skiing Marble Mountain to taking a walk around Quidi Vidi Lake.  However, physical activity need not be thought of as strict exercise.  Some everyday activities that can be incorporated into daily life include mowing the lawn, parking further from the store and walking the extra distance, doing sit-ups while watching television, sweeping the sidewalk, standing up while talking on the phone, planting a garden, having a snowball fight with the kids, walking the dog, going for a swim, taking the stairs, or going for a walk during lunch break.  The key elements to remember are to do activities that you enjoy and therefore will be more likely to continue, to be active at least every other day and to be patient, as the benefits of exercise do not appear overnight.

            Newfoundlanders have a reputation for being on the leading edge of progress.  When it comes to our health, we can no longer turn a blind eye to the obesity problem we are undoubtedly facing in this province.  In light of the huge debt obesity is creating in financial resources as well as to our health and well-being, change must begin today.  As awareness is the first step of problem solving, this article has presented the facts on obesity in Newfoundland and discussed ways to combat this serious problem.  Hopefully, in the years to come, the characteristic I will notice about Newfoundlanders will not be obesity but a dedication to physical activity and our health that is unsurpassed by the rest of Canada.

Biography:  Denise Haskell is a Physiotherapist currently working with Health and Community Services, St. John’s.  She graduated from Queen’s University in 2001 and previously worked in Ontario.  She lives in Conception Bay South with her partner and six-month old daughter, Abigail.  While work and family keep her busy, she tries to get out for some physical activity every day!

2002 Honourable Mention

A GOAL IN MIND

             Physiotherapists tend to be very structured people.  We like numbers and objective findings.  We like facts and treatment techniques backed by research and outcome measures.  Like every health professional we like to feel we’ve made a difference in a patient’s life.

            It stands to reason, then, that physiotherapists have a clear objective in mind for every patient with whom they interact.  Structured patient goals and the treatment techniques to achieve them are the basic tools for physiotherapists.

            Good goals have several things in common.  They are patient/client oriented, measurable, have a specified time frame and are achievable, as well as realistic.

            Sometimes achieving a goal is a group effort.  At the Children’s Rehabilitation Centre (now part of the Child Health Program of the Health Care Corporation of St. John’s) we have long used patient-oriented goals, developed by a multidisciplinary team, to direct the child’s care.  The input from both the child and his/her parents is instrumental in developing these goals, as any realistic hope of success relies on their cooperation.  For example, a parent’s main concern may be toilet training their wheelchair-using child, with the associated goal of “Johnny will be independent in toileting in six months” to be set by the team.  The team physician may prescribe medication to aid in bladder control while the nurse may initiate a bowel and bladder training program.  The occupational therapist will visit the home and recommend adaptive equipment for the bathroom or even renovations allowing wheelchair transfers onto the toilet.  The social worker could perform the advocacy role with the family to access funding for equipment.  The team physiotherapist would work on transfers, sitting balance and muscle strength.

            Each of these highly skilled professionals is working toward this coordinated goal, using their own areas of expertise to achieve the final outcome of independent toileting.

            Conversely some parents present with their own goals, which may seem almost unachievable or unrealistic.  As a paediatric physiotherapist, I frequently work with the parents of disabled children who have only one goal in mind – “I want my child to walk.”

            For many children, this goal may be years down the road – in fact some may never achieve it.  My role as a professional is to help the parents set shorter term, more realistic goals for their child.  “Johnny will roll over independently”, “Johnny will push up from lying to sitting independently”, “Johnny will pull to standing, one foot at a time, at a low table with minimal assistance.”

            While these “mini goals” may not be seemingly congruent with the initial desires of the parents, they do serve several highly useful purposes.  First, they help the parents understand that, although the therapist never lets go of their ultimate goal of walking, there are many steps along the way which need to be addressed initially.  A child who cannot hold up his/her head or roll over cannot yet be expected to walk.  Second, walking may take years to achieve.  How discouraging it must be for the parents and the child to return to physiotherapy week after week for years and still feel the child has not achieved the goal.  But, there can be great satisfaction and enhanced motivation for the parent in being able to say, “In the past six months, Johnny has learned to hold up his head, roll over and reach for a toy.”  A third benefit accrues directly to the therapist.  Mini goals give tangible direction and purpose to every treatment session.

            The benefit of these mini goals became especially clear in the case of a teenage girl.  What began as a minor injury progressed into the loss of use of both legs and accompanying pain with any leg movement.  There was tremendous pressure on this girl to “get back to normal" – walk, run, play sports.  She was completely overwhelmed at the idea of going from her state of dependence and pain to independent walking.  It seemed unachievable to her.

            At our first physiotherapy session, we acknowledged that walking was our ultimate goal, but we were “shelving” it for now.  Instead, we focused on small, incremental session-to-session goals.  In the first session the goal that was set was:

·        Your knees will bend to 45 degrees

while in subsequent sessions, the goals progressed to:

·        Your knees will bend to 60 degrees

·        You will stand in the hydrotherapy tank for 20 seconds

·        You will stand in the hydrotherapy tank for 45 seconds

As the weeks went on, she took greater ownership of her recovery as she began writing her own goals, completely confident in being able to achieve them.

·        I will take 10 steps with crutches

·        I will go up and down 5 stairs with a railing

Inevitably when she got discouraged, she would look back at the list of achieved goals in order to realize how far she had come.  One day, she walked into the physiotherapy department independently achieving her ultimate goal.

            Goal setting can be a useful exercise in the enhancement of your own professional life.  Our physiotherapy department has encouraged each therapist to set goals for themselves on an annual basis.  Often they are related to education or professional development.

·        I will become certified in the Gross Motor Function Measure and be proficient in its use 

·        I will lead three teaching sessions on facilitating movement

For junior therapists goals are frequently about gaining valuable experience and building confidence:

·        I will be comfortable assessing children in Spina Bifida Clinic and reporting my findings at the team conference

      ·        I will participate as a full team member on a traveling clinic

·        I will supervise a physiotherapy student for the first time

And the one that is on everyone’s list:

·        I will get my paper work done on time

In these times of decreased funding for educational opportunities, there is limited chance for professional development through formal courses and workshops.  It’s easy to feel that you haven’t grown as a professional.  Setting realistic goals for attending or providing in-services, informal peer teaching, researching single subject case studies and literature reviews can help to provide the positive reinforcement we all need.

What about in your personal life?  I frequently set personal goals but keep them to myself!

·        I will organize my photo albums by September

·        I will clean out the basement by next Thursday

·        I will write 10 Christmas cards each night for a week

I find the organizational benefits and sense of accomplishment from achieving even small goals to be worthwhile.  How about:

·        I will lose 10 pounds by September

Achievable?  Yes.  Measurable?  Of course.  Realistic?  Hmmmm…. Well, there’s always those photo albums!

 About the Author:  Cheryl Faseruk is a senior Physiotherapist at the Children’s Rehabilitation Centre (now part of the Child Health Program of the Health Care Corporation of St. John’s) where she has worked for more than twenty years.  She completed her Physiotherapy degree at Dalhousie University in Halifax in 1980 and moved with her husband, Alex, to St. John’s in 1981.  Cheryl and Alex have two sons, Andrew and Michael.  Cheryl has discovered that while personal goals help to organize her life, they are not easily imposed on teenage boys!