Background Despite having a life-limiting illness, patients wish to remain as independent as possible during their disease course (Yoshioka, 1994) and if this is optimised it can ameliorate their perceptions of hopelessness and despair and relieve some of the burden on the caregiver. Although intended to be supportive, evidence suggests that hospice palliative care may disable patients and reduce their ability to do things for themselves (Jennings, 2012).
Aims Explore how an approach to palliative care that focuses on maximising functional status, physical independence and quality of life, whilst acknowledging the patient’s advanced disease and limited life span, can be integrated into a hospice in-patient setting.
Methods The setting is a 15-bedded hospice inpatient unit.
Using participatory action research, a co-operative inquiry group (CIG) of clinical and non-clinical staff and volunteers collectively developed their knowledge in relation to a rehabilitative approach and organisational change; planned how to integrate a rehabilitative focus into the in-patient setting, attending to the potential facilitators and barriers; led on the agreed actions; met regularly to review progress and agree how the study should be evaluated.
Following the situational analysis, the CIG planned what action to take and after each period of activity, assessed the outcome and then further action was planned and executed.
Organisational change theory provides the theoretical lens for the study.
Results Achievements to date are aligned with Kotter’s (2014) leading change model as follows:
the CIG are excited and committed to change within the organisation, and
have become the guiding coalition for the change process
a vision is emerging to steer the change.
Conclusions Data collection will continue until June 2016 but early indications suggest that a group of hospice staff and volunteers identifying, owning and acting collaboratively, as described by Pascale and Sternin’s (2005) positive deviance model, can form the basis of effective organisational change.
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