142 Chapter 6 Abstract Objectives: A challenging rehabilitation environment (CRE) is a relatively new concept for offering geriatric rehabilitation and consists of multiple components. This study explores whether a self-evaluation tool (the CREATEtool) can be applied in teams and can identify areas for improvement for wards regarding CRE. Design: observational study Setting and participants: 50 professionals working on 5 geriatric rehabilitation wards in the Netherlands participated; 28 (para)medical staff and 22 nursing staff. Methods: The CREATE-tool with 70 statements in five clusters was developed based on previous studies. In the rating phase, participants were asked to score the statements of the CREATE-tool using the Plan, Do, Check, Act methodology. These scores were converted in individual and team standardized cluster ratings between 0 and 1 and visualized in a 5-axis radar chart. In the team discussion phase, a meeting was organized for each team, in which the results of the CREATE-tool were analysed and areas for improvement were identified. In the reporting phase, participants filled out an evaluation survey with 16 questions scored from 0 (lowest) to 10 (highest). Results: The rating phase showed that the standardized cluster ratings of the five teams vary between 0.41 and 0.78 and that there are differences between team members in how they assess CRE on their ward. The team discussion phase consisted of lively discussions and resulted in 11 to 29 ideas for improvement per team. In the reporting phase, alle questions were answered with a median score of 7 or 8. Conclusions and implications: The CREATE-tool, based on an evidencebased conceptualization of CRE, is successfully applied by professionals and helps to identify strengths and weaknesses of a ward. The CREATE-tool supports rehabilitation wards to improve their CRE, and therefore enhances the quality of geriatric rehabilitation. Keywords Geriatric rehabilitation, challenging rehabilitation environment, self-evaluation tool, CREATE-tool
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