153 The CREATE-tool: A self-evaluation tool for a Challenging Rehabilitation Environment Reporting phase The field notes show the remarks made during the team meetings. Participants experienced difficulties using the PDCA methodology. This methodology forced them to think carefully about their answers, but also resulted in different outcomes between team members due to differences in interpretation. This was reinforced by the fact that not all participants had read the descriptions of the statements. Furthermore, not all participants were involved in all parts of the rehabilitation process. This made it hard to answer all statements, and therefore the answer option “not applicable” was missed. The field notes reported that all team meetings were animated and two hours was relatively short to discuss all clusters. Also reported was that some participants spoke up more than others. A total of 38 participants completed the evaluation survey, the results are shown in Table 4. As not all participants completed the CREATE-tool or participated in the team meetings, not all participants were able to fill in all questions of the evaluation survey. This resulted in 34 to 37 answers per question. All questions were answered with a median score of 7 or 8, and only the question regarding recommending the use of the CREATE-tool to others scored 5 in the first quartile. Participants indicated that they needed a median of 15 minutes to complete the CREATE-tool (IQR 15-21.25) Discussion The CREATE-tool for CRE that was tested in this study proved to be feasible for use by rehabilitation wards and delivered suggestions for improvement. The tool is based on earlier elaborate research regarding CRE. It combines evidence-based, expert-based, and experience-based knowledge in one evaluation tool (7-10). The lively discussions during the team meetings, the number of ideas for improvement and the scores in the evaluation survey led to positive answers to both research questions of this study. The results of this study show that the CREATE-tool is able to identify the strengths and areas for improvement regarding CRE and visualize them in a table 6
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