154 Chapter 6 and a radar chart. Furthermore, the CREATE-tool stimulates the discussion in teams and identifies areas for improvement in teams regarding CRE. Also, the used methodology of the CREATE-tool is feasible, and participants in this study reported satisfaction with the use of the CREATE-tool. Questions regarding the content, process, and the added value of using the CREATE-tool are all answered positively with a median score of 7 or 8. During the development of the CREATE-tool, the PDCA rating was chosen because it can facilitate a discussion about the level of improvement, and the rating is of secondary importance. During the team meeting some participants mentioned that they considered the PDCA rating complicated because it forced them to think more carefully about their answers. In the evaluation survey, the question regarding satisfaction with the use of the PDCA methodology was answered with 7 (IQR 6-8). Also, the field notes showed that the variation in the rating of the statements was a rich source of discussion during the team meetings. The PDCA methodology is a frequently used methodology which is helpful to determine whether improvement occurs in a system or organization. It enables insight into improvement processes, and it is a standard rating system in literature concerning improvement management, organizational change, and quality management. (1416) Moreover, the used PDCA methodology provided insight into improvement processes in the team meetings. Therefore, this methodology remains the best assessment method for the CREATE- tool, as the tool is used as an evaluation instrument and source for discussion during team meetings. However, more information and explanation on how PDCA should be used in practice is probably necessary to improve the user-friendliness of this tool. In the evaluation survey, participants positively assessed the use of the CREATE-tool and indicated that the results of the self-assessment contribute to improving CRE on their ward. Only the question regarding advising other rehabilitation wards to use the tool scored a 5 in the first quartile. However, self-evaluation has proven to help organizations discern their strengths and areas for improvement, leading to improvement actions that can be monitored for progress. (1113) Nevertheless, the field notes of the team meetings provide no explanation for the low score. The overall results of this study support that a self-evaluation tool is useful for monitoring the implementation of CRE in rehabilitation wards.
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