171 General discussion In chapter 5 concept mapping was used to combine the input of the first three studies into an evidence-based, expert-based, and experience-based conceptualization. The results from the previous studies were summarized in 70 statements, which were divided over five clusters ; goals, rehabilitant and informal caregiver, staff aspects, environmental aspects, and exercise and peer support. The cluster goals summarizes aspects relevant for the goal setting process. In the next cluster, rehabilitant and informal caregiver, the focus is on factors concerning the rehabilitant and informal caregiver. In a CRE it is important that the rehabilitant and informal caregivers are part of the rehabilitation team. The third cluster focusses on staff aspects. Staff in a CRE should apply an interdisciplinary working method, and all team members should be focused on rehabilitation during daily activities. In the fourth cluster, environment aspects in a CRE are combined. The design of the rehabilitation ward should stimulate and challenge rehabilitants. The last cluster focusses on aspects relevant for exercise and peer support. Rehabilitants are encouraged to work on their rehabilitation throughout the day, which can be achieved by group training and patient regulated-exercise. In addition, peer support is encouraged, so that rehabilitants can learn from each other and encourage and support each other. The team self-evaluation tool for a challenging rehabilitation environment Based on the above-described conceptualization of CRE, a self-evaluation tool for teams regarding CRE was developed in the final study of this thesis (chapter 6). In this CREATE-tool an interdisciplinary representation of the rehabilitation team individually rated the 70 statements of the conceptualization of CRE using a plan, do, check, act methodology. These ratings were treated as ordinal data to convert them in individual and team standardized cluster ratings, which were presented in a radar diagram with five axes. The individual and team standardized cluster ratings were input for a team meeting in which the participants discussed the results per cluster and tried to identify the team’s strengths and areas for improvement. After this discussion the participants each indicated three quick wins and three ideas for improvement that are important but take more time to implement. 7
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