177 General discussion Concept mapping After the studies described in chapter 2, 3 and 4, a lot of information about relevant aspects had to be combined in a conceptualization of CRE. One of the most important factors of a CRE is the equality of stakeholders. Therefore, it was important that the three main stakeholder groups (rehabilitant, informal caregiver and professional) were involved in the development of the final conceptualization. After considering different methods, we opted for concept mapping to develop the final conceptualization. Concept mapping is a highly structured procedure which can be used as an exploratory consensus procedure for modelling conceptual frameworks based on specific elements and the input of relevant stakeholders.26,27 A major advantage of concept mapping is that all participants provide their input individually, without participants influencing each other. The input of each participant counts equally in the final conceptualization. This has led to a rich conceptualization of CRE which combines evidence-based, expert-based and experience-based knowledge. Aiming at the equality of stakeholders in a CRE, the concept mapping methodology seems most suitable for shaping the final conceptualization of CRE. CREATE-tool In this thesis it was studied to which extent a team self-evaluation tool is feasible to support rehabilitation wards by implementing CRE. Therefore, a delegation from the interdisciplinary team participated in the study in chapter 6. In this study, the participants were assigned by the team manager to achieve a good representation of the team. The readiness for change of the participants, was not considered. It is conceivable that this could influence the results in the study in chapter 6. Participants characterized with a lower readiness for change are likely to fill in the tool more conservatively and will therefore come up with fewer ideas to improve the CRE during the team meeting. They will probably complete the evaluation questionnaire less positively because they see less need for change. While participants whit a higher readiness for change are likely to identify more areas for improvement and are more positive about the entire tool. If the CREATE-tool is going to be used in practice, it is good to include the readiness for change of team members when selecting participants. An ideal mix of participants consists not only of a representation of different occupations, but 7
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