194 Summary disciplinary team individually assessed all statements using the plan, do, check, act methodology. These ratings were considered as ordinal data and converted into individual and team standardized cluster ratings. These ratings were shown on a five-axis radar chart. The individual and team ratings were the input for a team meeting, where the participants discussed the results per cluster. They tried to identify the strengths and areas for improvement per cluster. The areas for improvement were noted on a flip chart and after the discussion, all team members indicated three quick wins and 3 larger areas for improvement. In chapter 6, this methodology was tested on five rehabilitation wards. A total of 28 (para)medics and 22 nurses participated in the study. Afterwards, these participants completed an evaluation survey. The study showed that the tool was helpful in identifying strengths and areas for improvement of a rehabilitation ward. Between 11 and 29 areas for improvement were identified per team. The participants were all very satisfied with the use of the tool, which was reflected in a median score of 7 or 8 on all evaluation questions. Conclusion The studies in this thesis jointly led to an evidence-based, expert-based and experience-based conceptualization of the challenging rehabilitation environment in five clusters. This conceptualization has been incorporated into the CREATE-tool, a team-self assessment tool that can be used to implement and evaluate the challenging rehabilitation environment in geriatric rehabilitation departments. This CREATE-tool is able to identify areas for improvement for the challenging rehabilitation environment at ward level and professionals are satisfied with the use of the tool. This thesis did not investigate to what extent the use of the CREATE-tool contributes to the rehabilitation outcomes of individual rehabilitants or to the improvement of the challenging rehabilitation environment at ward level. In previous studies, components of the CREATE-tool have proven their effect on rehabilitation outcomes. It is therefore recommended to use the CREATE-tool at least once every two years to identify the ward’s areas for improvement. In addition, geriatric rehabilitation is a rapidly developing field. This also means that the conceptualization of the challenging rehabilitation environment is a dynamic concept and requires continuous further development.
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