Client-centred practices and work in inpatient rehabilitation teams: results from four case studies
Bibliographic record
Abstract
PURPOSE: To explore the relationship between client-centredness (CC) and work in teams in inpatient rehabilitation. METHODS: Case study, mixed-method design, with strong qualitative component. Methods include ethnographic observations of team and clinical encounters for 6 months; healthcare professional (HCP) interviews. HCP n=45; Observations = 40 encounters & meetings. RESULTS: Based on HCP perceptions, intra-team and organizational factors were identified that influence client-centred practice in rehabilitation. Team factors included relational and communication dimensions affecting work that can hinder or facilitate CC. These dimensions are presented in detail. HCP perceived organizational factors such as workload, schedules and hospital culture to influence their work on teams and with clients. CONCLUSION: CC is not a "one size fits all". It is affected by similar factors that affect work in teams such as organizational policies, team characteristics and culture. CC can be seen as an outcome of team performance. Implications for Rehabilitation Client-centred practice (CCP) is influenced by client, provider and organizational factors. CCP is not just about client-provider communication. How inter-professional teams work together is an important aspect of CCP. Shared knowledge, shared goals and mutual respect characterize the relationships among members in a team. These three dimensions influence, and are influenced by, the nature of team members' communication and the organizational structures and culture in which they take place. Effective teamwork does not automatically lead to enhanced client-centredness. Strategies are needed that ensure teamwork does not merely perpetuate the health professionals' control of the patient or that decisions are the "right" decisions from the health care professionals' perspectives.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.011 | 0.034 |
| Meta-epidemiology (narrow) | 0.000 | 0.001 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.003 | 0.004 |
| Science and technology studies | 0.007 | 0.003 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.005 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".