The Wessex-Ghana Stroke Partnership includes medical and nursing staff, occupational therapists, physiotherapists, dieticians, pharmacists, speech and language therapists, clinical psychologists, as well as managerial and administrative staff. Each discipline has skills and experience to offer the partnership as well as the patients in their care.
The Wessex-Ghana Stroke Partnership UK team and the Korle Bu Teaching Hospital (KBTH) in Accra, Ghana are working together to improve care for people who have had a stroke. The partnership began in 2009, following a period when Dr Claire Spice was working in Ghana. During her time there, Dr Spice identified aspects of stroke care that could be changed through education and training to make a big difference to outcomes and patient experience. On returning to the UK, she began work on exploring these ideas further and set up the partnership, working with colleagues in the UK and Ghana.
Through this partnership, KBTH has improved management and outcomes for patients hospitalised with acute stroke, initially by improving the training of health professionals and subsequently by developing a dedicated stroke unit, the first in West Africa, led by consultant neurologist Dr Albert Akpalu.
An interdisciplinary approach is at the heart of this partnership.
Good stroke care requires a variety of health disciplines, and the partnership includes medical and nursing staff, occupational therapists, physiotherapists, dieticians, pharmacists, speech and language therapists, clinical psychologists, as well as managerial and administrative staff. Each discipline has skills and experience to offer the partnership as well as the patients in their care. But having access to people from all these disciplines is not the same as having them working together.
Training and education was a key goal of this partnership, and the disciplines had much to learn from each other, so finding ways to bring people together was vital. Initially, this was often achieved in simple but effective ways, such as making sure that meetings during exchange visits involved groups of people from across the disciplines. Dr Spice remembers that putting people in a room together, in a way that would not have been done before, and focusing attention on the project, meant that the team naturally started to evolve. The project focus meant that different disciplines were united around a shared goal. The partnership also arranged for a series of teaching presentations, open to everyone, to be delivered by staff from different disciplines. In this way, the team heard about the importance of elements of care provided by people from other disciplines – such as continence care, or care in feeding – and could recognise and learn the value of different skills and experience.
In addition to teaching patient care skills – such as the importance of the position a stroke patient is put in, or how to assess a patient’s ability to swallow – the partnership has taught and modelled team working skills. Over time, interdisciplinary working has become more familiar to the team in KBTH, and has evolved to be a strong and valued way of working.
“Skills sharing and mutual respect are the key ingredients that make the partnership work. Everybody has something to learn from each other,” explains Dr Akpalu.
Working as an interdisciplinary team has benefits for patient care, but it is also beneficial for the partnership. It brings a broad range of knowledge and perspectives, and this diversity of experience has been a great asset in creative problem-solving, even in logistical elements of the partnership, not just patient care. The broad base of the partnership has also provided strength and stability, as changes are embedded throughout the system. The staff from each discipline continue to work on other projects alongside their peers – such as the project dietician who will continue to work in the dietetic department as well as the stroke unit – and in this way they bring new ideas and experience from the project group back into their own areas.
Dr Spice reflects, “It feels much broader – those different ideas, different experience, it does give you more resilience. Getting that hook in, in lots of different places, makes the change much more secure. You're not hanging off the side of a cliff with one rope, you've got a web.”
Multidisciplinary care is common for stroke patients, so the project team knew early on that it would be an important part of their approach. However, involving people with different skills, and with different levels of seniority, has been important to other aspects of the partnership too.
“I would advise partnerships to get lots of different people with different skills involved early on, even if at that point you don’t know exactly what their role’s going to be,” explains Dr Spice. “There’s something important about having a broad group, so that you’ve got a better perspective. A diverse group can look at things in a different way and be more resilient in trying to work out solutions.”
The partnership has found that interdisciplinary working gives people the opportunity to learn from others, to share skills, and to see things from other perspectives. It exposes staff to new ideas and ways of doing things. Interdisciplinary working may be new to people, however, and may mean breaking down silos and hierarchies. Communication is key, alongside building trust, particularly at the beginning of the partnership. Choosing your project team is not just about medical or technical skills.
The main thing, according to Dr Akpalu, is to involve individuals who are committed and who have a shared vision: "People have to reach out to members of their disciplines, and have to have a personal commitment to the project. Our team now is like a big family.”