Using the International Classification of Functioning, Disability and Health (ICF) to enhance healthcare communication: an action research project with an acute stroke service

Abstract

Background: Effective communication is key to team working in healthcare. It can be negatively impacted upon by existing cultures, logistical challenges, role confusion, and a lack of collaborative approaches to practice. Clinical guidelines recommend using the International Classification of Functioning, Disability and Health (ICF) to aid communication within stroke teams. Yet no empirical evidence exists on the process or outcomes of such implementation. Aims: This project aimed to explore ways the ICF could be used with an acute stroke service and identify key learning from the implementation process. Methods: Using an action research framework, iterative cycles were used within exploratory, innovatory and reflective phases. Content analysis was used to map patient notes’ entries to ICF categories. Thematic analysis was undertaken, using a model of immersion and crystallisation, on data generated via interview and focus group, e-mail communications, minutes from meetings, field notes and a reflective diary. Descriptive statistics were used to analyse quantitative questionnaire data. Data from all sources were combined to determine key findings. Findings: Participants chose to develop an ICF-based team transfer of care report with an ICF glossary to aid completion. Five overall themes were determined; the need to: (1) adopt the ICF in ways that met local service needs; and (2) adapt the ICF language and format. Once implemented, the ICF: (3) fostered communication within and beyond the stroke team; (4) promoted holistic thinking; and (5) helped to clarify team roles. Conclusions: These are the first empirical findings within stroke services that demonstrate how to make the ICF a clinical reality. Participants needed to adapt and own the ICF to adopt it. When implemented, it enabled specific team communication challenges to be overcome. The use of action research to implement the ICF has facilitated sustained change and improvements to communication, thus benefiting patient care.