DOI: 10.34894/hj0r8y
title: Werkplaats Zelfmanagement XL: Verpleegkundigen en verzorgenden implementeren en leren over zelfmanagement

description: For nurses, support of the patient’s self-management is a core task. Addressing the needs of patients and shared decision-making are pillars of person-centered nursing. Several methods and tools to support the patient’s self-management and let them determine for themselves are available. Often these evidence-based practices and tools have not yet been implemented in healthcare. In the Self-Management XL Work Lab, six healthcare organizations have started working on this.
The aim of this project is to implement effective self-management interventions in various care practices (hospital, mental health, nursing home and home care, epilepsy residential care), so that these become part of daily practice. In addition, the Self-Management XL Work Lab aims at learning how to successfully achieve sustainable implementation of self-management interventions. The central research question was: How are implementation and sustainment of self-management interventions optimally realized in daily care practice? 
In six healthcare organizations, implementation teams have chosen one or two interventions from a selected set of nine effective methods or tools that support self-management of patients/clients/residents. Some care organizations chose a familiar intervention whose implementation needed a boost. After having chosen the intervention(s), the implementation teams got started, applying suitable implementation strategies. For that purpose, local practice project leaders were supported by a Vilans coach. In addition, regular project leaders’ meetings allowed them to exchange experiences, and spreading inspiration and learning from other implementation teams. The implementation teams had 18 months to work on the implementation of the chosen intervention(s). After this first period, the implementation teams should pass the baton to another implementation within their organization for a next 18-month change project. (Teacher) researchers of the Self-Management XL Work Lab identified barriers and facilitators, and assessed the effect of implementation and sustainment efforts. Implementation. Research methods included a qualitative process evaluation (interviews, observations, inventories) and a quantitative questionnaire study on person-centered care among nursing staff (and where possible clients). Experts in implementation and self-management, and researchers participated in the project.
Six healthcare institutions participated in the Self-Management XL Work Lab: Maasstad Hospital, Antes Zorg (mental healthcare), Humanitas (nursing-home care), Laurens (home care), Oktober (nursing-home care) and Kempenhaeghe (epilepsy residential care). Wherever possible, collaboration was sought with interprofessional training units in which nursing education and practice work and learn together. Teacher-researchers conducted the research with the help of the implementation teams and/or students. 
The participating healthcare organizations selected the following interventions to improve self-management support: the Self-Reliance Radar (home care and nursing-home care), Self-Management Web combined with solution-focused interviewing (hospital care), Crisis Management Plan/Care and Support Plan (matching Individual Rehabilitation Approach in mental healthcare) and Active Support and My Dream (epilepsy residential care).
The Self-Management XL Work Lab gave a boost to the use of a chosen self-management intervention. In three of the six care organizations, the interventions to support self-management have been implemented successfully and sustainably. Two other organizations needed more time. In one organization, staff changes prevented continuing the project. It is also learned how successful implementation is achieved with the input from implementation teams, coaches, clients/patients/residents and relatives, project leaders meetings and interprofessional training units. Through research, promoting factors have been identified that facilitated implementation even when facing major challenges in healthcare. These promoting factors are illustrated in an Inspirational Plate 'Successful Change in Healthcare. What helps?’.
In future, the participating wards and teams must pay continued attention to the sustainment of the interventions/tools. This can be done by regularly discussing its progress in team meetings, or by sharing successes. Successes are the visible effects of good care. Using a new method or tool tends to slacken. Professionalization of new and old employees is important here. Monitoring can help to keep track of whether or not the desired approach is still shared by everyone. Monitoring also implies doing research. In this project, the research was mainly done by external researchers and students. As a result, the research was somewhat distanced from practice. Ideally, health care staff should be more involved in such research, so that they can better monitor progress themselves in the future. Observational research is important in this regard.