Rehabilitation is changing. The economic and regulatory environments continue to evolve, as does the science of rehabilitation. Addressing all of this change is quite a challenge. I believe it is possible to have our cake and eat it too. Over time, by focusing on a rigorous model of clinical best practice and the development of a differentiated brand there is the potential for long-term financial sustainability – and ultimately better care for the people we serve.
Sheltering Arms’ Vision: Shaping the future of rehabilitation for the communities we serve
When we crafted this vision a number of years ago, we immediately felt pressure to make it real. No pressure, right. In order to accomplish our goal we have determinedly worked to develop our people and allow them the autonomy to develop clinical programs with the best available tools and technology. From the beginning of our benchmarking and literature reviews, it was clear that the right tool used on the right patient at the right time could be a difference maker. By that I mean, someone that might go to live in an institution could potentially go home instead.
As we moved ahead, the disparity between the flow of rehabilitation science, the advancement of rehabilitative technology and what is actually practiced in the clinic became increasingly apparent. We generally had an idea that better practice was possible by infusing more evidence and potentially technology into practice, but which studies and what specific device. Unfortunately, there were, and are, no easy answers, and there is undoubtedly more than one way to achieve the same goal. So, what did we do? We started. Without all of the answers, we started and failed and learned until we got better. And then we kept working.
Making it real
Walking into one of our hospitals just the other day, I was reminded of just how far we have come. While we still have much to learn, we have made our vision into something real. One tangible example is that we now have a very busy outpatient program for people with spinal cord injury. The development of this program is based around the use of advanced technology, particularly the Indego Exoskeleton. Our program leader has defined the clinical practice and now uses the Indego to assist people in our community. Of all the devices and advanced technology we have, I have not seen a more positive impact on people in our community than with the Indego. To watch as a young man, who had injured his spine more than two years prior, walk 450 feet during his first session and then to have the privilege to see his mother weep and hug him while he stood at the end of the walk was truly remarkable. In addition to growing this community program from scratch, we are participating in multi-center trials to learn more and to add to our vision to serve the community.
How we made it real
At Sheltering Arms, we have devoted significant time and resources to understanding and hardwiring clinical best practice. In order to describe and sustain a new standard of rehabilitation for our facilities, we focused on three main areas:
Measurement – in order to describe best practice, it is essential to start with a defined set of outcome measures.
Standardization – while this may sound easy, writing down a clinical plan is quite difficult. More difficult still is getting broad agreement and more uniform practice. Through collaborative leadership and direct staff involvement, we have established a method to create clinical practice guidelines that are localized to our patients, mission and resources.
Innovation – ongoing innovation is critical. Our pursuit of best practice began with better practice, and has continued in the form of empowerment of clinical leaders and knowledge translation
I do not pretend that we have it all figured out or that all of what we have done could or should be replicated in every environment, but I hope it will be helpful and may spark some interest and inspiration to make it real in your environment.
This article was contributed by Matt Wilks, PT, MSPT, NCS. Matt currently serves as Associate Vice President of Rehabilitation and Community Wellness with Sheltering Arms Physical Rehabilitation Centers in Richmond, Virginia. Matt received his bachelor’s degree from the College of William and Mary in Williamsburg, Virginia and his Master of Science in Physical Therapy from the Medical College of Virginia. Matt is board certified in neurologic physical therapy. He has a passion for leadership development, community service, and collaborative learning.
Sheltering Arms serves the central Virginia region and is comprised of two inpatient rehabilitation hospitals with 68 total beds, ten outpatient therapy and wellness clinics, and comprehensive physician and psychology services.
Sheltering Arms was established as a free care hospital in 1889 and has been a specialty provider of post-acute rehabilitation services since 1981. Sheltering Arms has established innovative, standardized, and outcome-driven clinical programs including the iWalk and iReach Recovery Programs. Additionally, outpatient neurology practice has been transformed into specialty programs and centers in order to better serve community needs.
Recently, Sheltering Arms has formed a joint venture to build a new, state-of-the-art rehabilitation hospital with partner VCU Health. This exciting venture will help elevate the role and positive impact of rehabilitation for the surrounding region.