How My Work With FOX’s Capstone Helped Further My Clinical Excellence

By Horace Leung, PT, DPT

Geriatric Clinical Resident

By reading the title to this article, many of you might be wondering what a Capstone project is and why it would be of interest. Essentially, it is an independent research project that is relevant to practice. There are a plethora of articles that are published each year, but I can definitely say for myself that it can be overwhelming. When it comes to which articles to read and which ones to use in practice, we have too many options! A Capstone project focuses on a specific topic and streamlines information around the concept to bring research from randomized control trials and systematic reviews to the hands of practicing clinicians! This is one way to develop an appreciation for the current evidence within our field of practice and apply it in order to benefit our patients!

In my case, I have the opportunity to collaborate with other clinicians and work on FOX’s Capstone project through the FOX Geriatric Residency Program. The Capstone project I am currently working on involves identifying key behaviors FOX clinicians use to communicate and collaborate between disciplines in order to determine actions that enhance clinical value. We plan to analyze the results and look into ways we can teach, incorporate processes, and hold clinicians accountable to these behaviors to maximize the value of the care we provide. This idea was formulated between the residents of our FOX Geriatric Residency Program in Physical Therapy and a fellow of our FOX Geriatric Fellowship in Occupation Therapy. My colleagues and I are heavily involved in the stages of running this quality improvement project based on real patient data.

I am still in the process of completing the Capstone project, but I wanted to share how investing my time and effort into the project has impacted my journey as a lifelong learner who strives for clinical excellence for my patients. In this article, I will be providing my active reflection on key components that were enhanced through the Capstone process.

TEAM SPIRIT PRODUCES BETTER OUTCOMES AND PRODUCTIVITY.

Collaboration is a key component that has been emphasized throughout the process. As part of the Capstone, I work with team members who care about the project and are supportive throughout the whole process. These characteristics set the team up for improved efficiency and productivity.

For the Capstone project, we have been working on developing a survey that captures interdisciplinary communication and collaboration. Roles were divided to have certain team members gather the information, interpret the information, and formulate the survey. As the project progressed, we set expectations for each other to provide feedback while other members were tasked of making the necessary corrections.

All of these actions are essential to allow us to achieve the prioritized goal of developing a survey for our research in the allotted time. Throughout the process, we know each team member’s role and trust in each person’s capabilities to work toward completing objectives.

As individuals, we have a common understanding of the work demands, knowledge, and responsibility of this endeavor, and we hold each other to those standards throughout the course of the project. As a team, we work as a unit under this foundation in order to make progress with executing plans.

These characteristics are essential to ensure tasks are completed with proper accuracy and within an appropriate amount of time.

‘With this said, these characteristics can also be applied beyond the Capstone. As clinicians, we are part of various teams involving co-workers, physicians, caregivers, family members, and patients. In all teams, we must hold a standard of performance for each individual in order to provide the best outcomes. When we collaborate, we have a greater potential of achieving goals by making a greater impact!

EFFECTIVE COMMUNICATION ALLOWS FOR A GREATER EXCHANGE OF INFORMATION IN A TIMELY MANNER

Working on collaborative goals goes hand-in-hand with effective communication. The Capstone spans over a period of a year which requires frequent texts, emails, calls, and in-person meetings in order to establish open lines of communication.

Asynchronous ways of communication like email and text messages allow for information to be updated frequently with all team members, which ultimately influence the responsiveness of the decisions made. Calls and in-person meetings are synchronous forms of communication that allow information from communication threads to be confirmed to ensure total clarity and agreement.

Having a team member repeat back their understanding can allow the rest of the teammates to better understand the individual’s thought process and current understanding.

Furthermore, it is crucial to be succinct and stay on track when providing context and necessary details on the agenda with the limited time available. This is with respect to each team members’ unique perspectives as deviations from the main message can lead to misunderstanding.

As it translates to practice, I have acknowledged greater opportunities to think critically and align my approach in treatment to the comprehensive plan of care for patients when communicating effectively with my SLP and OT counterparts. In my experience, effective communication is the cornerstone of being solution driven!

UNDERSTANDING TIME MANAGEMENT AND APPLYING PRIORITIZATION INTO TREATMENTS

Collaborating and contributing to FOX’s Capstone takes a significant portion of the time. Despite the time dedicated to the Capstone project being manageable, life gets in the way. We all have a finite amount of time in a day. Accepting this was the first step for me to do the most meaningful work. A certain level of stress can easily be accumulated with knowing the territory you are crossing as a treating clinician, a full-time resident, and a foodie on the weekends with friends.

Through working on the Capstone, I quickly realized that time management is not mitigating the fear of wasting time but acknowledging the benefits of using our time wisely to effectively and consistently provide higher quality work. Being self-aware when setting a realistic schedule can reduce workload from becoming overwhelming. It is very likely that there are multiple tasks that could be done now but rarely do all of those tasks need to be done right away.

This might sound shocking to some since it may be construed as procrastinating, but in fact, that is the basis of prioritization! I personally struggled with giving up on multi-tasking, but I knew that switching between tasks consistently resulted in minutes lost when shifting gears between demands of tasks. Wasted time can easily add up with multiple outlets requiring attention. Through trial and error, I derived that prioritization is essentially picking out the urgent tasks from the important ones.

In terms of clinical care, I have often found that there are many different impairments to address when working with the complex older adult population. With this said, I find myself asking what are the most urgent impairments that will provide the greatest impact, in relation to their functional goals, to guide and effectively use my treatment time.

KNOWLEDGE TRANSLATION: PERFORMING RESEARCH IMPACTS CLINICAL DECISION MAKING

As you can see, embarking on the Capstone project my perspective and the way I treat. The act of researching primes the expansion of my knowledge base since my intention is to scour information and discern it. Usually, learning can be an uncomfortable experience and working on FOX’s Capstone has made me open to new information.

As I research my topic, a metaphorical information filter develops over my perspective. This filter picks up on pieces of information that were previously overlooked and as a result alters parts of my clinical decision making.

Utilizing the acquired knowledge applies stress to my current clinical decision-making process. Automatic responses were challenged which promotes greater critical thinking. As a clinician, I drew from presentation patterns, past experiences, and my knowledge, which causes the mind to instinctively attempt to implement new information into thought processes that are already currently implemented. Through self-reflection of the information collected and actual practice, greater carryover and application of the acquired knowledge is yielded.

All in all, FOX’s Capstone project is just one of many ways to further an individual’s clinical excellence. Whether it is through the FOX Geriatric Residency Program or your own endeavors, I strongly implore you to step outside your comfort zone, be open to learning opportunities and put the “why” back into health care. We chose to be healthcare practitioners because we have the desire to be part of something greater. We work to the best of our capabilities in order to be part of the solution for the people and communities we serve. We do what we do in research and in practice for the cause – to rehabilitate lives by believing in the strength of people! Broadly, this is why I’m with FOX’s residency program.