Problem: Rehabilitation services for brain injuries were largely organized around the needs of geriatric patients and thus failed to meet specific rehabilitation needs of younger patients; physical separation and a lack of communication between providers resulted in fragmented care delivery and hindered effective rehabilitation of patients with brain injuries.
Solution highlights: An outpatient rehabilitation centre specifically adapted to the needs of working-age patients recovering from brain injuries was opened in Bern; Direct clinical experience of the multi-professional leadership team helped draw awareness to service delivery gaps and aided the design of practical services to address observed needs; co-location of providers within the rehabilitation centre increased service coordination and improved access for patients, while external networking between providers helped generate referrals; gradual expansion of the initiative allowed time for sufficient resources to be collected and necessary partnerships to be established, ensuring steady and sustainable growth.
Description of practice
During the early 2000s, rehabilitation services for patients with brain injuries in Switzerland were largely focused on the needs of geriatric patients. However, this left a gap in services targeted to working-age patients who required specialized care to facilitate their return to work. Furthermore, the multiple specialists needed to rehabilitate these patients - including occupational therapists, physiotherapists and speech therapists – were fragmented, leaving patients with the burden of seeking care from different locations, preventing coordinated delivery of care plans and causing patients’ symptoms to be treated separately, rather than as part of a complex whole.
A group of occupational, physical and speech therapists joined together to open an outpatient rehabilitation centre specifically tailored to the needs of working-age patients recovering from brain injuries. Planning and preparations for the centre began in 2003 and start-up costs were self-financed by the leadership team. With no similar model for the integrated delivery of rehabilitation services in Switzerland in place at the time, the leadership team developed care guidelines and protocols based on their own expert knowledge and practical experience, supported by input from other providers. After securing a guarantee for the reimbursement of services from insurers, the centre – coined Rehapunkt, meaning “rehabilitation point” – opened in 2005. Initially offering rehabilitation services just one day per week, professional networking helped build patient lists and by 2008 the centre had expanded to a larger space and was open five days per week. Occupational therapists are employed directly by the centre. All other professionals (including physiotherapists and speech therapists) rent rooms in the centre and are contracted to provide services. Patients enrol for services through referral from inpatient rehabilitation centres and follow a six-month rehabilitation programme tailored to their individual needs and goals. General practitioners receive regular updates on their patients throughout the programme to support care continuity. Presently, the centre continues to grow and is currently seeking a larger space for further expansion. Additionally, the integrated multidisciplinary Rehapunkt model has been replicated by two other centres in Switzerland.
Implementation of practice
What stage is the practice currently in?
Fully implemented and scaled up
Who was/is responsible for the implementation of the practice?
The idea for Rehapunkt was formed by an entrepreneurial occupational therapist who, already running an occupational therapy practice, was well positioned to observe gaps in services and conceive an initiative to address these. Going on to become the owner of Rehapunkt, the centre was designed and managed together with a self-formed leadership team composed of motivated colleagues at partner physical and speech therapy practices. This leadership team first met in 2003 and, together with input from local physicians and experts, designed and opened Rehapunkt. This leadership team continues to oversee and manage the centre today, meeting regularly to coordinate necessary activities and strategize improvements.
While no formal outcomes are available to date, measures to monitor the centre’s performance are in place and research is conducted by university students as part of practical work placements hosted by the centre. Approximately 40% of patients are able to successfully return to work after completing the Rehapunkt six-month rehabilitation programme, with an additional 30% able to return in some capacity. Leaders of the initiative attribute a large part of the programme’s success to its unique use of group rehabilitation, noting that patients appear to particularly benefit from this type of care. Integration of patients’ family and employers in care is also considered to be a key influencer of positive patient outcomes.
This case was prepared as part of a larger effort by the WHO Regional Office for Europe and published (2016) in the document, "Lessons from transforming health services delivery: Compendium of initiatives in the WHO European Region".
© Copyright World Health Organization (WHO), 2016
The methodology used for the development of this case is slightly different from the templates used on the IntegratedCare4People web platform, in particular in the analysis of enabling factors and barriers to change.
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- Jacqueline Burki
- Rehapunkt rehabilitation centre