#FAIL: Defining, Understanding and Owning Our Failures.

Despite our best efforts to reform the healthcare system, significant challenges remain. To some extent, our progress is being hampered because of our hesitation to learn from past mistakes. In his article "Systematically Identified Failure Is the Route to a Successful Health System", Zwarenstein (2015) argues that we must right this wrong and begin to systematically identify, acknowledge and learn from failure if we want to make true progress. This commentary outlines some key steps that must be taken to help us move past failure and apply lessons to future healthcare reforms. To achieve this end state we propose adopting a disciplined approach that includes clearly defining policy goals, stratifying failures into categories to help facilitate learning and encouraging leaders to acknowledge and learn from failure.

Interprofessional stroke rehabilitation for stroke survivors using home care.

OBJECTIVE: To compare a specialized interprofessional team approach to community-based stroke rehabilitation with usual home care for stroke survivors using home care services. METHODS: Randomized controlled trial of 101 community-living stroke survivors (<18 months post-stroke) using home care services. Subjects were randomized to intervention (n=52) or control (n=49) groups. The intervention was a 12-month specialized, evidence-based rehabilitation strategy involving an interprofessional team. The primary outcome was change in health-related quality of life and functioning (SF-36) from baseline to 12 months. Secondary outcomes were number of strokes during the 12-month follow-up, and changes in community reintegration (RNLI), perceived social support (PRQ85-Part 2), anxiety and depressive symptoms (Kessler-10), cognitive function (SPMSQ), and costs of use of health services from baseline to 12 months. RESULTS: A total of 82 subjects completed the 12-month follow-up. Compared with the usual care group, stroke survivors in the intervention group showed clinically important (although not statistically significant) greater improvements from baseline in mean SF-36 physical functioning score (5.87, 95% CI -3.98 to 15.7; p=0.24) and social functioning score (9.03, CI-7.50 to 25.6; p=0.28). The groups did not differ for any of the secondary effectiveness outcomes. There was a higher total per-person costs of use of health services in the intervention group compared to usual home care although the difference was not statistically significant (p=0.76). CONCLUSIONS: A 12-month specialized, interprofessional team is a feasible and acceptable approach to community-based stroke rehabilitation that produced greater improvements in quality of life compared to usual home care. Clinicaltrials.gov identifier: NCT00463229.