15 / 06 / 2011
What we did and why
How we did it
Results and next steps
Heartlands Hospital is the flagship hospital of the Heart of England NHS Foundation Trust and offers a huge array of facilities and procedures. Its dedicated staff serve a diverse population with professionalism and pride.
The merger of Good Hope Hospital and the Heart Of England Foundation Trust created a need to develop an equitable response rate for adult musculo-skeletal physiotherapy referrals across the economy which was compounded by the eighteen week target. An analysis of demand and capacity and waiting lists across the three sites of the trust identified a variation between an access of six weeks and six months.
What we did and why
We carried out a programme of work to identify the levels of demand and capacity available. This led to the development of specific assessment sessions to meet the key needs of the individuals, while reducing the overall time spent on each assessment.
The need to further improve upon this was identified in order to address the targets for the white paper in terms of patient satisfaction and outcome measures. A quicker response rate demonstrates a greater impact upon recovery with improved outcomes and a lower number of initial assessment to follow up appointment ratios. This made the department more efficient and the patient more satisfied with their overall episode of care.
How we did it
We introduced a generic referral form against a validated score scheme, for use during telephone triage to indicate urgency and agreed an appointment date. By using a combination of the above the waiting time was reduced from six months to three weeks on all sites.
Further analysis of demand and referral criteria resulted in a decision to enhance the skills of Clinical Support Workers already working at Technical Instructor Grade and uplift them to Band 4 grade This allowed them to be included in assessment sessions alongside two skilled clinicians.
Once training was completed the Band 4's would then be responsible for continuing to provide the ongoing patient care. Candidates were recruited across the three sites in the early part of the 2010 financial year and the Clinical Team Leaders identified the criteria for the referrals which would be included in the assessments and a pathway for the patient intervention.
It was agreed that the Band 4's would assess total knee replacements, total hip replacements and colles fractures. A competency framework was written based on a collaboration of information from skills for health, essence of care, assistant practitioner training and university training in order to enable the skills for intervention.
We considered that the most important factor of the project was the ability to combine effective and strategic influencing with the engagement and empowerment of others. We did this by ensuring that the agenda was driven and owned by local people and staff across the sites.
Effective communication was essential to ensure that the reasons for the change were understood and to encourage all members of the team to find new ways of delivering and feel part of implementing the change. Leadership was shared to foster development, create space for others allow growth of confidence and capability
Results and next steps
The Band 4's completed their competencies between April and August 2010 and in September shadowed their mentors during assessments that fitted the criteria outlined above and then carried out assessments with their mentors shadowing them. Their progress and capability is monitored by the clinical team leaders at monthly reviews.
In October the Band 4's commenced their assessment slots offering an additional 30 per week in total across the three sites. Each assessment that takes place includes a log sheet to capture data against baseline measurements recorded before the outset of the pilot which formed the objectives of the initiation document.
This service development has been chosen as one of the successful projects to gain support from the Department Of Health and has championed career development initiatives to make full use of the workforce.
The project is easily sustainable now that the competencies and training package have been produced and we intend to use succession planning and improve the patient care further by increasing the use of the Band 4's in other areas.
The model is also easily transferable to other organisations for use in a variety of departments as long as the patient pathway is robust i.e. the team leaders have to clearly identify the criteria for patient selection and produce the competencies to support the acquisition of the skills required for the Band 4's to treat to a validated level.
The project has increased our productivity by allowing us to be:
- more flexible in the provision of assessment slots per week across the sites. This has effectively improved patient's access to treatment and decreased the wait from referral to treatment time to 2 weeks
- improving access to initial treatment the ratio of assessment to follow up contacts has reduced to 3 follow up contacts. This had the effect of making the overall episode of care shorter and returning the patient to their maximum functional capacity more quickly
- patient feedback cards have indicated a higher level of satisfaction since the service improvement commenced
- by using Band 4's in assessments showed a forecast of cost release, calculated as follows: average episode of care (assessment and 3 contacts) at £41 per session = £164 income per episode of care (expenditure based on 2 hours 10 minutes for total episode of care).
Further information and contact details
Julie Hunter, therapy team leader
Heart of England NHS Foundation Trust firstname.lastname@example.org
or call 01214 247195.