Physiotherapist and quality improvement leader talks to Jennifer Trueland about her desire for physios to influence change
When she was a physiotherapist working with people with neurological problems, Emer Hopkins loved seeing the actual difference she was making to a patient’s life. The hands-on nature of the job, getting to know the person and sometimes their family too, and being able to chart their improvement, all brought immense personal reward.
Perhaps that’s why she had to think very hard before leaving clinical practice to work in service improvement and transformation – moving from treating an individual to considering an entire population.
‘I was addicted to working with patients,’ she laughs. ‘It’s a question of instant gratification.
You can see them getting better quickly, and there’s constant reassurance that you’re doing a good job if your outcomes are good. But in service improvement, although it takes longer to see your impact, you’re actually making a difference for a whole lot of patients, not just the one individual that’s sitting in front of you.’
Today Hopkins is settling in to her relatively new job as deputy director for quality improvement with the Regulation and Quality Improvement Authority (RQIA) in Northern Ireland. As well as regulating and inspecting health and social care services (a bit like the Care Quality Commission in England) the RQIA has a role in assuring the quality of services provided by the Health and Social Care Board and HSC trusts and publishes guidance for both patients and service providers.
We are meeting in the RQIA offices, which are situated in a shiny modern tower in Belfast’s bright riverside area. The building has glorious views to the hills and over such Belfast icons as the Harland and Wolff cranes, but has another claim to fame, Hopkins tells me, in that the popular television series Line of Duty is filmed on another floor.
Hopkins is a striking example of the routes open to people with a physio background, although she says her career moves have been more chance than strategy. Even the decision to take up physiotherapy in the first place was a ‘happy accident’, she adds.
As a child I loved science, but was also very creative and loved arts subjects. I was looking at options for something science based, but which also had the potential for human interaction. I could have gone into medicine but I decided to explore other routes, and that’s when I decided on physiotherapy.’
She found being a student quite challenging, not least because she was diagnosed with dyslexia. ‘I didn’t know if I’d made the right choice, but as soon as I got into the working world and was managing my own patients, I knew it was the right thing for me.’
She says she was inspired by some amazing physiotherapists who shared and enhanced her own natural enthusiasm. ‘I get very drained where people are negative about their work. I feel very positive and like it when other people are too.’
Certainly the work environment was challenging in the early 2000s, when she was working in adult neurology at the then North and West Belfast Community Trust. The Troubles in Northern Ireland were still making themselves felt in health and social care – and physiotherapists were in the front line. ‘It was 2003, five years after the ceasefire, and we had a lot of people with brain injuries. There were people with injuries from joyriding, from drugs, from gunshot wounds. There were ex-prisoners, people from deprived areas, and people with very complex needs.
That’s when I realised that gosh, this job isn’t all about science. If you’re going to make a difference, you have to understand people too.’
She was ‘quite naïve’, she concedes. ‘I could do a treatment plan, but in a way that was less important than the broader health and support structures. I became very interested in how the whole system worked, and I probably knew then that I wasn’t going to be content to be a clinician for my whole career.’
Keeping patients in mind
In 2010, Hopkins moved to the Ulster Hospital in a team lead role, and became fascinated with leadership and how to motivate people. With the support of the South Eastern Trust, she embarked on a master’s degree in leadership at Queen’s University, Belfast, having, as she puts it, had her appetite whetted by a management and leadership course. ‘That taught me to think strategically, and look at the bigger picture,’ she says. ‘Then the master’s degree was fantastic. I had to work hard, but it gave me the opportunity to meet people from other organisations that I wouldn’t have come across otherwise. It was a great opportunity.’
It was as a direct result of doing the degree that she left her clinical role, although it wasn’t a deliberate move. ‘They [the university] encourage you to go for interviews, and I applied to be regional co-ordinator for the Northern Ireland stroke network. I didn’t think I’d get it – I was the first AHP in the role – but I was offered it and really didn’t know whether to take it or not. In the end, I decided it was a good time for me to do it. I felt I had the energy and the will to create a network and make a difference.’
Moving away from treating individual patients was a wrench, but she believes her physiotherapy background was valuable in her new job. ‘As a physio, I could see the importance of good stroke care and how it affected individual patients. But as a physio, you make decisions for patients every day, whereas as a co-ordinator nobody has to do what you say,’ she laughs.
‘I could only influence and motivate people to come along with me. But I constantly visualised the patients I had treated – I always kept them in my mind when I was negotiating with colleagues about the way forward.’
That work culminated in a consultation on a new stroke service for Northern Ireland, which aims to rationalise and improve the way that care is delivered, making better use of new treatments and concentrating specialist care on fewer sites. But just as this piece of work was coming to a conclusion (the consultation closes on 19 July), Hopkins decided to move again to take on her current role. ‘I was loving my job and I always leave a job when I’m loving it,’ she says. ‘It was a tough decision, but I’m excited about what lies ahead.’
Already her mind is buzzing with ideas on other priorities for Northern Ireland’s health and care service, including unscheduled care. Again, although her physiotherapy background is not strictly related to the job, she believes it has given her valuable skills and insight into the needs of patients. She also wants to encourage other physiotherapists to get involved in change.
‘In healthcare, there is such change afoot to redirect the focus to system change, prevention and transformation. I want physios to think about how they can influence it for their patients. We’ve spent a long time having to champion our voice, and now we have our voice so we have to use it. We don’t have to fight to have our seat at the table, but now we need to be sure that we use it responsibly.’
As Emer Hopkins says, physios are often reluctant to think about moving into a more strategic role because they love the patient interaction. However, in a strategic role you can influence decisions that impact on a whole group of patients rather than just one individual.
Other pieces in this issue of Frontline also discuss these issues:
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