A report by NHIR is a valuable resource for physios working in all areas
In this final part of our four-part series, Sarah Turner of Cambridgeshire Community Services (CCS) NHS Trust reflects on the benefits and challenges of embedding evidence from the Moving Forward review into a new service model for their DynamicHealth service, which delivers musculoskeletal (MSK) services and pelvic health physiotherapy across Cambridgeshire and Peterborough.
Benefits of implementing research into practice
1. Timely access to physiotherapy
Expanding our telephone physiotherapy self-referral service, Physio Advice Line, (based on the PhysioDirect study, which features in Moving Forward) has enabled us to provide an equitable service across the county, giving patients faster access to clinical expertise. In fact, 55 per cent of cases are now managed completely on the telephone.
2. Increased service capacity
Using the STarT Back tool has increased capacity and alleviated workload pressures by helping us match patients to the right treatment. For example, patients who would otherwise have had one-to-one physiotherapy now have access to low intensity pain classes. It also avoids us over treating patients who are able to self-manage their condition. As a result, our website has seen a significant increase in hits as more patients at low risk of persistent disabling pain are accessing advice and exercise videos online. And improving patients’ access to exercise classes, in line with evidence that exercise is essential for health and should be a core treatment in MSK pain, has helped to improve capacity and given patients a support network.
3. Reduced waiting times
The overall impact of embedding evidence from the Moving Forward review has been reduced waiting times. ‘In January 2017 we had 500-plus patients breaching the 18 week RTT (referral to treatment) target and it’s now just 50,’ explains Joe Piper, physiotherapy lead for the service redesign.
Implementing evidence from the Moving Forward review has enabled staff to distinguish between patients who could self-care and those with underlying psychological barriers affecting their recovery. And offering more exercise-based and combined psychological and physical group interventions has had a significant impact on our waiting times and RTT breaches.
4. Improved patient outcomes
Introducing our Understanding Pain (UP) classes, which combine a psychological and exercise approach based on the Back SkillsTraining (BeST) programme, has led to significant improvements (P≥0.001) in patients’ reported depression, anxiety, pain, function and musculoskeletal health.
‘I’m very proud patients have access to low intensity pain classes in all our community localities, which improves patients’ health and wellbeing,’ says Jenny van Maurik, clinical lead and MSK physiotherapy specialist. ‘This isn’t the case across the country and shows we’re able to provide access to evidence-based pain treatment (BeST) in a community setting.’
5. Positive patient feedback
In December 2018, 96 per cent of the 268 patients who responded to the service’s friends and family survey said they would recommend us to friends and family. A patient recently commented: ‘They are now easier to phone and delightful to visit, while all the staff are very pleasant to deal with. Wow, what a change.’
RTT breaches reduced by 91% in 24 months
‘Our patient feedback has always been high but it’s reassuring to know that despite the changes we’ve made, the quality of service hasn’t dropped and patients are happy,’ says Amy Edwards, programme manager, service redesign team.
6. Improved staff satisfaction
Using research evidence has helped to empower staff by knowing they are providing patients with the best and most up to date treatment. We have seen demonstrable improvements in staff turnover and short-term sickness. The service’s rolling year turnover rate for staff in April 2017 was 19.5 per cent, and it had improved to 15.5 per cent at December 2018. The short-term sickness absence rate is 2.3 per cent, well below the 3.6 per cent the trust set as an indicator of potential concern.
Chloe Gardner, junior MSK physiotherapist said: ‘After working in a variety of clinical settings I knew that I wanted to specialise in musculoskeletal physiotherapy. I was particularly drawn to DynamicHealth as it offers regular research-based training and innovative projects that I could be involved in.’
'We are pleased with the improvements that have been achieved and the subsequent reductions in waiting time, which will greatly improve outcomes and accessibility for local people'
Rob Murphy, Cambridgeshire and Peterborough CCG
Time and resources were imperative to the success of the redesign, and thousands of hours of clinical time were invested but not to the detriment of patient waiting times.
‘It was brave of our service manager, Sarah Saul, to agree to take clinical staff away from appointments as we knew this would impact on demand but their engagement was vital to the programme’s sustainability,’ explains Amy.
The main challenges involved change management, patient engagement and staffing.
‘Balancing our ambition to make changes and the ability of staff to implement them proved tricky. We have approximately 100 members of staff working across six units in a large geographical area and inevitably some colleagues were more open to change than others. However, staff worked incredibly hard to take on board so many changes over a relatively short period of time.
‘We also struggled with patient engagement and co-production and were unable to recruit a patient focus group. However, we did seek patients’ feedback on our osteoarthritis pathway and tested our website with a small cohort of patients. Additionally we identified a need to adapt staffing to fit our new service model. This led to the recruitment of more rehab instructors to allow us to expand our exercise classes,’ Amy said.
‘The focus of our service redesign has been on making sustainable and continuous improvements and we are proud of our achievements.
‘By embedding current MSK research into our redesign, we now have a service that is standardised, equitable and unified, and we move into 2019 driven by our ethos of continuous improvement to deliver modern, innovative and high-quality care.’
Tips for embedding evidence at service level
- Commit to being a research active department with leaders and staff who value research so it becomes a priority and part of the culture.
- Identify key staff with an interest in research that can link with your trust research department.
- Always have an enquiring mind and don’t be afraid to challenge the status quo.
- Have a continuous improvement model to ensure the most effective interventions are embedded into clinical practice as soon as possible.
Sarah Turneris communications officer (corporate services and ambulatory services) at Cambridgeshire Community Services NHS Trust.
With thanks to Sarah Saul, Joe Piper, Amy Edwards and all DynamicHealth staff
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