Strategy for success

Still flushed with pride after her initiative wowed the judges at the CSP Awards 2012, Lisa Roberts tells Louise Hunt why therapy services must prove their effectiveness.

The need for therapy services to prove their effectiveness and keep trust chiefs and commissioners in the loop has never been greater. But auditing and evaluating can seem like insurmountable tasks when everyday pressures loom large

One physiotherapist’s drive to bring together the clinical and academic worlds has resulted in a simple, but effective, model to identify areas for improvement and to raise the profile of therapy services.

The Clinical Effectiveness Group (CEG) at University Hospital Southampton NHS Foundation Trust was established in 2008 by Lisa Roberts. It won the ‘Demonstrating the impact of outcomes in patient care’ category of the CSP 2012 Awards and was named runner-up as overall ‘Physiotherapy service of the year’.

The group was formed out of Dr Roberts’ part-time consultant role at the trust, where she has a remit to support physiotherapy and occupational therapy (OT) staff in scholarly activities.

Her main job is at the University of Southampton, where she is an Arthritis UK senior lecturer in physiotherapy.

Her unusual role, spanning academia and clinical practice, reflects her ambition to get more therapists involved in research and prove the effectiveness of their services.

‘In my university world it was important to publish and evaluate practice and in my clinical world the pressure was on to demonstrate good outcomes, positive patient experiences and show that clinicians do this efficiently by using evidence-based practice,’ she says.

Research studies encouraged

To this end, Dr Roberts brought together representatives from each section of the therapy service, who take a lead on clinical effectiveness activity in their department, including supporting staff in undertaking research, audit projects and service evaluations.  

‘We meet every other month for an hour and the idea is that the group is responsible for keeping all the scholarly activity going in their section.

We talk about what work is going on, how far we’ve got with audits and what are the key findings.

We also talk about if there are opportunities coming up for research funding. We make sure people are disseminating the work they have done.

‘The information we gather feeds into the main hospital database.

We make sure all our audits are finished and reported on and if anyone wants to go on and write a paper for Physiotherapy or another journal then I can give them one-to-one support with that.’

Since the clinical effectiveness programme started, the therapy service’s research output has increased.

Last year 20 per cent of all the trust’s audits that were completed and recorded came from the department – ‘a phenomenal achievement’, says Dr Roberts.   

Developing feelings of confidence

Ideas for audit projects come from staff who have identified particular issues in their service.

For example, one physiotherapist was so fed up with over-running and inefficient goal planning meetings that she turned them into an audit project.

‘It was such a simple piece of work, looking at things like making sure meetings started on time and making sure patients and carers were there and goals were appropriate. It made a big difference to the team’s work.

The key change was the efficiency of the team. The meetings used to drag on and be a problem for everybody. After the audit the team became much more efficient and meetings became shorter,’ says Dr Roberts.

Over time the group is becoming more strategic in identifying key problems in their areas and more on-going projects are coming through the CEG, says Dr Roberts.

Several of these projects have resulted in improved clinical outcomes for patients and shortened hospital stays – results that are raising the profile of therapy services.

Dr Roberts points to one project that looked at the barriers to initiating rehabilitation in the general intensive care unit.

The main barrier was the high level of sedation in intubated and ventilated patients.

After reviewing sedation and weaning the mean time for initiating rehabilitation for appropriate patients fell from 14 days to 5.9.

The CEG model can be applied to a range of issues, but an essential part of the process in Southampton is taking part in audit workshops run by Dr Roberts.

‘In the first workshop we talk about the difference between an audit a service evaluation and research.

An audit must have measurable standards and so we look at how to set the standards and then each participant gets to lead a small audit project.’

Eight weeks later the teams report back with their findings. ‘It doesn’t matter if they haven’t quite finished.

But they report how far they’ve got. That’s been really instrumental in helping people in getting their confidence. Lots of people haven’t done an audit before and think it’s going to be endless data collection.

The idea is that when it comes to re-audit six months or a year later they get somebody more junior on board to help with the re-auditing while they work on a new audit, so there is a culture of audit where everybody gets involved in something.’

Winning the CSP award was ‘fantastic’

It’s vital to ensure therapy services can stand up to scrutiny,’ says Dr Roberts.

She adds: ‘The CSP award has been fantastic to get that kind of national recognition.

It’s very important to have support from managers who can see the benefits of this work, and move away from a culture where evaluating a service is seen as an add-on bit that you’re expected to do in evenings and weekends.’

Demand for Dr Roberts’ motivational training is spreading.

‘There’s a huge interest, particularly with the current pressures for physios to be marketing their services.

There’s a strong push to prove our clinical effectiveness.

Are we safe? Do we get our patients better? Do they get a positive experience and are we using evidence-based practice?

If we can prove those four things then it’s very powerful in developing services and getting out there and marketing them.’

Dr Roberts believes the clinical effectiveness programme could be replicated in therapy services everywhere. ‘When you see the progress and see patient care driving up, it’s really motivating.’ fl

Audit project aimed to prevent further falls

The orthopaedic therapy team identified a need to improve the quality of information provided to patients to minimise the risk of further falls.

‘We felt that we weren’t doing the best service for falls patients and wanted to see how we measured up against national standards,’ says Sasha Smith, a band 7 OT for trauma and orthopaedics, who led the audit.

‘We looked at the National Institute for Health and Clinical Excellence guidelines and the National Service Framework and picked out some specific standards for therapy.

These were: Are we taking and documenting patients’ falls history?

Are we observing their gait and balance for future risk and resolving any problems before they leave?

Are we providing patients with information on how to minimise risk at home and is there a clear pathway in place in the community if patients are at risk of more falls?’

The first audit in autumn 2011 revealed that the service did not reach national standards, which Ms Smith says was ‘unsurprising, but easy to fix’.

In response, the multidisciplinary team introduced more prompts to identify patients at risk of further falls, including the development of a risk assessment tool.

They worked with falls experts in the community, getting training in prevention exercises and advice.

They also produced leaflets for patients, and established a clear community pathway for those at risk of further falls.

A re-audit was undertaken in summer 2012 – this time led by band 6 OT Sally Davis. ‘The results against the standards were much better,’ says Ms Smith.

‘The big change in practice is that we are now meeting the standards and this has impacted directly on the quality of patient care.’

Ms Smith says the audit was not big enough to reveal whether the service is preventing further falls.

But she notes: ‘I think patients feel more confident about how to prevent falls and what to do if they fall.’

The next project will assess patient satisfaction and confidence so hopefully this will show our intervention is giving people more confidence,’ she adds.

The team presented a poster at the trust’s clinical effectiveness conference and gained third place.

The strong showing of six posters by the therapy services team resulted in the chairman of the trust visiting the department.

Louise Hunt

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