Making every contact count in musculoskeletal outpatient physiotherapy

Purpose

To improve the health and wellbeing of individuals accessing Doncaster and Bassetlaw Teaching Hospitals musculo-skeletal outpatient physiotherapy department through the implementation of NICE clinical guidelines CG189 and support physiotherapists to 'make every contact count'

Approach

A four-phase participatory approach to service improvement was selected based on NIHR CLAHRC YH Translating Knowledge into Action creative co-design methods.

Lived experiences of weight management service users and musculoskeletal (MSK) physiotherapists were explored and creative co-production workshops were carried out. The workshops allowed participants to gain a shared understanding of the challenges related to weight management/healthy lifestyle and consider ways to effectively and appropriately manage these together in line with current guidance, sensitive to the context of MSK outpatients. Prototypes were developed, tested and refined in the MSK physiotherapy department at Doncaster Royal infirmary.

Outcomes

The project resulted in a new strategy to tackle the 4 key areas of 'Making Every Contact Count'; healthy eating, physical activity, smoking cessation and alcohol reduction. The prototypes included changes to hospital appointment letters and check-in procedures to support readiness for change, weighing and measuring as a component of routine physiotherapy assessment, a documentation tool to support communication, rapport and immediate and accurate sign-posting. These were delivered using cohesive visual imagery. We also proposed a new healthy living service reflecting the needs of local people. Further implementation strategies are underway to evaluate public health impact (utilising RSPH everyday interactions toolkit), patient satisfaction and acceptability /feasibility by clinicians.

Implications

It is recognised that physiotherapists have opportunities to impact health every time they interact with a patient. However, despite availability of guidelines to support weight management, implementing guidance into everyday practice is challenging. Attention to coproduction resulted in pragmatic and contextually specific outputs fit for purpose in the complex clinical environment.

The creative methods applied in this project allowed patients and staff to work together across real and perceived hierarchies to develop a service that reflects the needs of their local population. The outputs within this pathway have the potential to overcome some of the many challenges faced by physiotherapists in promoting healthy choices every time they interact with a patient. This project also contributes to the emergent implementation/knowledge mobilisation literature around co-production and highlights potentially effective and transferable methods

Fund acknowledgements

Many thanks to the CSP Charitable Trust and NIHR CLAHRC YH TK2A who funded this project

Additional notes

This work was presented at Physiotherapy UK 2018.