Transformation of Therapy Services

Purpose

To examine the key factors influencing the transformation of Therapy Services within our institution, creating links to sustainable service quality improvements. In 2014 Salisbury NHS Foundation Trust (SFT) carried out a service wide consultation of Physiotherapy and Occupatonal Therapy provision with the aim of transforming Therapy Services. The key outcome from the consultation was the re-organisation of Therapy Services into defined team "clusters" under a single management structure, creating a Head of Therapy Services who reports directly to the Chief Operating Officer and Director of Nursing. The key challenges were addressing the collaborative working within Therapies and across the hospital taking into consideration professional isolation within Directorates, localities, Wiltshire and Wessex Deanary; staffing, recruitment and retention; morale and innovation; and patient flow.

4 occupied bed days saved per patient
by creating a specialist Early Supported Discharge team for fractured neck of femur.

Approach

To facilitate the Transformation, the leader of the new Therapy Services focused on four key areas:

  1. The integration of staff with a common purpose through integrated leadership meetings and service wide Governance meetings
  2. Talent management, looking for innovators and motivators, providing support and guidance throughout their journey of self and service development, and looking at new opportunities.
  3. Utilising professional networks to galvanise change gaining bids totaling £260,000 from the Better Care Plan WIltshire and Health Education England - Wessex. Further operational resilience money of £160,000 was also secured for an Early Supported Discharge (ESD) Team for fractured neck of femur (#NOF).
  4. Raising the profile of therapies within the Trust through innovation directly targeted towards our institutions service delivery pressures (patient flow and occupied bed days). Participation in national and regional projects for Advanced Practice and Productivity, and regional benchmarking have significantly raised SFT´s profile across the wider professional networks.

Outcomes

The successful transformation of Therapy services has been acknowledged by SFT´s Executive. This has been based on the implementation of services that have reduced hospital admissions, reduced occupied bed days and created valued new roles within the instituition. These services are:

  1. Delivering an effective Therapy led Frailty front-door team
  2. Using Advanced Practice physiotherapists to transform ortho-plastic patient pathways
  3. Using Advanced Practice Physiotherapists to develop a Virtual Fracture Clinic model in Orthopaedic out-patients.
  4. Creating a specialist ESD for #NOF reducing occupied bed days by an average of 4 days per patient.

Implications

Transformation of Therapy Services within SFT has occurred despite the background of tight financial controls and extended winter pressures. Giving the right staff the right support and permission to innovate and collaborate, linking with AHP innovations regionally and nationally, has resulted in an expanded Therapy service being viewed by the organisation as key drivers to influence and drive sustainable change.

By creating a positive innovative culture within Therapy Services, success is starting to breed success. Recent therapy led initiatives included a #endpjparalysis pilot, leading a "Break-the-rules" week, and the implementation of a collaborative vision to broaden the ESD model.The acceptance of a senior therapy team on a Quality Improvement Fellowship is a significant development to underpin this change in culture of innovation, embed quality measures and to ensure sustainability through the engagement of all therapy staff.

Fund acknowledgements

I would like to acknowledge the financial and educational support of Health Education Wessex for the opportunity and commitment to innovation for clinicians in the region, and in particular in supporting 3 significant projects within Salisbury NHS Foundation Trust Therapy department

Additional notes

This work was presented at Physiotherapy UK 2017.