Hope you are all well, and enjoying the ITS module so far!!!

 

I have decided to focus my project on the On- call / out of hours respiratory physiotherapy service that I am clinical lead for in my trust. Over the course of the past 18 months, my team and I have spent a lot of time and effort on re-designing and re-launching the induction / training programme that we offer to new people joining our trust. This work seems to now have come to fruition, whereby the new programme is now classed as the “norm” and seems to have become embedded in our department which is amazing.

 

However, now comes the big task which is looking at the training package that we offer to the pre-existing members of the on-call team where I work. This is going to prove to be very challenging, because our team comprises a range of bands (5, 6 and 7) and also a range of specialities, not just respiratory. I feel that, as was the case originally when we were looking at the induction package for new starters, this is going to be a massive piece of work, but I feel this is also going to be more challenging because I anticipate that I am going to face a lot of resistance from some key stakeholders and also due to the sheer number of people that are in our team I am going to have to develop a training package / programme which satisfies a lot of stakeholders with differing needs and also priorities. 

 

As requested I used the various different models in the Approaches to Service Improvements Presentation, I feel that the two best models which worked the best for me were the CATOWE and PDSA models. 

 

The CATOWE model I thought was a great model because it solely doesn’t focus on the “doing” it actually encourages and facilitates the person using it to analyse and evaluate key contextual factors which have the potential to impact on the success of service improvement and implementation. Undertaking a project which is focussed on education of a team, it would be very easy to rush in and focus on the “doing” and implementation. Yet, I felt that using the CATOWE model enabled me to identify all of the key stakeholders which are going to need to be engaged throughout the course of my service improvement project. Complimenting this, I feel that the PDSA model proved to be very helpful in-terms of the diagnostic and problem identification and evaluation phase, because again it prevented me from rushing straight into the “doing” and encouraged me to step back, view things from a wider contextual viewpoint and ask the question why, what, who and when. 

 

I hope this helps, and I look forward to your responses,

Thanks,

Ben 

I have chosen to look at the Multiple Sclerosis maintenance exercise group.  A part of a service which, when I took over, which had lost focus and with unspecified benefit to the patients who attended.  Our service had responsibility for the ongoing physiotherapy needs of the local MS population, excluding major relapse.  However, the community based neuro rehab team (CBNRT) had significant waiting lists and acute relapses frequently ended up being picked up by our team instead.  I have taken the approach of analysing the situation retrospectively (as I am not currently in practice) to see if anything could/should have been done differently.

Lean thinking is not really applicable in this situation as we are not looking for bottle necks, delays or stream lining.  I found it difficult to see what PEST analysis would add to the information above for this particular situation.  I also didn't feel that systems thinking would be appropriate for this scenario.

RCA might be useful further down the process of the project when analysing the results of the newly restructured service especially if issues such as a poor rate of return of patient satisfaction questionnaires persists.

PDSA will also be of use once the initial plan has been formed for how the restructuring will begin and be evaluated and modified.

 I have attached my spider diagram, CATWOE and SWOT analysis

Many thanks for all of your contributions to the Padlet discussion.  

I’ve put together a few thoughts to prompt further discussion over the coming week. 

Tsp prehab idea:

Could consider using parts of the PEST tool too ie politics of Physio Vs Nursing teams/nursing encroachment, directorate organisation – who wields power locally, budget holders. 

Technology use: standardised prehab info (leaflet, website, skype style, tel review, class based etc etc). 

Lean thinking: long term decrease in secondary issues would mean cost savings overall and could enable a business plan proposition method to show decreased cost.  Cost of additional Physio input Vs lower complication rates analysis. 

Examples from other areas of Physio include ACL prehab and TKR/THR services with pre-op Ax/Rx.  

Staff engagement from the off re what they feel would work best for them/enable compliance. 

Are there national standards of complication rates or other services that work differently to demonstrate where your department sits on this topic?

 

MS case: Lean thinking may well work here (the acute relapses were being seen by the maintenance service, why was this, what were the factors behind this, what factors generated a long waiting list – a root cause analysis method may work well for this).

RCA needs to be thought of ideally as a starting point to analyse but could as you say be used during a project to reflect ‘in action’ as it were.  The better we analyse the origins of the issue at the start, the less likely we will need to analyse the projects failings during it though.  

 
General Points:

Several people mention working through different tools and finding the one that worked best for them but why were the other models less effective? Could you combine them?

Any negatives for the overall favourite that is SWOT/CATWOE?

Think about the kind of MSc critique you may have used before for clinical tools and methods and try to apply this to these models too.  How robust are they? How well evidenced? Any proof of their usefulness over other methods etc etc.  

Thanks again for your contributions and do not worry about the practical rolling out of these improvement plans for now as that will be covered in the next folder.  

Simon