Data for impact

Showcasing the value of the support workforce

Cast your minds back to the Workforce and Education pages in last November’s Frontline. With the help of Richard Griffin, visiting research fellow at Kings College London, and Karen Lewis, deputy chief allied health professional at Dudley group NHS Trust, I wrote then about the challenges that preclude the pace and scale needed to grow and develop the non-registered (support) workforce. In that article Richard and I drew your attention to the lack of data at both national and local levels as a contributory factor. We cited this as a core issue in our depiction of a cycle of barriers to growth and development.

Almost weekly I hear great stories from members about how they have innovated in practice with support worker roles or have introduced initiatives to develop support workers, and I’m told what a difference this is making. Members are really keen to share their experience and success with others. The conversation proceeds something like this: ‘I’d love to help you showcase this. Have you got some impact data?’ Silence.  

Fundamentally, when introducing a service change by adjusting the skill mix in a team or developing new ways of working to optimise the skills and attributes of our workforce, we are entering a quality improvement cycle. Like any other quality improvement initiative, when implementing a workforce change it’s necessary to evaluate both the effectiveness of the change and importantly to ensure there are no unintended negative consequences. This simply can’t be done without some data and stories. We are extraordinarily good at evaluating workforce initiatives in this way at an advanced practice level, but not so well at other levels in our workforce.  

Showcasing initiatives

Imagine then how pleased I was this year when four abstracts highlighting support worker innovations were accepted in the Leading for Change theme at vPUK. They were accepted for conference for a number of reasons, namely they met the robust application criteria one of which was that they were able to demonstrate an impact in practice using data. 

I’ve chosen these pages this month to share snap shots of these four abstracts. This is to showcase some excellent support workforce initiatives and most importantly to provide some practical examples of how services have used simple impact data to evidence the success of their initiatives and to support their case for investing in and developing their support workforces. All four full abstracts will be available to view on the CSP website and can be accessed via the Innovations Database.

Assistant post in a MSK physio service

Caroline Moss, MSK physiotherapy team leader, Fairfield General Hospital, Bury and Rochdale Care Organisation. Northern Care Alliance NHS Group.

Purpose: To develop a physiotherapy assistant to be confident in assessing, treating and discharging patients using designated pathways. 
Methods: Using experience of a similar role an initial job plan was created. Local clinical pathways were constructed into simple, moderate and complex conditions, based on a consistent best practice approach. A comprehensive training programme was devised with supervision, mentoring and problem solving. 

Results: 

• Assistant has seen 445 new patients over a 12-month period. 
• Clinic use is up to 15% higher than for registered staff 
• Data demonstrates that pathways are followed correctly 
• Clinical supervision demonstrates pathways being followed appropriately and safely
• Assistant describes increased job satisfaction with upskilling. 
• Qualitative data demonstrates good patient satisfaction
• Investment in the role facilitated further development of an MSK role, increasing the efficiency of MSK service. 
• Feasibility to increase the clinic use by making changes at the MSK triage level and potential for more assistant roles within the department in the future. 

Conclusion: Developing a physiotherapy assistant in MSK physiotherapy demonstrates an effective use of resources when trained appropriately, using designated pathways. Investment at this level leads to increased skills and confidence, job satisfaction and further opportunities for development and career progression for other support staff. 

Impact: Optimising the capability of our support staff creates the potential for more cost-effective services by shifting the workload appropriately, enabling our registered physios to work differently to meet population demands. 

Developing a rehab specialist role in a community MSK pathway

Louise Lake, Jamie Wride, advanced practitioner physiotherapists, Royal Devon and Exeter NHS Foundation Trust 

Purpose: As part of a service review we wanted to improve the efficiency of the community MSK pathway, focusing on the way patients moved from physiotherapy services to the exercise and leisure sector. Working with a CSP officer for advice and guidance we scoped a higher level support worker role for someone with appropriate training and experience in the exercise sector.  We were aiming to reduce waiting times to community MSK physiotherapy, have a more cost effective staffing model for physiotherapy led exercise classes, build and develop links to community exercise provision; and improve patient confidence.

Methods: We used Plan, Do, Study, Act methodology and all members of the team supported the development of a competency framework, working processes, and governance arrangements. 

Results: Patient waiting time data was analysed at three and six months; patient and staff feedback at six months. Average waiting times reduced by seven days over the six-month pilot period.

Staffing costs for delivery of group exercise interventions reduced by 50% by using the rehab specialist vs registered staff.

Three community exercise schemes were developed and led by the rehab support worker including an ESCAPE pain programme. 

Links with local gyms were developed and patients were actively supported to attend joint sessions with the rehab specialist and gym staff.

Patients reported the model was ideal for them to feel confident to exercise independently and in gym settings. Staff reported that the skill sharing approach to staff training with the rehab specialist had enhanced their own knowledge especially in relation to strength and conditioning training.

Conclusion: Building and nurturing collaboration with exercise professionals in order to successfully move patients from healthcare to community exercise and leisure settings is crucial for the future physiotherapy workforce. Our pilot demonstrated that a rehab specialist role with a focus on exercise prescription was a safe and effective approach to achieve our service improvement aims. 

Impact: The development of rehab specialist roles is one way that the profession might enhance collaborative relationships with local exercise professionals, manage demand on already stretched services and reduce costs in running classes. 

Evaluating the impact of therapy support workers

Laura Breach, critical care clinical specialist physiotherapist, University Hospitals Leicester
The purpose of this project was to explore the use of therapy support worker roles in enhancing rehabilitation provision for critically ill adult patients within intensive care, in terms of patient outcomes, service performance indicators, and patient experience. 

Methods: Outcomes were compared for patients receiving physiotherapy rehabilitation versus a matched-comparison group receiving usual care prior to the introduction of the therapy support workers. Rehabilitation included active or active-assisted bed exercises, cycle ergometry, edge of bed sitting, transfer to chair, and mobilisation, Usual care consisted of passive movements and airway clearance by a registered physiotherapist. A locally designed questionnaire was used to collect patient experience data. 

Results: There was no significant difference in total ICU LoS; ICU Mobility Scale score; or CPAx score. However, more patients mobilised independently without a gait aid and all patients were at least passively moved to a chair before ICU discharge. There was a significant difference in patient satisfaction scores. 

Conclusion: This suggests that rehab provided by therapy support workers may be beneficial for patients. Further exploration may provide more robust analysis of the impact. Patient experience data showed a significant improvement. 

Impact: The data demonstrates that support worker rehab in critically ill patients receiving VVECMO is safe, and may provide a high quality, cost-effective alternative to qualified physiotherapy staff. 

Resource for non-registered AHP support staff

Jane Seagrave and Natalie Matchett, AHP practice placement facilitators, University Hospital of Derby and Burton NHS Foundation Trust.  

Purpose: We were searching for innovative ways to increase our practice learning experience and capacity for placements. From student feedback we identified the significant role our non-qualified workforce play in placement education, not only in improving the quality and pastoral support for students but also as role models with a wealth of knowledge and skills to share. We created a one-day course for our non-qualified workforce with the skills to support placement education and work alongside clinical educators (CEs), to give our assistant workforce additional skills relevant to placement education to support our CEs. 

Aims: 

• To improve understanding of the diverse learning needs of students 
• To develop observational, interpersonal, communication and teaching skills 
• To learn how to recognise appropriate student performance and competence 
• To develop skills in providing feedback 

Methods: The course was produced in collaboration with AHP placement and education providers. Delegates were occupational therapy, physiotherapy, operating department practitioners, radiography, radiotherapy and dietetic assistants. Teaching methods included taught sessions, interactive workshops and case studies/shared experiences. An interprofessional learning approach was used to broaden the learning experience, enhance knowledge and share expertise in the context of student education. 

Results: Delegates scored 4.84 out of 5 for satisfaction and quality of the course and reported increased understanding, increased confidence in involvement in practice education and felt better equipped to support the CE in providing positive and constructive feedback on student performance.