The LCS Impact Awards

Team Impact Award Winner: UHNM County Therapies Team

University Hospitals of North Midlands NHS Trust (UHNM) County Hospital Therapies Team Continuous Quality Improvement (cQI) Leadership Behaviors’ Award.

Background

The County Hospital in Stafford, Occupational Therapy and Physiotherapy team attended the 5-month Level 3 (LCS 1c) Improving Together training course offered by the Quality Improvement Academy at UHNM in August 2023. Improving Together is the UHNM approach to quality improvement. Improving Together is based on the Operational Excellence in Healthcare QI methodology (Catalysis, USA).  This cQI journey is a long-term cultural improvement programme at UHNM. When given the opportunity to complete Improving Together to enhance their service, they approached it with willingness, curiosity and a desire to learn and develop the therapy service to be the best it could be for their patients and colleagues.

During the 5-month training the County Therapies team were trained in the Improving Together tools, routines and behaviours that are underpinned by Lean. As part of the alignment part of their journey the team developed their own scorecard aligned to the UHNM strategic planning framework and using data agreed which drivers they would work on. They chose two drivers aligned to the UHNM strategic priority domains of people and responsive. They applied their learning to drive their improvement work within the therapy department.

Activity

The County Therapies team worked together using data to identify their scorecard metrics to drive improvement by reducing waste and variation in practice, exploring and removing barriers to best practice and testing innovative ways of working. What mattered most to the County Therapies team in order to make UHNM a “great place for them to work” was that their staff felt that they received inconsistent and inefficient supervision (which is a professional requirement) as per the current situation data below:

• 50% of therapy staff said they hadn’t received supervision in the previous 6 weeks
• 94% of therapy staff didn’t feel they have time to prepare for supervision
• 42% of staff report not feeling confident in preparing for supervision
• 53% don’t feel confident in leading supervision

The data demonstrated that there was a lack of a clear, consistent process for supervision which had an impact on therapy staff retention, wellbeing and morale as well as staff competence, patient safety and flow.

The other driver the team focused on was “Timely Out-patient Follow-Up Appointments as only 82% of patients (see data below) were receiving follow up appointments within the recommended timescales for their conditions.” This problem aligned to the strategic priority of responsive.

Impact

The County Therapies Improving Together team have embedded daily improvement huddles and cascaded the tools, routines and behaviours to the wider therapies team. By holding regular Improving Together meetings they’ve regularly reviewed the A3s for their drivers, refreshed their data through several PDSA cycles, used tools such a standard work, status exchanges and go look learns to achieve the following improvements:

• 63% of supervision (Apr 24) are completed and recorded on time compared to 30% (Oct 23)
• An increase from 47% to 90% when therapy staff were asked do you prepare for supervision?
• A rise from 53% to 93% of staff reporting they feel confident leading supervision sessions.
• Yes’ response increased by 45% when staff asked if they have time to prepare for supervision.
• 100% of staff said they feel confident preparing for supervision
• Greater than 90% of patients now receive timely out-patient follow-up appointments (sustained for the last 6 months (see scorecard below).

The benefits of implementing change in the Therapies supervision process is:

• Supervisors feel more confident and prepared for leading supervision
• Supervisee– address wellbeing, supports developmental needs, career development, timely support with ongoing issues- de-escalates problems early.
• Organisation– staff feeling valued and supports with retention of staff.
• Patients – staff that feel more valued, increased competency of staff, improved patient care and outcomes. The County Therapies team continue to show perseverance & self-discipline to keep up the momentum of improvement.