Physiotherapy

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Physiotherapy Seven Days a Week!!
Brighton Paradza Senior Clinical Specialist
Physiotherapist Cardiothoracic Acute Services The
James Cook University Hospital A commitment in
providing excellence in Clinical Service
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Background

• National Strategy to AHPs !
• -Meeting the Challenge(2000)
• -Making the change(2001)
• Traditional working patterns! 9 to 5 Model!!
  ??weekends and bank holidaysgt New Ways Of Working
• Patient expectations and choice! .24/7/365
  access to services modernisation for the 21st
  Century!!
  
• 
  
  (David et al, 2003)

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Previous Practice (37.5hr/5day shift _at_ 7.5)
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4-day Shift37.5hr/wk _at_ 9.5. April 06
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Change Models - can they help ?
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Change Models which one?
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Process of Organisational Change (Lewin 1951)

• 5 Day physio.service strategy
• EBP/Workforce planning
• Cardiothoracic Service Expansion(2004)gtincresed
  demand/workload/costs
• Design/Plan/Pilot/Implement 7 Day Physio.service.
• Monitorgt Audit!!
• Choose Best Service Strategy monitor/ Evaluate
  6-12 months!
• 7 Day flexible New way of Working!!

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..,, Every system is perfectly designed to
get the results it achieves
Don Berwick
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What we have achieved?

• Reduced length of stay by 2 bed days
• 29 improvement based on previous best
• (LOSlt7days increased 42 to 71).
• (LOSlt14days increased from 85 to 89)

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Audit to monitor the implementation of 7 day PT
Service

• 3 AUDIT CYCLES
• 1-Retrospectively during 5 day service (Between
  01Jan-March 2006).
• Shift Pattern-37.5hr/wk_at_7.5(9am-5pm)
• 2-Prospectively during 7 day physiotherapy
  service (Between 01April-June 2006)
• . Shift Pattern37.hr/wk_at_9.5(8am-6pm).
• 3- 5 day service with weekend cover (Between
  July-Sept. 2006).
• Shift Pattern-37.5hr/wk _at_ 7.5(8am-4.30pm)
• STANDARD-42 of Pts with LOS gtor 7 before
  service change. National average 9 days.

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Results Table 1
Means and Medians for Survival Time
LENGTH OF STAY

(a Estimation is limited to the largest survival
time if it is censored.)
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Baseline characteristics Table 2
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(No Transcript)
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Kaplan-Meier Analysis
Overall Comparisons Chi-Squared fSig.Log Rank
(Mantel-Cox) Test of equality of survival
distributions for the different levels of
Services
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• One of the greatest pains to human nature is the
  pain of a new idea, Itmakes you think after all,
  your favourite notions may be wrong, your firmest
  beliefs ill foundedNaturally, therefore, common
  men hate a new idea, and are disposed more or
  less to ill-treat the original man who brings
  it
• Walter Bagethot- Physics Politics

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Benefits to Service and Patients

• Improved quality of care
• Decreased L.O.S.
• Increased bed availability
• Lower hotel costs (ward600HDU800ITU 1500)
• Continuity of care rehabilitation
• Sustainability

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Benefits to Staff

• Allow for flexible working culture
• - Flexi-time, shift swapping, self-roistering
• Better work-life balance
• Improved job satisfaction.
• Improved efficiency productivity.

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Comments!

• ...Continuity of care t more time to see
  patients.. do our paper work!
• we miss the rush-hour traffic!
• self roistering allows more flexibility..we feel
  more in control empowered. Can swap shifts!
• ..Long hours might be difficult if you have
  children?
• ..Longer shift patterns means more time spent
  with patients after their rest period.
• Patients do not have to wait till Monday!!

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Conclusion

• 7 day physiotherapy is a feasible service
  strategy with potential beneficial consequences
  of reduced LOS, reducing bed days, cutting down
  Hospital hotel costs impacting on bed
  availability, cancellations.
• This is pioneering change to service delivery
  with implications to the future of acute
  physiotherapy care. it is sustainable-replacement
  for the limited On-Call emergency service.
• - by removing the missing physiotherapy days
  hence facilitate patient journey to discharge.
• there are huge staffing and financial
  implications as resources!!

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A final thought about change

• We are what we repeatedly do.
• Excellence, then, is not an act, but a habit
• Aristotle

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Where next ?

• ..As a pioneering service change-a multi-centre
  service trial would be appropriate to evaluate
  the effectiveness and the efficiency of 7 day
  service within Cardiothoracic Service Departments
  in UK .
• however more work needs to be done to assess
  and evaluate the clinical benefits of this
  service change on the quality of care patients,
  economic evaluation with regard to reducing
  healthcare costs.

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Any. . .
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National Strategy A challenge to Physiotherapy
Service provision

• Making the change, 2001
• the NHS needs a quality workforce in the right
  numbers, with the right skills and diversity to
  deliver a quality service to the patients at
  right time

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A Case for Change Modernisation

• Traditionally physiotherapists provide 9 to 5
  routine from Monday to Friday their services
  routinely during normal working hours with a
  limited emergency service only at weekends and
  bank holidays
• most common, popular shift pattern worldwide and
  indeed it is the current practice in most
  physiotherapy departments in the United Kingdom.
• 
  (David et al, 2003)

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Why change? Local Needs Targets

• Patient Expectations Choices
• .24/7 access to servicesgt service
  modernisation aimed to create a Quality
  Workforce-fit for the purpose!
• Service Capacity Demands Efficiency and
  Effectiveness
• . New Ways Of Working-cost serving measure by
  replacing the On-Call Service removing 2 missing
  physiotherapy days!!
• Flexible Working Model
• .KSF - skills mix , I.W.Ls (shift working/
  swapping/self-roistering /time off in lieu)
  except working from home!!

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Change Management Theories

• Transitional Change..Lewin(1951)
• gtEpisodic
• gtPlanned
• gtSecond order
• WHY CHANGE?
• Change aims to improve patients experience,
  clinical effectiveness, clinical excellence as
  well as life long learning
  
• Sackett et al (2000)

NEW STATE
OLD STATE
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Results Table3
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Field Force Analysis of Change Management
VISION