Improving outcomes through service redesign | Richard Cooper

Richard Cooper

As workload kept increasing at Cambridge Community Services’ DynamicHealth Musculo-skeletal (MSK) Physiotherapy Services, the time came to stop fire-fighting, take a step back and look again at how best to provide services to their MSK patients. Richard Cooper, non-executive director at the trust, tells the story of success although there is still more that can be done.

The challenge

Cambridgeshire Community Services (CCS) NHS Trust’s DynamicHealth MSK services operates from six hubs across Cambridgeshire and Peterborough and faced 15 per cent increases in referrals year on year. With minimal increases in contract value, the service was facing mounting numbers of patients waiting over 18 weeks for physiotherapy and specialist services. Patient complaints about access and waits were multiplying and staff morale was plummeting, leading to rising vacancy and sickness levels.

What we did

Supported by the trust’s service redesign team, we developed and successfully implemented an ambitious redesign programme.  Using the trust’s quality improvement methodology (Our Quality Way, based on best practice tools and techniques), we engaged staff in the redesign of a completely new service model:

  • Two clinicians spent dedicated time each week on service redesign and time was allocated for clinicians across the unit to be involved in specific work streams.  
  • 35 staff were involved in the detailed development of new pathways (approximately 36 per cent of the workforce). 
  • Workshops attended by circa 90 per cent of staff ensured understanding of the service redesign, its vision and significant benefits to both staff and patients.  

This high level of staff engagement ensured those with the skills and experience of what was working well, and where improvements could be made, were driving the redesign and could act as champions to promote the benefits to colleagues and stake-holders. 

The ambition 

What we wanted to achieve was to:

  • empower patients and support them to self manage conditions when this is clinically appropriate and know when to seek healthcare support 
  • ensure early intervention for patients and quicker access into the service
  • enable patients to receive appropriate and timely care
  • maximise efficiency of our clinics 
  • create a multi-skilled workforce aligned to the demands of the service.  

The results

Following over a year of hard work, with CCS staff working above and beyond the call of duty, the redesign programme was successfully implemented with significant improvements evidenced.  

The maximum waiting times between referral and first appointment in physio services significantly reduced:

  • August 2017: maximum wait was 20 weeks
  • July 2018: maximum wait was 13 weeks
  • December 2018: maximum wait was 14 weeks

The maximum waiting times between referral and first appointment in specialist services significantly reduced:

  • August 2017: maximum wait was 20 weeks
  • July 2018: maximum wait was 8 weeks
  • December 2018: maximum wait was 9 weeks

The number of patients breaching 18-week RTT target for physio and specialist is shown below.

18 week referral graph

In December 2018, 95.52 per cent of the 268 patients who responded to the service’s Friends and Family survey said they would recommend the service to friends and family; remarkable feedback given the level of change within the service over the last year. 

Indicators of staff satisfaction have improved. The service’s rolling year turnover rate for staff at April 2017 was 19.5 per cent, which has improved to a turnover rate of 15.5 per cent at December 2018, with the short-term sickness absence rate at 2.3 per cent, well below the 3.6 per cent the trust has set as an indicator of potential concern.   

What next?

There is more we can do. We will continue to look at innovative solutions to improve patient outcomes and drive efficiency such as a single point of access. This case study proves the value of taking the brave decision to stop fire-fighting - taking a step back to look again at how best to provide services. At Cambridgeshire Community Services NHS Trust, we are very proud of what our people have achieved and we are using the same methodology across many of our other community-based services.

Richard Cooper is non-executive director at Cambridgeshire Community Services NHS TrustFollow the trust on Twitter @ccs_nhst

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