26 September 2022

Bedfordshire Community Heath Services: Occupational Therapy Demand and Capacity Quality Improvement (QI) Project

By Sharon Eplett (Head of Quality and Performance) and Nicola Ballingall (Senior Improvement Advisor) 

Bedfordshire Community Health Services (BCHS) have made significant improvements to their physiotherapy and Occupational Therapy waiting times. Find out about the methods they used in this interview with their QI Coach, Sharon Eplett.

Nicola: How have you built momentum for the flow improvement work?

Sharon: “By trying to focus on the outcome and the benefit. We’ve changed the referral forms and changed the process, and there’s been some positive feedback as a result. So, people can see the benefit of triage – if it’s somebody who’s urgent we go straight on to do that, either a video session or carrying on onto telephone assessment and, actually, then it will save the clinician time in the long run.

The things that we were doing before weren’t working. The waiting lists were getting bigger. You know, we’ve still got the same resource. We were getting more referrals through because obviously we’re now getting the knock on of things like long COVID and the people who have been deconditioning for ages that suddenly are coming to us needing support.“

Nicola: Can you describe your role as the QI Coach?

Sharon: “To start with it was more around trying to get the momentum going and actually doing a lot more talking than I certainly do now because I was guiding people on what that process should look like. The two main people that are heading up this project were both doing the Improvement Leaders Programme (ILP) at the same at the time. So, it was a new process for them. The third person, who was doing all the data, was also on the same course. So, I was trying to support new people to know what the expectations are and actually trying to sort of help with their journey because it can be a little bit disconnected depending on time frames as to when the ILP is actually running. So, to be honest, to start with it, there was a lot more help to set it up and have conversations with those trying to lead in terms of what we should be doing and what stage we’re at.

Now we’ve got to the point where I’ve stepped back as the coach and actually someone has taken a lead on the project and I go to the meetings now and interject if I just want to query something or ask the question you know, have you thought about this? Have you we put our PDSA cycles on Life QI (Figure 1)? Are we feeding our data through? Have you got something to show actually where are we in the testing? What does this mean? It’s where I feel I should be, but obviously it’s the experience of the people that are leading that QI as to how much intervention you need to do and how much support you need to give.“

Nicola: How is the team measuring patient flow?

Sharon: “So, they’re measuring how many people breach their maximum 18 week waiting target. They’re also looking at numbers of referrals in. Because when we started this project, there were breaches in physiotherapy and occupational therapy target waiting times. They ended up working a weekend to do phone calls to all of the long waiters. Just so that we had a true understanding of what that list actually looked like. And there was a massive disparity across the locality. South had a lot more because they commissioned physio so it was trying to get everybody into the same place or at least have an understanding of what that place looked like. “

Nicola: How do you use Life QI?

Sharon: “Life QI, to be truthful, is more a repository of information. So, it’s sort of where we were storing what we were doing. You obviously look at it, you know there will be data, and you can go on at the moment and see what we’ve already tested. It’s looking at, you know, what did we learn, what have we done differently within that and obviously we’ve got all the original shared ideas and I’m sure the driver diagram is on there as well. So those original conversations around what we had. It’s not an afterthought, more a sort of repository. It’s getting somebody to update it. Megan is on the current ILP cohort is it’s about assigning somebody to try and keep that up to date. And I think it is important that there is somebody that has that administrative job for Life QI, because otherwise I think it gets lost. In in the whole process, I think it’s the thing that doesn’t get updated. I’ve been very lucky in that I’ve got people that have really engaged with that in terms of doing it.











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