Transcript Securing the future for MS services

Linda Miller consultant physiotherapist in MS
7/10/2010
Content
Personal & professional
journey
 The Job Description
 Challenges,
opportunities &
expectations
 Adding value &
measuring impact
 How can we secure MS
services in the future
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• The Journey
Professional Journey
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1986 - BSc physio
1995 - 2006 Senior 1 neuro out- patients, stroke project coordinator
1999, 2000 - MSc modules
Developed interest in MS, FES, spasticity & neuro rehab
2001 - 2005 p/t M Phil (TENS for spasticity in MS)
2003 - regional & national involvement in MS
2006 - ESP in MS ( 3 yr part funded by MS soc)
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Pilot MS in MCN, other specialist posts funded
2005 - 09 – Building on skills base (presentation, academic
writing, further research, led service redesign)
2007/8 – non medical prescribing
2009 – consultant in MS
WORKING TOGETHER
•Well established MS
service.
•Strong MD team
•Supportive head of
service & consultant
•MCN invaluable for
service development
Personal Journey
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MPhil & further research
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ESP post
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Demonstrate impact
Beginning to think strategically
Gaining clarity on expectations
Non medical prescribing
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Taking risks & gaining confidence
Systematic approach
Focused and lateral thinking
Collaborative working with HEI
Tenacity & maintaining momentum
Increased awareness of NMAHP roles
Holistic package of care
Releasing/supporting consultant time
Improving patient pathways
Consultant post
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Working in NHS & HEI
Focusing on high impact areas
Switching between levels
Position of influence
Breadth of involvement
Revalidation of values
Pushing out of the comfort zone
Consultant physiotherapist in MS: Job
Domains
Professional leadership
Educational & professional
development
Expert clinical practice
Research, service development
& evaluation
Extracts from job description:
Expert clinical practice
 To be responsible for a complex caseload
including the prescribing of medications in
accordance with delegated prescribing rights
 To create and develop protocols of care and
design patient care pathways with the aim of
providing examples of best practice across the
regions and/or nationally.
 Practice as an autonomous professional without
direct supervision including independent and
freestanding clinics which run parallel to
rehabilitation consultant clinics.
Expert clinical practice
 Defined clinical caseload
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including complex presentations
(FES, spasticity, pain, vestibular)
Provide advice to MDT (GP’s
prescribing)
Physiotherapy patient pathway
National advisory group for
implementation of QIS
neurological standards
Integrate non medical prescribing
& symptomatic management
All MS review clinics now NAHP
led
Professional leadership
 To provide effective leadership, motivating and
inspiring others to deliver the best care for
patients within the neurological field, including
Primary Care.
 To take a proactive role in cycles of
service/business planning, developing action
strategies and evaluating changes within and
across the rehabilitation services.
 To explore and exploit opportunities for change,
facilitate staff ownership of change, and ensure
robust systems of evaluation are in operation.
Professional Leadership
 Led & evaluated
 MS review clinic, MD domiciliary review
service, FES service
 BC for FES service
 Joint led
 West of Scotland MS Physio Network
 MS Physiotherapy Assessment Pack
 Evaluation of practice (spasticity)
 MS MCN
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steering group and sub groups
 A&A Physiotherapy
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clinical improvement groups
 Represent
 Board and National level
 Standards, education, clinical services, NM
prescribing
 Development need – clinical leadership
Educational & professional
development
 To promote and facilitate the development of a
learning environment, particularly by
encouraging reflective practice, such that multiple
sclerosis services continuously improve and
develop.
 To maintain and foster genuine partnerships
with higher education institutions and other
professional bodies relating to
neurological/physiotherapy care.
Educational & professional
development
 MCN education sub group
 Newly diagnosed, living with MS, carer programmes, GP training, CHP
staff training, leisure centre staff
 Regional/national events
 MS patient pathway
 I day a week with Glasgow Caledonian University
 Joint project with MS Society(Scotland) re accredited education for NAHP
& SW professionals
 Influence delivery of programme (under & post graduate level)
 Research to be targeted strategically & link with clinical practice.
 Facilitator/co-ordinator for AHP practice placements in Ayrshire
 Sit on NHS Education for Scotland physiotherapy advisory group
 Regular contact, joint assessments and advice for MD staff
Research, service development and
evaluation
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To collaborate with academic institutions through
clinical teaching and research activity to enhance the
evidence base impacting on developments within
local, national and international arenas.
To promote and demonstrate high quality evidence
based practice by implementing the findings of
research evidence into practice, and by encouraging and
supporting staff to be actively involved in research.
To lead service evaluation through selection and
design of complex clinical audit, and through the
dissemination and implementation of the findings.
Research, service development and
& evaluation
 MCN Research & Development, audit & monitoring subgroups
 Link with GCU
 Link with Glasgow University
 TENS study (MPhil)
 FES study & further study planned 2010/11
 Clinical supervisor 2 PhD students
 Pain in MS, leisure based exercise
 RCT - home based physiotherapy for patients severely affected by MS (2009).
Provisional acceptance for publication & CSO application for multicentre trial
 CSO proposal for tele-rehab
 Audit
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FES database & ongoing evaluation. Detailed review planned Jan 2011
QIS standards
Education events
Support physiotherapy staff in audit, evaluation & research
 Development requirement – Prof Doc/ PhD?
Challenges/Opportunities
 Clarity of role & direction - line management/mentorship
 Working between 2 departments
 Leadership is strategic not operational
 Balancing clinical priorities with research, education and clinical development
 Linking work streams & thinking strategically
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Keeping abreast of policy, guidelines, standards & research
Breadth of involvement -knowing what to get involved in & what not
Maintaining fitness for practice
New skills – influencing, marketing, developing BC
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Learning to say no & to delegate
Isolation
A new set of values
Managing expectations
 Demonstrating impact & added value
Expectations of the consultant role
 Colleagues
 Consultant
 Managers
 Health Board
 Patients ?????
Colleagues
 Because you review patients for the consultant I know that
you ask about nutritional issues. This has improved care,
made the review process more patient centred and holistic
and resulted in closer team working. I'm not sure what the
other aspects of your post are and would be interested to
find out (D)
 I don't think your role has had any particular impact on our
service (SLT) at the moment. An AHP consultant post may
impact more significantly. There could be an opportunity
for collaborative research within the team which you could
lead on.
Colleagues
 I see your key strengths in research and in prescribing
which enhances the service that patients receive. You are a
strong link in the team and always full of ideas & willing to
look at service redesign. You are a point of contact for staff
& patients but not sure if this differs from specialist role
(OT)
 It makes a difference that you know the patients from
diagnosis and know their problems. This gives continuity. It
is a real benefit to me that you are able to see the more
severely disabled patients at home ( MS Nurse)
Colleagues
 Because you are the first to see new patients to the service I am now
noticing that patients coming for physiotherapy are better informed,
have clearer expectations and are more engaged with their rehab. The
patients we see in physio are more appropriate and we are generally
seeing more positive results.
 Your ability to see the more disabled pts at home for assessment is
invaluable.
 We value your specialist input to FES and spasticity management and
your knowledge/experience in managing MS in the wider context. Not
having to go to the consultant all the time especially with things like
prescribing is a bonus(PT)
Consultant
 There is increased autonomy with your role as you are
independently reviewing and making decisions regarding
patients care. This has been enhanced by non-medical
prescribing. This is impacting on my clinic as I now see the
patients that are more appropriate for me to see.
 You are involved strategically in a leadership and advisory
role which should ultimately enhance the quality of the MS
service
 You have a responsibility to engage in teaching and
research as part of your role and to integrate this within the
rest of the team
Manager
 I really value your role. I see consultant roles as key in driving, supporting and
evidencing clinical excellence. I expect your role to provide a key link between
education, research & practice enriching all sides
 Provide support & overview of clinical based research using links to HEI to
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maximize wider impact
Support clinical improvement groups to drive strategically aligned clinical
improvement
Take a lead in setting strategic direction of R&D within AHP’s
Clinical expert in MS & provide support to staff locally & nationally
delivering excellence in your field
Identify & harness opportunities for service improvement within your field
Represent A&A nationally & internationally within your field & be an
ambassador for the wider service
Health Boards/PCT
 NMAHP consultants can bring
 Position of influence,
 Clinical vision & strategy
 Awareness of cultural shifts
 Challenging the status quo
 Make knowledge organisational
 Demonstrating added value
Moving MS services onwards & upwards?
Strengthening our MS services for
the future
 Not just about consultant posts but gaining high
profile is important
 Demonstrate added value & measure impact
 Define your key questions & drivers
 Know & manage your stakeholders
 Plan activities towards key impacts
Added Value
 ‘Added Value’ aspires to
enhance how we view, use
and understand mundane
everyday objects. It
questions the importance
the mundane carries in
our everyday lives.
http://www.by-louise.co.uk
Added Value
 “the act of giving the customer more than they think
they are getting”
 “increasing the worth of a product or service as a result
of a particular activity”
 How do we know that we have added value?
 What kind of value can we add?
 How can we measure this?
Measuring Impact – Key Questions
 what are you trying to achieve?
 VISION
 IMPACT (targets, efficiency)
 what is the desired outcome?
 Are there other options
 what indicators will demonstrate you have achieved
your outcome?
 OUTCOME INDICATORS
Where does it fit?
 National policy & strategy
 Better health, Better care, Quality Strategy,
Rehabilitation framework
 Focus on long term conditions
 NICE, SIGN, QIS
 Improving quality is a top priority
 Local targets (HB/PCT)
 Local delivery plan
 HEAT targets
 Cost
 Evidence Base
Know your stakeholders
 Identify the boss, expert, sponsor, team, user
 ‘WIFM’ – benefits, risks & costs
 What makes them tick
visual, auditory, tactile, big/small picture,
status, safety, profit
 Attach importance & manage appropriately
 Involve early & give opportunity to gain ownership
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Influencing others
 Know what you want
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Well defined smart objectives
Use positive language
How will it look, here, feel?
Is it within your control?
Who will be affected?
 Pitch the sale
 Pacing & leading
 Ask assertively
 Close the deal
What next?
PLAN ACTIVITIES
 Baseline measure
 Gather evidence
 Identify indicators
 Monitor
 Evaluate
IMPACTS
 ?affecting patient
needs/outcomes
 Resource efficient
 Contributing to HB
targets
Challenge assumptions & identify risks
Kotters 8 Steps
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Increase Urgency
Build a guiding team
GET THE VISION RIGHT
Communicate for buy in
Empower action
Create short term wins
Don’t let up
Make changes stick
What about data?
 Know your question (and the answer your
stakeholders are looking for!)
 Know your strategic fit
 Know your evidence base
 Define your indicators
 Is it meaningful? ( make it!)
 Know how to present your data
clinical outcome
patient centeredness
cost benefit
What will it take?
 Agreeing the right targets
 Focusing on outcomes
 Developing meaningful
measures
 Bold & thoughtful leadership
 Challenge current practice/rethink how we work
 Thinking outside our
professional box
 Can we do jobs others might
currently do?
 Impact of our work on others?
 DNA rates
 Winning hearts and minds
 Embedding quality in day to day
work
 Working together
Blue Skye Thinking?
Thank you for listening