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Quality improvement

Feature

Seeing the bigger picture , to make the greatest improvements

Davinder Kaur , Clarissa Sørlie and Will Diaz explain how Quality Improvement methodology is helping to reducing waiting lists for community therapies .

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ommunity therapy teams across Bedfordshire , Newham and Tower Hamlets have used Quality Improvement ( QI ) methodology to reduce waiting lists .

These community therapy teams provide comprehensive occupational therapy and physiotherapy assessment , treatment and care within a person ’ s home to improve their ability to do everyday tasks .

While people wait for therapies input , they may be at risk of falls , further functional deterioration , unnecessary dependence on social care , social isolation , reduced motivation and delay in follow-up rehabilitation .

Community health services in these three areas had all built up backlogs in their waiting lists for a combination of reasons . When therapy services were suspended for all but urgent cases during the COVID-19 pandemic , this led to reduced clinical capacity .

Teams were also affected by staff sickness absence , vacancies and an increase in referral numbers and complexity after the pandemic .

Waiting times varied across boroughs , with patients in Bedfordshire waiting up to 34 weeks , while those in Tower Hamlets waited an average of 18 weeks . In Newham , the average wait time was only five weeks , but an average of 31 people a month waited longer than the six-week target .

In Newham and Tower Hamlets , where therapies provision was divided into localities , patients experienced inequity in waiting times based on postcode , which was further exacerbated by a lack of cross-cover during times of staff absence .

Recognising how complex and multi-faceted the problem was , the teams used a tool called a driver diagram to visually represent what they could do to address waiting times ( Bennett and Provost 2015 ).

They generated numerous change ideas and systematically tested them using Plan Do Study Act ( PDSA ) cycles ( Langley et al 2009 ). PDSA cycles involve testing out changes before implementing them , to learn if the change is effective while minimising the risk of unwanted effects on the system .

Change ideas

Teams across the three boroughs got together to identify the change ideas that had the biggest impact on their waiting lists . They grouped these change ideas into the following categories :

Improving the referral process : recognising that valuable time was spent on rejecting inappropriate referrals , the teams tested a range of ideas including updating the questions on referral forms , updating referral criteria on the trust website and updating leaflets for patients and referrers .

Triage and screening : the teams evaluated their triage process and made changes locally . In Newham and Tower Hamlets , triage had traditionally been completed by nurses , with therapists only becoming involved if there were any queries .

Both teams now involve therapists in triaging all therapy referrals . In addition to this , Tower Hamlets has introduced a daily integrated triage meeting with social care / reablement and admission avoidance colleagues to reduce duplication and ensure that patients are on the correct pathway .

In Bedfordshire , the team re-designed its triage form to ensure continuity of information captured across the localities .

Administrative support : the teams leveraged administrative resource to free up therapist capacity for clinical work . This included contacting patients and booking visits . In Bedfordshire , administrative staff members received Millbrook training to support urgent equipment ordering on behalf of clinicians .

Increasing capacity : the Newham and Tower Hamlets teams trained their therapy assistant practitioners as trusted assessors and recruited occupational therapy apprentices able to conduct basic occupational therapy assessments .

Using existing resources in this way has freed up occupational therapists to focus on more complex assessments .

Integrating teams : to reduce inequity in waiting times between localities , both Newham

30 OTnews January 2025