by Nazia Ahmad – 30th October, 2018

“As a lead therapist with a background in Quality Improvement, I am interested in exploring how acute inpatient therapy teams in the NHS are using their own data,” writes Nazia Ahmad, an occupational therapist at Homerton University Hospital Foundation Trust who is currently working in as the inpatient therapy service lead , and who is also one of DigitalHealth.London’s Digital Pioneer Fellows.

She asks whether it is possible to evidence whether therapists (occupational therapists, physiotherapists, dieticians and speech and language therapists; along with unregistered clinical support staff) are making data-driven decisions and improvements. She concludes that digital is an enabler not a solution in itself and “at the heart of all of this lies people related change.”

In 2016, the Carter Report acted as a catalyst for a different way of exploring and understanding unwarranted variations in the NHS. Having read the improvement work coming out of the Getting It Right First Time programme (GIRFT), I felt primed to explore unwarranted variation within my context of inpatient therapies (to understand warranted and unwarranted variation, please refer to Matthew Cripps’ blog).

As with most therapy services, we collect data about the use of therapists’ time. Often this takes the form of self-reporting on electronic patient records or an electronic platform, and includes both face-to-face and non-face-to-face time with patients, and professional development activities. Currently there is a dashboard that presents some of this information in the trust, but it is not used consistently and needed to be reviewed to ensure it serves its purpose to help with decision making and workforce planning.

We analysed data from therapists from different professions and from a variety of services within the trust. We explored unwarranted variation, skill mix, capacity and demand, with an aim to improve our productivity.

Unwarranted variation

We looked at professional banding: for example, benchmarking what band 6 physiotherapists in elderly care reported they spent their time on, and compared it to how band 6 physiotherapists working on acute medical wards spent their time.

We also looked at multi-disciplinary team working to understand the proportions of time that teams spent on face-to-face patient contact, non-face-to-face patient contact, and on supporting professional activities. We then compared these reported figures to the role descriptions.

In both we explored why there was variation and whether we felt this was warranted or unwarranted.

Skill mix

We explored the stats of unregistered clinical support staff to consider where the variation was warranted and where it was not. This has also led to good discussions about the use of our therapy support staff. Clinical support staff can help in numerous ways, including increasing intensity of treatment, carrying out administrative duties, and assisting with management of resources. We have started to think about their career progression from being a therapy apprentice to a qualified technician.

Capacity and demand

Finally, we compared staff capacity in units of time as a team (using rosters) to actual time spent, as reported on the system.

Learning

We discovered that teams often record data using different rules and methods, and this is not uniform across the service, making comparisons and analysis challenging. As a result of this, we are developing a standard operating procedure for reporting of time spent, and will aim to incorporate some of these into a refreshed therapy dashboard. We are working closely with IT and data analysts in the trust to shape the data and the dashboard to achieve this goal.

In terms of staff engagement, the value bought to this project by multiple perspectives of staff within the hospital, as well as by other fellows and the mentors from the DigitalHealth.London Fellowship has been invaluable in developing the thinking and execution of the dashboard project.

This blog covers one small part of the therapy dashboard’s development. My plan for the next few months is to focus on the visualisation of data with support from the DigitalHealth.London Fellowship mentors and othes. At the end of the project, we will evaluate whether the refreshed dashboard has enabled better operational decision making related to how therapists spend their time i.e. productivity and whether it improves future work force planning.

If you are interested in therapy dashboard or have one you’d like to share please do get in touch with me at Nazia.ahmad@nhs.net

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