Reducing waiting times for community-based physiotherapy

Mary Ross, Sandwell Primary Care Trust
Leaders for Change
Mary Ross
Mary Ross, Locality Business Manager at Sandwell Primary Care Trust

Treatment waiting times remain a big issue for the NHS. Mary Ross is a Leaders for Change award holder who has been working to reduce the time people wait for treatment at Sandwell Primary Care Trust.

The Health Foundation's Leaders for Change scheme aims to equip health professionals working in service improvement with the skills and knowledge to lead change projects. It is designed to give them the time and space to develop a new understanding of the change process and to apply this to their own work.

Mary’s project is addressing the long waiting times to access rehabilitation therapy in the community. Previously, people in Sandwell with neurological conditions had to wait 8–10 weeks to see an occupational therapist or physiotherapist. Mary’s goal, which she has now achieved, was that people living with long-term conditions should be able to see a therapist within a week.

Responding to patients' needs

Project participants included people with multiple sclerosis, stroke patients and elderly, frail people recovering from a fall. “These people can get instant treatment if they go to hospital and tend to get followed up for a few weeks afterwards,” Mary explains. “But they’re still living with a long-term condition.”

One aim was to help people manage their own care and decide for themselves when they needed help. “If you’ve got multiple sclerosis, your physiotherapist might recall you every six months,” Mary says. “You might be all right then while three months earlier you needed help. So it was about being much more responsive to patients’ needs, helping them to manage their own conditions and helping therapists to become more effective.”

The project strived to recognise the challenges people face in rebuilding their lives after an illness such as stroke. When they are first admitted to hospital, stroke patients can receive up to six weeks rehabilitation treatment but then are discharged with just a couple of follow-up visits.

“Before they had a stroke, that person was probably living a completely different life,” Mary comments. “We expect them to have adapted in six weeks because we’ve done everything we could for them at the time, but once they’ve got home and are learning how to adapt to different things, they might want different advice. We wanted to get to the point where they could then refer themselves.”

Whole system review

To tackle the problem, Mary carried out a whole system review with her teams in the community. She asked a range of stakeholders, including patients, what they would like to see changed, and consulted social services on how to use the patient pathway into day centres more effectively.

Following the review, a number of processes were changed. All follow-up appointments were recorded in a new, centralised computer system. Staff recorded patients’ preferred follow-up options, including being able to arrange the next session themselves by phone.

“We came up with a plan and, over an eight-month period, changed the processes and cut our waiting lists down to seven days,” Mary says. “Now, people just ring us, they don’t have to go back to their doctor. I’ve changed the whole system really by exercising my leadership among the team.”

“We came up with a plan and, over an eight-month period, changed the processes and cut our waiting lists down to seven days”

One of the challenges Mary faced was persuading staff to give up control of their own diaries. She tackled this through negotiation, bringing in other people’s opinions – particularly those of patients – as evidence.

“Some of the staff didn’t like it at first,” she explains. “But in the end everyone realised that it was much more efficient to say, ‘I’ll have patients at 11am and 2pm on Tuesday’, and then allow administration staff to book them in under those rules. It doesn’t sound that different, but for a lot of therapists it is.

“Other people were frightened of allowing patients to self refer because they thought they’d be swamped,” Mary continues. “We explained that every patient gets treated eventually, so it’s just when you intervene that changes. Also if this happens earlier, you’ve probably got less to do than if they become chronic further down the line.”

Peer to peer

Mary highlights the leadership training and peer support she received from The Health Foundation: “We learned how to analyse more complex systems problems using tools like the change kaleidoscope,” she says. “We also did cultural analysis of organisations, which helped you understand how you could work better within your own to achieve your aims.

“Sharing ideas and problem was also very useful,” she continues. “I was with other health professionals for quite long periods of time. We could discuss problems with a small group of trusted peers, making it easier to come up with a solution.”

Continuous improvement

Mary has now moved into another role but the project she set up is continuing to develop under a new leader. The team has made further changes to the system so that they can provide a fast response to people in crisis as well. “I knew from the beginning that the change couldn’t just depend on me,” Mary comments. “I had to get everybody else on board so that they owned it.”

The lessons learned from the project have also been applied to other services in Sandwell PCT, including musculoskeletal therapy and podiatry, where other teams have set up self-referral systems.

Perhaps the biggest impact of the project has been a complete culture change, to the point where Mary’s approach is now common practice. “I think a lot of the staff have forgotten that 12–18 months ago we had such a long waiting list,” Mary says. “It’s just accepted now that it isn’t a suitable way to work.”

26 March 2008

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