Transformation of Musculoskeletal service at Central London Community Health NHS Trust

Rupal Parikh is an Advanced Physiotherapy Practitioner and Spinal Pathway Lead at the Musculoskeletal Service and co-chair for the north central division Race Equality Network Forum at Central London Community Health NHS Trust. In this blog she explains how our Improvement Leader Fellowship supported her project, digitalising a key patient service.

The vision

The vision for the MSK service has always been to move towards digital platforms to support patients in engaging with their self-management. [My project aim was to] develop a dedicated suite of Musculoskeletal (MSK) webpages to promote self-management in patients with long-term MSK conditions in the community and develop digital assessment and screening tool, to improve efficiency and staff and patients’ satisfaction.

Meeting an unmet need

During COVID-19 pandemic lockdown MSK services had to step down and be redeployed, at the time there was no webpage in existence to signpost the patients to manage their long term MSK condition. So, it became necessary to develop dedicated MSK webpages to allow early and timely access ​to specialist information. This will support and empower patients in their ability to independently self-manage their musculoskeletal condition when appropriate. It can be accessed in any language, and it also has facilities for reading aloud for anyone with vision impairment.

The new webpages will enable the service and staff to allocate time more effectively for conditions that cannot be self-managed and will allow patients who need to access 1:1 assessment in a more timely manner. This will also allow the staff to signpost patients to digital resources during and on completion of their treatment.

Digital transformation of the service

The challenges were the effect of the pandemic and the stepdown and redeployment of MSK service during lockdown. In addition, there was no webpages in existence to signpost the patients to manage their long term MSK condition. The other challenges were the ever-growing waiting list, and the lack of an efficient digital electronic system to improve staff efficiency and satisfaction. This had significant impact on service Key Performance Indicators (KPIs) and patient care. Every crisis brings new opportunities, and this was perfect opportunity for digital transformation of MSK service.

Ensuring equitable access

During our search through literature and other online resources we learned a lot about inequality, digital poverty, and health literacy and how webpages can be made accessible to everyone.

The aim was always: ''To provide better quality of care for adult using MSK service in Barnet.''

The main objectives were:

· Improve the self-management of MSK conditions by digital platform

· Improve staff satisfaction and engaging patients by improving the digital patient’s electronic system

· Improve digital accessibility and health literacy for patients

· Improve the KPIs of the MSK service

I am pleased that in spite of all challenges as a team we were able to complete and launch the webpages. The work is still in progress with digital MSK assessment and screening tool.

Benefits of the Improvement Leader Fellowship

I was grateful for the NIHR ARC NWL team to give me this opportunity. The fellowship has helped me to find my confidence to be a decisive leader which was very important to manage this project. The fellowship has helped me to gain the trust of my team who worked with me on this project and make it possible. I was able to see their potential and was able to empower them to be the leader of their QI project.

‘’Nothing is more difficult and more precious than to be able to decide.’’

The digital transformation and webpage development involved engagement with various stakeholders and simultaneously organising the fund for webpage development. During the fellowship, the process mapping workshop especially helped me to develop the process map of my entire service, which then help me to analysis and identify the changes required within the process to improve efficiency and productivity. It also helped me to develop a process flow for digital screen and assessment tool which is under development on our current patient electronic system.

If anyone who wants to see a change in health service and passionate about making the change then this fellowship is for them. This is the perfect platform if you are an emerging leader and wants to develop your project management skill. I strongly recommend this fellowship programme.

Impact and future plans

Through this fellowship and with the guidance and support of the NIHR ARC Northwest London team. I was able to successfully complete webpage development project and launch in a timely manner. All the interactive workshops delivered by Drs Rowan Myron, Vimal Sriram, Kandy Sisya and Fiona Moss and the support I got during the mentoring session has developed my communication and negotiation skills. These were essential for this project and allowed me to have a dialogue and engage with some of the difficult stakeholders. This in turn allowed me to secure the funding required for this project. This fellowship has helped me to be confident decisive leader, and this has helped me to secure the responsibility of Co-chair of Race Equality Network forum in CLCH trust.

As this is a huge project, I will continue working on the second part of the project; the development of a digital assessment tool and associated pilot study. I will also be supporting my colleague with her self-management QI project. I will be working on the additional responsibility of promoting of implementation of a national back pain pathway as a North Central London regional representative of the National Spinal Network. I will be exploring the opportunity to continue my journey with research and applying for pre doctorate fellowship in the future.

More

Commenting on Rupal's work as part of the Improvement Leader Fellowship Vimal Sriram, Deputy Theme Lead, Collaborative Learning and Capacity Building Theme commented:

“Rupal has used her knowledge and skills acquired through her NIHR ARC NWL Improvement Leader Fellowship to work with internal and external stakeholders for this project securing support, goodwill and funding. She has developed a digital ready, MSK services for her organisation that will improve patient experience and outcomes as well as save time and effort for her colleagues to continue to provide exemplary care.“

The Central London Community Healthcare NHS Trust Musculoskeletal Physiotherapy webpages can be accessed here: https://clch.nhs.uk/services/musculoskeletal-physiotherapy

Watch this video for more information:

How to apply

If you are interested in applying for the Improvement Leader Fellowship application are open until 11 April 2022, for more information and to apply visit: https://www.arc-nwl.nihr.ac.uk/news/applications-are-open-for-nihr-arc-nwl-improvement-leader-fellowship-2022

Associated research theme