Allied Health Professionals, Clatterbridge Rehab Centre

1. Allied Health Professionals, Clatterbridge Rehab Centre Supporting & Engaging Staff through a Period of Major Change

2. Reason for LiA: Major reorganisation of AHP services due to co-location of Wirral Neuro & the Stroke Unit into the ‘CRC’ → integration of 4 highly specialised AHP neuro teams with very different ways of working. Resulting in: • Effect on Staff: Low staff morale and high levels of stress. • Operational Difficulties: Decreased patient flow and increased LOS; Gaps in timetabling of rehabilitation slots; problems in co-ordinating rehabilitation between the Therapies; inconsistent levels of rehabilitation provided for some individual patients; difficulties in achieving rehab goals. • Concerns / complaint re patient care.

3. Aims: • To support and engage staff during a period of major service reorganisation. • To address new and existing concerns and issues that were important to AHP staff. • To ensure effective and open communication between staff and managers. • To facilitate the development of more integrated working practices and to enable more effective planning & co-ordination of therapy. • To improve staff morale.

4. Core Members of Team • Ray Roberts (Physio) • KiriCitrine (OT) • Gill Drewary (SLT) • Gill Ayriss (Ward Manager) • Nicky Norriss (Chair) • Tony Probbing (Vice-Chair) • Richard Adams (Physio) • Felicity Hale (OT) • Nadine Barron (Physio) • Jennie Langston (OT) • Sarah Sach (Physio) • Nicola Branscombe (OT) LiA Support from: Sue Green – LiA Sponsor Cathy McKeown – LiA Lead Angela McLoughlan – LiA Support

5. LiA Staff Conversation 4th April 2013

6. Main Issues Identified There was a lot of consistency in the issues raised by staff: The top 3 were: • Leadership / Communication: it was felt that there was a need for strong Team Leadership to coordinate therapy teams, maximising communication both with individual teams and MDT meetings.. • Gold standard of care: To be able to offer quality effective, skilled care as per RCP guidelines (45 mins X 5 per week, seamless through acute care to CRC to community). . • Time tables and joint working: To provide a timetabled 24 hours approach to patients, and maximising the opportunities for rehabilitation activities throughout the day. Joint working, joint documentation etc.

7. Links to PROUD & Trust Goals PROUD: Support staff, raise morale & facilitate the delivery of a high standard of patient care. .Trust Goals: • Quality and Safety: To enable staff with highly specialised skills to provide a ‘gold standard’ of patient care, by addressing key issues. • Access: To consistently achieve RCP guidelines – 45 mins therapy x 5 /wk • Flow: To ensure effective timetabling and co-ordination of therapy • Patient Experience: To ensure that every patient gets the optimum level of therapy.

8. Action Plan Agreed 3 Key Actions identified: • Improve Communication and Planning of Patient Care. • To Review Timetabling. • Individual Patients to be Allocated to a ‘Named Therapist’. ‘Quick Wins’ identified:

11. Achievements – 3 Key Action Points • Communication & Planning of Patient Care. • JointGoal Setting meetings instituted from 13/05/2013. (key to the provision of a co-ordinated and focused approach to meeting the needs of individual patients). • Patient Communication Board for co-ordination of discharge planning and OT and Physio goals. Staff have responsibility to ensure this is regularly updated. • Formal Processes agreed re taking appropriate information to RAG board / meetings and feeding back to staff consistently.

12. Achievements cont....... 2. Timetabling. • OT and Physio Team Leaders have agreed timetables with complementary treatment times, to enable co-ordination of treatment slots and joint working opportunities. 3. Individual Patients Allocated to a ‘Named Therapist’. • All patients now are allocated to a ‘Named Therapist’ to ensure consistency in delivering patient care and planning and communication.

13. Quick Wins Achieved • Communication book: • Additional phone in quiet room for confidential phone calls: • Increase AHP Manager’s understanding of services by job shadowing • Provisional review of office facilities and therapy environments: • Ensure robust CPD and Clinical Supervision processes in place:

14. LiA in a Time of Major Change In retrospect, this may not have been the optimum time to implement the LiA procedure to: • The enormity of the changes in co-locating and integrating two units: This not only impacted on the morale of AHP staff, but also had a global impact on the other CRC staff groups and co-ordination of patient care within the unit. • Significant logistical problems re the size of the combined Therapy Team and the complexity of joining together two highly specialised therapy services with very different ways of working • AHP Service Review - change in the AHP Directorate management structure. The new structure meant that many staff changed their line manager, which caused further uncertainty and changes.

15. Main Learning Points: • LiA staff conversation is a very effective way to discover the issues that concern staff and to identify what they feel can be done to address the issues. • LiA may be best done when a team or service is in a relatively ‘stable position’ but has specific issues that need to be addressed. • Staff engagement and staff accepting their individual responsibility for their actions, or identified tasks, are key to making progress on aims and objectives.

16. This isn’t the end it’s just the beginning! Any Questions?