Linda Miller consultant physiotherapist in MS7/10/2010

Content Personal &

professional journey The Job Description Challenges,

opportunities & expectations

Adding value & measuring impact

How can we secure MS services in the future

• The Journey

Professional Journey 1986 - BSc physio 1995 - 2006 Senior 1 neuro out- patients, stroke

project co-ordinator 1999, 2000 - MSc modules Developed interest in MS, FES, spasticity & neuro

rehab 2001 - 2005 p/t M Phil (TENS for spasticity in MS) 2003 - regional & national involvement in MS 2006 - ESP in MS ( 3 yr part funded by MS soc)

Pilot MS in MCN, other specialist posts funded 2005 - 09 – Building on skills base (presentation,

academic writing, further research, led service redesign)

2007/8 – non medical prescribing 2009 – consultant in MS

WORKING TOGETHER•Well established MS service.•Strong MD team•Supportive head of service & consultant•MCN invaluable for service development

Personal Journey MPhil & further research

Taking risks & gaining confidence Systematic approach Focused and lateral thinking Collaborative working with HEI Tenacity & maintaining momentum

ESP post Demonstrate impact Beginning to think strategically Gaining clarity on expectations

Non medical prescribing Increased awareness of NMAHP roles Holistic package of care Releasing/supporting consultant time Improving patient pathways

Consultant post Working in NHS & HEI Focusing on high impact areas Switching between levels Position of influence Breadth of involvement Revalidation of values

Pushing out of the comfort zone

Consultant physiotherapist in MS: Job Domains

Expert clinical practice

Research, service development& evaluation

Educational & professional development

Professional leadership

Extracts from job description: Expert clinical practiceTo be responsible for a complex caseload

including the prescribing of medications in accordance with delegated prescribing rights

To create and develop protocols of care and design patient care pathways with the aim of providing examples of best practice across the regions and/or nationally.

Practice as an autonomous professional without direct supervision including independent and freestanding clinics which run parallel to rehabilitation consultant clinics.

Expert clinical practiceDefined clinical caseload

including complex presentations (FES, spasticity, pain, vestibular)

Provide advice to MDT (GP’s prescribing)

Physiotherapy patient pathwayNational advisory group for

implementation of QIS neurological standards

Integrate non medical prescribing & symptomatic management

All MS review clinics now NAHP led

Professional leadershipTo provide effective leadership,

motivating and inspiring others to deliver the best care for patients within the neurological field, including Primary Care.

To take a proactive role in cycles of service/business planning, developing action strategies and evaluating changes within and across the rehabilitation services.

To explore and exploit opportunities for change, facilitate staff ownership of change, and ensure robust systems of evaluation are in operation.

Professional Leadership Led & evaluated

MS review clinic, MD domiciliary review service, FES service

BC for FES service Joint led

West of Scotland MS Physio Network MS Physiotherapy Assessment Pack Evaluation of practice (spasticity)

MS MCN steering group and sub groups

A&A Physiotherapy clinical improvement groups

Represent Board and National level

Standards, education, clinical services, NM prescribing

Development need – clinical leadership

Educational & professional developmentTo promote and facilitate the development

of a learning environment, particularly by encouraging reflective practice, such that multiple sclerosis services continuously improve and develop.

To maintain and foster genuine partnerships with higher education institutions and other professional bodies relating to neurological/physiotherapy care.

Educational & professional developmentMCN education sub group

Newly diagnosed, living with MS, carer programmes, GP training, CHP staff training, leisure centre staff

Regional/national eventsMS patient pathway I day a week with Glasgow Caledonian University

Joint project with MS Society(Scotland) re accredited education for NAHP & SW professionals

Influence delivery of programme (under & post graduate level) Research to be targeted strategically & link with clinical

practice.Facilitator/co-ordinator for AHP practice placements in

AyrshireSit on NHS Education for Scotland physiotherapy advisory

groupRegular contact, joint assessments and advice for MD staff

Research, service development and evaluation To collaborate with academic institutions

through clinical teaching and research activity to enhance the evidence base impacting on developments within local, national and international arenas.

To promote and demonstrate high quality evidence based practice by implementing the findings of research evidence into practice, and by encouraging and supporting staff to be actively involved in research.

To lead service evaluation through selection and design of complex clinical audit, and through the dissemination and implementation of the findings.

Research, service development and & evaluation MCN Research & Development, audit & monitoring subgroups Link with GCU Link with Glasgow University

TENS study (MPhil) FES study & further study planned 2010/11 Clinical supervisor 2 PhD students

Pain in MS, leisure based exercise RCT - home based physiotherapy for patients severely affected by MS

(2009). Provisional acceptance for publication & CSO application for multicentre trial

CSO proposal for tele-rehab Audit

FES database & ongoing evaluation. Detailed review planned Jan 2011 QIS standards Education events Support physiotherapy staff in audit, evaluation & research

Development requirement – Prof Doc/ PhD?

Challenges/Opportunities Clarity of role & direction - line management/mentorship Working between 2 departments Leadership is strategic not operational Balancing clinical priorities with research, education and clinical

development Linking work streams & thinking strategically

Keeping abreast of policy, guidelines, standards & research Breadth of involvement -knowing what to get involved in & what not Maintaining fitness for practice New skills – influencing, marketing, developing BC

Learning to say no & to delegate Isolation A new set of values Managing expectations

Demonstrating impact & added value

Expectations of the consultant role

ColleaguesConsultantManagersHealth BoardPatients ?????

ColleaguesBecause you review patients for the consultant I

know that you ask about nutritional issues. This has improved care, made the review process more patient centred and holistic and resulted in closer team working. I'm not sure what the other aspects of your post are and would be interested to find out (D)

I don't think your role has had any particular impact on our service (SLT) at the moment. An AHP consultant post may impact more significantly. There could be an opportunity for collaborative research within the team which you could lead on.

ColleaguesI see your key strengths in research and in

prescribing which enhances the service that patients receive. You are a strong link in the team and always full of ideas & willing to look at service redesign. You are a point of contact for staff & patients but not sure if this differs from specialist role (OT)

It makes a difference that you know the patients from diagnosis and know their problems. This gives continuity. It is a real benefit to me that you are able to see the more severely disabled patients at home ( MS Nurse)

ColleaguesBecause you are the first to see new patients to the service

I am now noticing that patients coming for physiotherapy are better informed, have clearer expectations and are more engaged with their rehab. The patients we see in physio are more appropriate and we are generally seeing more positive results.

Your ability to see the more disabled pts at home for assessment is invaluable.

We value your specialist input to FES and spasticity management and your knowledge/experience in managing MS in the wider context. Not having to go to the consultant all the time especially with things like prescribing is a bonus(PT)

ConsultantThere is increased autonomy with your role as you

are independently reviewing and making decisions regarding patients care. This has been enhanced by non-medical prescribing. This is impacting on my clinic as I now see the patients that are more appropriate for me to see.

You are involved strategically in a leadership and advisory role which should ultimately enhance the quality of the MS service

You have a responsibility to engage in teaching and research as part of your role and to integrate this within the rest of the team

Manager I really value your role. I see consultant roles as key in driving,

supporting and evidencing clinical excellence. I expect your role to provide a key link between education, research & practice enriching all sides Provide support & overview of clinical based research using

links to HEI to maximize wider impact Support clinical improvement groups to drive strategically

aligned clinical improvement Take a lead in setting strategic direction of R&D within AHP’s Clinical expert in MS & provide support to staff locally &

nationally delivering excellence in your field Identify & harness opportunities for service improvement

within your field Represent A&A nationally & internationally within your field &

be an ambassador for the wider service

Health Boards/PCTNMAHP consultants can bring

Position of influence, Clinical vision & strategyAwareness of cultural shifts Challenging the status quoMake knowledge organisationalDemonstrating added value

Moving MS services onwards & upwards?

Strengthening our MS services for the futureNot just about consultant posts but gaining

high profile is important Demonstrate added value & measure impactDefine your key questions & driversKnow & manage your stakeholdersPlan activities towards key impacts

Added Value‘Added Value’ aspires

to enhance how we view, use and understand mundane everyday objects. It questions the importance the mundane carries in our everyday lives.

http://www.by-louise.co.uk

Added Value“the act of giving the customer more than

they think they are getting”“increasing the worth of a product or service

as a result of a particular activity”How do we know that we have added value?What kind of value can we add?How can we measure this?

Measuring Impact – Key Questionswhat are you trying to achieve?

VISIONIMPACT (targets, efficiency)

what is the desired outcome?Are there other options

what indicators will demonstrate you have achieved your outcome? OUTCOME INDICATORS

Where does it fit?National policy & strategy

Better health, Better care, Quality Strategy, Rehabilitation framework

Focus on long term conditionsNICE, SIGN, QISImproving quality is a top priority

Local targets (HB/PCT)Local delivery planHEAT targetsCost

Evidence Base

Know your stakeholdersIdentify the boss, expert, sponsor, team,

user‘WIFM’ – benefits, risks & costsWhat makes them tick

visual, auditory, tactile, big/small picture, status, safety, profit

Attach importance & manage appropriatelyInvolve early & give opportunity to gain

ownership

Influencing othersKnow what you want

Well defined smart objectivesUse positive languageHow will it look, here, feel?Is it within your control?Who will be affected?

Pitch the salePacing & leadingAsk assertivelyClose the deal

What next? PLAN ACTIVITIESBaseline measureGather evidenceIdentify indicatorsMonitorEvaluate

IMPACTS?affecting patient

needs/outcomesResource efficientContributing to HB

targets

Challenge assumptions & identify risks

Kotters 8 StepsIncrease UrgencyBuild a guiding teamGET THE VISION RIGHTCommunicate for buy inEmpower actionCreate short term winsDon’t let upMake changes stick

What about data?Know your question (and the answer your

stakeholders are looking for!)Know your strategic fitKnow your evidence baseDefine your indicatorsIs it meaningful? ( make it!)Know how to present your data

clinical outcome patient centeredness cost benefit

What will it take?Agreeing the right targetsFocusing on outcomes Developing meaningful

measuresBold & thoughtful leadershipChallenge current

practice/re-think how we work

Thinking outside our professional box Can we do jobs others might

currently do? Impact of our work on

others? DNA rates

Winning hearts and mindsEmbedding quality in day to

day workWorking together

Blue Skye Thinking?

Thank you for listening