Mid Cheshire Hospitals Foundation Trust have recently trialled the introduction of a therapy champion role, to improve the 24 hour approach to rehabilitation on the rehabilitation ward. Vacant therapy assistant hours were used to fund the therapy champion role. The therapy champions are healthcare assistants (HCA’s) currently working on the ward who were interviewed for a fixed term temporary role as champion. They then underwent therapy competency training within the therapy team, as well as working HCA shifts.
The work supports delivery of several NICE guidelines and quality standards, including rehabilitation after critical illness, freeing up physiotherapist time to carry out a comprehensive clinical assessment and agree rehabilitation goals. It supports delivery of the intermediate care guidance (NG74) and falls guidance (CG161) and quality standard (QS86) by up skilling healthcare assistants to support mobility and independence. It improves patient experience in line with CG138 and QS15 patient experience in adult NHS services. The therapy champion role supports continuity of care in line with QS15, quality standard statement 11, coordinated care through exchange of patient information (QS15, statement 12) through the use of the ward booklet. Ward booklets support improved communication and sharing of information enabling patients to actively participate in their care.
Aims and objectives
The aim of this project was to transfer skills learnt as therapy champions back into the HCA role, to be a mobility champion and to lead and support the therapeutic approach on the ward with other nursing and care staff.
An additional aim to the project was to improve clinical skills and confidence of HCA staff by completing physiotherapy and occupational therapy assistant competencies to create a ‘therapy bank' of competent assistant staff. With the aim of having access to increase staff at times of high demand with the goal of reducing locum contracting and combating the difficulty in recruiting to fixed term contracts.
Reasons for implementing your project
We conducted the project on the 24 bedded rehabilitation ward, at Leighton Hospital, Crewe.
Before the project started it was identified that therapy intervention and care needs were treated separately on the ward. Transfers and washing and dressing advice was given by the therapist, but a true understanding of patient goals, therapeutic approach and joint working was limited. Regular training sessions for the ward staff were offered but because of time pressure and staffing levels on the ward, these were poorly attended. The therapy champion role was introduced to break down this barrier and ensure all members of the team on the rehabilitation ward had a core level of competencies in the therapeutic approach.
Patients were often unable to continue aspects of their rehabilitation when therapists were not available. The aim was to improve the service patients receive including opportunities to practice activities of daily living and mobility throughout the day. Ward booklets were introduced to increase patient ownership and commitment to their rehabilitation stay and with exercises that could be supported by ward staff and families. This could also support progress within therapy sessions, and prevent deterioration at weekends. Consequently, a reduced the length of stay, and improved patient experience was expected. Feedback was gained throughout the process from patients and ward staff in the form of questionnaires.
Also, an additional aim to the project was to create a ‘therapy bank' of staff. With the aim of having access to increase staff at times of high demand with the goal of reducing locum contracting and combating the difficulty in recruiting to fixed term contracts. This reduces staffing costs significantly and provides a more flexible workforce.
How did you implement the project
The idea of the therapy champion was developed however funding was not available to provide this. When a therapy assistant vacancy arose we took the opportunity to run a pilot, using the vacant funding. This idea was presented to the ward manager and therapy staff, in order to release HCA’s from their roles on a temporary basis. The ward manager was keen to support the initiative and release HCA’s through the ‘therapy champion’ post on a fixed term basis with the aim of increasing knowledge and skill to a number of HCA’s. We could promptly recruit to a vacant therapy assistant post preventing a gap in staffing due to the recruitment process.
Initially this was carried out by two HCA’s over a 6 month period and it has become an ongoing role due to its success. A baseline audit collected data for therapy contacts and outcome measures. A re-audit after the 6 month period demonstrated an increase in therapy contacts, and positive outcomes were seen.
We implemented a ward booklet that could be used to empower the patient to take ownership of their own rehabilitation. On completion of patient satisfaction survey a gap was highlighted in the lack of therapies out of normal working hours and lack of opportunity to work towards rehab goals. Also, a variability of handling skills was identified. From this patient feedback, ideas to improve the patient experience were gained to bridge this gap in the service. Clear themes were highlighted with patients wanting to have more opportunity to practice what they practiced in therapy including personalised exercise programmes, as highlighted in CG83 Rehabilitation after critical illness.
Therapy workshops were used to educate staff about the changes, show the benefits of the new way of working, including how to go about the implementation of NICE CG83, CG138, QS15. We further offered a study to promote the evidence based practice approach. This was delivered at ward meetings and fed back to management.
The project demonstrated extremely positive outcomes, meeting the aims and objectives set out.
Length of stay and falls were both measured at baseline as were patient and staff satisfaction. Positive results could be seen for both length of stay and reducing falls from the introduction of the therapy champion.
The feedback from patients and service users was gained from questionnaires and user groups, was positive and staff reported increased work satisfaction.
Patients were happy to complete exercises with health care staff at the weekends and evenings, continuing the 7 day / 24 hour approach to care and therapy. The patients felt happier that exercises and more complex transfer practice were completed in the absence of therapy staff, enabling the transfer of skills into ADL practice throughout the whole patient day.
Specific feedback from one of the therapy champion is as follows:
- Gained confidence in moving and handling skills with patients.
- Gained an insight into the differences between physiotherapy and occupational therapy, understanding the rehabilitation process from initial assessments to discharge and how we record our outcomes.
- Felt able to explain to other members of the MDT the reasoning behind the therapy decisions regarding patients function and mobility. Thus, bridging the gap between therapists and nursing staff.
- Felt able to demonstrate mobility and transfers to other HCAs for more complex patients to ensure 24hr rehabilitation.
- Gained an understanding of the pressures therapists face in terms of caseload management, limited staffing, liaising with MDT/family members and recording data/stats.
- Competency packs provided clear objectives and training needs.
Patients felt they were given opportunities to practise activities of daily living and supported to mobilise throughout the day. Patients demonstrated increased ownership of their care and a commitment to their rehabilitation. The ward booklets enabled ward staff and families to continue therapy at weekends; helping to maintain improvements when therapists were not available. The results of this were a prevention in secondary complications of immobility, as outlined in CG83.
The joined up approach and increased understanding of patient goals also helped reduce delays in home visits and streamlined the service. Therefore increasing productivity and efficiency throughout the patient journey. It allowed qualified therapy staff to work alongside therapy champion staff within the HCA role. We could also better utilise the skill mix and have qualified staff completing more complex patient caseloads, new patient assessments and facilitating discharge processes.
Finally the use of the therapy champions freed up qualified therapist time. This enabled therapists to deal with more complex cases, such as supporting rehabilitation after critical illness, in a timely and efficient manner.
Key learning points
Key learning from this initiative was that when the HCA’s returned to the HCA role permanently it was important to reinforce the change of practice and support this from all staff. Ensuring they returned as key therapy champion workers, had an educational role to other staff, alongside therapy workshops, providing ongoing education and competencies for all ward staff.
Workshops included twice weekly drop in sessions for HCA’s on the ward to access to share learning and skills from the therapy team and the therapy champion.
Different badges were considered to highlight the ongoing change of role, and ongoing audits of washing and dressing advice being adhered to by ward staff took place. Ongoing joint working was important to reinforce the role and the understanding of goals and the therapeutic approach to daily care. This role has continued with another intake of HCA’s from the ward into the role. Going forward we plan to commence a covert audit to measure the transfer of skills back in to the healthcare role and to define the role further with a change in uniform.
In order to sustain the role it may require joint investment from therapy and ward budgets.
We hope to implement the dual role to other wards in the trust by presenting our findings and benefits of the patient experience.