Sara James and Mark Knight-Davies
Aneurin Bevan University Health Board
Background
ABUHB (Aneurin Bevan University Health Board) Physiotherapy, like many other directorates within ABUHB, experienced unprecedented change upon the arrival of COVID-19, undergoing mass redeployment and rapid and significant outpatient service restructure numerous times. Staff readily adapted in order to meet the fast-changing needs of the service and the patients within. In doing so, they had to acquire or refresh skills, in new teams and environments, within an emergent and changing pandemic.
The ‘Physio diaries’ project aims to utilise the power of voice, through listening to staff and patients of their experiences of working in, and receiving physiotherapy during COVID-19, to learn about changes that should exist in a post-COVID-19 Physiotherapy service. Through learning about what has been effective on the ground as a result of changes that have had to occur during COVID-19, we can learn about what should stay, and what should go, following the pandemic. Through directly involving stakeholders, we can gain insight from lived experience, as opposed to making assumptions about wants and needs. The involvement of stakeholders in decision making is not only a desire but a legal obligation.
The first stage of this work involved speaking to staff on the ground during COVID-19 in an effort to learn about their experiences during COVID-19 and their thoughts moving forward. Many themes emerged from analysis of this data, and allowed us to begin to explore these themes to a greater depth. This particular part of the project aimed to explore patient and staff experiences of receiving and delivering virtual physiotherapy during COVID-19, and their thoughts for an Outpatient Musculoskeletal Physiotherapy service following COVID-19. The consequent themes allowed for more in depth and deductive exploration of pertinent topics. The second stage of this work aimed to explore E-health in Physiotherapy Outpatients, and it’s place in a future service.
Project Aims:
The key focus was to directly involve stakeholders in the re design of future ABUHB Musculoskeletal Outpatient Physiotherapy service, through talking to them about their experiences, thoughts and feelings, and organising the findings in a clear and transparent way.
‘I feel like, receiving Physiotherapy over video, it was almost as good as being in the room with someone. It really helped my mental wellbeing. I feel like, on the phone, it’s kind of like, not that they don’t care, but it’s not the same as when someone looks at you, you know, it makes you feel ‘oh someone is doing something about it’ it makes you feel more involved in your progression. For the future, I feel face to face is best, but I think video could be very helpful with making initial contact with people, so they don’t have to wait as long’
Patient receiving virtual Physiotherapy during COVID-19
This aim came as a result of the findings from our initial interviews. The first interviews were found to additionally provide a platform for staff to offload and have a voice, and so acted as an intervention to air the impact of working during COVID-19, and so a second aim of this work was to understand the impact of COVID-19 of delivering, and receiving outpatient physiotherapy, to ensure stakeholders have been heard.
‘I think part of being a physio, especially in outpatients, it’s very busy, lively, dynamic, patients coming in and out, lots of throughput. As a physio, you work in that area because you thrive off that environment. I think that’s been missing; having patients in and around, that atmosphere. That’s been hard, that’s where its hit me personally. Sitting at a desk, feeling quite separate, doing your consultations via telephone, and you may not get a chance to interact with any other people for hours. It can be quite difficult to keep your motivation and enjoyment of your job up.’
The methodology used allowed for rapid data collection, parallel understanding of the data and also an innovative and engaging way of delivering results through the use of video stories. Thus a further aim was to deliver findings in a digitally innovative way.
Challenges:
The evolving nature of COVID-19
The twists and turns of COVID-19 meant that adaptations have occurred several times. This had implications for the collection of the data and the content of the data, dependent on the phase of the pandemic. However, the use of interviews meant that the data was raw, minimally invasive and actually facilitated by digital innovation and virtual recording, but also allowed for collateral familiarisation of the data, allowing for conclusions to be drawn and shared quicker.
‘Buy-in’
Qualitative approaches to research are well documented for its utility, but lags behind in its availability and conduction during unprecedented times. Research suggests that this is because of the potential emotional implications that data collection strategies like interviews can bring, and the difficulty drawing meaningful conclusions. We too found that interviews acted as an outlet and also a checking in point for our staff, whom were redeployed to every pocket of geography in the health board. The use of framework analysis allowed for systematic presentation of findings, easily communicated in the form of infographics, for anyone who wishes to learn. We hope that the ease and utility of this methodology will encourage more such work to be done on the ground.
Key Outcomes:
Framework to inform system change
The initial research allowed for the development of key themes and recommendations for future physiotherapy practice, based upon lived experience. This stage of the work allowed for co-produced recommendations for a future physiotherapy outpatient service.
We now know what our staff and patients would like to see from a future physiotherapy service, based on their past and current experiences of both traditional and virtual physiotherapy management. It facilitates the design of a co-produced, informed, meaningful change in which we are actively considering the needs of our stakeholders, by speaking to them and gaining insight, and not assuming what it is they would want.
Staff wellbeing
Interviews were well received, gave staff an outlet and a voice. We were able to identify concerns for future staff wellbeing, and act on this in a timely manner through collaborating with the Employee Wellbeing Service.
Qualitative evaluation
We have effectively utilised methodology in which quality rich information can be gained, analysed and interpreted. This is a step away from traditional quantitative methods in which tell us a lot about performance but less about the individual needs of our heterogenous population.
Next Steps:
- Continue to explore themes found in stage one of this work.
- Present stakeholder views and recommendations for future Musculoskeletal Outpatient Physiotherapy in ABUHB.
- Spread and scale methodology with a view that it is used when exploring other new and pertinent topics.
- Continue to listen to, and engage stakeholders in decision making and service design.
- Aim to publish results in order to inform our profession what it has been like to work during covid-19 for a physiotherapist.
Showcase:
Contact:
Sara James: sara.james@wales.nhs.uk or Twitter, @j90_sara
