It can be a challenge for clinical and frontline staff to get involved in quality improvement, above and beyond their intense workload. This team takes a different view and has some nuggets of wisdom to share.

Last year, a team of physiotherapists was awarded the Quality Improvement Project of the Year at Quality Convention. I had a chat with Er Wei Xiang, who was the project lead, to understand about the challenges they faced when trying to solve this problem, and how they circumvented them.

The project was conceived from ground-up, said Wei Xiang, as a result of many physiotherapists voicing out that some patients they were seeing were not appropriate referrals. “Valuable time was thus spent seeing patients who might not have needed urgent care, or for whom physiotherapy was unnecessary or even unsuitable,” he explained. “Morale and a sense of satisfaction in treating patients were affected as well.”

After digging deeper into the root of the problem, the team decided to focus on resolving various inconsistencies in physiotherapy processes and practices, leading to inappropriateness of patient classifications. Wei Xiang recalled, “It was an immense challenge. While we were clear about the problem to be resolved, we couldn’t dive head in with our own conceived solutions. We had to have straightforward conversations with our colleagues from different clinical specialties, and truly understand why things were the way they were.”

To achieve buy-in for the project, the team needed to convince their colleagues that they were all working for the betterment of their patients and colleagues, and were not blindly criticizing the current practice. “It was scary having to convince a mentor 10 years my senior to buy into change that isn’t guaranteed to reap benefits. We also had to communicate the proposed solution across various discipline teams. Verbal, pictorial, digital, print, email, shared network folders, e-learning platforms and department meetings – you name it – we catered to all preferences of communication in order to achieve correct and accurate usage of the solution.”

Once they arrived at a mutual understanding with their colleagues, the project team set in place a common guideline across the department to decrease variations in the classification of patients. Having one common guideline rather than 7 pre-existing and distinct clinical guidelines made it far less ambiguous for physiotherapists to prioritize patients, and determine the frequency of consultations for them.

Then I asked the million dollar question – how did the team find time to do this on top of their clinical work? Wei Xiang smiled and said: “We had to do this outside of our usual working hours.”

But there were two nuggets of wisdom he wanted to share, which he felt made his QI journey a far more meaningful one. “View the time spent on QI as an investment with significant returns.”  Wei Xiang elaborated, “The project team may not have achieved the target we set [they were about 1% off], but any time invested towards investigating a problem is already a huge step towards understanding it. Meaningfulness is what you make out of it!”

Second nugget of wisdom: help is always a phone call away. “There’s no need to take on the QI project alone. There are so many resources that you can tap on. When we got stuck, reaching out to QI coach Samantha Woon was the best decision ever made. Besides directing us towards established investigative methods, she made charting root causes and weighing proposed solutions a breeze, clearly setting our QI team towards its final minor success,” shared Wei Xiang. “Another person we are truly grateful to is our senior coach Yong Soh San, who personally volunteered to perform calibration with our developed solution across individual discipline teams in the Physiotherapy Department, leading to implementation across all 7 teams instead of the initially planned 6.”

“Sometimes, all you need to do is ask!”

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