Storyboard submission Follow the detailed instructions in this template for writing a description of your storyboard. Type your information in each section below and save this completed storyboard document as a Microsoft Word file. Please spell check your storyboard before submission as it will be published on the NHS Wales Awards website. Please note: The storyboard should be between 500 1000 words maximum (including references but excluding headings, images or graphs) Submit your storyboard using the online submission system at www.nhswalesawards.org.uk by Friday 25 January 2013. Storyboard submission 1. Storyboard Title Developing an Occupational Therapy Graduate Rotation Scheme and a Workforce for the Future 2. Brief Outline of Context (Where this improvement work was done; what sort of unit/department; what staff/client groups were involved) The storyboard will describe how the Aneurin Bevan Health Board occupational therapy (OT) service developed its graduate rotation scheme from eight OT practitioners rotating every six months within the physical hospitals to twenty-eight OT practitioners rotating every year across a variety of clinical and service delivery areas. Developing the graduate rotation scheme involved listening to and working with all the occupational therapy staff and collaborating with senior colleagues
and managers across the Health Board and local authorities within Gwent and South Powys. It has resulted in an OT workforce more skilled, experienced and confident in meeting the changing needs of the population. 3. Brief Outline of Problem (Statement of problem; how they set out to tackle it; how it affected patient/client care) Within the organisation, the diverse nature of occupational therapy intervention across adult physical services, paediatrics, CAMHS, mental health and learning disabilities in the hospital and community settings was often misunderstood by other senior managers who questioned the value and effectiveness of occupational therapy. OT practitioners joined a rotation that was limited in its opportunities for clinical experience. This resulted in a high turnover of staff leaving to gain experience in other clinical areas. OT interface across hospital and community boundaries was poor with little or no transference of skills from one area of OT to another. Service users were often referred on to other areas of OT to benefit from another OT s knowledge and skills. Recruitment and retention of OT practitioners was poor and the sustainability of the service was an issue with little or no financial investment. 4. Assessment of Problem and Analysis of its Causes (Quantified problem; staff involvement; assessment of the cause of problem; solutions/changes needed to make improvements) A root cause analysis of the problem identified that the rotation was limited with too much clinical specialisation at too early a stage in a new graduate s career. Analysis of the causes included: ingrained practice across all clinical areas, a lack of vision relating to the strategic expectation that more care will be delivered on the community a risk aversion to employing newly qualified graduates in some clinical and service delivery areas
a lack of understanding of the need for the OT service to modernise its workforce. the demographic requirement to address the increasing frailty and complexity of the population s needs Expanding the rotation was seen to be key to creating a more skilled and confident workforce in OT with the subsequent benefits for the service users, the recruitment and retention of staff and inter-agency working across traditional boundaries of health and social care. 5. Strategy for Change (How the proposed change was implemented; clear client or staff group described; explain how they disseminated the results of the analysis and plans for change to the groups involved with/affected by the planned change; include a timetable for change) A workforce review and analysis of clinical service delivery was undertaken to identify where the OT practitioner posts would have the greatest impact. These key areas included: older adult mental health adult mental health child and adolescent mental health children and young people learning disabilities community reablement social services The change required was delivered by listening to and engaging with key stakeholders who included: the entire OT workforce to ensure their co-operation in regard to completely redesigning the workload and skill mix within their clinical and service delivery areas. budget holders, internal and external to the Health Board, to discuss the value of the rotational scheme and to negotiate how funding could be re-allocated, managers of OT services not within the management sphere of the Head of OT services e.g. mental health, where there existed a fear that the rotational scheme would be disruptive to established services the OT practitioners themselves who were supported through a robust preceptorship programme by the Practice Development & Education Lead for the OT service who also leads the OT practitioner development group, a forum that meets quarterly.
Developing a worfkforce for the future: Adult Mental Health OT Rotational OTs working in community and inpatient settings with adults Adult Physical Services Rotational OTs working in acute & rehabilitation hospitals Social Services OTs Rotational OT employed by Health Board & working in children with disability team Older Adult Mental Health OT Rotational OTs working in community and in-patient settings with older adults Community Resource Team Rotational OT working as part of an integrated hub of OTs working across health, social services and reablement ABHB-WIDE OT SERVICE Delivery of core clinical services Delivery of the integrated model Flexibility & sustainability Governance & CPD Recruitment & Retention Rotation Scheme Training & Development Service Re-design Workforce Planning Learning Disabilities OT temporarily reallocated CAMHs New rotational post which will work as part of the core community service Children & Young People s Service 2 rotational OTs working from children s centres into schools, homes & nurseries with children with complex disabilities 6. Measurement of Improvement (Details of how the effects of the planned changes were measured) Measures of improvement include: expansion in the OT practitioner rotational scheme from 8 places in physical hospital bases to 28 placements across a range of clinical and service delivery areas as of December 2012 see chart below.
Original placements 1 Ysbyty Ystrad Fawr 2 Ysbyty Aneurin Bevan 3 Nevill Hall Hospital acute medicine & 4 Nevill Hall Hospital acute medicine & 5 Nevill Hall Hospital trauma & orthopaedics 6 Royal Gwent Hospital acute medicine & 7 Royal Gwent Hospital acute medicine & 8 Royal Gwent Hospital acute medicine & 9 Royal Gwent Hospital acute medicine & 10 Royal Gwent Hospital acute neurology 11 St Woolos Hospital 12 County Hospital 13 Monnow Vale 14 Chepstow Community Hospital New placements 15 Caerphilly Children s Centre Paeds 16 Serennu Children s Centre Paeds 17 Ysbyty Ystrad Fawr Older Adult Mental Health 18 St Cadocs Hospital - Adult Mental Health Adult Mental Health 19 Ty Siriol, County Hospital - Older Adult Mental Health 20 St Woolos Hospital - Older Adult Mental Health 21 Ysbyty Tri Chwm Adult Mental Health Adult Mental Health 22 Felindre Ward, Brecon Hospital Adult Mental Health 23 Clywedog Ward, Llandrindod Wells Hospital - 24 Monmouthshire CMHT 25 CAMHS CAMHS 26 Mardy Park Reablement 27 NHH Acute med/ New central funding (CDU) 28 Torfaen children with disabilities team Local authority (new post)
feedback received from other health board managers about the excellence in practice that OT practitioners have delivered in areas where it was considered that only static experienced OTs could work. increase in applications for the OT practitioner rotation based on the depth and breadth of the clinical areas offered increased retention of OT practitioners who have the opportunity to work across a variety of clinical areas 7. Effects of Changes (Statement of the effects of the change; how far these changes resolve the problem that triggered the work; how this improved patient/client care; the problems encountered with the process of changes or with the changes) The expansion of the rotational scheme has been a catalyst for re-designing the whole OT workforce. The following outcomes have been achieved: OTs have developed more holistic skills as they rotate across areas of mental and physical health creating workforce flexibility and sustainability Skilled Band 5 OTs can apply for internal Band 6 vacancies which aids recruitment and retention and creates opportunities on the rotation for new graduates. This is particularly noticeable in mental health where OT posts have been lost due to inability to recruit in the past. Service users benefit from more holistic practice across hospital and community boundaries and across adult physical and mental health e.g. service users with dementia and physical health co-morbidity receive intervention from one holistically skilled OT. This has reduced the need for transfer of patients between OT services. An enhanced understanding of the benefits of OT across many areas of health and social care as practice is more effective and value for money can be demonstrated 8. Lessons Learnt (Statement of lessons learnt from the work; what would be done differently next time) Reviewing the scope of practice and the development needs of new graduates in respect of the clinical experiences they needed to become skilled and confident, presented new opportunities to change the way that occupational therapy is delivered across the wider service.
We also learnt that experienced clinicians need support and development to enable them to change their thinking and evolve their practice to lead and deliver flexible and sustainable occupational therapy services. 9. Message for Others (Statement of the main message they would like to convey to others, based on the experience described) Staff are our most costly investment but also our greatest asset. Engaging all staff in their development has the potential to develop their thinking and evolve their practice to ensure a workforce which is flexible and sustainable to meet the increasingly complex and diverse needs of the people that we serve.