To improve and develop a service is a concept that I did not necessarily consider when deciding to be a physiotherapist (1). I always considered improving and developing my own personal skills through strategies like CPD as the CSP emphasises us to do (2), but I did not consider the impact that I could have on the wider services of physiotherapy and healthcare. During and throughout my Physiotherapy Masters, we were introduced to methods that highlighted to me that physiotherapists should consider ways and means to help support the development of physiotherapy (3). This certainly opened my eyes and we were introduced to how we could potentially influence service development within our careers.

The first opportunity we had to understand and experience improving and developing services was in a practical manner, where we completed a service improvement project. This consisted of myself identifying and critically evaluating practice within a clinical setting, and appraising the service in order to inform my service improvement idea to develop and re-design the current clinical practice (1). I used a number of methods to commence this project, using a PDSA (Plan, Do, Study, Assess) form (evidenced – PDSA Form) in order to lay the foundation for my idea, allowing me to construct what I had identified as an area of improvement in a clinical setting to critically evaluate and appraise the existing service, where I noticed a trend around a lack of hand hygiene, a hot topic in clinical practice currently with the current Covid-19 outbreak (4). The use of the PDSA Form enabled me to begin to plan and facilitate the changes I wanted to implement whilst the use of others methods to recognise where the root cause for the discrepancies in hand hygiene may be (evidenced – Fishbone Diagram), allowing me to further critically analyse and appraise the service in order to inform the development and service re-design (1). Following the completion of the PDSA Form and the Fishbone Diagram, I was able to develop innovative and sustainable recommendations to improve the quality of the service, in a cheap and efficient way (evidenced – Service Improvement Poster), where minimal changes are made to the service to ensure safe and effective practice for the patients being managed (1). I considered how to I would monitor the success of my service improvement idea, which is through the use of sustainable patient and physiotherapist questionnaires and covert surveillance, monitoring the frequency and technique of the hand-washing regime physiotherapists are using (evidenced – Service Measurement Methods). In addition to timescales in order to understand how to the service will be run and monitored to efficiently manage the change of the employed new service concept (1). Following the completion of this task, I felt it was pertinent to learn and critically evaluate the process and outcome, this consisted of a reflective essay (evidenced – Reflection: Service Improvement). This enabled me to consider all the obstacles, red tape and other factors that influenced the service improvement process and assisted me to consider how I may conduct myself in the future during a service improvement project to ensure I achieve the best possible outcomes, demonstrating this descriptor effectively and an understanding of the need to establish and maintain a safe practice environment for patients and staff (1,5).

The service improvement project gave me valuable skills when I was presented with an opportunity to develop a business case (evidenced – Business Case) for an area of physiotherapy. I decided to the topic of respiratory first contact practitioners in GP practices would be a useful concept due to the demand of GP’s generally and the quantity of respiratory based admissions which could be managed better in primary care (6–8), demonstrating an ability to critically evaluate practice and use appraisal to inform service improvement development and re-design (evidenced -  slide 3-4 Business Case) (1). On slides 4-7 of the Business Case, I highlight an ability to develop innovative recommendations to improve the quality of the service (1) and evidence its sustainability on slides 14-15 of the Business Case where I demonstrate the financial and patient-related benefits for the service, showing I have critically evaluated the process and its outcomes through thorough planning, facilitating and managing the business case effectively, supporting the development of physiotherapy and commitment to excellence for the profession and its patients (1,3).   

Reference List

1. Physiotherapy CS of. Chartered Society of Physiotherapy Framework [Internet]. 2013 [cited 2020 Mar 23]. Available from: http://www.csp.org.uk/professional-union/careers-development/cpd/csp-eportfolio/my-eportfolio/cpd-
2. The Chartered Society of Physiotherapy [CSP] CSP Education Position Statement: Continuing Professional Development [Internet]. [cited 2020 Jun 9]. Available from: https://www.gov.uk/government/publications/education-outcomes-framework-for-healthcare-
3. Charted Society of Physiotherapy. Chartered Society of Physiotherapy xx Professional Values of Members’ Code and Behaviour 2 Code of Members’ Professional Values and Behaviours [Internet]. 2019 [cited 2019 Apr 9]. Available from: https://www.csp.org.uk/system/files/csp_code_of_professional_values_behaviour_full.pdf
4. COVID-19: Five dimensions of impact | The Health Foundation [Internet]. [cited 2020 Jun 2]. Available from: https://www.health.org.uk/news-and-comment/blogs/covid-19-five-dimensions-of-impact
5. Council H and CP. Physiotherapists | The Standards of Proficiency For Physiotherapists [Internet]. 2013 [cited 2020 Mar 24]. Available from: https://www.hcpc-uk.org/standards/standards-of-proficiency/physiotherapists/
6. Online G. Only one in 20 GP trainees plan to work full time, poll reveals | GPonline [Internet]. [cited 2020 Apr 14]. Available from: https://www.gponline.com/one-20-gp-trainees-plan-work-full-time-poll-reveals/article/1667423
7. Ansari Z. The concept and usefulness of ambulatory care sensitive conditions as indicators of quality and access to primary health care. Vol. 13, Australian Journal of Primary Health. CSIRO; 2007. p. 91–110.
8. England PH. Public Health Profiles [Internet]. [cited 2020 Apr 14]. Available from: https://fingertips.phe.org.uk/search/respiratory#page/0/gid/1/pat/46/par/E39000046/ati/154/are/E38000106/cid/4/tbm/1/page-options/ovw-tdo-0