Services are often met with challenges, such as the Covid-19 pandemic (2), which require evaluations of practice and recommendations for improvement.  Both Public Health England (3) and the CSP (4) have standards and policies in place to assure the quality of services and to promote innovation and leadership in developing improvements to services. For me, the whole concept of service improvement was difficult. I felt inadequate to improve a service as an inexperienced student. After having numerous conversations with my peers, I realised that we all felt similar emotions when it came to this project - out of our depth.  By having various discussions with educators over the course of my placements, I realised that services are continuously improved through small regular changes and that the important aspect is identifying something small that could be optimised. After hearing this, I was relieved. I felt that identifying a small area for change would be achievable. To help with the process of identifying an idea, I read a CSP article (5) which gave me more guidance on the overall process. By having greater understanding of what was involved, I felt less worried about conducting this task. I then reflected on conversations /research and went about identifying services that worked well and others that did not over the course of my placement. 

While on my third placement, I noticed discrepancies between prescribed volumes of oxygen and actual volumes being received through errors. The two main errors I observed were inappropriate venturi valves for the prescribed amount of oxygen and oxygen flow meters being set inappropriately, delivering too much or little oxygen to patients. I believe I had discovered an area I could improve.  Next was the planning of what to do. With, the guidance of my educator and my lecturer, I critically evaluated practice with the aid of a 'Plan, Do, Study, Act (PDSA)' and a 'measurement plan' .Within my PDSA I was able to identify an idea for a service improvement. Initially, I had some struggles with the PDSA. This was due to my aims not being entirely quantifiable. I returned to my PDSA and attempted to adjust it. By stating my aim in wishing to reduce the number of patients receiving incorrect volumes by 50% after 4 weeks of the project, I feel I was able to correct this. I feel that my measurement plan was appropriate, as measurement could be validated. This was achieved by measuring 4 weeks prior to the project and 4 weeks after to see if any change was observed. If no change was made, the project may need to be tailored.

The project was accomplished by critically evaluating practice to identify the root cause of the problem and the aims for a solution. I shared the outcome of this appraisal with my clinical educator. With the aid of my PDSA, I had identified that the root cause was that there was no reminder for staff to check patients are receiving the correct amount of oxygen throughout the day. During the pandemic, wards staff were incredibly busy. Add to this, regular change in supplemental oxygen prescriptions, due to the changing demands of patients. This was somewhat influenced by Covid-19. I used a problem solving approach to develop safe and effective recommendations to improve the service in the form of a 'poster', which I have included as evidence. The purpose of this bedside poster was to act as a reminder to staff to ensure patients were receiving the correct volume of oxygen as per the patient's drug chart. The overall aim of the poster was to establish and maintain a safe practice environment. One element of this process I found particularly challenging, was the root cause. I used a 'fishbone diagram' to assist in this process. I think my struggles with identifying a primary cause of the problem were related to it being my first ward based placement. I was still getting my head around how a ward operates which led to some confusion. Creating the poster also created some problems. I would put this down to not having an artistic nature and perhaps I was not creative enough at times. I attempted to navigate this challenge by using stock images of oxygen masks and venturi valves to make the poster more visually stimulating.

Due to being in the final weeks of my placement when I thought of the idea, I was unable to implement the service improvement due to time constraints and other University commitments. I completed the remainder of the project in retrospect. Therefore, on this occasion I was unable to contribute to change and development within the service. However, I am presenting a sample of evidence depicting how I have engaged in questionnaires to contribute to change, ' CSP questionnaire' . While it was a shame to be unable to see my idea implemented on placement, completing the project has a number of positives. I now have a service improvement idea ready for implementation should I notice similar services not maintaining a safe practice environment. I also have the experience of completing the steps involved in a service improvement. This will allow for smoother involvement in similar projects, as I already am aware of the commitments involved.

As part of the project I also completed a 'service improvement reflection' on the process in order to reflect on the change process, & use this information to appraise the outcome & inform future practice. As I was unable to contribute to change in a service in this instance, reflecting and reviewing practice will be of value moving into a band 5 role. Reflecting and appraising the process, has aided me in viewing the strengths and weaknesses of the project. For example, keeping changes to the service small and achievable.  By completing reflections like this, I demonstrate my commitment to continuously improve. There are a number of areas I will look to improve in future practice. One is ensuring that any poster I am involved in is aesthetic. Secondly, I will look to ensure that my aims are always quantifiable, as without this there is no way to measure how effective the project was.

1. The Chartered Society of Physiotherapy. Physiotherapy Framework. 2013.

2. Health and care in 2021 | The King’s Fund [Internet]. [cited 2021 September 23]. Available from: https://www.kingsfund.org.uk/blog/2021/01/health-care-2021-what-can-we-expect

3. Clinical governance [Internet]. GOV.UK. 2021 [cited 22 September 2021]. Available from: https://www.gov.uk/government/publications/newborn-hearing-screening-programme-nhsp-operational-guidance/4-clinical-governance

4. The Chartered Society of Physiotherapy. Quality Assurance Standards for physiotherapy service delivery | The Chartered Society of Physiotherapy [Internet]. 2013 [cited 2021 September 22]. Available from: https://www.csp.org.uk/publications/quality-assurance-standards-physiotherapy-service-delivery

5. Service improvement: an introduction | The Chartered Society of Physiotherapy [Internet]. [cited 2021 Oct 9]. Available from: https://www.csp.org.uk/professional-clinical/improvement-and-innovation/improving-and-transforming-your-service/intro