Helping patients to help themselves

Development and implementation of a patient-therapy agreement

Willow signing the agreement

Poster made by Physiotherapist and Zak to tell others about what therapy is.

Overview of the Project

To promote active patient engagement in partnership working, to empower the use of self management skills to manage own health. Development of a patient-therapist agreement to clearly outline goals and expectations of both staff and patients. Patients and staff were involved in a consultation process to design test and evaluate the agreement. To reduce the number of missed appointments, with increased patient empowerment and ownership of own health. It is now implemented in paediatric therapy and is rolling out across the Therapies directorate. The organisation is reviewing how the agreement may be utilised to promote a helping you to help yourself culture.

Working without hierarchical authority was challenging. I utilised clear communication and provided opportunity for patients and staff to discuss, develop and evaluate the project. Positively influencing the engagement in service improvement projects in busy clinical areas has been challenging but rewarding for both staff and patients.

Results
There are two patient-therapy agreement, one for short term conditions and one for longer term conditions. The agreements have been implemented in paediatrics for three months. They are rolling out to other clinical areas in therapies now. Missed appointment data is currently being audited and the results are due to be completed early September, but the initial findings are that the agreements have increased engagement by providing patients a formal opportunity to buy into therapy, and a small reduction in missed appointments. Children and parents involved in using the agreement have talked positively about the experience. Use of the agreement will be sustained as a clinical standard for the department in identifying patient goals and will form part of the directorates notes audit.

Leadership Challenges
Aligning project aims, organisational aims, Directorate strategy and therapists drive to promote patient independence reduced staff resistance to change. The agreement needed to reflect needs of patients, leading to 2 versions. This delayed implementation. The project proposes a change in ethos for public focusing on selfmanagement skills, and increased patient and staff accountability.

Contact Information Vicky Mulvana Physiotherapy Team Leader Victoria.mulvana@york.nhs.uk 01904 726753