How can physiotherapy services and business build their reputations?

The physiotherapy profession in the UK is held in high regard by the public. The Chartered Society of Physiotherapy and members have worked hard to achieve this. Reputation is not about how good your service is. It is all about how others see you and see the profession.

Perceptions are influenced by both direct experiences and what people hear about you from credible sources. In crude terms, the more people see or hear a positive endorsement the greater the positive impact on your reputation. However, if third parties are critical you can end up with a poor reputation despite the reality being you’re providing a great service.

Increasing visibility

The most basic way you can improve your reputation is to be clearly identifiable. If people do not know you are providing physiothepy, how can you expect them to value physiotherapy?

There are lots of ways to raise the visibility of your physiotherapy service including:

  • Ensuring clear signed outside and within buildings
  • Ensuing physiotherapists and physiotherapy support staff are uniformed and that their uniforms clearly shows that they are physiotherapists or physiotherapy support staff
  • Wearing CSP badges where allowable
  • Displaying CSP  posters and other material in appropriate spaces such as patient waiting areas or staff notice boards
  • Ensuring you have a website or that corporate websites lists your physiotherapy service
  • Listing your service on the CSP Physio2u directory http://www.csp.org.uk/your-health/find-physio/physio2u
  • Organising stalls or displays to explain what you do at a community event or in a public area of your building.

The CSP has designed logos and badges for use by individual Chartered Physiotherapists, students and physiotherapy assistants. We can also offer branded work wear and uniforms via our licensed supplier. For details visit the website: http://www.csp.org.uk/using-csp-brand

 

Recommendations

Patients will talk to friends and colleagues about their experiences. People generally trust advice from those they know. It is not surprising therefore that many private practitioners tell us that their greatest source of new referrals is personal recommendation. Physiotherapists and physiothepy support staff may feel uncomfortable about encouraging patients to spread the word about their services, but providing this is done reasonably it is not unprofessional.

Good feedback systems promote positive comments as well as complaints, so you should be encouraging patient feedback through notices asking for feedback, through patient surveys and in conversations with patients. Collecting positive patient feedback and, with their permission, sharing it with others is also a good way to promote a positive reputation.

Genuine patient endorsements can be used, with patient permission:

  • on corporate websites
  • in social media
  • in evidence for awards
  • as the basis for media case studies.

Raising your media profile

The media can have a disproportionate impact on how people see physiotherapy and individual providers. Whether you work in the NHS, private sector, education, the military or for a health charity you are potentially good news (see my blog on Ten reasons health communicators should promote physio).  The CSP press team and regional campaigns officers can offer advice to members who have an opportunity to take up media opportunities in a personal or professional capacity.

If you work in the NHS, higher education, professional sport or any large organisation it is likely that your employer would expect you to talk to your press office about any media engagement. You therefore need to develop a relationship the communications team in your organisation. Ask to meet them, invite them to see your service and offer to be the subject of media stories. Suggest to them that they could work with you as part of Workout at Work Day or Older People’s Day.

If you own your own business you may want to buy in professional support. The PR consultancy sector is diverse ranging from local sole traders to multi-national agencies. If you do want to hire professional PR help; be very clear what outcome you are looking for, decide how much you can afford to spend and ensure that you are getting advice from a professional by checking the Chartered Institute of Public Relations register http://www.cipr.co.uk/pr-register 

As regulated healthcare professionals physiotherapists are responsible for the advice they give in any setting. Giving advice via the media is no different. The HCPC requires that your media activity meets four of their standards of conduct, performance and ethics:

  • You must act in the best interests of service users
  • You must respect the confidentiality of service users
  • You must keep high standards of personal conduct
  • You must behave with honesty and integrity and make sure that your behaviour does not damage the public’s confidence in you or your profession.

If you are employed you will also be bound by any rules laid down by your employer.

Stakeholder engagement

Stakeholders are organisations or individuals who influence your work or the environment in which physiotherapy takes place. Your stakeholder could include:

  • Senior managers or Board members
  • Other health professionals who refer patients to you
  • Insurers or other funders
  • Local businesses
  • Local sports clubs
  • Service commissioners/ local health boards
  • Patient groups
  • Local councillors, MPs, MSPs, AMs or MLAs.

You will want to maintain a good reputation with your stakeholders because they are likely to have a major impact on your service and because they will often influence wider public perceptions of your service. A positive endorsement by a third party in the media is particularly valuable.

If you are not sure who your stakeholders are, go through a stakeholder mapping exercise:

  • List all the different people and groups who impact on your service.
  • Log them on an influence/interest in grid to help identify who you need to focus on

 

High Influence over you

 

Priority – Build relationship

 

 

 

 

Priority – maintain relationship

 

 

 

 

Low influence over you

 

 

Not relevant

 

 

 

 

Low priority

 

 

 

 

 

  Low interest in you High Interest in you
  •  Work out what your priority stakeholders might want from you and what you have to offer them.
  • Decide what you need from them
  • Plan how to engage those you don’t have an established relationship with.

Unless you have a very clear business opportunity to pitch to a stakeholder, and are in a position to approach them directly, you are likely to need to start by getting the attention of a target stakeholder. Good ways of engaging stakeholders can include:

 

  • Inviting them to visit your service to see first hand what you do
  • Asking to meet with them to discuss areas of mutual benefit
  • Inviting them to share in a PR opportunity such as Workout at Work Day.

 

 

 

Make a plan

Now you have an idea of the ways in which you can enhance the reputation of your service, what are you going to do?

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Does customs control need to be taxing post Brexit?

Disclaimer: Nothing in this blog represents the views of my employer. These are personal comments. For information, the CSP position supports continued rights to live, work and learn in the UK for European national resident here after Brexit, and the same for British physios working in the EU. The CSP has particular concerns about healthcare across the Island of Ireland post Brexit, so support the continuation of the Common Travel Area.

There has been a lot of noise from both the British Government and EU about the form customs controls might take after Brexit, and in particular, the Irish border arrangements. This week the Commission said that invisible borders were “a fantasy” whilst the British Government said it wanted “a frictionless” border.

I worked for the UK Border Agency at board level in the past. I do not claim to be an expert on customs controls but it did give me an insight into the range of customs, immigration and security solutions used to manage the flows of people and goods between countries. I was also lucky enough to spend time with Border Force staff in Northern Ireland who told me about the “old days”, pre single market. So, I have a little knowledge I can share.

The first thing to say is that even within the single market now, there are border controls between the EU (largely excluding Ireland) and the UK. Immigration and some customs controls are in place despite free movement and the single market. That is why you are still passport checked when you come back from a holiday in Spain. That is why you see lorries being searched as you come off your ferry in Dover. The media speculation over the last few weeks seems to be based on the idea that that we have totally open border now. We do not. So we are not talking necessarily about introducing extra border controls. The unknowns will be what extra customs and immigration checks the U.K. might want, or have to apply post Brexit.

Behind the rhetoric is a very basic issue; what could customs, immigration and security controls look like in the future? I guess most people think of the customers and immigration checks at ports and airports as “the border”. The physical lining up of vehicles or people to be checked is probably what you are thinking of when the media start talking about a hard border between the Republic and Northern Ireland for example.

However, the picture you may have ignores the reality that there are already a wide range of alternatives border management solutions used across the world, including in the U.K. and EU. Some retain physical checks, but not at the actual border, some are virtual and we also have de facto open borders most of the time in most places.

It is important to realise that not all customs and immigration controls are physically at the border. For example, anyone who has used the Euro Tunnel or Eurostar will know that the UK and France operate “juxtaposed” controls on some transport routes. By mutual agreement, U.K. Border Force can check people and vehicles before they reach the UK Border and PAF, the French border police, check passengers at St Pancras station in London. There are similar international arrangements allowing customs and security checks on goods from some ports by foreign officials. This helps speed transit whilst maintaining security. There is nothing to stop the UK and EU agreeing to allow one another to conduct customs or immigration checks in one another’s territories.

A second option would be a reciprocal agreement to operate one another’s customes and/or immigration controls on one another’s behalf. For example, the EU and UK might agree that EU bound goods entering the Port of Belfast are customers cleared to EU rules  by the UK Border Force on their behalf. Similarly, the Irish Customs Service could clear U.K. bound goods transiting via Shannon Airport.

A third option is the use of e-borders. Using electronic checks is already fairly common. The UK, Spain and some other countries already use advanced passenger data to pre-check passengers against immigration and security databases. Airlines are required to deny boarding to people who are not acceptable to the relevant national authorities. This is already a first line of border control.

Customs checks have long included review of documents in advance of clearance. There has been an option for UK ministers to agree to make more use of digital checks for several years, but the perceived political risks have so far prevented this being fully utilised.

What electronic checks can’t do is see if there are people hiding in the back of a lorry or undeclared goods in a container. Physical checks, based on intelligence, will always need to be used to back up electronic controls. However, they are used now, so this would be no different from the existing situation within the single market.

Checks in ports are used because the border is the second line of defence against bad people and dangerous goods. However, in-country checks are also used. HMRC and Home Office Immigration Enforcement operate away from the border to enforce customs and immigration rules. This will not change post Brexit. There is a political choice to make about whether to rely more on in-country checks. Reliance on enforcement away from the border would allow light touch controls at the border. The downside is that it is often harder to enforce controls once people and goods have entered the country.

The final element that could be used to keep the border frictionless, especially in Ireland, is to acknowledge a reality, which politicians do not usually like to accept. No border is controllable. Not even North Korea has successfully managed to totally close their borders.

Whilst border controls operate at main ports and airports in the U.K. and EU most small ports and the land border are effectively uncontrolled. The simplest solution for the Irish / U.K. land border might simply be to accept it will be an unmarked and unregulated border. As in the pre-single market days, there will be huge scope for smuggling and tax fraud across the border but these risks can be managed in other ways if we want to.

So the technicalities around customs and other border controls are not actually insurmountable problems. The good folk of UK Border Force, HMRC and their EU colleagues can find ways to manage a frictionless border if that is what they are asked to do. Focussing on what sort of border we will have is just a distraction to allow both sides in the negotiations to avoid addressing the substantive issues. Which goods and people are able to move and how much they pay for the privilege, not how you then manage the movement, is what we need politicians to focus on.

London 2017 PR troubles

London’s hosting of the 2017 World Athletics Championships should have been an opportunity to celebrate sporting excellence. For many of us it is an opportunity to relive the joy of London 2012. Instead the Games has been overshadowed in the British media by a debate about Botswanan sprint medal hopeful, Isaac Makwala. He was initially bared from competing with a suspected case of novovirus.  Only those behind the scenes will know the full truth. Viewed from outside it looks like a car wreck due to poor crisis comms.

It is perplexing why the IAAF, which has access to some of the most experienced sporting PR advice in the world, seems to have got this so wrong. My own credentials to comment are that I worked on the London 2012 Olympic and Paralympic Games.  I was one of the senior Government comms managers who worked in the Message Integration Centre (MIG) at games time. MIG was a unique comms command and control centre. It brought the sports, transport, security and government worlds together to manage games related communications. We planned extensively for different scenarios, including public health problems and issues with individual athletes. We were very lucky. The only challenges I had involved the wrong flag being put up and keys to a room at a venue being lost!

Any PR professional knows that managing reputation in the “blame seeking” stage of a crisis is important. It appears that the IAAF initial response was to try to blame someone else, pointing to the hotel where affected athletes were staying and claiming it was a food poisoning incident. Passing on blame rarely works. It did not work here.

Why didn’t the IAAF brief the media and issue public advice on Sunday? They briefed the teams on the public health findings and advice but appear to have tried to keep this quiet. Organisations can be overly anxious about commercial relationships, legal liability or think that saying nothing protects their reputation. Did the IAAF get caught on one of these issues?

Being open about a problem, whilst reassuring people it is being managed, can be an active part of reputation management as well as an important role in its own right. Public health issues can give rise to overstated levels of fear amongst the public. Ensuring clear safety advice to athletes, spectators and the public would have been responsible. As responsible as insisting athletes complied with public health advice, even if that meant them not taking part in events. It would also have avoided awkward questions about athletes who did not start races and the inevitable revelation that there was a health problem.

It is amazing it took until Isaac Makwala’s protesting about his barring for the story to come out. Apparently, the Canadian team briefed the Canadian media on Sunday that there was a norovirus outbreak affecting a number of teams. I have spoken to a volunteer who saw a well known athlete being violently sick before their final. This was never not going to become an issue, so why was it not proactively managed?

The handling of Isaac Makwala’s withdrawal is itself a case study in the challenges of PR at a major sporting event. The Botswanan team officials were able to seek out the BBC live coverage and make a case to the media and public over the heads of the organisers and public health authorities. The IAAF should have realised this could happen. The media had been discussing Makwala’s case for several hours, and it was being discussed on social media. Yet it was only after the BBC interviewed team officials that the IAAF responded with a media statement and by putting up their chief medic, clearly at short notice. They don’t seem to have engaged with social media at all.

On social media there were people defending the IAAF, including clinicians. These supportive voices were not used by the IAAF. Instead, they ended up finding a precedent setting solution with Makwala being able to qualify for the semis via a solo race. That may have made the immediate issue go away, but has now generated a debate about the fairness to other athletes who did follow the public health instructions.

Perhaps there is good reason or the decisions taken, but as a PR professional, sports lover and someone working with clinicians who support elite sportspeople it feels like a pretty poor performance. Proactive communication of the problem, advice and clarity about action being taken might have avoided a lot of negative comments, and a few headaches for the future.

How can we argue that physios be part of the solution in primary care when they are in shortage?

This is the heart of the question posed by David Oliver on Twitter.

1 in 5 GP appointments is MSK related. Using a senior physiotherapist to deal with such cases can save GPs time and save money on needless diagnostics. David’s challenge is, given there are clear shortages of physios, should the CSP argue that physio can relieve pressures in other areas such as general practice?

This is just a quick exposition of the narrative and thought process, rather than an evidenced paper, so please read it as such.

The CSP is clear; there is a shortage of qualified physiotherapists. Fear of oversupply and low levels of funding for HEIs in past years have meant not enough new graduates have been joining the profession. CSP members, both managers and union reps, are reporting problems recruiting at entry-level physiotherapists (Band 5) right across the country.

The CSP’s workforce model, http://www.csp.org.uk/professional-union/practice/evidence-base/workforce-data-model suggests we need at least extra 500 physios graduating each year to meet existing population demand. Add to this the challenges faced by overseas-qualified physios; tougher visa restrictions and the uncertainty over Brexit, and the future may look bleak.

We were fully aware of this context when we started campaigning on extending physiotherapy in primary and community care. So how do we square the circle?

The environment is not as bleak as it at first appears. Firstly, some of the solutions the CSP is calling for do not require any more staff. Self-referral to physiotherapy changes how patients access local service, not the level of patient demand. What it does do is relieve pressure on GPs by cutting out needless appointments. Equally, moving more physiotherapy and rehab services from acute to community or primary settings changes where the service is provided, not the number of physios needed to provide the service.

Secondly, in the specific case of general practice physiotherapists, they are not drawn from the ranks of the newly qualified. First contact physiotherapists are typically Band 7 or 8 senior practitioners, with advanced practice skills. There are physiotherapist ready and able to step up into these roles. The challenge may be to backfill their old roles rather than filling the new general practice roles.

Thirdly, there is scope for trained physios who are not currently working in physiotherapy to be tempted back into the profession. Despite under supply of graduates we have seen growth in the HCPC physio register. We suspect more returners and fewer people taking shorter career breaks are part of the reason. Paul Chapman at HEE is doing excellent work promoting return to practice https://twitter.com/PaulChapman09/status/851770370868875264 .

Fourth,  there is likely to be an expansion of physiotherapy training over the next few years. Physiotherapy courses have long been oversubscribed with high quality candidates. The CSP supported the changes to bursaries and lobbied successfully for higher level funding for physio courses. We expect to see more universities opening physiotherapy courses and existing courses expanding. We know that practice based learning opportunities (placements) could be a blockage, so we are working to get more of our members to take students. Add to this the development of “earn while you learn” degree apprenticeships, and we can start to see that a better supply of newly qualified physios in the next few years. Given that it is quicker to train a physio than a doctor, this means that physiotherapy can become more of a solution over time.

Finally, expanding the support workforce in physiotherapy offers a way to manage some pressure within physiotherapy. Support staff – physiothepy assistants, rehab assistants, exercise instructors etc – have long played an important part in physiotherapy services. With training and supervision, they undertake many of the routine activities newly qualified physios might perform. In many cases, physio support staff develop expertise and high levels of skill that go well beyond this.

In a number of services we are now seeing the recruitment of qualified, but not in physiotherapy, staff a part of the support team e.g. sports theorists and sports rehabilitators. They are not physios. They are not regulated and have different training, but operating under clinical direction they can add capacity where newly qualified physiotherapists are in short supply. This frees up registered physios for work only they can do, in the same way physio can undertake work that both they and GPs can do.

So, whilst the message may feel contraintuitive,  it is coherent to say both that we need more physios and that physiothepy can relieve pressure on GPs.

 

 

Insight for membership organisations

Why does knowing what members think matter? The simple answer is that without evidence of what members actually think we might make the wrong decisions. A classic example is the future of the CSP member magazine – Frontline.

The Chartered Society of Physiotherapy has over 56,000 members. We are a member led organisation. But, only a small number of members can get involved in our elected Council, Country Boards and committees. So how do we find out what our members think, want and need?

Part of the answer is through structured market research. We have used member surveys and focus groups to understand our members. Some research related to specific services or issues; for example, what members want from their member magazine or the destination of new physiotherapy graduates.

Other exercises research specific member segments. For some years we’ve had a rolling programme of both surveys and focus groups covering student members, newly qualified members, overseas trained members, longer standing members and associate members. Each group was researched every few years, largely to inform our membership recruitment and retention work.

We have also run an annual large-scale member perception survey. This is sent to a representative sample of at least 10,000 members. This was used to help our Council judge our performance. Together these exercises provided a patchwork quilt of insight into our members.

This year, we ran a major exercise using external contractors to understand all our member segments at one time. This involved in depth telephone interviews with 65 members. They were representative of all types of member, of different levels of involvement and included members from all countries and regions. The qualitative results informed the design of a large-scale market research survey.

Over 1000 usable responses were received to a survey sent to a stratified sample of members. The survey is likely to by 99% accurate for results to a plus or minus 4% margin of error. Together the qualitative and quantitative work give us a greater degree of certainty about what our members actually think about the CSP.

The research tells us a lot about how members want to communicate with us. Channel use and preferences are things we have tested regularly before. This year’s more comprehensive exercise gives us more of a sense of how key communications fit into members views of the broader package of member benefits. Our magazine, Frontline, is rated as one of our top three member benefits.

Most members read Frontline, but even if they don’t many more like receiving it as a reminder of their belonging to the Society. They see it as almost a luxury item in some cases. We have now learnt that it is also their main source of information on our campaigns. In contrast, only 6% of members choose to engage with the CSP via Twitter. This is perhaps surprising given our relatively young average age.

These insights are critical to making the right decisions. Periodically colleagues have suggested we save money by moving to a digital only version of Frontline. Members of our Marketing & Communications Committee have sometimes suggested changing the focus or tone. Our annual reps conference this year even discussed moving to an opt-in requirement to get the magazine at all.

If we did not ask our members what they thought, we might have concluded these were good options and that members would be happy with change. However, the research suggests this would be a big mistake. The silent majority of members want Frontline and want it in hard copy. Most read it and most think it is right for them. So the insight has helped us avoid making a mistake, which would have damaged our relationship with our members.

We are still digesting the 90 pages of our latest insight report. But the initial learning is fascinating. Some of the data confirms what we thought, but some is surprising. Asked to personify the CSP now we were described as; male, young enough to be active but old enough to be knowledgeable and smart. Being described as male was a surprise for us.

Over 70% of our members are women. Our Chair and CEO are women. Most of our Council and Leadership Team are women. However, respondents told the researchers that the face of the CSP for them, is their workplace rep. Men are probably disproportionately represented amongst our stewards. This probably explains this perception. It certainly gives us something to think about.

The research also gives us a wealth of information about why members join and what they want from us. Our suspicion that our members are deeply tribal has proved to be accurate. Many join the CSP because it is the “done thing” amongst physios and physio support staff. Building on this sense of belonging, to enhance engagement, is clearly an area we need to work on.

Equally, we  knew that our core services are highly valued. PLI cover, employment (union) advice and support for career development are all important to our members. However, they are not always sure what the full range of benefits is or how to access them. Some thinking is clearly needed about whether the offer is overly complex or needs communicating differently.

I am told the CSP is unusual amongst professional bodies and unions for our focus on insight. Although we may feel we are good at collecting insight I am not sure we are always so good at using it to inform decisions. This is largely due to it not being shared and discussed widely enough. So, we are looking at how we repackage the data into more easily digested chunks to assist our Council, and colleagues across the organisation, in their decision making and planning.

Insight is never completed because the more you learn about members the more you realise what you don’t know. We plan to review our annual survey and rolling insight programme in light of the new work. There are opportunities to refocus and build on the more sophisticated ways of recording insight we have used this year. For example moving from simple overall perception scores to graduated rating of; engagement, customer experience and sense of value for benefits. It would be great to share ideas with similar organisations.

What has been the experience of other membership bodies of gathering insight?

Frontline magazine

Frontline, http://www.csp.org.uk/news-events/frontline-magazine is the CSP member magazine.

How popular is Frontline?

The last annual member survey found that 64% of respondents rated Frontline as useful and that  52% prefer to get information via Frontline, compared to 32% by e-bulletin or 6% for Twitter. 59% thought the magazine had improved thanks to design and content changes made during 2015.

Why is Frontline automatically sent as a hard copy?

Members have told us they feel that the hard copy format makes it stand out from the electronic communications they receive. Members can opt out of receiving Frontline as a hard copy, but most do not.

Why isn’t Frontline a digital magazine?

Frontline is available in both digital and hard copy formats. News items are available online before the hard copy is distributed. Our communications approach is to offer a range of different channels of communication. This is because all the evidence we have suggests that no single approach will be right for the majority if our members. Providing information across more channels means we reach a greater number of our members.

Why is Frontline published 21 times a year?

We do review this annually. When we last asked members 56% said roughly two-weekly is about right.

Even with the current frequency we can’t cover everything suggested. If we reduce frequency we might have to more strictly focus content on CSP priority campaigns and advice, which would mean less member suggested content.

Experience from other publications  suggest that as frequency falls recognition of the information provided falls disproportionately.

Our advertisers find the frequency of Frontline a positive. It allows relatively swift inclusion and the opportunity of regular multiple adverts.

How does the CSP test Frontline with readers?

We use a mix of qualitative and quantitative methods. We ask questions about member communications preferences and views in our annual member survey. We have run regular focus groups for specific member segments over the last few years and have asked about their views on Frontline in those focus groups. In addition, when we reviewed Frontline, we ran additional focus groups to test views in more depth and to test alternative formats.

We  welcome direct member feedback via frontline@csp.org.uk

What has the insight told you?

There is high awareness of the magazine amongst members. It is one of the most used sources of CSP information. Members feel that the hard copy format makes it stand out from the mainly electronic communications they receive. They prefer a less formal tone.

Most members look at the cover or flick through the magazine to find content of interest – they read it quickly at work or at home. The most read sections are ‘Comment, ‘News’ and ‘Networks and Networking’. Members are generally most interested in reading about:

  • What others in the profession are doing
  • Clinical/professional developments
  • How physiotherapists reach unusual or interesting positions
  • Anything that has human interest, ‘a feel good factor’, humour or is inspirational
  • How the CSP responds to the big national health/physio issues in the news
  • What the CSP is doing to support members and promote the profession.

Members working in the private sector are least interested in reading anything presented as union news.Prior to changes the magazine was perceived as being written predominantly for established NHS physiotherapists.

What have you done as a result?

We redesigned the magazine and changed our editorial approach. We now have a policy of deliberately seeking to cover a wider range of members; from across all corners of the British Isles, in all sectors and in all stages of their career. We have introduced a range of new regular features, for example on awards and research findings. We have also tried to get away from artificial “union” and “professional” distinctions in stories and instead aim to reflect the holistic experience members have at work or in business.

We have also developed alternative ways of reaching some of the groups who read Frontline less. We have introduced bespoke e-bulletins for students, associates and newly qualified members.

Why isn’t there more scientific content?

Physiotherapy www.csp.org.uk/journal is the official CSP scientific journal. Frontline fills a different role, covering a wider range of issues in a more accessible style. This does include clinical content and the promotion of journal content. Research amongst members suggested that they want Frontline to be more about “translating” research and signposting clinical issues.

What input do qualified physiotherapists have into the content?

We commission many articles directly from physiotherapists. Any member can suggest articles to the Editor via frontline@csp.org.uk.

Where non-physiotherapists write articles with clinical aspects, they are expected to verify the content with a specialist member or one of the CSP in house physiotherapists.

Why does Frontline carry advertising for services or products which some people regard as not representing best practice?

Adverts are an important source of income for the CSP. Whilst the content is the responsibility of the advertisers and the inclusion of adverts in no way represents an endorsement by the CSP, all advertisements are accepted in good faith according to the Code of Advertising Practice as laid out by the Advertising Standards Authority.

It is part of professional responsibility of every physiotherapist to critically appraise services and offers. The CSP can’t do this for members, especially when there is legitimate debate within the profession on some modalities.

How much does Frontline cost?

The net budgeted costs in 2016 were £562,000. This is made up mainly of postage and print costs, less advertising and sales income. It does not include staff costs as the staff involved work across a range of channels.

Can I opt out and save money?

You can opt out of receiving the hard copy and rely on the online version, however we can’t offer a discount for this. Any individual member may use some CSP services more than others, or different services at different times. We can’t offer both a comprehensive range of services and be financially sustainable on an “a la carte” basis.

Does not taking the print copy reduce costs for the CSP?

It does save on postage but most production costs are fixed regardless of the number we print and printing is not priced by individual copy.

Transforming healthcare through marginal changes

At the moment there is lots of talk about transformation, systems thinking and strategy across health and social care.

Recently I was helping a friend who was preparing for a job interview. My friend was anxious because the role was to provide strategic direction to a big transformation programme in social care. Although they had already done a very similar role they doubted their ability to think strategically. The conversation went something like this:

Friend – I’m not sure that I can show that I am strategic

Me – Why do you say that?

Friend- Well, I am good at bringing people together, identifying problems and finding practical solutions but not at having big ideas

Me – So do you have a clear sense of where you want to organisation to get to?

Friend – Yes

Me – Do you have a sense of how to get there?

Friend – Yes, but it is about getting our people to make lots of smaller changes which move us in that direction, not one big change

Me – Do you have a sense of how you can get them to do that?

Friend – Yes, it is change management and using their knowledge and enthusiasm to improve things for their service users

Me – That sounds like a strategy to me.

This is not a unique conversation. I have met many bright and articulate people who feel daunted by either the strategy word or transformation. Sometimes this is because they have seen their organisations parachute in experts who say their strategy of one big change will revolutionise things. Certainly for some services or organisations a big strategic shift, for example from face to face to online services, can be transformative. However, in most organisations there isn’t going to be a single big game changer, or the big project will only deliver part of the strategic shift needed.

At its simplest strategic change is “just” setting clear ambitions, and inviting appropriate actions to move the organisation in that direction. I am great advocate for the Dave Brailsford strategy of making multiple small improvements across a business as or system.

Brailsford https://en.wikipedia.org/wiki/Dave_Brailsford is the man credited with transforming the performance of British cycling. Under his direction the GB and now Team SKY have become dominant in the world of cycling. His approach is to look for many marginal improvements which add up to a big improvement overall. A 1% improvement on 100 things can be the equivalent to 100% improvement in one.

It is not surprising that some of our top leaders in the world of health (Simon Stevens and Jim Mackey for example) are talking about system transformation coming through local actions. Enabling change at team, ward or service level is going to be the key to change in the NHS and social care. Who better than frontline staff and their patients to say what can be done better, faster or more cheaply?

However, just as having a big idea does not guarantee change nor does exalting people to make local changes. Marginal gains will only make system level change if they are supported with wider change, which is where they become strategic in my view. So what is needed to achieve change through marginal improvement?

* Cultural change – For marginal improvement to flourish there needs to be a shift in culture. Too often health and care are characterised by professional hierarchies and approvals mechanisms. We need to empower the frontline to self-manage change in their own area.

* Better communication – We need to share new ideas more quickly between and across organisations. It is no good a great but simple idea being used in one team in one trust in one town. Sharing simple ideas needs to be as common as sharing the results of large scale clinical research. The Vanguards are trying to encourage this as are initiatives such as http://www.fabnhsstuff.net/ and social media communities such as @Physiotalk.

* Time – In all organisations there can be a tendency to see time spent thinking about change as “not proper work”. This is particularly true in healthcare where patient contact is seen by most clinicians as their main role. Unfortunately this is reinforced by some of the initiatives intended to transform the NHS. Productivity schemes which classify non-patient contact time as non-productive won’t help harness the knowledge of frontline staff to make change. So we need to build time to develop improvements and evaluate new activities into the concept of productive time.

Talking to my friend many of these are issues sound common to social care too. They have a pretty clear vision for how she can engage colleagues to make their own service changes. So I had no qualms in reassuring her she is a strategic thinker. Oh, and they got the job.

What do you think we need to do to harness the power of marginal improvements in health and social care?