Personalised Approaches in Musculoskeletal (MSK) Service redesign

Background 

We began working with colleagues in Musculoskeletal care (hip and knee pathway) when Virtual Clinics were being introduced.

The Virtual Clinics were designed to enable a conversation between a First Contact Practitioner (FCP), a Hip/Knee Consultant, and a person with a potential hip or knee replacement need.

The new Virtual Clinics reduced people's travel time and helped to speed up the process of listing people for surgery.

But not everybody with joint pain ends up having an operation, so what happens...?

Exploring the MSK care journey

We began by exploring the person's care journey (or pathway) from the point of the person, starting with "Ouch! My knee hurts!" right through to their recovery from surgery.

We undertook a system review, looking at the individual, the social environment around them, the organisations that they interact with, the physical spaces that they visit, and also the policies and procedures that impact their journey.

Colleagues from multiple organisations mapped the journey and began to highlight touchpoints where personalised approaches could be embedded.

We then surveyed the workforce to better understand their existing levels of knowledge and confidence in personalised approaches, and, where appropriate, introduced our personalisation tools and resources, and training opportunities. 

We undertook a similar process for people on a hip or knee care journey. Facilitated by our co-production partners, Every-One, people with lived experience of the hip/knee surgical pathway met with physios, occupational therapists, and managers to share their experiences, concerns, and unanswered questions. Their frustrations with their MSK journey experiences helped to spur us on! 

So what did we do?

Armed with our increased knowledge and understanding, we focused our efforts in four key areas:

Engaging with people

• Co-producing solutions with 'experts by experience'.
• Determining the optimum moments in the pathway for personalised approaches to be introduced.
• Embedding a Patient Activation Measure (PAM) approach.
• Preparing people for their care journey so that they ask questions about their care.

Developing the workforce

• Embedding personalisation e-learning and virtual training.      
• Ensuring Shared Decision Making Tools are utilised.
• Growing our network of It's All About People Personalisation Champions within MSK teams.
• Shared Decision Making meets audit standards.

Connecting the system

• Collaborating with Health Coaching and Social Prescribing colleagues.
• Personalised approaches are understood and shared across MSK care provision.
• Introducting recording systems to track personalised approaches.
• Using collected data, insight and feedback to improve service delivery.

Building the narrative

• The person’s journey is heard multiple times.
• Personalised ways of working are advocated.
• Learning is shared openly. 
• Personalised approaches become the norm.

These ambitions continue to guide the work of a small Task and Finish group of representatives from across the system. 

Sharing resources, good practice and stories

The workforce is more knowledgeable about the resources and services that are available, and we have seen continued improvements to website content which signposts people to helpful resources.  

People are sharing their stories and this information is being used to shape approaches, such as prehabilitation classes and self-management opportunities.

New literature has also been produced that 'talks' to the MSK cohort in a way that makes the services feel appropriate and accessible.

Grantham Aches and Pains Hub

We coordinated the community-based Grantham Aches and Pains Hub as a way of challenging MSK delivery partners to think differently about their usual practice.

This event brought all aspects of the system together in an integrated way within one space. 

Staff training

Staff teams have been trained on the use of Decision Support tools, and ongoing advocacy of these tools by staff is enabling more colleagues to hear about their uses.

Likewise, there is an increased knowledge of partnership opportunities, with commissioned services getting their activities to the people that need them most. 

Recording activity

Recording approaches are being developed to measure Patient Activation levels, where Shared Decision Making conversations are taking place, and what resources are being distributed to support self-management. These datasets are helping managers to measure their services and audit for success. 

What next?

There is still a lot of work to do before personalisation is firmly embedded in MSK care, but we are continuing to support colleagues to achieve the improved outcomes they are aiming for.

For more information about this work, contact matthew.evans34@nhs.net