Team GRI Learning session 17/3/17 InS:PIRE at GRI Team GRI Learning session 17/3/17

Cohort 11 & 12 Nov-Dec Invited n= 17 Attended n= 13 Feb-March Invited n= 20 Attended n= 16 Patient volunteer Irene and husband Eddie Psychology student volunteers Mia and Michael

What Worked Well

What worked well Eliminating exercise class Bigger cohort size Sleep and dietetics session Changed appointment times External input at debrief on wk 5 Discharge letters Elimating exercise class – planning for full integration into the NHS and especially within a health board that is severly in debt we have tried to analyse the cost effectiveness without loss of patient benefit on everything we are doing. One of the first things we really wanted to test was removing the exercise class – more cost effective as no requirement for pre-Ax with fitness testing, time to take the actual class etc but especially we have had a few patients who we felt were isolated from group as not keen to exercise. Our main concern with removing the class was the effect of this on peer support as the class can be a great ice-breaker and a chance to let people talk more informally. What we found was people still bonded within the group talks as aimed as getting patients and family members to share their experiences to help others feel that they are not ‘alone’ and to normalise the experience. I found I could complete a more thorough physio assessment, completed paperwork and referrals, did not isolate patients who did not feel ready for group exercise especially if we consider the nigh number of patients who are anxious, did not decrease numbers referred to the gym (25%). Our attendance was not only better at the start of the cohort but maintenance was better too. Also, felt that with the bigger cohort size we would not have been physically able to have a class safely in our seminar room. This is something I have shared with all the physios at each site so its maybe something to try out at each site to test and see what works for your site as everywhere is different. Bigger cohort size did not jepordise peer support as anticipated – we invited the same number of patients and more attended, discussion around whether this was because in the invitation letter there was no mention of exercising in a group as nothing else was different Sleep and dietitics session covered by team members – important as integrated more into whole clinic rather than when specific professional visited. Referred to specialist if required. Helps make the programme more cost effective too Changed appointment times – previously after ex class staff would have up to three 1:1 appointments (long wait for some). Now split between pre and post group session which has reduced waiting times. A lot of our patients have issues with fatigue and possibly chronic pain so this has hopefully improved their experience. CAB and vocational rehab specialist attended debrief – holistic approach, educated and increased insight into their roles and improved teamwork to develop a clear picture of patient situation Discharge letters – completed together as a team, hoping to do this a s we go for next cohort

What We Noticed/Learned Peer support despite no class Volunteers pivotal Larger number – weekly patient check Not dependent on personalities Care of volunteers Patients still bond despite not having a class. Volunteers are pivotal – speak to patients identifying those that are possibly more anxious in social situations Larger number – weekly check with team as felt could easily miss a patient with questionnaires - More organising with larger groups Not dependent on personalities – different staff joined and ran smoothly which is important for future cohorts – rotating through clinic so that pressure isnt on one person per profession, important to consider in times of sickness and annual leave. Volunteers – avoiding dependence

How Did It Feel Positive Increased confidence and understanding of roles ‘It’s more than a feeling!’ Very positive as new members of team slotted in smoothly with debrief and support from relevant professionals Increased confidence in what every professional can offer i.e CAB and voctional rehab specialist and referring appropriately. External roles – maximising the help we can provide It’s more than a feeling – a member of our team described the clinic so eloquently, I wont mention any names but Stephen you know who you are!

What we plan to do next? Identification badges Volunteers – support and boundaries Check-in on board Personal goals by medical/nursing together InS:PIRE banner Volunteers - make it clear clarification of roles and patient confidentiality, support we can give them Board outside seminar room for attendance check – everyone arrives together from two entrances and can be chaotic Banner – location of programme at the lifts for direction

What we plan to test next? CAB and vocational rehab specialist to continue wk 5 attendance No exercise class GP letter update as we go Patient feedback requested at week 3+5

What We Need Help With Continued feedback from other teams to help with own development Support within discipline across different teams (group email)

What We Could Help With Sounding board for other teams Moral support Planning for integration into NHS Sounding board – we may have already had the same problem and save you time Moral support – everyone has had their highs and lows with the programme. Its just trying to remember that if something isnt working, its not failure its just learning and changing whats not working is the most . That might help other sites avoid it too. Integration into the NHS – every site is probably at different stages so might help to speak about it.