UK Peterborough PE11US | 07767934009 | vyasn.priyanka@gmail.com | https://www.linkedin.com/in/priyanka-vyas-04716025b
PRIYANKA VYAS
UK Peterborough PE11US | 07767934009 | vyasn.priyanka@gmail.com | https://www.linkedin.com/in/priyanka-vyas-04716025b
SKILLS
Problem-Solving and Strong Communication Skills
Client Engagement
Excellent command of comprehension.
Basic Computer Knowledge.
Strong knowledge of utilizing all modern teaching aids.
Stock management
ACCOMPLISHMENTS
Received a promotion after assisting the company in fixing its delivery and management issues
At Covid Camp, zero delivery and stock errors were made.
Won the 2010 B.Sc. Final Science Exhibition, taking first place.
Placed second in the 2012 M.Sc. Final Science Exhibition for Model Presentation
Presented a poster at a symposium on "Bhumiamala (Phyllanthus niruri).
Came in second place in Botany, M.Sc. 2012
WORK EXPERIENCE
Shanti Suman Hopspital (Covid Center)
Store Assistance (Volunteer Member) April 2020 to March 2022
Organized
I was actively volunteering in many of my medical camps and events in rural and outskirt areas under SSH, where medical services were sparse. During that time, I assisted my team in the management and administration of these events. My duties were there:
Restock carts with medical supplies, including gauze, medical tape, hospital gowns, and blankets.
Make patient rounds to determine needs; fulfill needs when possible and alert staff when necessary
Assist visitors in the waiting area, including directing them to the correct locations and answering questions about parking, food, etc.
Assisted visitors and family members in locating their loved ones and in navigating other areas of the hospital.
Responded promptly to requests from nurses, asking for clarification as needed.
Delivered mail, newspapers, and flowers to different parts of the hospital.
Assisted with the maintenance of the unit by taking care of supplies as directed, including thermometers, oximeter, blood pressure monitors.
TECHNO BUILD SOLUTIONS
Marketing Executive Dec 2014 to Mar 2020
My responsibility there as a member of the marketing team was to keep the manufacturing team and sales team in sync. I was able to identify problems in the supply chain and assist the delivery and production lines by using my problem-solving and line management talents.
I organized promotional events such as trade shows and exhibitions and worked with the team to ensure that materials and products were delivered on time.
I collaborated with marketing departments and advertising agencies to increase customer acquisition.
Evaluating and improving marketing campaigns in order to find cost-effective solutions.
Marketing and new sales of TBS
Generating business with TBSs existing distributors and developing a new distribution line.
EDUCATION
Pursuing M.Sc. Health and Management at University of Brighton, Falmer, 2022
B.Ed. (Science) from Jai Narayan Vyas University, Jodhpur 2015
M.Sc. (Botany) with first division from JNVU, Jodhpur 2012
HOBBIES & INTEREST
Dancing, Cooking, Listening to music
Regards
Priyanka Vyas
NAM52: Leadership and Service Development in Health and Social care.
Summative Assessment Brief.
Module Leader: Deborah Miarkowska, Senior Lecturer, Leadership & Service Development in Health & Social Care.
Assessment method: Written proposal and reflection
NAM52: Submission dates via Turnitin:
NAM52: Monday 5th June 2023 by 4pm
NAM52: Ext or LSP: Monday 19thJune 2023 by 4pm
NAM52: Ext & LSP: Monday 3rdJuly 2023 by 4pm
Please note that if you submit in the later period, that is up to two weeks after the deadline, if your work passes it will be capped at 50%. If you are unable to submit on time please ask about an extension or refer to the current COVID Safety Net Policy.
Pass mark: 50%
Assessment word limit (must not exceed): 3000 words: 100% Weighting
Date of publication of results (subject to examination board reflection): The module team will endeavour to have a draft module result and feedback available within approximately 20 working days. (GEAR regulations allow for flexibility). This result will be subject to ratification by the course examination board.
Contact (to request extensions):
Deborah Miarkowska for single module students: d.miarkowksa@brighton.ac.uk
Please contact your relevant Course Leader if part of a programme of study
Dr Henry Leonard Joseph - Course Lead MSc Health & Management
How will results be published: Via Turnitin on MyStudies.
NAM52 Module Learning Outcomes:
Top Tips:
The module learning outcomes and marking criteria are key as they act in set the direction of how we deliver the content of the module and how we assess you.
Please look at the wording and what we are asking you to action.
Assignment brief - Summative Assessment
Service Development Plan and Reflection on Leadership Style.
Think about the themes we have discussed across the module and how you might select, critically evaluate and apply your choice of these to both your service development/business plan and self-reflection.
NAM52 Summative requirements:
A 3000-word piece of work made up of:
Part A: A 2000-word business or service development plan, usually related to your current employment, including a critical analysis of the potential strengths and possible limitations of the proposed service development/business plan with suggestions for how the limitations identified could be overcome.
The latter part of the work should be a 1000-word reflection on how the learning in this module will inform your leadership style going forward, with reference to implementation of your proposal.
PART A:
Service Development Plan
It is suggested that you include the following in your proposal
Context of Business or Service
Provide a brief overview of the current service / business, enough to enable the reader to understand your proposed new service.
Include a description of the current aspect of the service to be developed, if this is complex you may wish to include a structure diagram or service process flow chart in an Appendix, as you will not have sufficient words to go into great detail.
About You your professional role identity and sphere of practice in relation to leadership and service innovation
Rationale for the new development
Why does the current as is service need improvement?
What is the issue your proposal is aiming to address?
What tools have you used to analysis the current situation and identify the need for change? SWOT/PESTELE/OCAI?AS IS Analysis/Fishbone
Include some evidence for the need, for example waiting list data, bed days, service user feedback, data on unmet needs, financial information on profit/costs or market research (you may wish to include information in an Appendix). If you are unable to access data to evidence, say what information you would ideally include for evidence.
How does the need you have identified fit with current drivers for change, e.g., finance, strategy of the organisation, guidelines for management and national policy drivers
Detail of the proposed development
What are you proposing? (If the proposal is complex, you can use flow diagrams, or other visuals to help you describe it)
Who will be involved in this development?
How will your proposed development improve the current situation?
Briefly discuss how will you drive the change- what change and project management models will you look to use and why?
How will you demonstrate innovative thinking to creatively support innovation and quality improvement in your area of practice?
How will you ensure that you align your practice alongside the principles of sustainability?
How will you evaluate the impact / effectiveness of your change?
SWOT analysis
Include a SWOT analysis and discuss any weaknesses and threats, suggesting how these may be minimised.
Recommendations for your organisation
Conclusion:
Concluding recommendations in relation to your proposed development.
You should support your proposal with references, for example published guidelines and standards, published papers using similar approaches to service development, papers supporting the need for the service, change management, business & marketing literature.
You should write in a formal third person for your proposal A SWOT analysis was conducted The organisation will expand This proposal will identify. (No more than 2000 words)
Top Tips in completing Part A:
Please weigh up the potential strengths and possible limitations of your service development plan.
A Business Plan Template is a useful tool to complete and reflect upon the use of, in your reflection.
A detailed range of business plan templates are available review and select are here:
The NHS Health at work Network, business planning resources: HERE or via the link: Business planning resources - NHS Health at Work NetworkThe Princes Trust Guidance and Business Plans including financial tables: HERE or via the link here: Business plans and templates | Business tools | The Prince's Trust (princes-trust.org.uk)Create your free business plan depending on your industry: HERE or via the following link: Business Plan Template | Write Your Free Business Plan (UK) | LawDepotWrite a business plan via GOV.UK: HERE or via the following link: Write a business plan - GOV.UK (www.gov.uk)Part A also clearly requests you to discuss how these limitations can be overcome.
This can be approached in various ways and we are not being specific on this as it is based on what your foresee as obstacles and how you will look to overcome these.
How you present your ideas, is your choice to enable you to apply creativity and lateral thinking. However, as an example you could consider how you would look to:
achieve buy in from those that we work alongside, the stakeholders, as a leader of service improvement?
You could also briefly review a change or project management model to overcome challenges and how this process will have the potential to overcome issues that arise as your Service improvement Plan is initiated.
How you will seek to make effective decisions in the development and implementation of your plan and how you will look to overcome these.
Part B: Reflection on your Leadership Style:
Top Tips for Part B: a 1000-word reflection where you need to examine how the learning from the module will influence your own leadership and how you will drive the implementation of your proposal.
You should reflect on how your learning in this module will inform your leadership style going forward.
Consider if you were to implement your proposed change, would you approach leadership any differently having undertaken the module?
Your reflection should refer to Leadership theories and identify which theory or theories align with your Leadership approach.
You are encouraged to critically explore the context of your role and self-development strategies as a Leader of change/change agent and project manager to examine if your ways of doing things are yielding success and how you might successfully implement a successful service development plan.
You should include references in your reflection and write in the first person.
(No more than 1000 words)
Please see the Quality Improvement Evaluation Resources on My Studies- Day 5.
This will enable a level reflection on your service improvement project.
This is a brief section but needs to be clear and focused on how you will drive your ideas forward as leader of service development and evaluate your proposals, on an ongoing basis.
Useful resources:
Please see the presentations attached to MyStudies study Materials to review key themes to reflect upon and apply
Steve Radcliffes book entitled Leadership Plain and Simple, 2012 as it offers a simple model of Future-Engage-Deliver as a simple way for anyone to grow as a leader. You may wish to look at this text. Similarly, Bill Georges Discover your True North is an excellent read.
The work of Simon Senek, Obi Abuchi and Daniel Goleman are also really rich reads that can add to your own personal toolkit.
Handing in your assignment
Please note the following:
Do not write your name on coursework put your student number on the work so that it can be identified after it has been marked.
If you have a Learning Support Plan, please include the statement provided by the administrator on your work so it can be taken into account when marking.
Submission is electronic only to Turnitin via MyStudies in the Assessment section of the module area
We do not accept e-mail assignments to the School of Sport & Health Sciences
Guidelines for assignment
All assignments should:
have a completed student declaration form (appendix one)
have a title page stating the module name, module code, title of assignment, name of the student and word count.
be typed, double spaced in black print no smaller than point 10.
Students are reminded that this assignment is an academic essay, not a report.
Points which strengthen the assignment:
the work links clearly to the marking criteria
clear intentions for coverage are set out in the introduction
arguments and theories are clearly presented and followed through (not just stated)
the ability to draw together theories into a coherent pattern
the ability to form a consistent argument about the relationship between theory and practice
Points which weaken the essay:
stating theory without drawing out what the theory says
description without analysis
drawing out a conflict in the theories then leaving this hanging for the reader to make of it what they will
saying more than one thing per sentence
Things to be aware of:spell checking and proof reading
general presentation, a contents page and page numbers
Students are expected to produce clear and accurate referenced using the Harvard System (see School of Health Sciences Guide and studentcentral module site under assignment information). A bibliography is not required.
Do not overuse appendices but refer to each appendix you highlight in the essay
Plagiarism
University Plagiarism statement
To steal from the writings or ideas of another Chambers English Dictionary 1989
Plagiarism occurs when the writing, ideas or diagrams of another author are included in an essay without reference to their original source. Altering the order and/or some of the words of the other author still constitutes plagiarism. Plagiarism, in whatever form it takes is unacceptable and will result in an automatic fail for the piece of work in which it appears. The University reserves the right to use the JISC plagiarism detection service, so you will be required to submit electronic versions of all assessed work to Turnitin which will be found in the module area on student central.
Word count
The stated length of written coursework must not be exceeded at all. In accordance with University guidelines - where the word limit is exceeded no marks will be awarded beyond the word limit.
Abstracts, appendices and reference lists are not included in the word count.
Please review the Universities guide on understanding and avoiding academic misconduct in relation to the following:
Plagiarism
Collusion
Falsification
Cheating in an exam
Impersonation
Ghosting
Unethical Behaviour
Commissioning
All My Own Work? Understanding and Avoiding Academic Misconduct at University (sharepoint.com)Resubmission of work:
In accordance with GEAR, students that do not meet the criteria for a pass in their summative assignment (50%) may be given the opportunity to resubmit their work (at the discretion of the exam board).
Referencing system:
Please refer to the post graduate student handbook for reference guidelines.
If you are a single module student, please use the Sage Harvard referencing system.
Level 7 Marking descriptor for NAM52 (see below) incorporates with the NAM52 Module Learning Outcomes:
Critically evaluate leadership theories and measures of leadership effectiveness
Analyse the cultural and organisational impact of leaders in organisations
Demonstrate self-direction, originality and creativity to write a service development plan based on the needs of the service in which they work.
Analyse and provide critically reasoned proposals for how the limitations of the service development/business plan could be overcome.
NAM52 Leadership & Service Development in Health & social Care - Level 7 Marking Descriptor
Marking Criteria 80-100 (A+) First class/Distinction: An outstanding response to the task. All criteria have been achieved to an exceptionally high level 70-79 (A A-) First class/Distinction: An excellent response to the task. All criteria have been achieved to a high standard and many at an exceptionally high level 60-69 (B+ B B-) Upper Second class/ Merit: A good to very good response to the task. All criteria have been met fully at a good or a very good standard 50-59 (C+ C C-) Lower Second class/Pass: A sound, competent response to the task. All criteria have been met and some may have been achieved at a good standard 40-49 Fail
An unsatisfactory response to the task
One or more of the criteria have not been met 0-39 (E+ E E-) Fail:
An unsatisfactory response to the task
Most of the criteria have not been met
Knowledge and understanding Authoritative knowledge, critical understanding and depth of reflection of relevant theories, models, policies, principles, ethics, legal requirements and philosophical debates and concepts of professional leadership, service improvement and practice innovation.
An outstanding ability to apply creative and disruptive thinking in relation to leadership and service improvement and to synthesise new insights into the application of ideas for service improvement and team development within their own work context.
An outstanding ability to evaluate the delivery of a service improvement project and self as leader.
Excellent knowledge, critical understanding and depth of reflection of relevant theories, models, policies, principles, ethics, legal requirements and philosophical debates and concepts of professional leadership, service improvement and practice innovation and the creation of a service improvement plan.
An excellent ability to apply creative and disruptive thinking in relation to leadership and service improvement and to synthesise new insights into the application of ideas for service improvement and team development within their own work context.
An excellent ability to evaluate the delivery of a service improvement project and self as leader.
Good to very good knowledge and critical understanding and depth of reflection of relevant theories, models, policies, principles, ethics, legal requirements and philosophical debates and concepts of professional leadership, service improvement and practice innovation and the creation of a service improvement plan.
A good ability to apply creative and disruptive thinking in relation to leadership and service improvement and to synthesise new insights into the application of ideas for service improvement and team development within their own work context.
A very good ability to evaluate the delivery of a service improvement project and self as leader.
Sound knowledge and critical understanding and depth of reflection of relevant theories, models, policies, principles, ethics, legal requirements and philosophical debates and concepts of professional leadership, service improvement and practice innovation and the creation of a service improvement plan.
A sound ability to apply creative and disruptive thinking in relation to leadership and service improvement and to synthesise new insights into the application of ideas for service improvement and team development within their own work context.
A sound ability to evaluate the delivery of a service improvement project and self as leader.
Limited knowledge and critical understanding and depth of reflection of relevant theories, models, policies, principles, ethics, legal requirements and philosophical debates and concepts of professional leadership, service improvement and practice innovation and the creation of a service improvement plan.
A limited ability to apply creative and disruptive thinking in relation to leadership and service improvement and to synthesise new insights into the application of ideas for service improvement and team development within their own work context.
A limited ability to evaluate the delivery of a service improvement project and self as leader.
Very limited knowledge and critical understanding and depth of reflection of relevant theories, models, policies, principles, ethics, legal requirements and philosophical debates and concepts of professional leadership, service improvement and practice innovation and the creation of a service improvement plan.
A very limited ability to apply creative and disruptive thinking in relation to leadership and service improvement and to synthesise new insights into the application of ideas for service improvement and team development within their own work context.
A very limited ability to evaluate the delivery of a service improvement project and self as leader.
Communication and presentation The communication of work to specialist and non-specialist audiences using the techniques of the discipline across a range of contexts, including structure, coherence, accuracy and presentation is exemplary throughout and work is of a publishable/exhibitable standard
Referencing throughout, including construction of the final list of references, and adherence to technical requirements such as word count is exemplary
The communication of work to specialist and non-specialist audiences using the techniques of the discipline across a range of contexts, including structure, coherence, accuracy and presentation is excellent throughout and there is potential for the work to be published/exhibited
Referencing throughout, including construction of the final list of references, and adherence to technical requirements such as word count is excellent
The communication of work to specialist and non-specialist audiences using the techniques of the discipline across a range of contexts, including structure, coherence, accuracy and presentation is very good
Referencing throughout, including construction of the final list of references, and adherence to technical requirements such as word count is very good
The communication of work to specialist and non-specialist audiences using the techniques of the discipline across a range of contexts, including structure, coherence, accuracy and presentation is sound
Referencing throughout, including construction of the final list of references, and adherence to technical requirements such as word count is sound
The communication of work to specialist and non-specialist audiences using the techniques of the discipline across a range of contexts, including structure, coherence, accuracy and presentation is adequate but may contain inaccuracies
Referencing throughout, including construction of the final list of references, and adherence to technical requirements such as word count is adequate
The communication of work to specialist and non-specialist audiences using the techniques of the discipline across a range of contexts, including structure, coherence, accuracy and presentation is inadequate and contains inaccuracies
Referencing throughout, including construction of the final list of references, and adherence to technical requirements such as word count is inadequate
Identifying, analysing and solving problems An original approach to the identification and analysis of an actual or potential service improvement project demonstrating outstanding levels of intellectual rigour in formulating evidence-based approaches to the impact of a service improvement project and change leadershipinitiative is discussed in an original manner with a very high level of fluency. . An original approach to the identification and analysis of an actual or potential service improvement project demonstrating excellent levels of intellectual rigour in formulating evidence-based approaches to the impact of a service improvement project and change leadershipinitiative is discussed in an excellent manner.
Some originality in the approach to the identification and analysis of an actual or potential service improvement project demonstrating some originality of intellectual rigour in formulating evidence-based approaches of the impact of a service improvement project and change leadershipinitiative is discussed with some originality.
Ability to identify and analyse an actual or potential service improvement project is presented in a standard way, and sound evidence of formulating evidence-based approaches to the impact of a service improvement project and change leadershipinitiative is discussed in a standard manner.
Limited ability to identify and analyse an actual or potential service improvement project and limited evidence of formulating evidence-based approaches to the impact of a service improvement project and change leadershipinitiative is discussed in a limited manner.
Very limited ability to identify and analyse an actual or potential service improvement project and limited evidence of formulating evidence-based approaches to the impact of a service improvement project and change leadershipinitiative is discussed in a limited manner.
Critical enquiry and appraisal of evidence Originality in the approach to using established techniques of research and enquiry to critically appraise arguments and methodologies and to propose quality improvement initiatives aligned to service improvement.
Extensive range of current and relevant literature used Originality in the approach to using established techniques of research and enquiry, to critically appraise arguments and methodologies and to propose quality improvement initiatives aligned to service improvement.
Wide range of current and relevant literature used
High level of ability to use established techniques of research and enquiry, to critically appraise arguments and methodologies and to propose quality improvement initiatives aligned to service improvement.
Range of current and relevant literature used
Appropriate level of ability to use established techniques of research and enquiry, to critically appraise arguments and methodologies and some ability to propose quality improvement initiatives aligned to service improvement.
Current and relevant literature used
Insufficient ability to use established techniques of research and enquiry, to critically appraise arguments and methodologies and limited evidence of proposing quality improvement initiatives aligned to service improvement.
Limited range of literature which may be old and/or irrelevant
Failure to use established techniques of research and enquiry, to critically appraise arguments and methodologies and no evidence of proposing quality improvement initiatives aligned to service improvement.
Inadequate use of literature
Decision-making and demonstrating initiative and personal responsibility
Exceptional decision-making within complex (professional) contexts with incomplete data, and levels of initiative and personal responsibility as well as demonstrating self-direction and autonomy in providing evidence-based ideas for practice. Excellent decision-making within complex (professional) contexts with incomplete data, and levels of initiative and personal responsibility as well as demonstrating self-direction and autonomy in providing evidence-based ideas for practice. Good decision-making within complex (professional) contexts with incomplete data, and levels of initiative and personal responsibility as well as ability to show autonomy in providing evidence-based ideas for practice. Sound decision-making within complex (professional) contexts with incomplete data, and some level of initiative and personal responsibility as well as some ability to show autonomy in providing evidence-based ideas for practice. Little evidence of decision-making within complex (professional) contexts with incomplete data, and limited evidence of initiative and personal responsibility or autonomy in providing evidence-based ideas for practice. No evidence of decision-making within complex (professional) contexts with incomplete data, nor evidence of initiative and personal responsibility or autonomy in providing evidence-based ideas for practice.
Reflection and analysis of learning needs Exceptional analysis of own learning needs in relation to continuing professional development and critical awareness of leadership and change management concepts, theories, models and frameworks Excellent analysis of own learning needs in relation to continuing professional development and a high degree of awareness of leadership and change management concepts, theories, models and frameworks Good analysis of own learning needs in relation to continuing professional development and very good awareness of leadership and change management concepts, theories, models and frameworks
Sound analysis of own learning needs in relation to continuing professional development and sound understanding of leadership and change management concepts, theories, models and frameworks Limited analysis of own learning needs in relation to continuing professional development and limited understanding of leadership and change management concepts, theories, models and frameworks
Very little analysis of own learning needs in relation to continuing professional development and no understanding of leadership and change management concepts, theories, models and frameworks
Writing at Level 7- critical evaluation
At level 7 - You need to demonstrate how you critically review the ideas you have assimilated and (for the highest awards) how you creatively put information together in an innovative way for your practice and contexts. Its the synthesis of ideas that are key.
Consider the themes we have discussed together and how you will look to critically evaluate the ideas and apply them to your practice and context.
Sample NAM52 paper:
University of Brighton
School of Sport & Health Sciences,
NAM52 Leadership in Service Development in Health & Social Care
Business Proposal and Personal leadership style reflective essay
Student number:
Date:
Business Proposal Word Count 1999 pages 2- 11
Reflective essay Word Count 998 pages 12 - 20
Business proposal for an Advanced Practice Physiotherapy led Adolescent Idiopathic Scoliosis pathway for patients aged 10-18 at East Spinal NHS Trust.
Context of Business Plan
Adolescent Idiopathic Scoliosis (AIS) affects between 2-4% of 10 to 18 year olds and is a lateral curvature of the spine of more than 10, when measured radiologically (Kenner et al, 2019). It represents approximately 1.5% of MSK Paediatric referrals at East Spinal NHS Trust (ESNT). Treatment varies depending on the degree of curvature with mild curves requiring physiotherapy and monitoring, moderate needing bracing and consideration of surgery, depending on age and progression of curve, and curves exceeding 40 requiring corrective surgery (Weinstein et al, 2013). There is no specific pathway for these patients at ESNT.
Currently, the Referral to Treat Time (RTT) for this cohort of patients at ESNT is 3 to 18 months for referrals from Primary Care. Appendix 1 demonstrates patients possible journeys through ESNT, which can include accessing a Specialist Paediatric Physiotherapist (SPP), Advanced Practice Physiotherapist (APP) and radiology prior to Orthopaedics. Additionally, it demonstrates having to access multiple specialties with the risk of rejected referrals, shown with red lines, and delays at several parts of the pathway. Informal service user feedback, conducted for the purpose of this proposal, with ESNT AIS patients demonstrated concerns around wait time for diagnosis and difficulties around not knowing which team their care was under.
Rationale for new development
Weinstein et al (2013), Beausejour et al (2007) and Kenner et al (2019) all advocate the benefit of early bracing in preventing progression of curve and therefore reducing the need for surgery and that a delay in the identification of scoliosis can lead to an increased need for surgical intervention. The Kings Fund in 2021 reported that Trauma and Orthopaedics have the largest proportion of patients breaching the national standard of 18 weeks for receiving definitive treatment. Getting It Right First Time (GIRFT) for Spinal Surgeries published recommendations in 2019 that if surgery is required for AIS it must be performed at a specialist spinal centre (SSC). The current wait times for these SCCs is between 60 and 300 days for initial assessment (Hutton, 2019). Reducing the time taken to refer to a SCC while being able to complete concurrent bracing could have a dramatic effect on patient outcomes.
The aim of this business proposal is to reduce the RTT and streamline the pathway for patients aged 10-18 with an undiagnosed AIS at ESNT.
A retrospective audit from August 2021 to March 2022 identified 19 patients with undiagnosed AIS. Curve size ranged from 12 to 76 and 47% of the patients presented with curves meeting the threshold for onwards referral for surgical opinion, the other 53% were referred to physiotherapy for onwards management. 78% of the patients referred to SSC waited more than 13 months for their initial ESNT appointment. They then waited an additional 60-300 days for their initial appointment at the SSC. All but one of these patients were in the 13 to 16 year old age group and could have benefitted from an earlier bracing intervention to reduce curve progression during growth spurts. Reducing RTT to 5 months could have significantly affected their outcomes and need for surgery.
This business plan would align to the recently published GIRFT documentation for Paediatric Trauma and Orthopaedics (2022) which suggests the need for Paediatric orthopaedic surgeons to be supported by multidisciplinary team with sufficient specialist physios (Hunter, 2022). Furthermore, it would demonstrate the implementation of the NHS People Plan and NHS 5 Year Plan of working in new ways to deliver care including clinicians working out of their traditional scope of practice and learning and developing new skills to support patient needs.
Various studies have demonstrated the benefits of physiotherapists working as APPs in the Orthopaedic setting to help significantly reduce Orthopaedic wait times (Oakley and Shacklady, 2015, Belthur et al, 2003, Mir and OSullivan, 2017, Mir et al, 2016). Additionally, studies by Banaszek et al (2019) and Hutchinson and Higginson (2017) demonstrate an 80-98% accuracy of APP correctly diagnosing spinal conditions when compared with imaging and Orthopaedic Consultant review. This proposal would fall inline with the ESNT 2022 strategy for paediatrics two fold by enabling early intervention, supporting improved access and targeting outcome inequalities within the paediatric provision at ESNT and expanding the workforce with Advanced Paediatric Practitioners (ESNT, 2021).
Business plan details
Appendix 2 demonstrates the proposed new pathway with the AIS service become APP led with a single point of access, thus reducing the RTT to 1 to 5 months. This is a 3.6 times reduction in RTT. Patients would be seen as part of normal APP/physiotherapy work without the need for a specified initial appointment. Once scoliosis was identified by either an APP or SPP, the APP would make a referral to the radiology department for specific images. The APP would then monitor for completion of imagining and measure the degree of curvature and then place the patient on the most appropriate pathway for continuation of care. For curves below surgical threshold the APP would continue to monitor the curve size until skeletal maturation was complete. This would eliminate the need for monitoring appointments within the Orthopaedic department as well as initial appointments.
There are very clear Internationally agreed guidelines around the treatment of scoliosis and when and what treatments should be completed based on curve size making this an easily evidence based pathway. There are also similarly run services in London and neighbouring Trusts to ESNT.
The successful implementation of this business plan would require the Orthopaedic and Radiology departments and the MSK Physiotherapy management team (MSKt) would need to be strongly involved. Meetings with senior management and relevant individual staff members from all departments would be required. The Paediatric Orthopaedic Consultants (POC) would need to be available to support the APP, especially with any sinister findings once imagining has been performed. The POC would also need to assist in ensuring the competence of the APP to detect and correctly measure the degree of curve. There would also be a minor loss of work within Orthopaedics and the impact of this would need to be discussed. Radiology would need to be agreeable to an APP referring for the specific imaging required by SCCs. These x-rays require the patient to be exposed to relatively large doses of radiation, so there may be some initial reticence to this. Additionally, there would need to be regularly auditing of the appropriateness of the referrals and some training of the APP from both Radiology and Orthopaedics. The engagement of Orthopaedics and Radiology would have a minor opportunity cost in the need for staff to be away from clinical duties for a small amount of time to complete training of the APP. The MSKt would need to agree to the change in pathway as it may result in a slight increase in patient numbers being seen by the APP during APP/Physiotherapy time, and therefore may marginally increase the current RTT for physiotherapy. However, the RTT within the current physiotherapy service is lower than the regional average for physiotherapy and there is no nationally agreed target RTT for physiotherapy (SMPC, 2022). Furthermore, any risk to increased RTTs should be mitigated by the relatively small patient numbers that this proposal would apply to and the improvement in patient care and experience. The local CCGs could be very influential in the successful implantation of this plan; however, they are unlikely to have much interest as it does not require further funding or moving work from where it is currently commissioned. Additional stakeholders can be seen in Appendix 3 along with their expected influence, interest levels and management.
Benefits alongside the reduction in RTT include a cost saving of 112.5 per appointment by the APP being primary clinician as opposed to a POC (2700 yearly), earlier detection of sinister pathologies and underlying conditions, alignment with relevant GIRFT papers, the MSK plan and NHS people plan, cost benefit to patients and carers and reduction in orthopaedic wait times. There is also the potential for a cost saving as earlier detection and bracing may reduce the need to send to a SSC, with the cost associated with needing appointments from a service outside of the CCG catchment area. The proposed plan would be assigned within current physiotherapy and APP time with no effect on current capital expenditure and minimal opportunity costs. The sustainability impact of this proposal is demonstrated briefly in appendix 5.
One year following the implementation of this plan an audit would be completed to compare RTT, number of patients referred to SSCs and average curve size to the pre-proposal data to demonstrate and evaluate any changes. A small focus group of AIS patients and their parents/carers would be asked to describe their experiences and any changes they would recommend to the service. The service would then undergo a review based on the audit and focus group comments, along with any additional feedback from radiology, POCs, SPPs, APP and SSCs.
SWOT analysis
A SWOT analysis completed for this plan can be found in appendix 4 and the weakness and threats will now be discussed.
The lack of formalised training and specificity of radiological exams has already been discussed above.
This cohort of patients is relatively small compared to other MSK related conditions accounting for less than 2% of both orthopaedic and physiotherapy work. However, the potential for psychological and physical difficulties if left untreated or if incorrectly treated is great and this alongside the lack of any great financial or opportunity cost should mitigate the small numbers.
The greatest weakness with this plan is that there is only one Paediatric MSK APP within ESNT, therefore, if there was an occasion where this person was absent for a prolonged period, such as sickness, the service would not be able to continue. This could be addressed by having SPPs complete the assessments and then request an adult spinal APP with additional training request imagining. Further discussion with the SCC could allow for referrals to be made from the SPPs not just the APP.
Threats to the plan mostly surround attitudes relating to the condition being seen by an APP not POC from both healthcare professionals and patients. Banaszek et al (2019) demonstrated a 95-97% self-reported satisfaction rate with patients seeing an APP as opposed to consultant in spinal orthopaedic clinics, suggesting that most patients would be satisfied with this pathway.
Discussions with POCs as part of scoping for this business plan was able to garner their support for this service development along with the agreement to support the APP as and when needed and an agreement to spend time training the APP in interpreting the imagining.
A lack of appropriate details on the referrals from Primary Care may cause patients to not be placed on this pathway at point of triage delaying their care, however, as these patients will still access physiotherapy or APP in Orthopaedics then these patients will still follow the appropriate pathway once identified.
As IRMER training has already been completed by the APP and imaging is already being ordered a discussion with Radiology, along with demonstration of the SCC pathway requiring these images, should satisfy any concerns around the choice of imaging requested.
Recommendations
Implementing this business plan will drastically reduce the RTT for the AIS population within ESNT with little to no cost and minimal disruption to current services. The risk of not implementing this plan is firstly, to the health and wellbeing of the local population of patients with AIS and the risk that the delay in care they currently receive may dramatically increase their chance of needing surgery. Secondly, that in earlier detection and treatment there can be a cost saving by not having to refer the patient to a SCC or for surgery. It is therefore the recommendation of this proposal that this business plan be implemented as soon as possible and reviewed in one years time to make any necessary adjustments.
Appendix 1 Swim Lane Diagram of current service;
Paediatric Orthopaedics 67957706350Yes -Onwards referral to specialist centre or local orthotics for bracing and D/C
00Yes -Onwards referral to specialist centre or local orthotics for bracing and D/C
6781800830580No- Refer to physiotherapy and monitor 6-12/12 as required
00No- Refer to physiotherapy and monitor 6-12/12 as required
223520267970Referral triaged with 1/12
00Referral triaged with 1/12
287464511398250374967511417300-59055650875010204458667750010204456508750102044516827500469582586868000-5397565278000339407520193000884237510274300888047510274306638925868680005889625102743006638925290830003781425551180Scoliosis identified
00Scoliosis identified
347662571628005229225322580At or above threshold for bracing/surgery
00At or above threshold for bracing/surgery
163512593980Urgent seen within 2/12
00Urgent seen within 2/12
1635125551180Routine seen within 10/12
00Routine seen within 10/12
1654175989330Referral rejected
00Referral rejected
Radiology 28555951131570003749675113982511474452298700011347459474200011347456045200-209556616700282575396875Referral triaged
00Referral triaged
414337511334753394075193675-22225663575033940756635750163512579375Urgent seen within 2/52
00Urgent seen within 2/52
1635125498475Routine seen within 8/52
00Routine seen within 8/52
1635125974725Referral rejected
00Referral rejected
3844925161925Report completed within 2-4/52 and sent to GP
00Report completed within 2-4/52 and sent to GP
5362575193675Referral accepted and completed in clinic
00Referral accepted and completed in clinic
Physiotherapy 223520130810Referral triaged with 48 hours
00Referral triaged with 48 hours
7960995297815008213725153670D/C
00D/C
5776595729615Advise and refer to GP for imagining/onwards referral if not formally diagnosed
00Advise and refer to GP for imagining/onwards referral if not formally diagnosed
58737513030205886451301115005873759918700107759581851500107632518542000107632561087003007995107886501787525896620Referral rejected
00Referral rejected
1781175452120Routine seen within 12/52
00Routine seen within 12/52
178752526670Urgent seen within 2/52
00Urgent seen within 2/52
348932523622000368617561087005534025775970004295775458470Scoliosis identified
00Scoliosis identified
555942536957000577532577470Treat if imagining complete and below surgical threshold
00Treat if imagining complete and below surgical threshold
663892512649200451167510807700
Primary Care 167322581915Referral made to Physiotherapy
00Referral made to Physiotherapy
5886454445001076325107950-952576200Pt accesses GP with back or scapula pain
00Pt accesses GP with back or scapula pain
4511675134620010763251346200
721042517335500267017582105507413625173355167322527305Referral made to Orthopaedics immediately or following physio, radiology rejection/advice
00Referral made to Orthopaedics immediately or following physio, radiology rejection/advice
-5397582105500-222256813550107632531305500107632514795501673225490855Referral made to Radiology
00Referral made to Radiology
Appendix 2 Swim Lane Diagram of proposed service;
Paediatric Orthopaedics 555625130683000349256591300034925652780055562513068300267017584963015557593980Referral triaged with 48 hours by AP physio
00Referral triaged with 48 hours by AP physio
1635125551180Scoliosis likely re-directed to physio
00Scoliosis likely re-directed to physio
163512593980Not likely scoliosis continues on normal pathway
00Not likely scoliosis continues on normal pathway
949325652780094932517018000
Radiology 709612530162551085751260475510857512604750067659259556750675957531432505000625180975Urgent seen within 2/52
00Urgent seen within 2/52
4562475288925005000625822325Routine seen within 8/52
00Routine seen within 8/52
45561257207250040862258731250040862251260475003705225320675Referral triaged
00Referral triaged
474027512604750
Physiotherapy 555625130302055562510934700111125185420Referral triaged within 48 hours
00Referral triaged within 48 hours
53054256616706657975185420006740525103632000695642533020Yes -Onwards referral to specialist centre (London), for local bracing and physio
00Yes -Onwards referral to specialist centre (London), for local bracing and physio
6924675795020No- Physiotherapy and monitor 6-12/12 as required
00No- Physiotherapy and monitor 6-12/12 as required
5432425331470At or above threshold for bracing/surgery
00At or above threshold for bracing/surgery
4518025185420Imaging requested and reviewed by AP
00Imaging requested and reviewed by AP
4302125661670002854325223520003038475833120003038475496570Scoliosis identified
00Scoliosis identified
9620251854200096202594107000113982577470Urgent seen within 2/52
00Urgent seen within 2/52
1139825877570Routine seen within 12/52
00Routine seen within 12/52
Primary Care 167322581915Referral made to Physiotherapy
00Referral made to Physiotherapy
55562563500012414251079500015557576200Pt accesses GP with back or scapula pain
00Pt accesses GP with back or scapula pain
3492573850500124142524955500272732559880501717675313055Referral made to Orthopaedics
00Referral made to Orthopaedics
longer
Appendix 3 Stakeholder table
High Influence Low Interest
Orthotics Management (update via MS teams meeting may get increase in request for bracing due to earlier detection of scoliosis get feedback from them in one year)
GPs/Primary care Providers (update regarding new pathway being APP led and waiting time during locality meetings)
CCG (update as part on Business, Performance and Governance report and Trust board meeting)
SSC (need to agree to accept APP and potentially SPP referrals MS teams meeting to discuss follow up meeting/emails to ensure appropriateness of referrals.)
High Influence High Interest
Orthopaedics Management (meeting to discuss removal of small amount of work from orthopaedics to physiotherapy, the required time and support from a POC and to get feedback in a year. To update throughout implementation of proposal)
MSK Physiotherapy Management (meeting to discuss slight increase in patient activity, risk to increase of RTT for physiotherapy, keeping informed about implementation and any changes to proposal.)
Radiology Management (need to agree APP imaging requests meeting providing evidence from SSC to demonstrate need for this. Keep up to date with any changes to proposal- related to radiology only)
Low Influence Low Interest
Physio Admin team (inform via email/MS teams slight change to pathway and need for patients to be kept on long term waiting list for imaging reviews)
Orthopaedic bookings team (inform via trust email communication that new pathway for scoliosis in case patients/parents/carers call for info on appointments)
Radiology bookings team (inform via trust email communication that new pathway for scoliosis in place)
Orthotics bookings team (inform via trust email communication that new pathway for scoliosis in place)
Low Influence High Interest
Patients/Patient family (discuss with current patients proposal for any feedback on other changes they would recommend)
Orthopaedic Consultants (meetings to discuss support and training needed keep up to date on implementation of proposal)
MSK Physiotherapists/ SPP/APP (meetings to discuss support and training needed keep up to date on implementation of proposal)
Local cross county Special Interest Group (inform at quarterly meeting to discuss similarities and success on proposal with other local/ regional services)
Orthotist (discuss potential for increase in referrals to orthotist for bracing and what is required for this)
Appendix 4: SWOT analysis
Strengths
Significantly reduced RTT
Simplified journey for patient seeing just one clinician throughout
Cost saving 139 (POC) vs 26.50 (APP) per appointment
Sooner detection on more sinister presentations/cause to symptoms
Less overall radiation to patient as correct imagines performed first time
Quicker access to brace improved outcomes
Quicker access to surgery
Ensures all of cohort accessing care at ESNT receive same care
Low opportunity cost fits into normal physio clinic time
No change to capital expenditure
Reduced paediatric orthopaedic wait times
In line with NHS people plan, MSK plan and GIRFT Paediatric Trauma and Orthopaedics
Clear evidence based international guidelines for treatment.
Evidence to support diagnostic accuracy of physiotherapy determining spinal pathologies
Weaknesses
No formalised physiotherapy training in radiological interpretation.
Small overall number of patients
Small patient cohort 1.45% of Orthopaedic and 1.86% of physio contacts
Sustainability only one APP what happens if they are unavailable for a long period e.g. sickness
Opportunities
Can be more in line with specialist centres e.g. London hospitals have similar physio-led pathways
Opportunity to have similar effect on orthopaedic wait times as demonstrated by adult APP clinics based in orthopaedic setting
POC able to assist in learning and development of pathway.
Support of POC for any sinister/unusual findings (digitally and in-person during clinic)
Threats
Patient/carers may not be happy seeing APP as wish to see POC
Reduced activity in Paediatric Orthopaedics
Traditional thought paradigms of POC/GPs that this patient group would fall within POC remit
Not enough details on referral from referring clinician to successfully triage to appropriate pathway
Radiology willingness to perform certain imagining requests and to accept APP referrals
Appendix 5 Sustainability diagram
3346450266065Environmental
Less need for patients to travel to appointments
Less radiation used so fewer radicals released into environment
Potential reduction in surgeries needed so less products/electric etc needed to perform surgery
00Environmental
Less need for patients to travel to appointments
Less radiation used so fewer radicals released into environment
Potential reduction in surgeries needed so less products/electric etc needed to perform surgery
32131005651500
51435001821180Economic
Cost saving with APP not POC
Cost saving with reduced need for SSC/ surgery (up to 50,000 according to Scoliosis Surgery website)
Increased cost of living fewer appointments needed for patient parents need to take less time off work and less travel.
Less long term cost to NHS
Fits NHS people plan and ESNT Strategy for Paediatrics
00Economic
Cost saving with APP not POC
Cost saving with reduced need for SSC/ surgery (up to 50,000 according to Scoliosis Surgery website)
Increased cost of living fewer appointments needed for patient parents need to take less time off work and less travel.
Less long term cost to NHS
Fits NHS people plan and ESNT Strategy for Paediatrics
20637502011680Social
Improved individual well-being of AIS patients less body dysmorphia
Easier to follow pathway for clinicians and patients
Improved local public health
Standardised pathway for all patients
00Social
Improved individual well-being of AIS patients less body dysmorphia
Easier to follow pathway for clinicians and patients
Improved local public health
Standardised pathway for all patients
38798502703830Sustainable Health and Care System
00Sustainable Health and Care System
18034001790065004718050179006500
References
Banaszek, D., Inglis, T., Ailon, T., Charest-Morin, R., Dea, N., Fisher, c., Kwon, B., Paquette, S. and Street, J. (2019). The efficacy of advanced practice physiotherapy assessment for cervical and lumbar spine pathologies. The Spine Journal 19 (2019) s158-s194
Beausejour, M., Roy-Beaudry, M., Goulet, L. and Labelle, H. (2007). Patient Characteristics at the initial visit to a scoliosis clinic. A cross-sectional study in a community without school screening. Spine 2(12); 1349-1354
Belthur, M., Clegg, J. and Strange, A. (2003). A physiotherapy specialist in paediatric orthopaedics: is it effective? Journal of Postgraduate Medicine 79(938): 699-702
ESNT (East Spinal NHS Trust) (2021). Clinical Strategy 2021-2026. Available online at request Actual Trust anonymised for the purpose of this assignment. Accessed 29th April 2022
Hutchinson, C. and Higginson, R. (2017). The Diagnostic accuracy of spinal pathologies referred for by telephone based advanced level physiotherapy triage service. Physiotherapy 103 e50-51
Hutton, M. (2019). Spinal Services GIRFT Programme National Specialty Report. Available from https://gettingitrightfirsttime.co.uk/wp-content/uploads/2019/01/Spinal-Services-Report-Mar19-L1.pdf#page=54 accessed 19th April 2022
Hunter, J. (2022) Paediatric Trauma and Orthopaedic Surgery GIRFT Programme National Specialty Report. Available from https://gettingitrightfirsttime.co.uk accessed 24th April 2022
Kenner, P., McGrath, S. and Woodland, P. (2019). What Factors Influence Delayed Referral to Spinal Surgeon in Adolescent Idiopathic Scoliosis. Spine 44(22): 1578-1584
Oakley, C. and Shacklady, C. (2015). The effectiveness of the Extended-Scope Physiotherapist role in Musculoskeletal Triage: A Systematic Review. Musculoskeletal Care. 13: 204-221
Mir, M., Cooney, C., OSullivan, C., Blake, C., Kelly, P., Kiely, P., Noel, J. and Moore, D (2016). The Efficacy of an extended scope physiotherapy clinic in paediatric orthopaedics. Journal of Childrens Orthopaedics 10:169-175
Mir, M. and OSullivan, C. (2018). Advanced practice physiotherapy in paediatric orthopaedics: innovation and collaboration to improve service delivery. Irish Journal of Medical Science 187(1): 131-140
Scoliosis Surgery Website (2022) Available from http://scoliosissurgery.co.uk/scoliosis-surgery-cost.html accessed 29th April 2022.
Sussex MSK Partnership Central (SMPC, 2022) Wait times. Available from https://sussexmskpartnershipcentral.co.uk/wait-times/ accessed 29th April 2022.
Weinstein, S., Dolan, L.,Wright, J. and Dobbs, M. (2013). Effects of bracing in adolescents with idiopathic scoliosis. New England Journal of Medicine 369: 1512-1521
WE ARE THE NHS: People Plan for 2020/2021 action for us all Available from www.england.nhs.uk/ournhspeople accessed 24th April 2022Personal leadership style reflective essay
There are a multitude of leadership theories from early concepts suggesting great leadership comes from great men (Great man theory) and their traits (Trait theory) to more modern ones around leadership at all levels across a team (Distributed leadership theory) and differing styles for different situations (Situational leadership theory). Traditionally leadership theories were based in business and not healthcare but, more recently studies have been applying theory to this specialist and unique area (Kennedy et al, 2020, The Kings Fund, 2019 and Fu et al, 2022).
Completing this course has allowed me to explore a variety of leadership styles to determine my predominant style, understand its limitations and how using a variety of styles depending on my situation could be greatly beneficial.
At the start of this module, I completed a leadership questionnaire (The Calculator.co, 2015) which determined my predominant leadership style was authoritative. My initial reaction to this was concern until I came to understand the differences between authoritative and authoritarian. An authoritative leader is more of a visionary leader who encourages a team to complete a journey of change with them as opposed to for them (Stobineski, 2019). It allows a team to work towards a clear goal, although not necessarily a goal chosen by the team, through the inspiration of the leader and to share credit for its success. Authoritative leaders are also knowledgeable in their chosen area of expertise, whilst also being self-confident in creating a vision and motivating others to follow it (Stobineski, 2019 and Ahmed et al, 2021). Fu et al (2022) report the main disadvantage to an authoritative leadership style is that it can be detrimental to employees psychological need to be creative in modern healthcare workplaces. An authoritarian/autocratic leader on the other hand is someone who makes all the decisions in a workplace with no input from or consideration of staff and blames individuals for mistakes rather than processes (Sfantou et al, 2007).
I feel the description of an authoritative leader to be accurate to the way I try to lead and whilst I try to accept and implement ideas from my team, at times I can be challenged to see the merit or benefit of changing the original plan. I also struggle to inspire others to reach a goal if I do not believe in its purpose, feel that its detrimental to patient care or does not fit with my own personal moral code. This fits more with the servant and compassionate leadership models (Trastek et al 2014) and I believe I embody several of the traits assigned to servant and compassionate leadership including; stewardship of staff within my team and patients in my locality, listening, empathy to both patients and staff, trying to build a community within the workplace, and trying to help remove obstacles to staffs successes (Trastek et al 2014, West and Bailey 2022). West and Bailey (2022) discuss that the implementation of compassionate leadership can lead to a 30-40% increase in staff productivity and demonstrates large gains in staff and patient satisfaction.
I believe I developed this combined style following several years working as a team lead and as an implementation manager before returning to a more clinically focussed role. Whilst the implementation manager role allowed me to greatly improve my influencing and networking skills it required a more autocratic approach as the project needed to take place within a set timeframe and to include certain parameters. Although, in some ways this was easier to implement it led to a high incidence of staff dissatisfaction reflecting the findings of Samarakoon (2019). My team lead role allowed me to work with a variety of people of various gradings and fine-tuned my ability to work with a more flattened authority gradient. Research from Cosby and Croskerry (2014) demonstrated medical errors taking place as the result of an authority gradient, where staff are fearful of challenging those above them due to historic, hierarchical professional status and job titles and this is echoed by The Francis report (2013).
The Kings Fund (2019, 2011) has been vocal in its desire for the NHS to recognise that leadership comes from all levels and that everyone should be able to communicate and lead ideas as part of shared leadership. This should support me in proposing a business plan that is cross divisional at ESNT and involving staff that would traditionally sit higher on an authority gradient than myself, but I feel I may have to alter my style to be more situational to achieve this. Appendix 1 shows the NHS leadership model completed by myself in relation to this business proposal and shows how the different dimensions and leadership styles would allow me to use skills I have already attained to achieve this change from a leadership standpoint.
I also completed an ADKAR model of change, appendix 2, for this business plan and it allowed me to see I would need to use a variety of different leadership styles to implement this business plan as different people and professions would need influences and input. An example being that an autocratic leadership style would not be successful in encouraging the Orthopaedic management team to implement the plan, however a combination of authoritative, servant and distributed leadership probably would. Additionally, Kennedy et als (2020) description of a human-centred leadership approach would align well to this implementation as it involves leading from within healthcare to exact a change to patient pathway and shares many traits with Wests (2021) compassionate leadership for healthcare.
I believe that now having a greater understanding of leadership approaches, I need to be more skilful at adapting my leadership style to the situation rather than expecting the situation to bend to my leadership strengths. Combining a plethora of different leadership styles to convey and develop this business case would allow for the benefits of each leadership style to be used with less influence of its negatives and should lead to a greater chance of successful implementation.
Appendix 1: Application of the NHS Healthcare Leadership Model
Appendix 1 NHS Healthcare Leadership model
Dimension Self assessed level achieved How to use to implement business proposal
Inspiring shared purpose
Strong:
Taking personal risks to stand up for the shared purpose Do I have the self-confidence to question the way things are done in my area of work? Do I have the resilience to keep challenging others in the face of opposition, or when I have suffered a setback? Do I support my team or colleagues when they challenge the way things are done? Questioning the traditional approach to the assessment of AIS patients both in my area of work of physiotherapy and outside of it in orthopaedics.
To keep advocating for this change against any potential initial push back due to the dramatic change in RTTs and patient experience.
Support SPP in improving scoliosis assessment in clinic.
Servant leadership to patient cohort by putting them first and Transactional and human-centred leadership to management with reduced RTT and cost savings if they agree implementation of the plan and being the patient voice regarding RTT and confusion around service provision. Authoritative leadership to encourage radiology and orthopaedics to want to implement the plan due to the improvement in patient care.
Leading with care
Exemplary:
Spreading a caring environment beyond my own area
Do I take positive action to make sure other leaders are taking responsibility for the emotional wellbeing of their teams?
Do I share responsibility for colleagues emotional wellbeing even when I may be junior to them? Understanding that this requires a level of trust between myself as the APP and the POC in my abilities to effectively diagnose AIS.
Recognise and discuss any reticence to the plan due to traditional paradigms of thought surrounding AIS, which is considered general to be orthopaedic work not physio.
Demonstrate that the loss of AIS from the POC caseload will allow for patients with other conditions to be sooner.
Distributed leadership with POC sharing workload with them but allowing their input to alter pathway if needed and Transactional leadership to management with reduced RTT and cost savings if they agree implementation of the plan. Authoritative leadership to encourage radiology and orthopaedics to want to implement the plan due to the improvement in patient care.
Evaluating information
Exemplary:
Developing new concepts
Do I develop strategies based on new concepts, insights or perceptive analysis?
Do I create improved pathways, systems or processes through insights that are not obvious to others?
Do I carry out, or encourage, research to understand the root causes of issues? Short retrospective audit completed for this business plan with the aim to complete a large audit one year following implementation. To then compare with regional/national wait times as able.
Potential to adapt to new conditions if successful. Ensure there are no serious incidents due to the change in pathway and if there are to fully investigate.
Transactional - benefit to reduction in RTT with implementation
Connecting our service
Exemplary:
Working strategically across the system
Do I build strategic relationships to make links across the broader system?
Do I understand how complex connections across the health economy affect the efficiency of the system?
Do I understand which issues affect decisions across the system so that I can anticipate how other stakeholders will react? Understanding my role as an APP within Orthopaedics as well as physiotherapy to assess AIS and the impact it may have on other areas such as radiology and orthotics due to changes to referral patterns.
Contingency for long term absence written into business plan
Implementation of electronic referral system (ERS) in the ESNT allowed for my efficient triaging and the ability to quickly redirect these patients to the correct pathway.
Communicating with Orthopaedics and physio regarding change of work between services.
Distributed and authoritative leadership to adult APP with additional training for contingency plan. Transactional with POC to allow orthopaedic triaging to be completed by myself as saves them time as only work as outreach clinics so previously only able to triage x1 a month and would lead to big backlog of referrals. Authoritative leadership to encourage radiology and orthopaedics to want to implement the plan due to the improvement in patient care.
Sharing the vision
Strong:
Making long term goals desirable
Do I encourage others to become ambassadors for the vision and generate excitement about long-term aims?
Do I find ways to make a vivid picture of the future success emotionally compelling?
Do I establish ongoing communication strategies to deal with the more complex and difficult issues? Ensuring as APP I am available to SPP for complex discussions and second opinion if unsure of scoliosis presence.
Discussions initially with POC to see if viable change to service. Following POC agreement to the have conversations with management of multiple areas prior to implementation.
Clearly explain through meetings and flow chart (business plan appendix 1 and 2 and reflective appendix 3)
Servant leadership with SPP to ensure their learning needs are met.
Transactional and Human-centred with POC reduced caseload for them and management due to reduced RTT and better patient outcomes/journey. Authoritative leadership to encourage SPP, radiology and orthopaedics to want to implement the plan due to the improvement in patient care.
Engaging the team
Exemplary:
Stretching the team for excellence and innovation
Do I stretch my team so that they deliver a fully joined-up service, and so give the best value they can?
Do I support other leaders to build success within and beyond my organisation?
Do I create a common purpose to unit my team and enable them to work seamlessly together to deliver?
Do I encourage my team to deliver on the shared purpose, as much as on their individual targets? Plan in one year to receive formal feedback from patients and staff around new service. Adaptable to changing sooner if needed from feedback if safety issue or more efficient pathway suggested.
If staff come with problems due to this plan to assist them in finding solutions.
Situational and servant leadership adapting to the feedback given throughout the process and at formal audit. Authoritative to maintain motivation of staff over the year to see the pathway become successful as proven by data.
Holding to account
Strong:
Challenging for continuous improvement
Do I constantly look out for opportunities to celebrate and reward high standards?
Do I actively link feedback to the overall vision for success?
Do I notice and challenge mediocracy, encouraging people to stop coasting and stretch themselves for the best they can attain? Ensuring that my referrals and curvature measuring is audited by appropriately qualified staff to ensure my own capabilities meet the pathway requirements.
Clearly specified in the business plan what would be expected from POC and radiology departments to be able to implement and safely maintain this pathway.
Business plan is linked to multiple national and local goals.
Get feedback from patients
Present results of audit to trust board (through divisional performance review).
Authoritative leadership to ensure all aiming for same goal nationally/locally and to encourage radiology and orthopaedic to want to implement the plan due to the improvement in patient care.
Developing capabilities
Exemplary:
Creating systems for succession to all key roles
Do I create the conditions in which others take responsibility for their development and learn from each other?
Do I take a strategic approach to people development based on the future needs of the NHS?
Do I share in borad organisational development and succession planning beyond my area of work? Primary meeting and training with SCC to be completed to ensure competency in using non-radiological tests and skills to determine likelihood of scoliosis during assessment.
Opportunity to observe appointments to discuss results with patients to be able to increase their skills in having similar conversations with patients if they have similar questions during initial physiotherapy assessment.
Regular supervision with SCC from APP where opportunities to discuss problem patients can occur, including spinal patients.
Authoritative with SPP to ensure engaged in the pathway and then distributed to allow them to play a bigger part in the pathway
Influencing for results
Strong:
Developing collaborative agendas and consensus Do I use networks of influence to develop consensus and buy-in? Do I create shared agendas with key stakeholders? Do I use indirect influence and partnerships across organisations to build wide support for my ideas? Do I give and take? By fostering a good relationship with POCs working within ESNT I have been able to gain their support for this business proposal.
Previous seconded job working as a service implementation manager allow me to network with influential people throughout the trust and use these links to be able to set meetings with the correct people to present my business plan and gain their support for it.
Also being the lead clinician for the cross region special interest group for Paediatric MSK Physiotherapy I can take ideas to the group to find similarities and differences locally and help to set regional guidelines and pathways. The change my pathway based on their feedback if relevant.
Authoritative, Servant and Situational leadership to work with multiple different people in and from different settings.
Appendix 2 ADKAR change model
Appendix 3 ESNT pathway flowchart for staff
Reference list
Ahmed, I., Abid, G., Arshad, M., Ashfaq, F., Athar, M. and Hassan, Q. (2021) Impact of Authoritative and Laissez-Faire Leadership on Thriving at Work: The Moderating Role of Conscientiousness. European Jounral of Investigation in Health, Psychology and Education. 11(3):667-685
Cosby, K. and Croskerry, P. (2004) Profiles in Patient Safety: Authority gradients in Medical Error. Academic Emergency Medicine 11(12): 1341-1345
Francis, R. (2013) Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. Available from https://www.gov.uk/government/publications/report-of-the-mid-staffordshire-nhs-foundation-trust-public-inquiry accessed 1st May 2022
Fu, Q., Cherian, J., Ahmad, N., Scholz, M., Samad, S. and Comite, U. (2022). An Inclusive Leadership Framework to Foster Employee Creativity in the Healthcare Sector: The Role of Psychological Safety and Polychronicity. International Journal of Environmental Research and Public Health 19(8): 4519-4532
Kennedy, K., Campis, S. and Leclerc, L. (2020) Human-Centered Leadership: Creating Change From the Inside Out. Nurse Leader 18 (3): 227-231
NHS Leadership Academy (2014) Healthcare Leadership Model The nine dimensions of leadership behaviour. Available from https://www.leadershipacademy.nhs.uk/wp-content/uploads/2014/10/NHSLeadership-LeadershipModel-colour.pdf accessed 1st May 2022
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