Adult and Specialist Rehabilitation

Project

Implementation of Microsoft Teams app to communicate patient changes

Leads: Elesha Todd, Team Manager, and Siu Yin Cheng, Team Administrator.

What was the problem?

Patient schedule changes were communicated via paper handover, which caused unclear communication, delays to scheduling and visit allocation the following day, and changes being missed altogether if a nurse didn't hand in their paper notes, often overloading the administrator with changes in the afternoon.

Aim

To achieve 99% of patient schedule changes being communicated and acknowledged through Microsoft Teams by June 2026, improving communication, reducing missed or delayed visits, and easing the afternoon workload for the administrator.

What did we do?

Piloted using Microsoft Teams for changes only, for two weeks, after learning that another team used it for lone working and changes. Considered privacy and confidentiality, and set up a private channel with controlled access, adding and removing non-regular staff on the day as needed, and agreed what information should be shared via the app to keep messages clear and concise. The change introduced was a Teams channel to share real-time updates on patient schedules, 
visit times and notes.

What are the benefits for patients and staff)?

Staff received schedule changes more quickly and consistently, in real time, reducing reliance on phone calls and paper messages, easing pressure on the administrator in the afternoon, and improving coordination of patient visits and staff allocation, with fewer changes missed during the pilot.

Measures used

Speed and consistency of communication, number of phone calls needed to coordinate changes, and number of missed or delayed schedule changes during the pilot period, with ongoing monitoring planned to ensure the change remains embedded and sustainable.

Qi tools used

• Plan, Do, Study, Act (PDSA) cycle.

Project

Lead: Maria McMahon, Physiotherapist

What was the problem?

A 2024 audit found very low use of outcome measures across the Orthotics service, with only 20% of delivery appointments and 2% of review appointments having a measure recorded, and none at all for upper-limb, Lycra and telephone reviews. This limited the service's ability to demonstrate treatment effectiveness, monitor goals, identify deterioration, and meet Care Quality Commission (CQC), National Institute for Health and Care Excellence (NICE) and Trust quality requirements.

Aim

To increase the proportion of delivery and review appointments with at least one outcome measure recorded from 11% to 100% for all orthotics patients by July 2026.

 
What did we do?

• Reviewed evidence and the ICF framework, and analysed baseline data by appointment and orthosis type to target improvement, including a review of appointments where measures were missed to understand barriers.
• Made outcome-measure forms and a pro forma easily accessible by attaching them to the RiO note, building them into a Standard Operating Procedure (SOP), and displaying them near clinicians.
• Held quarterly team meetings following Lewin's change model, sharing results and action points with staff by email.

What were the benefits for patients and staff? 

More consistent recording of outcome measures allows the team to better demonstrate treatment effectiveness, track personalised goals, identify deterioration and adjust prescriptions promptly, supporting compliance with CQC, NICE and Trust quality requirements. Staff also benefit from clearer expectations, exception rules and individual feedback on their own performance.

Measures used

• Feedback obtained from keyworkers via survey.
• Maintenance working group was set up who met quarterly to audit the Moodle site and review / evaluate future surveys and progress.
• The project had an extensive improvement plan which identified actions and used Red Amber Green (RAG) rating outcome measures.

Project

Advice to boost nutritional intake with Chinese foods.

Lead: Ying Man Tam (Christy), Community Dietitian

What was the problem?

Standard food fortification advice did not reflect the usual dietary habits of service users from the Chinese community, as existing resources mainly focused on British, Asian, and Caribbean/African dietary patterns. With a growing number of Chinese service users referred to the Nutrition Support Team, a more culturally appropriate resource was needed.

Aim

To develop and implement a culturally appropriate food fortification resource incorporating Chinese foods and meal suggestions, to support service users from the Chinese community in increasing their nutritional intake.

 
What did we do?

Researched common Chinese foods, dietary habits and potential barriers to nutritional intake, then adapted existing food fortification guidance to include Chinese-style meal suggestions, ways to boost energy and protein intake using familiar ingredients such as sesame oil, soya sauce, eggs, fish and tofu, and lactose-free alternatives such as fortified soya milk. The draft resource was shared with the Nutrition Support Team for feedback, refined, then uploaded to the shared drive and circulated via the Friday brief.

What were the benefits for patients and staff? 

Service users from the Chinese community now have access to nutrition advice that reflects their usual diet, making it more practical, relevant and acceptable, which should support better adherence and improved nutritional outcomes. The resource also increases the availability of culturally appropriate materials across the Adult and Specialist Rehabilitation (ASR) division.

Measures used

• Verbal and written feedback from the Nutrition Support Team on content, clarity and suitability.
• Confirmation the finalised resource was uploaded to the shared drive and shared via the Friday brief.
• Ongoing monitoring of patient feedback.

Qi tools used

• Plan, Do, Study, Act (PDSA) cycle.
• 5 Whys.

Project

Oral Nutritional Supplement (ONS) trial GP letter template

Lead: Ying Man Tam (Christy), Community Dietitian

What was the problem?

GP letters confirming successful Oral Nutritional supplement (ONS) trials and requesting ongoing prescriptions had to be written manually and tailored from scratch each time, which was time-consuming and delayed prescription requests to GPs.

Aim

To develop a standardised ONS trial letter template for dietitians, reducing administrative time and ensuring prescription requests are sent to GPs promptly following a successful supplement trial.

 
What did we do?

Reviewed previous GP letters to identify consistently required information, then developed a standardised, editable template including a supplement summary table (product, quantity, flavour and nutritional content) and a concise statement confirming tolerance, so only patient-specific details need to be added before sending. The draft was presented to the Nutrition Support Team at a QI huddle for feedback, refined, then uploaded to the shared drive for dietetic teams to use.

What were the benefits for patients and staff? 

Reduces administrative time for dietitians by removing the need to write letters from scratch, supports consistent, clear communication with GPs, and helps ensure prescription requests are sent promptly following a successful ONS trial.

Measures used

No formal outcome data has been collected yet; feedback will be monitored and collated to check the improvement is working.

Qi tools used

• Plan, Do, Study, Act (PDSA) cycle.
• 5 Whys.

Project

Musculoskeletal (MSK) referral management and digital pathway transformation

Lead: Rachel Preston, RMC Senior Team Leader; Ant Guest, Advanced Physiotherapy Practitioner; Nabeela Mukadam, RMC Service Manager

What was the problem?

The Orthopaedic Triage Service (OTS) previously operated on Appointment Service status only, delaying referral visibility until patients contacted the service. This, along with inaccurate dummy appointment letters, caused confusion, complaints and increased calls from patients and GPs.

Aim

To reduce the number of complaints and queries regarding patient appointments for the Orthopaedic Service by redesigning the referral process, by March 2026. 

 
What did we do?

OTS redesigned its referral process in partnership with BCHC Digital Technology Services, clinical teams and Birmingham and Solihull (BSol) partners, adopting the Referral Assessment Service (RAS) model to improve referral visibility and streamline triage. Phase 1 eliminated dummy appointment letters and improved patient and staff experience, while Phase 2 will integrate e-RS with the Rio Electronic Patient Record using FHIR APIs before wider rollout

What were the benefits for patients and staff? 

Stopping dummy appointment letters has reduced complaints and unnecessary calls, while immediate referral visibility enables faster triage, improves governance and removes the risk of hidden referrals. Phase 2 will further reduce manual administration, minimise errors and delays, and support faster referral handling.

Measures used

• Baseline data is being collected through time and motion studies, call volumes, and referral turnaround times. 

Project

Bladder and Bowel Clinic: dignity bags

Lead: Alex Evans, Patient Experience and Engagement Lead, and Liz Tyson, Bladder and Bowel Service

What was the problem?

Patients attending bladder and bowel clinic reviews had to carry samples from the lavatory to the clinic room, which affected their dignity and caused embarrassment or anxiety. This was also raised during an Essentials of Care visit.

Aim

To reduce embarrassment, anxiety or concern by providing discrete packaging to transport samples between departments, by the end of December 2025.

 
What did we do?

Introduced dignity bags, trialling them first at Sutton Cottage Clinic. Patient feedback was positive, and the bags were rolled out to all bladder and bowel clinics across the city (Sutton Cottage, Richmond, Summerfield, Moseley Hall Hospital and West Health), with all staff briefed on their use for samples, containment products and supporting literature.

What were the benefits for patients and staff? 

Patients feel more dignified and less self-conscious carrying samples and products, including sheaths and catheters, between departments. It is a low-cost intervention that is now embedded across all clinics.

Selection of qualitative data

I gave a patient a dignity bag to put their urine sample in, also some gentlemen feel very embarrassed when leaving clinic with products, I gave a prostatectomy gentleman a bag to put his containment products in, overall, the patients were happy with this improvement and advised it protected their dignity and they no longer felt so self-conscious.

Staff member

Measures used

The number of samples processed annually for bladder and bowel patient assessments and reviews, and ongoing use of the bags across all clinics as a low-cost dignity intervention.

Qi tools used

• Feedback gathering with the Patient Experience team.

Project

SPARK project.

Lead: Dr Afshan Tahir, Specialist Registrar in Rehabilitation Medicine

What was the problem?

Staff knowledge and confidence in managing spasticity needed improvement. Inconsistent referral processes and lack of awareness could delay timely management, increasing complications such as contractures, pain, falls and care needs.

Aim

Improve staff knowledge and confidence in managing spasticity by 30% within 6 months through teaching and visual resources, and introduce a standardised inpatient spasticity referral pathway to make the process clearer and more consistent across wards.

 
What did we do?

• Delivered teaching sessions.
• Created awareness posters.
• Gathered feedback and began developing a standardised referral pathway and referral form.

What were the benefits for patients and staff? 

Improved staff awareness and confidence support earlier recognition and management of spasticity, promoting better rehabilitation and more consistent referrals.

Measures used

• Outcome: staff confidence/knowledge scores; referral appropriateness.
• Process: attendance, survey responses, referral form use.
• Balancing: workload and staff engagement.

Qi tools used

• Plan, Do, Study, Act (PDSA) cycle.
• Teaching sessions.
• Visual posters.
• Surveys and feedback.

Project

Lead: Selina Wilson Specialist Occupational Therapist

What was the problem?

The team support relatives of patients with complex needs by providing updates and guidance from admission to discharge. However, the growing demands from relatives, including their own social and mental health needs, increased stress and anxiety for staff in the keyworker role. This led to staff sickness and retention issues, as there were no specific educational resources or training to help keyworkers handle the role while protecting their own mental health.

Aim

To reduce keyworker staff stress, anxieties, sickness and promote workforce retention through education and wellbeing in the keyworker role by December 2025.

 
What did we do?

• Completed focus groups and surveys to gather data from keyworkers to identify their needs.
• Set up a working sub-group that developed educational resources for the team.
• Created and launched a keyworker Moodle site with education and resources for keyworkers to provide support for relatives and patients.
• Designed a keyworker leaflet explaining the role to relatives.
• Developed an educational video explaining the keyworker role for staff.

What were the benefits for patients and staff? 

• Keyworkers experienced reduced anxiety and stress by using educational resources and having a better understanding of the role's boundaries.
• ]Feedback from patients and relatives indicated that receiving information and being signposted effectively provided an equitable and inclusive service. Survey findings support this, showing how keyworkers felt their role supports the staff, patients, and relatives, rather than just the relatives as initially thought.
• The qualitative data highlighted how the keyworkers feedback is now supportive of the keyworker role.

Selection of qualitative data

Maintains good communication with families and carers.

Good to have one point of contact.

Relatives feel supported and listened to.

Acts as a way to develop as a member of staff and develop a greater understanding of the patient journey.

It can be very rewarding.

It can prevent stressful issues from potentially escalating.

Centralises everything relating to the patient.

Good to have a collective understanding of the keyworker role so all are doing the same and offering the same level of support as a keyworker.

Enables staff to develop knowledge andconfidence in different areas they may not be exposed to if working elsewhere.

Strengthens staff ability to have difficult conversations, etc. 

Measures used

• Feedback obtained from keyworkers via survey.
• Maintenance working group was set up who met quarterly to audit the Moodle site and review/evaluate future surveys and progress. 
• The project had an extensive improvement plan which identified actions and used Red Amber Green (RAG) rating outcome measures. 

Qi tools used

• Plan, Do, Study, Act (PDSA) cycle.
• Driver Diagram.
• Six thinking hats ©.

Project 

MSK Service diagnosis codes.

Lead: Jonathan Price, Musculoskeletal (MSK) Research Lead

What was the problem?

Only 35% of new MSK physiotherapy patients had diagnosis codes recorded in Rio, the electronic patient record system. This gap limits our understanding of the patient population and reduces the effectiveness of training, service development, and research efforts. Improving coding compliance will enhance data quality and support better-informed decision-making.

Aim

Increase diagnosis code recording for new MSK patients to over 70% within 12 months.

What did we do?

• Introduced a dynamic monthly data dashboard.
• Collected monthly feedback of data for completion rates – individualised.
• Updated induction training.
• Enabled peer comparison and clinic-level visibility.
• Facilitated team discussions on the importance of diagnosis coding.

What are the benefits for patients and staff?

Following targeted interventions, diagnosis reporting for new MSK physiotherapy patients increased from 35% to 90%, significantly enhancing our understanding of the patient cohort. This improvement has streamlined clinician training, enabled targeted research, and laid the groundwork for automated data collection and analysis.

We have begun linking the project to outcome measures, allowing us to identify which patient populations and clinical diagnoses are being managed effectively, and where there is room for improvement. This approach supports the development of more personalised, data-driven treatment plans and is expected to lead to better patient outcomes across the MSK service.

Measures used

• Percentage of new patients with a recorded diagnosis code.

Qi tools used

• Run Chart.

Project

Ward 6 Breakfast Club

Leads: Rumbi Marira, Ward 6 Matron; Michelle Ho, Ward Manager; Salil Parker, Therapy Lead.

What was the problem?

Patients were spending long periods of time in bed whilst being an inpatient.

Aim

To create a structured routine similar to normal home life whilst allowing social interaction and independence to prepare the patient for discharge.

What did we do?

The Breakfast club was initiated to promote patient wellbeing and rehabilitation by encouraging patients to be washed, dressed, and to take their breakfast in the dayroom and create a structured routine similar to normal home life whilst allowing social interaction and independence.

Aims:

• To enhance patients' wellbeing through weekly participation in breakfast club that reflects everyday home routine.
• To prioritise the involvement of patients identified by occupational therapy as going home on discharge.

Objectives:

• To reduce pyjama paralysis by supporting patients to be dressed and seated out of bed for breakfast.
• To aid joint working between night and day staff to ensure patients are prepared to attend the breakfast club at 8.30 a.m.
• To provide therapy team support in assisting with patient transfers and in coordinating the set-up of the dayroom with food items.
• To encourage patient participation in some of the preparation and serving of breakfast thereby promoting independence, functional skills and engagement.

What are the benefits for patients and staff)?

• Ending pyjama paralysis and promoting daily routine.
• Enhancing patients’ wellbeing and social interaction.
• Encouraging independence through participation.
• Supporting rehabilitation and discharge planning.

Measures used

• Feedback from service users and carers.

Qi tools used

• Plan, Do, Study, Act (PDSA) Cycle.