Making the good better: developing a streamlined competency set for ICU Physiotherapists within an Academic Health Science Centre

ABSTRACT

Introduction: One team, multiple sites is a principle supporting our Academic Health Sciences Centre (AHSC) partnership vision for academic and clinical excellence. COVID-19 has highlighted the need for co-ordinated crossorganisational working within ICU. There is currently no nationally agreed competency framework for ICU Physiotherapists. Having a streamlined set of competencies across the AHSC would be beneficial for safety, quality of care, training efficiency, workforce development, workforce mobility and further embed collaborative cross-site relationships. Objective: To develop streamlined competencies for ICU Physiotherapists working within an AHSC. Methods: Physiotherapy ICU leads from each site in the AHSC were identified via stakeholder mapping. This work stream was facilitated by a dedicated project lead, using a Plan-Do-Study-Act (PDSA) cycle. Organisational and national competencies1-3 relevant to ICU Physiotherapists were collated. Benchmarking and mapping were completed to identify commonalities and deficits. Initial meetings were conducted weekly via virtual forums to ensure benchmarking and mapping procedures were validated by all members. Two face-to-face meetings were employed to discuss the ideal competency set based on expert clinical opinion alongside the results from benchmarking and mapping. A whiteboard collaboration platform provided by Miro4 enabled all members to contribute whilst negotiations were facilitated by the project lead. Consensus on decisions pertaining to the streamlined document required all members to be in agreement. The method for achieving this centred on open discussion and regular communication. Results: The work stream utilised eighteen organisational competency documents and three national documents.1-3 The final competency set was formulated using common themes which allowed for incorporation of specific competencies from each site. Agreement on each theme and specific competencies were easily reached due to the extent of commonality between existing organisational documents. Rather than using bands to denote progression through competencies the work stream agreed on use of the terms Foundation, Specialist, Advanced and Expert, aligning the document with the Intensive Care Society AHP professional development framework.1 These levels are loosely aligned to the expectations for staff in bands 5-8, though allows staff to develop skills through the levels with no ceiling effect based on paygrade. The group comprehensively devised the foundation level set of competencies and approved a sign-off procedure using elements from organisational documents, including self-reported confidence measures and senior supervised assessment of competence. Conclusion: Using quality improvement methodology, the work stream was able to rapidly produce a comprehensive streamlined competency set for foundation level Physiotherapists in ICU across the AHSC. Next steps include gaining workforce feedback as part of a further PDSA cycle to refine the document prior to implementation. Continued collaboration by the work-stream will enable additional competency levels to be built from the foundation set. Education and training aligned to the document is essential for its success. Development of this will extend and reinforce the cross-organisational working and collaboration which is now embedded within the teams. The methodology to date demonstrates a proof of concept which can be utilised with other AHP groups in ICU, other settings or wider regional areas.