MSK Reform #4 Aspiring to Clinical Excellence

DEFINING EXCELLENCE 

MSKR propose that Clinical Excellence is delivered by clinicians who value: 

Patient-centred care 

– patient needs, goals and outcomes central to care 

  • Uninterrupted time to articulate story and work with them to identify meaningful, personal goals 
  • Embrace complexity, all aspects of care in patient’s best interest 
  • Options clarified and decisions reasoned 

A holistic biopsychosocial model 

– holistic, all-encompassing recognises and values all possible contributing variable in line with Clinical Excellence 

Communication skills 

– collaborative but persuasive 

  • Identify common ground, communicate coherent, scientifically robust route to patient goals 

Empowerment 

– Trust patients to make informed decisions 

  • Self-manage condition 
  • Recognise when to lead, stand shoulder to shoulder and be led through recovery journey 

Clinical Reasoning 

– Ddx frequently reviewed 

  • Reason between treatment methods 

Evidence-informed Care 

– up to date, reliable, validated examination and treatment  

Lifelong learning 

Reflective Practice 

– pause and reflect on care 

  • Self-awareness 

Critical Thinking 

– recognise variety of clinical options available to them and patients 

  • Think critically, rationally, objectively and sceptically about topic or decision 

Shared-decision making 

– lived experience of patient relevant 

  • Respect patient’s expertise 
  • Decision making equal partnership towards setting goals 

This overview of Clinical excellence emphasises the multiple skills and questioning required in practice. A collaborative way of working with patients alongside evidence based, reflective practice. These proposals fit well with many of the nuances of osteopathy. There is perhaps a need for osteopaths to move further away from biomedical-holistic reasoning to consider the whole-person including the psycho-social aspects of symptoms. 

ACHIEVING EXCELLENCE 

MSKR proposes a central, digital library of best practice guidance for common MSK presentations that are efficiently peer reviewed for quality, clarity and brevity. 

This is a proposal that many practitioners would welcome. There is already a lot of helpful best practice advice available through NICE clinical knowledge summaries however more detail is often required in terms of specific exercises, prescriptions and more understanding of which patients are most likely to benefit from what interventions. MSKR rightly expresses the concern that this kind of resource has the potential to become recipe-like, non-critical and risks under-reviewed. 

  • Primary rationale of treatment = scale individuals life function from where we are to where we wish to be post treatment 
  • Review chartered status 
  • All job roles accessible 

MSKR propose a promotional campaign to highlight the unifying nature of functional rehabilitation as a core component of healthcare 

Individualised functional rehabilitation – context-sensitive, progressively scaled, goal-focussed, 

The primary rationale of treatment is to scale an individual’s function from where they are at this moment in time and where they wish to be post-treatment. 

Quality rehabilitation accounts for the commonalities of basic human needs such as breathing, eating, sleeping, reproducing, washing, moving and working combined with the diversity of each individual’s requirements and goals. 

Graded functional rehabilitation is a vital feature of health and social care. 

MSKR propose a review of the term ‘Chartership’ as used in Physiotherapy and of the criteria required to qualify for chartership. 

MSKR suggest that the use of the term chartered by physiotherapists may be misleading the public. They compare the requirements for physios to use the term chartered with chartered accountants and chartered surveyors and identify a significant disparity. 

MSKR advocates for all MSK job roles to be accessible by professionals who can demonstrate that they meet the criteria outlined by the role, regardless of the profession. 

MSKR consider that no profession stands out in terms of clinical excellence in MSK. They consider that it is in the public’s best interest for MSK roles to be open to the best professionals regardless of profession. This proposal is advocated for raising standards and promoting Clinical Excellence by disrupting the complacency that can appear in the absence of competition. 

CONCLUSION

The description of an excellence in a clinician is excellent in my view. A reflective practitioner, working in a holistic patient-centred manner. I suspect this is one of the more difficult areas for osteopaths. Personally I like the idea of a best practice guideline and rehabilitation as a core component but I know it might not sit comfortably with the way that all osteopaths practice. However, exercise as the key to MSK care repeatedly holds the best evidence base. I think a non-profession specific service, based on excellent care must be better for patients. So many are confused about who to see, and receive conflicting advice. The more we can work together, applying all of our expertise the better care patients will receive. 

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