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NELFT Quality Improvement Services News

NELFT Quality Improvement Services News

QIS Student Placement with Abbee Lloyd and Juliet Nkomo

Abbee Lloyd, Occupational Therapy Student, Brunel University

“My name is Abbee Lloyd, and I am an Occupational Therapy master’s student from Brunel University. Our degree qualifications require real world placements where we work in hospital, community, or leadership-based settings to sharpen our OT skills and practically apply our education. We do not get to choose our placements, but rather, we are told about them a week or two before they occur, and you are only given your educator’s name and email with the title of your placement and location. There are very few placements available at present and practitioners have little incentive to change this. One way the NHS is trying to combat this reduction is available placements that are not necessarily field based but improve the student’s leadership skills. This particular placement was created by an Allied Healthcare Professional but works directly with a Speech and Language Therapy Team and Quality Improvement Team on a co-production project. We were brought in to complete patient interviews for adults who had experienced laryngectomies in order to gather qualitative data that we would then thematically analyse in order to determine how patients would like their care to be improved. Our placements do require 8 hours/week of direct OT supervision, so once a week on Tuesdays we attended clinical hours in a different location.  

From the very beginning, I knew this placement would not be the typical placement. It doesn’t follow any direct rules or traditional OT placements and required me, as a student, to engage in autonomous work, creative problem solving, self-management, utilization multiple modalities of communication, and think very critically. If I’m honest, at the very beginning I was terrified. I have social anxiety and performing interviews for patients with a condition I had barely heard of had me reeling a bit. I did as much reading as I could so I understood the care the Speech and Language Therapy team would have performed and understood a little bit about the process. We then went on a couple of patient visits with the SALT team and got to understand a bit more of what cares were needed for these patients. I also had never done any work with quality improvement. We had discussed it in a class briefly, but I had never seen it in action and had never heard of the term “co-production.” After having a crash course in all of this, it was time to work with the patients to actually perform the interviews.

There were actually many barriers we incurred when trying to start the interviews. We had to wait for questions to be created and consent forms to be crafted which delayed our start date. We also had to problem solve and find a way to record these interviews with our very minimal supplies. We had received laptops from the AHP team that we then used as recording devices, utilizing Teams meetings as a way to record them. It was a very creative solution, but we ran into a few bumps along the way. For instance: patients that have had laryngectomies have very raspy voices or use electrolarynx devices, both of which Teams does not recognize and would not record all of what the patients would say. We also tried to get the patients to do their interviews separately from their carers, but every single patient decline and asked that their carers be present because they were afraid of being understood. This meant that they are often interrupted by their carers or talked directly to the carers, which meant that if Teams didn’t record, we had more trouble reading their mouths to determine what was said. Working with patient’s schedules and our limited schedule also presented other issues such as last-minute cancelations, sickness, or sometimes they just forgot and weren’t available. It meant that what could have only taken a couple of weeks ended up taking four weeks. We were instructed not to do thematic analysis until we had completed all of the interviews and with 16 interviews that each take 2-3 hours takes a lot of time. Unfortunately, we just ran out of time and were not able to complete the compilation video we were hoping to complete. The reality is that even with perfect planning and preparation, things don’t go as planned and learning to be flexible is an important skill all practitioners need.

Now that I am at the end of my placement, it is much easier to see what I was able to learn/glean from it. I can see how working with a different team that is part of the larger Allied Health Professional pool helps you see how even though what you do is unique to your profession, there are professional standards of practice that are universal. A leadership placement also puts more of a focus on how to build leadership skills that are transferrable to any profession, but also narrowing the scope to your field. According to the NHS, three stages to leadership development are 1. Self-development, 2. Working with others, 3. Improving Healthcare. These stages are the pillars of what they want leadership placements to teach students. I can see how this placement, though untraditional, did an amazing job at really creating opportunity to fulfil these.

I am a firm believer that you only get out of something what you’re willing to put into it, and I feel like I created opportunities for myself to build on what I already knew and add what I learned working with the QI and SALT teams. I worked on my professional communication, time management, organizational, and quality improvement skills, and I know that these are services I can take with me into any role I have. I also think it is invaluable to learn how to actively engage and utilize co-production with patients because I believe the future of all healthcare is patient led. I’m very grateful to the teams that welcome me in and let me learn from them and I hope I don’t forget what I have learned in this placement.”


Juliet Nkomo, Occupational Therapy Student, Brunel University:

“My name is Juliet Nkomo an OT student from Brunel University. My first placement was in July 2021 and did not get another one for a while.  I was offered another placement in March 2022, which was later on cancelled because I had bereavement in the family. I then waited for a long time until I was offered this Leadership placement.

I struggled understanding what I was doing as it looked like everything was everywhere. I found myself among professionals from different disciplines. I managed to pick myself up trying to learn skills applied by professionals from different disciplines in an effort to make patients get better or become independent again. I realised that it was an honour to get this leadership placement as I learned skills I might not have learned on one clinical OT placement.

It was a great advantage working alongside SLT as I learned how they manage Laryngectomy patients helping them to lead the lives they want to lead. Although, it is not OT per se, I have been able to learn clinical skills in this placement as observed them checking and cleaning stomas.

Working alongside the Quality Improvement Services broaden my way of thinking as I am now aware that clinicians from different professions get together to discuss their views on how best they can improve they provide to patients for them to live better lives.

At first, I was not very sure of what was going on when clinicians get together, but got used to the system and understood what it is all about.

I have learnt that treatment and support for patients should be holistic and patients should be treated as individuals. For the patients to get quality service, clinicians from different professions should get together and share ideas on how they can provide quality service to make a difference to patients.

Although, my peer students discouraged me from taking this placement, I realised that, it was worth doing it as I learned quite a lot of skills within one placement. I would encourage other students to do this style of placement.”