Lakshman Thuraisingham

For those looking to see how physiotherapists can work outside their traditional roles to enhance patient care, not just with individual patients, but at system level, Lakshman Thuraisingham, is a prime example.

Starting working life with a biomedical science degree and after a couple of years as a healthcare support worker, Laksh (as he is known) realised that physiotherapy was his passion. He worked as a physiotherapist assistant and studied for a master’s in physiotherapy, which was awarded in 2014. But what he saw on the wards made him realise that significant improvements in patient care and efficiency would only happen if he got involved in making changes at system level. 

Now as matron for quality at Queen Alexandra Hospital, part of Portsmouth Hospitals NHS Trust, a role traditionally occupied by someone with a nursing qualification, he can do just that.

While he loves respiratory physiotherapy, his experience on yearly job rotations made Laksh realise there was never enough time to implement changes. ‘You would go on rotation and come back and realise no one has done anything about this problem,’ he said.

In 2016,  in a permanent job at Queen Alexandra, he was involved in quality improvement “sprints” looking at ways to improve patient flow, discharges, and reduce overall length of stay. 

It gave him the opportunity to work with the multidisciplinary team, understand their roles and how they can support each other. While the sprints helped, he could still see key areas where the discharge to assess pathway could be sped up. So he approached the director of discharge services with a pitch to create a role to transform the pathway between acute and community care.

He researched relevant roles, many of which were not physio roles, and said “I could do that” in answer to the job specs. The pitch resulted in a four-month secondment, backed by winter pressures funding, to work within the integrated discharge services and the intermediate care team. 

Laksh says systems are not always geared up for delivering appropriate specialist care either because the pathway simply doesn’t exist or the workforce is not there to provide it. As a result patients slip through the net. 

He says the funding of the pathways also creates blockages to transformation because of the way clinical commissioning groups (CCG) fund services. ‘It’s a vicious cycle to argue the case for funding. You can’t secure funding without data, but to get the data you need a pilot and of course the pilot needs to be funded.’

Quick wins 

Greenlighting a pilot project requires a leap of faith from the CCG, so good influencing skills are required to get backing for your idea. Laksh says that one way is to identify people with links to those you want to influence, and approach them so that they can represent a shared vision and a stronger voice to argue the case. 

‘I held meetings with important stakeholders, including community partners at different trusts, to start a review of the system and to identify changes that needed to be made.’

One of the ‘quick wins’ was turning the referral form for onward support in the community, either at home or in formal rehab, from a four page slog that required input from a doctor, into a simple page of A4 that now takes just five or 10 minutes to complete. The form was based on one already used at Brompton and Harefield Hospital. 

Such changes are about making the process lean says Laksh: ‘It’s not my time it’s the patients’ time we are using. If I can save time writing forms, I can save time for the patient – perhaps two days in hospital. 

‘Look at it in the context of the last 1,000 days campaign.

If you had a last 1,000 days to live how many of them would you want to spend in hospital?

Seeing an advertisement for the matron for quality post Laksh realised his ideas had the potential to benefit patients across the trust and the opportunity to influence the traditional nursing model of patient care.  

Before the extensive and intense interview process for the job he confessed to “a feeling of imposter syndrome” as an allied health professional (AHP) applying for a nursing role.

‘I spent significant time reading into the nursing elements, but also wanted to highlight my unique selling points as an AHP. I also approached the leads of the quality team to understand the role, and sought peer support from friends who work in healthcare.’ 

He was appointed last October and welcomed by a relatively new senior nursing team, who he says were happy to have an 
AHP on board with views that might challenge accepted wisdoms.  

Crucially everyone wanted to see change and improvement centred on ward accreditation – a national scheme that holds ward staff to account for specific standards of excellence and provides support to meet these standards.

Compassionate leadership

Laksh finds his physio background an asset in his new role. ‘A mobile patient whose activity levels improve is less likely to have falls or have pressure and tissue viability issues, they will have better nutrition and be less likely to clinically decondition. 

‘As ward accreditation scores are linked to falls, nutrition, hydration and discharge process metrics, it’s easy to see what a difference physiotherapists can make in being part of the shared governance structure.’

Ward accreditation offers a “shared governance” opportunity, where each ward takes ownership of how the ward is run.  

‘Generally things are hierarchical; they are done to you as a ward. We run our own ward by supporting our staff and that means the whole multidisciplinary team working environment. You can’t solely focus on nursing. Everyone must be part of what they see as the vision for the ward.  We need to tell AHP colleagues from other disciplines what is happening and invite them to become part of that new governance structure, and also tell patients about the changes and involve them.’

As part of his wider remit he looks at patient safety and care, how staff are supported, using safety learning event report forms, understanding when an incident happens and learning from it to make sure it doesn’t happen again – be it to do with medication error, oxygen delivery, falls or even adverse events like deaths.

Breaking boundaries

Laksh is an advocate of “compassionate leadership” – making staff feel  they are supported and their voices are being heard – especially where Covid-19 saw them parachuted into stressful environments such as ITU. 

‘I have seen some examples of great leadership where staff were checked on daily to ensure they were comfortable and working safely for patients and themselves, but others where staff were left scarred to some degree.’

He is also passionate about being a role model for black, asian and minority ethnic (BAME) staff given that many people from these groups remain stuck at band 5 or 6 and don’t rise to senior roles.

‘No matter what your background if you are passionate, driven and the right person for the job it doesn’t matter about your race, you will get to where you want to,’ he says. 

The trust runs the beyond boundaries programme to get people from BAME communities into senior positions. The programme looks at issues such as conflict resolution and modelling leadership behaviour. Laksh was in one the first of the two cohorts of the programme so far. 

‘Listening to other people’s stories in that cohort I was shocked. There have only been two experiences in my working life where someone was negative to me because of my race. I reflected on them and moved past them. But when I heard from others in the cohort, their experiences were so much worse – so it’s clear they must get more support from now.’

The trust also runs a reverse mentoring scheme where Laksh says senior, usually caucasian leaders are matched with BAME colleagues “so they can learn about cultural differences and what matters to staff so they can be better senior leaders”.

It’s a tribute to the trust that it now employs three physios including Laksh in non-traditional roles. Cate Leighton is the divisional director of clinical professions -managing all AHPs – and Hayley Price is part of the patient safety team looking at falls around the hospital.

‘When I was at university I never heard from speakers about the wider roles that we could take up. I am very keen to speak up about not pigeonholing yourself as a physio and how you can redesign or commission services for the future, asking where patient safety and quality lie in all that. We have so many transferable skills with which we can do that.

‘When I went for the matron job I went up against nursing colleagues. I was successful because I was the right person for the job with the right skillset– bringing what I believe and exuding passion rather than a textbook answer. In my interview I said: “I am a physiotherapist and I bring skills as an AHP and what you see is what you get”.’