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FLS Implementation Toolkit

The charity can offer support for the development of services from business case right through to outcomes and performance measurement. This support has already proved to be effective in achieving service improvement in several areas and is currently provided free of charge.

The FLS Implementation Toolkit aims to help commissioners, service managers and healthcare professionals:

  • Understand the local impact of fragility fractures, both in terms of numbers and socioeconomic costs.
  • Predict the local increase in fragility fractures over the next 5-10 years because of the ageing population (the ROS need to be contacted directly for this: fls@theros.org.uk)
  • Provide a local model of the clinical and cost effectiveness of developing an FLS through an evidence-based business case.
  • Commission high-quality, effective FLS, integrated within a system-wide approach to fracture prevention.
  • Provide sustainable high-quality services based on available evidence, demonstrating positive clinical outcomes.
  • Make implementation easier, cheaper and more effective for commissioners and providers.

Audience and Eligibility:
The FLS Implementation Toolkit is open to all healthcare professionals and commissioners with an interest in setting up a FLS in any healthcare setting.

The start point is simple: talk to colleagues and others who are directly or indirectly involved in providing care to people with fractures, people at risk of falls or people with osteoporosis.

These early conversations should aim to test and to shape ideas and to understand if the improvement project might be viable. In this early work you should agree the most appropriate person to give clinical leadership to the project; we might call this person the ‘Clinical Champion’ or ‘Clinical Lead’.

The outcomes from this stage should be:

  • A functioning Project Team
  • A first meeting of your Stakeholder Reference Group
  • A populate Project Plan
  • An agreed Project Initiation Document

Tools:

In this stage, the evolving Project Team will develop a better understanding of the current situation, associated issues and start to create a process and plan for the improvement project. You need to map out your current services and understand what you want future services to look like, you can use the ROS Clinical Standards for FLS to help you with this. What benefits will your service provide to people in your local area? Speak to all relevant stakeholders and engage them early in the process. Importantly understand what is required from a patient perspective, speak to patients and patient representatives.

The outcomes from this stage should be:

  • An understanding of the current patient pathway and patient journey
  • An understanding of the patient pathway that you would like to put in place
  • A clear set of objectives for your project
  • An outline of the Service Model
  • Identification of where you need to gather further information or data

Tools:

This stage requires the use of data to fully understand the level of need in the local population and to quantify some of the problems you might already have highlighted. Identifying, extracting and analysing these data can be difficult and it is likely that you will need expert support. Speak to your IT and Data Support/Audit Teams. The ROS can support you with this, you can e-mail them on fls@theros.org.uk

The outcomes from this stage should be:

  • Quantification of the number of patients that your FLS will need to assess and treat
  • An understanding of the likely impact that your service should have on the number of fragility fractures for your population
  • A good idea of the staff and other resources that you should need to deliver the service.

Tools:

By now you should have worked with your colleagues and other stakeholders to get a good understanding of the current situation including:

  • Definition of your population
  • The level of need in the population (population needs to be defined. Local Authority area? Trust area? CCG area Health Board Population?)
  • The service that is currently available to meet (or not) the need
  • Quality or other problems in the current patient pathway
  • Patient concerns about how their care is delivered

Going through this process you will have started to form ideas about how the service can be improved: it is time to draw these ideas together into a plan that can be shared with others. This part of the process should involve the widest possible opportunity for people to engage. One helpful method is to hold an event for your project team and your reference group to come together for a facilitated workshop to describe the patient pathway and draw up a service specification.

What will your service look like? What are the costs related to your service? What will your clinical pathway look like? Have a look at the ROS Clinical Standards for FLS to help you with this. Who will deliver your service? Have a look at the ROS Competency Framework for HCP working in Fracture Prevention, for some help.

The outcomes from this stage should be:

  • A clear description of the service standards, outcomes and service model all captured in a clear service specification
  • A business case that has been approved, thereby securing your funding
  • Detailed plans to get your pilot up and running

Tools:

Refine your clinical pathways and clinical templates and resources, based on feedback and regular evaluation. Build in regular monitoring and evaluation of what is working well and what needs to be improved. Inputting into national audits, such as the FLS-DB is recommended. A set of 11 KPIs were developed by the Fracture Liaison Service Database (FLS-DB) multidisciplinary advisory group, which includes patient representation. All the KPIs are based on NICE technology assessments and guidance on osteoporosis and the Royal Osteoporosis Society (ROS) clinical standards for FLSs. The FLS should aim to deliver these KPIs as part of their service.

Tools:

Sustainability is built on comprehensive service planning with firm understanding of how the service fits within the wider healthcare environment, engagement of the right people and realistic expectations about what is achievable within a given timeframe and budget.

Collecting data so you can share the success of your service and understand how to improve it, is key. A set of 11 KPIs were developed by the Fracture Liaison Service Database (FLS-DB) multidisciplinary advisory group, which includes patient representation. All the KPIs are based on NICE technology assessments and guidance on osteoporosis and the Royal Osteoporosis Society (ROS) clinical standards for FLSs. The FLS should aim to deliver these KPIs as part of their service.

Tools:

Disclaimer:
This template is provided free as part of the FLS Implementation Toolkit by the Royal Osteoporosis Society. This template does not represent the views of the Royal Osteoporosis Society. Every effort has been made to make sure that the information contained within this document is accurate and in full compliance with UK law and with best practice at the time of writing. There is no guarantee as to the accuracy or reliability of any of the information contained in this template and use of this template is entirely at the user's risk and no liability whatsoever is accepted by the Royal Osteoporosis Society.

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