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Active Hospitals

Find opportunities

Understanding the realities of specific conditions and the journey that patients with those conditions take through services can help to identify opportunities to promote more activity.

What is the issue?

Click on the boxes below to explore the issues highlighted by staff in the Active Hospitals pilot project

It makes sense to focus your efforts

Ideally, every interaction a patient has with the health service would be an opportunity to talk about physical activity.

‘When you go to pick up your prescription at the pharmacy the pharmacist says, here’s a leaflet about physical activity. When you go and see your GP, they remind you. When you’re in hospital we have that chat. If you’re having your outpatient appointment, the clinicians there have that discussion as well. And the more times people start to have those conversations, I think the more patients will think about it.’ Consultant

In reality, we have to focus our efforts. With limited resources, attempting to change too much at once might be unsuccessful. It also makes sense to focus on patients who stand to gain most from becoming more active.

“I think it should happen everywhere. But I think there are certain populations that really would benefit more.” Outpatient Physio

Patients aren’t always open to change

It is important to recognise that there are times when patients are more or less open to a conversation about their physical activity behaviour. Sometimes patients aren’t ready for this conversation because they’re already at risk of information overload, their immediate priorities are elsewhere, they’re dealing with powerful emotions,  they are coming to terms with new identities, or because they are too unwell.

“The patient has to hear a bunch of things. And what is most likely to get heard is what is relevant to their agenda. So, a patient’s willingness to hear advice about movement is related to whether or not it’s relevant to their issue right now.”  Consultant

“There’s the body image side of it too… where they want to do it but are thinking: I don’t want anybody to see me in a swimsuit or gym wear, or, I don’t want people to stare at me. ”  Outpatient Physio

“They’re not at their normal yet. We’re catching them at this point where they’re trying to rehabilitate and get back to a place where they’re at a point where they are ready to then increase their physical activity.”  Physiotherapy Assistant.

“If you do raise the subject of physical activity, they can be very, very angry about that. You know, I’m telling you I’m in agony and you’re telling me to do more.”  Rheumatology ANP

“You’ve got to remember that they’ve gone into that session, having not necessarily been diabetic for very long and they say, oh okay so I’ve got to do finger-pricking, now I’ve got to count my carbohydrates. Oh, now you’re telling me I’ve got to do exercise too? It’s really overwhelming.”  Research Midwife

It makes sense to identify times when patients might be more open to consider changing their behaviour.

“It definitely is relevant where people are more well, you’re thinking about discharging them soon and helping to get them towards that point.” Foundation Doctor

Staff aren’t always around at the right moments

In services with a rapid throughput, for example, opportunities may be limited – especially if those services are dealing with patients at times when they may be least open to conversations about physical activity.

“Is this the right time to say: Have you looked at the amount of physical activity in your life? Quite honestly, I think they might tell you where to go. When they’re under such huge stress at that point in time. Really, the first thing is survival and then it’s getting home to see loved ones. And just being able to function and do the things in life that they really need to do.” Outpatient Physio

“You say, yes, that’s the perfect person to get going a bit more… but before even we realise, within a day or two, the person is discharged back home.” Acute General Medicine Physiotherapist

Within a team, too, some staff may have less opportunity than others to  have a conversation around moving more as they see patients for a limited time.

“It’s easy for us to tell them they need to do something. You can do that in three seconds. But for it to be switched around and for them to say: I need to do this – you need much longer. You can’t do that in a couple of minutes.” Research Midwife


“Where do we best capture patients: is it before they have surgery? is it when they’re in? or is it a bit further on?”

Inpatient Physio

What does this mean in practice?

You may find some of the following suggestions helpful

Talk to staff

Offer staff the space, time and the opportunity to think creatively. They are often best placed to identify where changes could be made in the services they help to deliver.

The Insight How to guide (below) provides some suggestions about how to organise this.

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Encourage staff to challenge their own preconceptions

While staff are well placed to identify moments of opportunity, they may also sometimes see the world from inside the barriers they face. There can be value in exploring whether it’s really true that patients aren’t open or that staff don’t have time.

“You’re right, they don’t feel like running a mile. But what I have found, to my surprise, is that they’ve been really happy to engage in a conversation along the lines of: I know it’s not where you are right now, but if we can think about your physical activity, where can you see you might be in a couple of months’ time? And I’ve found those conversations have gone really well. I was expecting a bit of a kickback such as ‘I don’t want to talk about it’ and ‘I just absolutely don’t feel like it’, but I’ve not been getting that. In fact, I’ve been getting the opposite. People saying, ‘Yes, I’d really like to’ or ‘I want to. And the sorts of things I’d like to get back to are….’. Inpatient Physio

 “I was thinking of returning him to his usual activities. Now he’s interested in something which I might not have thought of before. And because you see that happen, you think: Just because this person is 89 doesn’t mean that they won’t be interested in exercise class. Let’s give it a go next time.”  Outpatient Physio

Encouraging staff to challenge their own preconceptions may also mean addressing some of the other barriers that they face.

Reframe the question

Behaviour change is more likely to be the product of many conversations, and many factors, over a period of time.

The reasons why people don’t engage with physical activity are complex and take quite a long time to unravel.” Consultant

Perhaps we should ask  “What opportunity do we have in this moment?” – bearing in mind that that opportunity might be no more than setting up another conversation at a more appropriate moment.

“On a trauma ward, now isn’t the time to talk about their general exercise. But maybe it’s something that could be brought more to the forefront of people’s minds in those acute settings. So that they’re thinking not just: this patient’s goal is to return to football because that’s something they did before and that’s where they want to get to. But: this person maybe struggled a little bit with their care post-surgery because they have a slightly higher BMI. And if it’s more in the forefront of people’s minds to initiate that, they would put it in as part of the goals for the rehab that you’re referring them on to.” Outpatient Physio 

Insight ‘How to’ guide

Download this step-by-step guide to completing your own insight conversations