Bone Abstracts

Background: FLSs are multidisciplinary services designed to identify, assess, treat and monitor adults aged 50 years and over, who sustain low-trauma fractures after a fall, to reduce their risk of another fracture. There is significant variability in Key Performance Indicators (KPIs) used to inform data-driven service improvement between FLSs in England and Wales, UK. The aim of this study was to understand the lived experiences and key organisational factors of FLSs for patients receiving care and for staff providing care.

Methods: This study was informed by Heideggerian Phenomenology. Qualitative interviews were undertaken with 18 multidisciplinary healthcare professionals and seven patients between April and August 2024, from 8 FLSs in England participating in the FLS-DB national audit. To capture a breadth of data, FLS sites had varying KPI scores. Reflexive thematic analysis was used to identify codes and themes.

Results: Patients described their vulnerability and the impact of fracture and osteoporosis on their lives. Staff identified 3 themes: leading, being part of a team, and being progressive. Leading was a creative process of sourcing funding, utilising resources, sustaining progress and striving to improve the quality of the service. Being progressive included digital optimisation of the FLS pathway. Existing FLS-DB KPIs were helpful, but progress was constrained by local organisational factors.

Conclusion: Specific themes raised by the patients around vulnerability should be incorporated into the basic FLS management pathway. Leading was identified as a major predictor of FLS performance, but there are currently no FLS resources that support this beyond the FFN competency framework checklist. Support for developing leaders within FLSs should be prioritised as a key step to improving FLS performance.