Paired Learning/Vanguard Programme
Evaluation Report
26 April 2013
1
Contents
Section 1. Introduction
Section 2. Evaluation findings
Section 3. Service improvement projects and outcomes
Section 4. Programme improvement suggestions
Appendices
Appendix 1 - Participants in the evaluation/feedback process
Appendix 2 - Interview questions
Appendix 3 - On line survey questions
2
SECTION 1 - INTRODUCTION
3
Objectives, processes and data sources for this
evaluation
Objectives
The objectives of this evaluation were set out in the original brief as follows:
‘The aim of the evaluation is to develop an understanding of the benefits and challenges of participating in the programme for the
participants, sponsors and their organisations; to learn lessons, celebrate success and to inform future leadership development
programmes in the Region’.
Evaluation process/data
The evaluation process and the findings presented in this report take into account the following elements:
•
NHS Institute for Innovation and Improvement evaluation data
•
Semi-structured telephone interviews at the end of the programme with:
– The Programme Sponsors (x2)
– The Programme Manager
– Programme facilitators from the Region (x3)
– Participants (all invited; x19 conducted)
– Project sponsors (x6)
•
An on-line survey to all participants at the end of the programme (all invited; x14 completed)
•
Review of participant assessment presentations and posters (x22)
•
Review of the assessment process and outcomes
Notes:
•
A full list of names of those interviewed and completing the on-line survey, together with the questions used are shown at
the Appendices.
•
A document containing all the participant posters is attached separately with this Report
•
Full interview notes and survey data have been provided to the Project Manager
4
Background and programme aspirations
•
•
•
•
•
The Paired Learning programme was commissioned within the overall frame of the Emerging Leaders initiative under the
sponsorship of Chris Bain, Chief Executive, Rotherham &Doncaster and South Humber NHS Foundation Trust David
Wilkinson, Postgraduate Dean, Yorkshire and Humber Deanery. Fiona Sullivan was the Project Manager
It was organised and delivered in collaboration with the Institute for Innovation and Improvement who designed and
delivered the ‘NHS Vanguard Programme’ elements. Vanguard had run successfully in 2011/12 , with six participants from
Yorkshire and the Humber involved. The programme was offered again this year and interest was expressed by both
Yorkshire and Humber and the Southern region
The integration with the ‘Paired Learning’ focus was unique to the Yorkshire and Humber programme
It arose from reflections on Emerging Leaders and was aimed at strengthening relationships and networks between
clinicians and mangers in the Region and to build leadership sills for service improvement. The intention was that a manager
and clinician ‘pair’ would work closely together on the programme - supporting each other in their project work and overall
learning
Publicity literature targeted applicants as follows:
– ‘The Yorkshire and the Humber Deanery and the Yorkshire and Humber SHA have teamed up to develop a new six
month Paired Learning Scheme to help leaders deliver service improvements. We will pair up ‘emerging leaders’ ,
circa Bands 7 and 8 manager and clinicians (circa ST5 and 6) as ‘buddies’ in order to support leadership development
and encourage collaborative work on service and quality improvement activities for the benefit of patients’.
I believe passionately in this
type of
development
Chris Bain
The aim was to build on the Vanguard
foundations – and really to strengthen our
clinician-manager relationships and
networks
Fiona Sullivan
I was very committed to the principle
of clinicians and managers working
together – as early as possible
David Wilkinson
5
Overview of the programme and its elements
•
•
•
•
•
•
The programme ran over a six month period from September 2012 to April 2013
There was a heavy emphasis on ‘virtual’ delivery – with webinars (covering service improvement themes and tools) and
Virtual Action Learning Sets delivered entirely on line
These were organised at fixed times and participants were expected to achieve a 70% attendance level
Participants met face to face at launch, assessment and final celebration events (alongside Sothern Region participants)
Participants were individually responsible for organising their project work – in conjunction with their project sponsor.
Sponsors attended an on line coaching webinar and had access to all the learning materials and sessions
Participant pairs were responsible for organising the most effective ways of working together through the programme.
One to one preparatory
discussions
Collective Events –
Launch and
Celebration
Assessment
Programme
Elements
Webinars (x9)–
pre-reading and
web resources
Virtual Action
Learning Set (x9)
Sponsored project
work
Paired learning
6
Profile of programme participants
Recruitment
•
25 participants from Yorkshire and Humber were selected for the programme drawn from a wide range of disciplines and
localities
•
Participants were paired in advance of the programme (a clinician with a manager)
•
Some pairs were proposed through the application process
•
Most were matched centrally after application – with efforts made to reflect potential common/shared interests for project
work
•
Most pairs did not working in the same organisation
•
A full list of participants and pairings is shown at Appendix 2.
Completed
•
3 participants dropped out before the final assessment process
•
The remaining 22 participants successfully completed the programme and were awarded the innovation practitioner
certificate
Awards
•
Alastair Mew, Senior Commissioning Manager, Sheffield and Laura Wakely, Vitreoretinal Fellow, York were awarded Best in
Region.
7
SECTION 2 - EVALUATION FINDINGS
8
Overall feedback from participants
Would you recommend
this programme?
YES
This evaluation aims to look at the programme in detail but it is perhaps useful to begin with the final question in both interviews and
the on-line survey asking participants it they would recommend the programme to colleagues. Of 19 participants interviewed the
overwhelming majority answered that they would recommend it – and many would do this strongly . The on-line survey data (with a
smaller response size) reflects this majority view.
Many expressed a hope that the learning from the programme can be amplified and shared widely - and a number offered support and
suggestions for doing this. But within this very positive feedback there were also improvement suggestions which are provided at
Section 4.
Interviews - Would you
recommend it?
1
Yes
18
No
It was very useful.. very
powerful…should be
commonplace…part of the
fabric…and I hope that managers
and clinicians who have been on it
take it forward…that we don’t lose
the talent developed here
On-line survey - Would you
recommend it?
2
Yes
9
No
9
Recommending the programme - comments from
participant and sponsors
Participants (x19)
•
This programme would be beneficial to people from any area; I have already recommended it to others. I hope it continues to
run
•
I would recommend this programme to middle grade, operational people. Am I glad I did it? I think so – it helped me to debate
some ideas in my own mind
•
I would definitely recommend it. A good programme. I am enthusiastic about it.
•
It should be highly recommended… I would definitely say to doctors yes its worth doing… a lot of common sense but worth
doing…I feel very, very grateful
•
I would recommend it – you can see how much effort has been put in; there is a body of learning about NHS improvement…
science behind it…methodology…you can do it in a meaningful way…make more of improvement projects; a very rewarding
experience; be good if it could continue
•
This type of training needs to be more widely available in the NHS; more about being a leader (not another ‘management’
course) - participative leadership, engaging people; Band 6 and 7 should be exposed to this kind of course; I would absolutely
recommend it
•
I would recommend it; it does all come together… a journey; I don’t know whether Public Health will have access to this sort
of programme in future?
•
I would definitely recommend it.. thought it very worthwhile.. increased my skills and confidence…good for junior doctors to
have on your CV…; I will definitely use the improvement tools to help implement change; made me aware of what motivates
people in work etc
•
I would recommend the programme – but just be aware of the time commitment
•
I have already written an article about the programme for the British Society of Rheumatologists; I think every new NHS
consultant should have to go through this. .. it is bread and butter for the role
•
I would recommend it strongly to clinicians – without hesitation – think they found it fantastic; maybe reframe for manager like
me with better matching of experience between managers and clinicians. However overall my impression has been very
positive; I have learned a lot – particularly from the challenge of my VALS facilitator
•
I would recommend this programme; I’ve done a few management programmes and thought what was that all about? This
time I’ve come away with models I’m using… I’m actually quoting things …. readings etc
•
I would certainly recommend it to others – but make sure they understand the time commitment – was a bit of a struggle
juggling childcare to make sure I could attend
10
Recommending the programme - comments from
participants and sponsors (cont)
•
I would recommend the programme but make sure you understand the time commitment; I would really like there to be a
VALS in this region – keep something going
•
I would recommend it to others; in fact we are going to try and run a type of programme with junior doctors in my area – got
the backing of the Trust Improvement Team; running short lunch time improvement sessions to give people tools and
approaches; then going to give them projects and I will help and guide them with these; if this works well then I’m sure other
Directorate Managers will be interested to do something like it too
•
I would recommend it – with the caveats for improvement
•
I would definitely recommend it; I’m the trainee rep from Yorkshire on the Royal College of Physicians training committee;
happy to help in any way I can; I hope it happens again
•
I absolutely would recommend the programme; I think the pitching is pretty good; do people know it exists? how to keep the
profile going ?
•
I would still have opted to go on it (even though did not complete) …very well pitched in terms of what the NHS needs to do
….value for money, improvement, quality
Sponsors (x4)
•
I would love for it to continue ; it would be a real shame if it falls by the wayside… it has been really helpful for her and for
the team
•
I think it has been well received
•
I think this programme is a wonderful gift for clinical trainees and I would recommend it . If you do it (centrally) that would
be fantastic… but if not we would do it locally … I am willing to help push it forward as a ‘link person’ … there may be ways
the Deanery can channel funding to this?
•
I would recommend it – definitely there is value in the tools and techniques it exposes them too ; but be careful with
expectations of delivering an ‘earth shattering’ project in this time frame
•
I really think this should be pushed more for consultants …they come into the role with very little idea of how things work or
how to change things…. They are used to working in clinical teams but don’t know the intricacies of how to get other people
motivated.. how managers work
•
Yes I would recommend this programme – it should have a future; I hope it is not another NHS ‘good idea’ then we never see
it again; I think it is really valuable for someone who is newly appointed to a senior manager role – I would certainly
recommend the Vanguard model
11
Overall usefulness and benefits of the programme
On-line survey - Usefulness of the
programme?
Not useful
0
The online survey indicated that the majority rated the programme as very useful
or useful. No one thought it had not been useful.
The interviews explored the specific benefits which participants felt the
programme had brought. These typically fell under three major headings:
3
6
2
Tools to use on this project and beyond:
•
Helped to push projects forward
•
Relevant to day to day work
•
Sustainable learning because putting it to
use
•
Practical and useful resources to go back to
•
Understanding the people issues of projects
•
‘My project developed more in the last 6
months than it had in the last 3years’
Somewhat
useful
Useful
Very useful
Personal development:
• Building confidence
• Stepping back and reflecting
• Space to explore issues
• Being challenged in the VALS
• Tough managing the time commitment
• The amount covered in 6 months
• ‘Glad I did it’
Relationships and networks:
•
Access to other perspectives
•
Sharing ideas
•
Hearing about other people’s projects
•
Great support from the VALS
•
Understanding the NHS structure better
•
Having a sponsor to give access to the system
12
Impact on areas of work
Given the focus of the programme on building relationships, working in teams and across boundaries, the on-line survey invited
ratings of the programme’s impact in a number of specific areas. Responses on the chart below show that areas of greatest impact
were:
• Clinician-manager partnerships
• Working in a team
• Initiating projects
• Project managing
Areas of lowest impact were understanding hierarchies and commissioning which may reflect the organisational turbulence at the
time of the programme.
14
Impact on areas of work
12
10
8
6
4
2
Outstanding impact
Significant impact
Some impact
No impact
0
13
Feedback on the webinars
Seminar 1
Seminar
Focus area
Highly effective
1
The NHS Change Model
2
Sustainability
3
Measurement for improvement
4
Innovation and creativity in practice
5
Creating contagious commitment (1)
6
Creating contagious commitment (2)
7
Demand and capacity
8
Human dimensions of change
9
Mindset for change
Effective
Somewhat
effective
I was sceptical about the whole
management thing - overdoing
common sense; as the programme
went on I became more and more
convinced of the importance
the teaching
was
inspirational
• The interviews, on-line survey and Institute evaluation information show that the majority of participants valued the webinars but varied
in their views on the most useful content areas - with needs, interests and relevance to project work varying across the group.
• Some participants (particularly the more experienced managers) were familiar with the NHS Change Model and associated innovation
approaches and tools and saw the webinars as an opportunity to refresh their knowledge. By contrast, all the material was new to some
of the clinician participants .
• A number of interviewees commented on the value of hearing Helen Bevan at seminar 1 . The Institute’s evaluation survey data on this
seminar completed by 11 Yorkshire and Humber participants appears to reinforce this (chart above); Julia Taylor on Creating Contagious
Commitment was also commended by a number of interviewees
• Participants were very impressed with the quality of the resources made available to them - ‘great reading materials’; ‘access to experts’;
‘a privilege’
• A small minority of interviewees thought the webinars were too long (1.5 hours) with duplication/repetition of pre-reading
• One participant valued the passion of the presenters but was wary of over-deference to a single approach to service improvement
14
Feedback on the VALS
Almost all of those interviewed commented that the VALS was a key strength of the programme – well facilitated and offering fresh
perspectives, support and encouragement.
Seeing clearly some of the
hostility between doctors
and managers
I thought the VALS were
the best aspect – very
supportive
I was very encouraged by
my group - brought a range
of perspectives – like a
breath of fresh air
The VALS was really
beneficial – everyone
had ‘air time’ but
using a structured
questioning process
The VALS was brilliant ; I’m a bit gung
ho so the VALS was really good at
giving other perspectives..
sometimes better to hold back a
bit…a nice diverse mix of clinicians
and commissioners
There was an absolutely
wonderful moment towards the
end when a girl who was sceptical
at the outset had done a fantastic
project… came out of herself…
there was real excitement in the
group… a highlight
I would state my challenges and
they would give an impartial view;
give ideas – pity but we are not
continuing to meet
Sometimes I wanted ideas to make my
project more effective; but more
importantly I got to hear about other
projects – and understand them
VALS worked well; a
very good facilitator
VALS – a great bunch
of people;
great facilitation –
could have been a
nightmare!
A really good VALS facilitator she made
me do stuff; challenged my approach;
some deep learning; made me reflect on
how I approach things
VALS group rallied round if
you were struggling with
your project; used good
questioning; also offered
suggestions and tools from
their experience
15
Feedback on the paired learning element
•
•
•
•
•
•
The paired learning element divided opinion amongst participants
A few saw it is one of the strengths of the programme offering a source of support for project ideas and general
encouragement
However many felt the time commitment from other elements of the programme was already intense and because the
VALS gave regular access to a clinician-manager network and project challenge/support many participants could not see the
added-value in the paired learning element for the further time pressure it created
For those paired with someone in another organisation the practicalities of finding time to meet were an inhibitor –
although most made contact by phone and e mail
There was also felt to be less guidance and structure than for other aspects of the programme; and some participants were
confused because members of their VALS (from Southern region) were not paired
Higher satisfaction with the paired learning element came where there was a good ‘bond’ of shared interest within the pair
- eg working in the same organisation or on a similar project. Here it was felt that strong relationships were established.
Definitely paired learning was
a useful part of the
programme – but we both
work part time so hard to
carve out time together
The paired element was a
bit of a funny one - not
really sure what we were
supposed to do
Idea was great but in reality I
got most help from my
sponsor ; you are so busy with
your day job, the programme
and the project that you just
don’t have time to help
someone else out
He helped me when I was
having a problem with
commissioners on my
project
Pairs are critical to the
programme … can’t have
doctors who do everything
alone…can’t have managers
who do everything alone…
Maybe the success of pairing
depends on having shared
ground with your partner
We never really found the time
to work together as a pair;
we met in the VALS and got on
well but not outside it
I suppose you get out
of it what you put in
and we might have
made more effort
16
Assessment process and outcomes
•
•
•
•
•
The final assessment of the programme was based on a number of elements:
– a 10 minute powerpoint presentation to demonstrate programme learning linked to the service improvement project.
(assessment criteria were set out in detail as shown on the table below)
– a poster summarising the learning from the programme and its application
– 70% attendance at webinars and VALS sessions
All 22 participants successfully passed (with one required to re-present) and were awarded the innovation practitioner
certificate
Most of interviewees felt that the assessment process was clear and fair
One felt the process was weighted against those without previous experience of presenting in this way, that 10 minutes was a
very short time to present on hundreds of hours of project activity and that the pass/fail approach was inappropriate for a
programme that does not have external accreditation
A manager who passed the first presentation thought the process could have been more rigorous
The assessment criteria for the presentation were clearly set out eg…
The primary purpose of the presentation is the certification of the emerging leader. However,
sponsor attendance (not to co-present but to observe) at this presentation would support
engagement and demonstrate the partnership nature of the programme, and at the end of the
presentation questions may be put to sponsors to explore their assessment criteria.
I can’t say I enjoyed it but
it was good to be clear
what was expected
Is the purpose of the business critical project clear? Is the aim well defined and described, e.g.
What by When? (3) Alignment with QIPP (3) Is onward sharing of learning included to
demonstrate the spread of this learning beyond the pair to a wider audience with specific
actions. (2)
This slides demonstrates the transfer of learning into practice… The 5 areas demonstrated
should be taken from the 9 web seminars. Assessment criteria includes: Have at least 5 elements
of the NHS Vanguard programme curriculum been highlighted in relation to transfer to practice ?
Your business critical project outcomes will be summarised here. Assessment criteria include:
Project achieved planned goals? Project success is not necessary to attain marks in this section.
Clear evidence that the project has progressed within the lifespan of the project. (4) Have either
goals been achieved or If goals have not be achieved what learning has been shared, or
anticipated date of achievement clear (4)
17
Feedback on programme practicalities and quality
•
•
•
•
•
•
•
Most participants welcomed the virtual nature of much of the programme and the travel time this saved
Where technical problems were encountered support was available to sort things quickly
The chat facility on the webinars was not widely used although it was noted by a number of participants that this gave
the opportunity to raise issues live if you wished to
Participants were generally very complimentary about the quality of resources, support and administration
However a number of participants commented on the volume of e mails and big attachments which were sent out
One interviewee felt it was ‘over-administered’
One project sponsor questioned the cost of providing all the materials to him in hard copy
I would like to say the resources
available – slides, seminars,
information were fantastic,
amazing
You could do all
this without
leaving your office
I loved the virtual part
of it … very cost
effective… you can
develop a relationship
using a webcam!
18
SECTION 3 - SERVICE IMPROVEMENT
PROJECTS AND OUTCOMES
19
Overview of the project work and sponsor role
Project progress
•
Many interviewees commented on the value that the programme brought to their service improvement project by:
– bringing focus and attention to the way they were approaching their project work
– offering tools and theories for practical application
– bringing new ideas and challenge from the members of the VALS group and pairings
– strengthening relationships with the sponsor
•
For a number of participants this meant that their project progressed faster and more effectively than they believe would have
been the case without the programme
The role of the sponsor (participant perspective)
•
The majority of interviewees commented positively on the support they received from their sponsor – although the level of their
input varied some meeting weekly whilst others less frequently
•
For many the sponsor was already the line manager working closely on the project - but the programme brought additional focus
to the project review and learning activity
The programme allowed more reflective time together than we would have in our normal line
management relationship. I used to go behind her to meetings. But after the first project meeting she
said she couldn’t make the next one … she wanted me to go on my own… the programme allowed this
to happen
The role of the sponsor (sponsor perspective)
•
The sponsors valued the structure offered by the programme, the tools offered and relevance to the project work
•
They generally agreed that that the programme had significantly increased the confidence and skills of the participant in their
project activity and increased their understanding of the system as a whole
•
As sponsors they valued the development offer available:
– For their coaching role
– Giving them access to all the webinar materials
•
But In reality sponsors did not have time to attend many of these
The following pages give a summary of the projects undertaken and what has been achieved to date. All of the project posters are20
provided as an attachment to this report.
Improvement projects and outcomes to date (1)
Participant
Project overview/aims
Outcomes
Ian Anderson Specialist Neurosurgical
Registrar, Leeds
Reducing the number of last
minute cancelled operations in
neurosurgery
•
•
•
•
Early improvements in LMCO rates
More patients discharged before 11am bed meeting
More patients receive appropriate paperwork
Initial pathway created with A&E and radiology for MRI of patients who
may not need admission
Morna Cooke Senior Commissioning
Manager, Wakefield
Children’s specialist equipment
– improving budget
management , patient
experience and outcomes
•
•
•
•
Actual spend below budget
Faster supply; better meeting patient needs
Improved maintenance
Improved staff engagement with the issues; less wasted time
Gemma Cuss –
Ophthalmology
Directorate Manager,
York
Integrated Vitreoretinal
pathway - quality for patients
through services closer to
home; reduced cost; increased
income from improved coding
• Reduced waiting times through increased capacity. One attendance
reduced per patient to allow capacity for more patients
• Patient satisfaction – patients report that although prepared to travel
for surgery they want outpatient appointments close to home.
• Reduced cost of the service by £67 per patient ; reduced dependence
on Locums costing £200 more per session
Srilatha Dampetla – ST 5
Endocrinology,
Scarborough
Transitional Clinic for young
people with diabetes moving to
the Adult Clinic to ensure a
smooth process
• Full team working together from beginning of March
• Due for audit after 12 months to compare results
Sarah Dawson Service Manager
Planned and Unplanned
Care, NE Lincs
Urgent Care Dashboard support GPs to use the
information to proactively
manage patients accessing
urgent care services; share best
practice; develop further
• All GP practices have access and have received training
• Development of the Urgent Care Dashboard based on practice
feedback
• Development of best practice
• Improved care for patients where the information is used and acted
upon
• Clinical Lead needed for sustainability
21
Improvement projects and outcomes to date (2)
Participant
Project overview/aims
Outcomes
Nikki Dunlop –
Commissioning
Manager, Hull
Align GP practices with care
homes and introduce a
proactive approach to support
management of Long Term
Conditions and contribute to
reduction in emergency
admissions
• Real engagement from the GP Practices along with a commitment to
provide clinical input into the service
• A joint forum with representatives from Care Homes, Local Authority
and in the future GPs
• Support from the Community Geriatricians to be a part of the project
• Consultation and engagement with the LMC
• Developed networks with other areas and shared good practice
• Next steps to finalise the Local Enhanced Service and to roll out across
the GP Practices in April 2013
Tom Hall – StR in Public
Health, East Riding
Develop and implement a
structure and process for
discharging the new public
health responsibilities of
East Riding of Yorkshire Council
•
•
•
•
•
•
A vision for Public Health developed and owned by staff
Team leading and driving commissioning
Services based on outcomes
Vision articulated to the Council
Public health processes adapting to the Council’s structure
Freedom of direction
Angela Harris - Lead
Nurse Urgent Care, YAS
High quality care at end of life –
improve paramedic knowledge
of EOL; reduce 999 calls and
emergency admission; share
best practice
•
•
•
•
•
Presented at national /regional ambulance service networks
Questionnaire to paramedics; focus groups in care homes
EOL training package developed; in stat man from April
Working with CCGs
Reduced number of call s from selected care homes
Gemma Hayden Project Lead
Communication
Partners, Rotherham
To improve NHS services
for people living with LTC
by working with volunteers –
empower patients; more for
less; get rid of NHS revolving
door; influence future of
volunteering so part of NHS
community teams
• Reduce visits required from AHP and other NHS services
• Client maintains and even improves health and wellbeing when rehab
complete
• NHS Vanguard produces booklet about project
• Other NHS services adopting innovations
Improvement projects and outcomes to date (3)
Participant
Project overview/aims
Outcomes
Siobhan Horsley Health Improvement
Practitioner (Maternal
and Infant Health),
Sheffield
To define a public health
approach to support reduction
in A&E attendance by 0-5 year
olds
• Multi-agency stakeholder event defined common purpose
• Enhanced approach to provision of Common Childhood Conditions
information
• Communications plan to support self-care and access to health visitor
or GP for common childhood conditions: targeted at general
population, parents and health professionals
• Use of data for planning clear actions for community provision;
planned analysis of A&E attendance trends by GP practice; better
unity of research projects
Ambreen Kalhoro Specialty Trainee,
Bradford
Using virtual clinics for low-risk
diabetic retinopathy patients –
reduce patient waiting; realise
staff potential; meet Trust
objectives
•
•
•
•
Victoria MacFarlane Business Manager
Cardiac surgery
& Neurosurgery, Leeds
Reduce the number of last
minute cancelled operations in
neurosurgery - Improve theatre
scheduling; prevent late starts
in theatres; prompt patient
discharges; prevent
inappropriate admissions
• Theatre scheduling now two weeks in advance – aim for three; more
notice for patients.
• Start first case in theatres leading to better use of theatres and fewer
cancellations due to no theatre time
• Inpatient Flow project started – better discharge planning and
escalation of delays
• Number of Last Minute Cancelled Ops remained stable despite bed
reduction
Tony Margetts –
Substance Misuse
Manager, East Riding
Drugs and alcohol
commissioning moves to public
health - cost effective, evidence
based services; continuity of
service
• Understanding of the change and commitment of stakeholders
retained strong and weak ties
• Services have continued “steady hand at the tiller”
• Opportunities and developments taken during transition
• In a position to move forward to make improvements and develop
new services
Reduced wait time
Engaged staff to run pilots
Gained organisational support for large scale change
Built team commitment for longer term implementation
Improvement projects and outcomes to date (4)
Participant
Project
Outcomes
Alastair Mew - Senior
Commissioning Manager,
Sheffield
Develop foot and ankle surgical
pathways to maximise the use
of an award winning
community based clinical
podiatric surgery unit
The new pathway ensures:
• Equity of care
• Evidence based best practice is followed
• Conservative treatments are trialled where appropriate
• Wherever clinically appropriate care takes place closer to home in a
community setting
• Patients can move seamlessly between community and secondary
care as best meets their individual clinical needs
Mani Nallasivan- SpR
Rheumatology, Hull and
East Yorkshire
Commissioning a new early
Psoriatic Arthritis clinic in Hull
• Pathway meeting and CCG discussion- 20 members
• Collaborative partnership-NHS commissioning Board
• Trust agreed this initiative- 8th Feb
Yasir Parviz – SpR
Cardiology, Sheffield
Repatriation of patients from
tertiary cardiology centre
•
•
•
•
•
Muhammad Riaz -SpR
Anaesthetics, Hull and East
Yorkshire
Quality, patient experience and
cost improvement in Surgical
Admissions Lounge
• High quality standard information given to the patient well in
advance
• 600 – 800 minutes of nursing time saved equivalent to 1-1.5
nurse/day (£21,176 - £40,157 /yr)
• Reduced incidence of DVT, pressure sores, falls etc
• Increased number of smoking cessation referral's (1/day at present)
Keir Shillaker - Head of
Planning, Bradford
Prioritizing Capital
Developments - to develop a
tool that can be used by BTHFT
to assess and prioritise capital
funded developments in a
meaningful way
•
•
•
•
•
•
•
Repatriate patients within 24hours
Maximise beds
Improve service – waiting times; readmissions
Low mortality
Cost effectiveness
Prioritisation of resources – better decisions – developed:
Capital Project Group
Risk Assessment Framework
2 Year Capital Process
Strategic outline proforma
Reduces wasted time & ‘toing and froing’
…Then rolled out to IT and Estates
24
Participant projects and outcomes to date (5)
Participant
Project
Outcomes
Sachin Thakur - ST6
Acute Medicine, Hull
and East Yorkshire
To implement the pneumonia
care bundle in order to reduce
mortality by start of 2013
• Successfully implemented in A&E
• Ongoing implementation in AMU
• Ongoing audit to measure baseline and reaudit to measure
improvement
• Sustainability model to ensure continued success of the project
Laura Wakely Vitreoretinal Fellow ,
Service improvement in
Vitreoretinal Surgery
• Clinic waiting times calculator and patient questionnaire emailed
to whole department (50)
• Departmental teaching session (20) on using operating note
templates – all eye consultants accredited for access and
partnered by junior doctor for ongoing support
• Management tools uploaded to hospital intranet (500) for
dissemination in the context of future local leadership training
James West Paediatric Registrar,
Doncaster
Improving patient / parent
satisfaction in Paediatric
Outpatients – reduce DNAs
• Questionnaire to assess satisfaction
• Identified process breakdown areas
• Improve appointment reminder service; surge in follow-up
appointments
• Results fed back to staff
Adnan Zahid – Project
Manager, YAS
Implement risk data
management system across
Yorkshire Ambulance Service
•
•
•
•
•
•
York
Developed culture of learning, feedback and openness
Half of users are trained
Sustainability of training through e learning package
Robust process to ensure data quality and integrity
More codes to capture clinical incidents and near misses
Remove time consuming redundant processes; single database
25
SECTION 4 - PROGRAMME
IMPROVEMENT SUGGESTIONS
26
Improvement suggestions/future programmes
Communication and targeting:
•
•
•
•
Communicate more clearly about the actual time commitment (an overwhelming view) so that participants realise that
whilst it is largely ‘virtual’ the timings of session are fixed
Allow a longer lead time for the application process to help people plan the time commitment
Target clinician/manager pairs from the same organisation/project area to improve the effectiveness of this element
Encourage early career participation for clinicians
Delivery:
•
•
•
•
Timing of webinars mid-Wednesday not ideal for clinicians – general preference to run things early or late in the day
Webinars 5 and 6 both on Creating Contagious Commitment could be combined
Reduce the number of VALS
The above time reductions could increase time available for the paired learning element
Content:
•
•
•
Tailor content to the different learning needs of clinicians who may never have come across the webinar material before v
experienced managers who may be very familiar
Include More input from practising NHS Trust leaders/senior managers
Include stronger review of the paired learning element at the final assessment
Administration:
•
Reduce the number of e mails
Offers of support for future programmes:
•
•
A number of interviewees (participants and sponsors) made offers of support to keep a programme of this kind running
Some are already sharing learning locally - or are considering ways of doing this
27
What future for the programme?
28
APPENDICES
29
Appendix 1 – Participants in the evaluation/feedback
process
Name and involvement
Name and involvement
Programme Sponsors (interviewed)
Chris Bain, Chief Executive, Rotherham &Doncaster and South Humber NHS
Foundation Trust
David Wilkinson, Postgraduate Dean, Yorkshire and Humber Deanery
Programme Participants (on-line survey)
Ian Anderson - Specialist Neurosurgical Registrar, Leeds
Morna Cooke - Senior Commissioning Manager, Wakefield
Gemma Cuss - Ophthalmology Directorate Manager, York
Sarah Dawson - Service Manager Planned and Unplanned Care, NE Lincs
Nikki Dunlop - Commissioning Manager, Hull
Tom Hall - StR in Public Health, East Riding
Gemma Hayden - Project Lead Communication Partners, Rotherham
Ambreen Kalhoro - Specialty Trainee, Bradford
Lynn Kerry, Commissioning Manager Hull CCG (did not complete programme)
Victoria MacFarlane - Business Manager Cardiac surgery & Neurosurgery, Leeds
Tony Margetts, Substance Misuse Manager, East Riding of Yorks Council
Alastair Mew - Senior Commissioning Manager, Sheffield
Mani Nallasivan - SpR Rheumatology, Hull and East Yorkshire
Muhammad Riaz - SpR Anaesthetics, Hull and East Yorkshire
Programme Manager (interviewed)
Fiona Sullivan – NHS Yorkshire and Humber
Programme Facilitators (interviewed)
Carol Borrill, Head of Organisational Psychology/OD, Sheffield
Claire Hannon, HR Operations Manager, Bradford
Paul Hughes , e learning Manager, Leeds
Programme Participants (interviewed)
Morna Cooke - Senior Commissioning Manager, Wakefield
Gemma Cuss - Ophthalmology Directorate Manager, York
Srilatha Dampetla - ST 5 Endocrinology, Scarborough
Sarah Dawson - Service Manager Planned and Unplanned Care, NE Lincs
Nikki Dunlop - Commissioning Manager, Hull
Tom Hall - StR in Public Health, East Riding
Angela Harris - Lead Nurse Urgent Care, Yorkshire Ambulance Service
Gemma Hayden - Project Lead Communication Partners, Rotherham
Siobhan Horsley - Health Improvement Practitioner , Sheffield
Ambreen Kalhoro - Specialty Trainee, Bradford
Jim Khambatta – Snr Commissioning Mgr, N Yorks (did not complete programme)
Victoria MacFarlane - Business Manager Cardiac surgery & Neurosurgery, Leeds
Alastair Mew - Senior Commissioning Manager, Sheffield
Mani Nallasivan - SpR Rheumatology, Hull and East Yorkshire
Muhammad Riaz - SpR Anaesthetics, Hull and East Yorkshire
Keir Shillaker - Head of Planning, Bradford Teaching Hospitals
Sachin Thakur - ST6 Acute Medicine, Hull and East Yorkshire
Laura Wakely - Vitreoretinal Fellow , York
James West - Paediatric Registrar, Doncaster
Participants who were invited but did not respond to this evaluation (either
interview or on-line)
Yasir Parviz - SpR, Cardiology, Sheffield Teaching Hospitals
Adnan Zahid – Project Manager, Yorkshire Ambulance Service
Kerry Lynn - Commissioning Manager Hull CCG (did not complete programme)
Mohit Sharma - ST6 Acute Medicine Sheffield Teaching Hospitals (did not
complete programme)
Sponsors for participant projects (interviewed)
Ian Carr, Head of Chidren’s Integrated Services, Wakefield
Dr McMurray, GP and CCG Medical Director,
Dr Ganesh Gopalakrishnan , Consultant Anaesthetist
Paul Harriman, Development Manager, Sheffield
Dr Elaine Baguley, Consultant
Dr Julian Mark, Medical Director, YAS
30
Appendix 2 – Participant pairings
Name and role
Name and role
Morna Cooke - Senior Commissioning Manager, Wakefield
Gemma Hayden - Project Lead Communication Partners, Rotherham
Alastair Mew - Senior Commissioning Manager, Sheffield CCG
Mani Nallasivan - SpR Rheumatology, Hull and East Yorkshire
Gemma Cuss - Ophthalmology Directorate Manager, York
Laura Wakely - Vitreoretinal Fellow , York
Muhammad Riaz - SpR Anaesthetics, Hull and East Yorkshire
Adnan Zahid – Project Manager, Yorkshire Ambulance Service
Srilatha Dampetla - ST 5 Endocrinology, Scarborough
Jim Khambatta – Senior Commissioning Manager, N Yorks and York
cluster (did not complete programme)
Keir Shillaker - Head of Planning, Bradford Teaching Hospitals
Yasir Parviz, - SpR, Cardiology, Sheffield Teaching Hospitals
Sarah Dawson - Service Manager Planned and Unplanned Care, NE
Lincs
Sachin Thakur - ST6 Acute Medicine, Hull and East Yorkshire
Kerry Lynn - Commissioning Manager Hull CCG (did not complete programme)
Mohit Sharma - ST6 Acute Medicine Sheffield Teaching Hospitals (did not
complete programme)
Nikki Dunlop - Commissioning Manager, Hull
Angela Harris - Lead Nurse Urgent Care, Yorkshire Ambulance Service
Tom Hall - StR in Public Health, North Yorkshire CC
Tony Margetts, Substance Misuse Manager, East Riding of Yorks Council
Siobhan Horsley - Health Improvement Practitioner , Sheffield
James West - Paediatric Registrar, Doncaster
Victoria MacFarlane - Business Manager Cardiac surgery & Neurosurgery,
Leeds
Ian Anderson - Specialist Neurosurgical Registrar, Leeds
Ambreen Kalhoro - Specialty Trainee, Bradford
31
Appendix 3 - Interview questions
Overall benefits/impact of the programme
•
What do you see as the main benefits of this programme
– For you?
– For your organisation?
•
How have you changed your practice as a result of the programme?
•
How has the programme enabled this change?
•
What are the key pieces of learning you will take away from the programme?
•
How will you continue to apply these now the progamme is over?
Approach/ format of the programme
•
(NB You are asked on the on line questionnaire to rate the effectiveness of each element of the programme but I would like to
explore in more depth the overall strengths, weaknesses and suggestions for improvement)
•
What are the challenges of participating in this programme for
– The individual?
– Their organisation?
•
What do you see as the particular strengths of this programme?
•
And the weaknesses?
•
How effective have the various elements of the programme been?
– Most useful? Why
– Least useful? Why?
•
What could be done in the future to improve the progamme/minimise the weaknesses?
Relationships – Paired learning; mixed-group learning; sponsorship
•
What have been the benefits of participating in a programme with a group of professionals from mixed disciplines?
•
What have been the benefits of being paired with a professional from a different discipline to your own?
•
What have been the benefits of being on a programme with someone involved in your project?
•
Any suggestions for making the paired learning relationship more effective?
•
How has your sponsor been involved?
•
What have been the benefits of having a sponsor?
•
Any other comments/suggestions for improvement
32
Appendix 4 – On line survey questions
Reflecting on your experiences of the programme, please rate the impact it has had on how prepared you feel in each of the
areas of work below (1=No impact; 2=Some impact; 3=Significant impact; 4=Outstanding impact)
•
Working alongside senior management colleagues
•
Working alongside clinical colleagues
•
Working in clinician-manager partnerships
•
Working in a team to deliver a service
•
Communicating with all members of my department
•
Communicating with all stakeholders
•
Leading multi-professional teams to improve services
•
Developing a business case to support a development plan
•
Initiating a project (gaining commitment) to improve local services
•
Project managing a quality improvement initiative
•
Measuring outcomes of projects
•
Understanding how management decisions are made
•
Understanding the professional hierarchies within clinical teams
•
Understanding how services are commissioned and funded
Please tell us the most useful/essential webinar topics of the programme
Please tell us any improvement suggestions you have for any element of the programme
33