UniS
Improving Healthcare through
Work-Based Learning:
Practice Development Facilitators
In Surrey and Sussex
Report
Centre for Research in Nursing and Midwifery Education
European Institute of Health and Medical Sciences
Submitted By:
Larsen JA, Rhodes A, Colliety P, Ryle S, Smith P, Volante, M
Content list
1. Executive summary...................................................................................... 4
2. The introduction and development of the PDF role ...................................... 5
3. The PDF role................................................................................................ 8
3.1 Key characteristics ................................................................................. 8
3.2 Variation: meeting Trusts’ needs ............................................................ 9
3.3 Competency requirements, education and experience ........................ 10
4. Accredited Work-Based Learning .............................................................. 12
4.1 The EIHMS pilot module ...................................................................... 12
4.2 The pilot programmes .......................................................................... 13
4.3 Outcomes: learning, practice and patient care ..................................... 16
5. A sustainable framework: recommendations ............................................. 18
5.1 Trust support ........................................................................................ 18
5.2 University support................................................................................. 19
5.3 Practice development partnerships ...................................................... 21
References .................................................................................................... 24
Appendices are found on the CD-ROM included in this report:
A
PDFs’ Activity Reports
B
EIHMS Handbook for AWBL pilot module: Using Work-based Learning
to Enhance Practice, Level 2
C
EIHMS Handbook for AWBL pilot module: Using Work-based Learning
to Enhance Practice, Level 3
D
AWBL pilot programme: Rehabilitation and Promoting Independence
for Older People, levels 2 and 3 (The East Surrey Primary Care Trust)
E
AWBL pilot programme: Managing the Acutely Ill Patient on a Ward,
levels 2 and 3 (The Royal Surrey County Hospital NHS Trust)
F
AWBL pilot programme: E to F Grade Development Programme for
Critical Care, level 3 (The Royal West Sussex Trust)
G
Mid-way
Evaluation
Questionnaire
for
Work
Based
Learning
Programme
H
End Evaluation Questionnaire for Work Based Learning Programme
I
Mentor Evaluation Questionnaire for Work Based Learning Programme
J
Manager/Assessor Evaluation Questionnaire for Work Based Learning
Programme
K
Pilot AWBL programme evaluation
L
Evaluation of non-accredited WBL programmes in mental health
M Paper on suicide prevention (The West Sussex Health and Social Care
NHS Trust)
3
1. Executive summary

This report describes the development of
University accredited work-based learning
(AWBL) programmes. This approach
supports developing a more effective and
responsive health service (DoH 2000a,
2000b) where patients’ needs are in focus
(DoH 2002a, 2004c) and the workforce is
supported to develop their skills and take
on new roles (DoH 1999, 2002b, 2004a,
2004b). The AWBL approach provides a
timely response to training requirements
arising from the National Service
Frameworks.

Findings from the evaluation demonstrate
that the pilot AWBL programmes created a
positive learning environment where staff
demonstrated:
 an increase in confidence regarding
practical skills and academic writing;
 increased knowledge base including
ability and competency;
 development of personal skills in
leadership,
communication
and
assertiveness;
 the ability to relate theory to practice;
 the confidence to converse with
patients on issues of care that were
previously difficult due to a lack of
knowledge;
 being a more effective member of the
multi-professional team and sharing
best practice;
 more effective patient care and
service delivery.
The approach reflects a partnership
between NHS Trusts and a Higher
Education Institution (HEI). Since January
2001 Practice Development Facilitator
(PDF) roles were financed by the Surrey
and Sussex Strategic Health Authority
(SHA) and supported through an action
research approach by the European
Institute of Health and Medical Sciences
(EIHMS) at the University of Surrey.
The PDF role is characterised by
operating at many levels of service
delivery, integrating Trust-wide strategic
policies with clinical needs and concerns
at ward level. The effectiveness of the role
is dependent on the balancing of the
critical outside perspective with practice
knowledge in clinical teams. PDFs
demonstrate flexibility and sensitivity to
meet the particular needs of Trusts while
taking on board the National Agenda. The
success of the PDF role depends on the
postholder’s professional and personal
qualifications and available support
structures.
The successful implementation of AWBL
programmes has potential to stimulate the
learning environment in the workplace and
improve staff’s job satisfaction as a result.
The report suggests recommendations for
a sustainable framework for AWBL:


PDFs have taken a variety of approaches
to practice development and team
learning. This report pays attention to the
work to develop AWBL programmes
supported by the EIHMS pilot module
Using Work-based Learning to Enhance
Practice, Levels 2 and 3. The report
presents details of three pilot AWBL
programmes:

Managing the Acutely Ill Patient on a
Ward (details in Appendix E)
E
to
F
Grade
Development
Programme for Critical Care (details in
Appendix F)


Rehabilitation
and
Promoting
Independence for Older People
(details in Appendix D)
4
Trusts to provide support through the
establishment of and sufficient support
for PDF type roles.
HEI to provide support through the
establishment of a flexible module
framework, an AWBL co-ordinator role
and area-specific lecturers to engage
in AWBL projects and support
research to ensure the evidence base.
Practice development partnerships
involving Trusts, HEIs and
patients/users.
Commitment from the SHA to fund
and encourage practice development
partnership initiatives.
2. The introduction and development of the PDF role
The Practice Development Facilitator
(PDF) role was established in January
2001 in a joint initiative between the
Surrey and Sussex Strategic Health
Authority (SHA) and the European Institute
of Health and Medical Sciences (EIHMS)
at the University of Surrey.
The University of Surrey was funded by
the Surrey and Sussex SHA to engage
with the PDFs in an action research
approach. This engagement involved three
phases.
Action research is a participatory approach
to develop a product or achieve an
outcome by using research in a circular
feedback process (Bate 2000).
The rationale behind the initiative was to
support the development of innovative
ways of delivering continuing professional
development (CPD) in the practice setting
(DoH 1999, 2004b). This is in line with the
modernisation framework as set out by the
Department of Health in the documents
The NHS Plan (DoH 2000a) and
Liberating the Talents (DoH 2000b). The
project aimed to bridge the theory-practice
gap, to strengthen the evidence base for
healthcare practice (DoH 2000b) and to
improve patient outcomes by shifting the
balance of power (DoH 2002a) and putting
people at the heart of the service, as
outlined in the NHS Improvement Plan
(2004c).
Phase One
In the first phase (January 2001 –
December 2002), this engagement paid
attention
to
the
introduction
and
development of the PDF role. The purpose
was to put in place a system of support for
the PDFs to meet service expectations of
the post. Three approaches were taken.
Firstly, supervision groups with a senior
member of the University (mental health
and critical care with intermediate care) to
address the individual development needs
of the PDFs. Secondly, the Head of
Academic and Practice Development
negotiated with the PDFs to set up a
project monitoring and evaluation group
consisting of PDFs, their managers and
the University (this group evolved to
become the project’s steering group).
Finally, an external facilitator was brought
in to support and develop the PDFs’
knowledge, understanding and skills of
critical reflection to manage and evaluate
the post. The development programme for
the PDFs in the period 2001-2003 was
subsequently formulated into a module
‘Enabling Innovative Practice’, 20 credits
at level 3 and offered within the EIHMS
Lifelong Learning framework.
National Service Frameworks were key
drivers for the establishment of PDF roles
in mental health, critical care and
intermediate/primary care. The Trusts
involved were:











Ashford and St Peter’s Hospitals NHS
Trust
East Surrey PCT
Frimley Park Hospital NHS Trust
North West Surrey Mental Health
Partnership NHS Trust
Royal Surrey County Hospital NHS
Trust
Royal West Sussex NHS Trust
Surrey Hampshire Borders NHS Trust
Surrey Heath and Woking PCT
Surrey Oaklands NHS Trust
Surrey & Sussex NHS Trust
West Sussex Health and Social Care
NHS Trust
Phase Two
As SHA funding was provided for
continuing the PDF roles for a further two
years, focus was directed towards the
development and piloting of a framework
for University quality assuring and
accreditation of work-based learning
supporting practice development in Trusts.
The University of Surrey was funded (July
2003 – December 2004) to reengage with
an action research approach to support
this development and evaluation work.
Figure 2.1 overleaf illustrates the Trusts’
involvement throughout the period January
2001 to December 2004. By detailing the
months of PDFs’ employment the figure
also demonstrates issues of continuity and
retention in the PDF roles.
5
Figure 2.1: Overview of Trusts’ and PDFs’ involvement in the project period 2001 – 2004, Phases One and Two
Clinical Area
Trust
2001
2002
Critical Care
Ashford and St Peter Hospitals NHS Trust
Karen Coertze
2003
2004
Ruth Towell
Frimley Park Hospital NHS Trust
Alison Stevens
Royal Surrey County Hospital NHS Trust
Intermediate/
Primary Care
K. Tylor
Ba
tes
S. Keating p/t
Sam Keating (leave 6/03-11/03)
Catherine Derham
Rosemary Maundrill
Royal West Sussex NHS Trust
Jo Morgan (has continued Trust funded PDF role in Intensive Care)
Surrey and Sussex NHS Trust
Paula Sloan
East Surrey PCT
Surrey Heath and Woking PCT
Liz Mouland (has continued PDF work as Nurse Consultant)
Sandra Evans
Mental Health North West Surrey Mental Health Partnership NHS Trust Kevin Acott (left to Surrey Oaklands)
Surrey Hampshire Borders NHS Trust
Surrey Oaklands NHS Trust
West Sussex Health and Social Care NHS Trust
Kirsty Thurlby (leave 10/03-6/04)
Eileen Welland
Camille Whiby
Sara Opie
Kevin Acott
Bob Birtwell
Alex Jones
PDFs were given Honorary Contracts with
the University of Surrey and provided 0.2
fte of their time for this collaboration.
September 2002, headed by Ms. Sheila
McKinley from the Surrey and Sussex
SHA. Since the end of 2003 the first hour
of the PDF Steering Group meetings did
not include the PDFs. The meetings set
out the strategic aims for the development
of the PDF project and defined objectives
for PDFs and the EIHMS team to deliver.
An additional component of the PDF
Steering Group meetings was to present
an update on the project’s progress and to
allow PDFs to express their experiences
and views. The meetings have been
essential to keep the stakeholders
updated on the progress and agree a
direction for the project’s development.
Meetings between PDFs and the EIHMS
team were held at a regular interval.
Between July 2003 and December 2004 a
total of 29 PDF meetings were held at the
University Campus. At these meetings
PDFs presented and discussed their
ongoing work with each other and worked
collaboratively with University staff to
develop a collective approach to service
development through the provision of
accredited work-based learning (see also
section 4). Summaries of the PDF
meetings were distributed by email shortly
after each meeting to keep an audit trail of
the projects’ development and to allow
PDFs who couldn’t attend the meeting to
keep informed on the progress.
Since 2003 Dr Charlotte Ramage and Ms.
Helen Stanley from the University of
Brighton have attended PDF Steering
Group meetings to contribute their
experience with setting up Negotiated
Work Based Learning. In addition,
separate meetings have been held with
the University of Brighton to inform the
work in the PDF project.
At the regular PDF meetings the EIHMS
team comprised Ms. Alison Rhodes (Tutor
with expertise in development and workbased learning and member of the
workgroup for ‘Negotiated Learning’ at
EIHMS) and Dr John Aggergaard Larsen
(Research Fellow with a Social Sciences
background and expertise in qualitative
and participatory research methods). The
wider EIHMS team comprised the PDF
Strategic Group with the additional
members: Dr Margaret Volante (Head of
Practice Learning and Education in
EIHMS), Professor Pam Smith (Director of
the Centre for Research in Nursing and
Midwifery Education and an experienced
action researcher), Dr Pat Colliety (Senior
Tutor, has conducted a study on practice
development and is supporting the
community PDFs in Phase Three – see
below) and Ms. Sue Ryle (Head of
Continuing Professional Development and
Postgraduate Programmes at EIHMS).
Additional support for the development of
Level 1 AWBL programmes was provided
by Ms. Melaine Coward (Deputy to Ms.
Ryle and responsible for co-ordinating the
CPD framework at EIHMS). During 2004
the EIHMS PDF Strategic Group met
monthly to discuss the progression of the
PDF project and how it might relate to the
education provision strategy for EIHMS.
Phase Three
A third phase of the project started in
January 2004 as the Surrey and Sussex
SHA provided two years funding for PDFs
in primary care. EIHMS is supporting
these community PDFs in a parallel
project (key responsible person is Dr Pat
Colliety). This phase involves these
Trusts:
 Adur, Arun and Worthing PCT
 Eastbourne Downs PCT
 Horsham and Chanctonbury PCT and
Crawley PCT
 North Surrey PCT
 Surrey Heath and Woking PCT
Key points
PDFs have been introduced in Surrey and
Sussex through three phases:
 Phase One (January 2001 –
December 2002): PDF roles were
introduced and they worked on Trust
specific practice development needs.
 Phase Two (January 2003 –
December 2004): focus was directed
towards developing AWBL
programmes and suggest a
sustainable framework for future TrustHEI partnership.
 Phase Three (January 2004 –
December 2006): PDFs have been
introduced in primary care and will
build on previous experiences.
A PDF Steering Group was established to
provide monitoring and evaluation (see
Phase One) through regular, half-yearly
meetings involving PDFs, PDFs’ line
managers, the EIHMS team and, since
7
3. The PDF role
Working at a strategic level
While
working
alongside
clinical
colleagues the PDF has also an important
strategic function, stimulating best practice
and
working towards
the
Trust’s
performance targets. The PDF has to be
‘politically aware’ of these strategic
requirements and seek to implement them
in practice, while bridging the gap between
policy formulations and the requirements
of everyday practice. PDFs have benefited
from taking an active part in Trust-wide
strategic meetings concerning training
provision and practice development (e.g.
‘Training and Implementation Group’ or
‘Practice Development Group’) as well as
the relevant clinical group (e.g. ‘Nursing
Forum’ or ‘Nursing and Midwifery Group’).
The Trust-wide strategic involvement gives
the PDF insight into ‘the bigger picture’
and allows identification of structural
issues to direct their work focus and avoid
‘working in a silo’. Equally, by being a
member of these groupings the PDF has a
direct voice at a Trust level and is better
able to make a significant impact on Trust
practice development priorities.
The PDF role presents a unique mix of
clinical, strategic, interpersonal and
educational functions, which distinguishes
it from other practice educational roles
(see e.g. Ramage 2004). The PDF role
pays special attention to the development
of an organisational culture that genuinely
supports innovative and creative clinical
practice, and the learning – and integration
– of new skills. This section specifies the
characteristics to avoid the lack of clarity
and confusion which often accompanies
the introduction of new clinical roles and
titles (Jones n.d.).
3.1 Key characteristics
Key characteristics of the PDF role
became apparent at the PDF meetings
(see section 2). The discussions continued
during collaborative writing for academic
publication (Larsen et al., n.d.) which
further stimulated the ongoing reflexive
process.
Getting into practice
It is crucial that the PDF is actively
involved in clinical work in the Trust.
Working alongside clinical colleagues
gives the PDF insight into the work culture
at ward level and complexities related to
the clinical work as well as staffcollaboration. At times PDFs have been
struggling to establish a recognisable
‘membership role’ as an insider in the
practice setting. Some PDFs have
reported initially being seen as ‘a spy’ sent
by management. PDFs have also felt
tensions with other senior clinical staff who
at times felt threatened by the PDF,
challenging their position and authority in
the staff hierarchy. PDFs have generally
experienced that it took time, patience and
continued effort to be seen as having
‘clinical credibility’ and recognised as
having a positive and supportive function
among staff. Practice development
parallels good patient care: true and
honest engagement is a necessary and
respectful first stage. This forms a basis
for the development of trust, which is
essential for staff to engage in learning
and practice change.
‘Drip-drip-drip’ approach
Due
to
the
above
mentioned
characteristics of the work PDFs have to
be ‘thick skinned’ and not expect quick
and immediate changes to practice
development. They are by the very nature
of the role in it for ‘the long haul’ if they are
to succeed. Practice development is an
ongoing
process
which
demands
continuous attention and deliberate action.
It has to do with creating and sustaining a
certain practice culture which embodies
the ideology and practice of a ‘learning
environment’. The PDF is, as the title
says, the facilitator of this ideology and
practice. PDFs have described how they
see themselves as providing their clinical
colleagues and the practice culture with
the ‘optimism’ and ‘energy’ to develop and
sustain best practice.
Insider-outsider status
The PDF role incorporates insider and
outsider characteristics in terms of the
clinical practice environment. PDFs are
working hard to be recognised as insiders
in order to have clinical credibility and be
8
seen by clinical staff as a positive resource
for their work. At the same time PDFs are
critically evaluating practice in order to
stimulate
the
development
and
sustainability of best practice. PDFs have
reported that they have to be assertive
and demonstrate positive energy and
optimism to achieve this. The social
position and interpersonal demands can
be emotionally draining for the PDF, and
especially in the beginning it may be
necessary to have ‘thick skin’. It is,
however, an important function of the role
to be in that insider-outsider position as it
is necessary in order to identify problems
and suggest changes.
strategic
approach
development.
to
service
3.2 Variation: meeting Trusts’ needs
Common elements characterise the PDF
role, as outlined above, but an equally
important characteristic of this role is its
local variation. This is due to the fact that
PDFs are in post to address the particular
needs of Trusts who are working to meet
the National Agenda within their individual
practice environments. It is essential that
PDFs demonstrate flexibility and sensitivity
to meet and follow such individual
requirements whilst taking on board the
National Agenda. (Examples of PDFs’
different activities are presented in
Appendix A.)
Support from peers
The PDF project has demonstrated the
important value of support for the PDF, not
least due to the emotional labour and
stresses from being in the insider-outsider
position. Without doubt it is important that
the PDF has support in their immediate
work environment, and interviews with
PDFs’ line managers confirmed the value
of regular supportive meetings. The PDF
project has also, however, shown the
importance for the PDFs to have
opportunities to share experiences and
support each other at the regular
meetings. Mental health PDFs have been
less frequent visitors at these meetings
and this might relate directly to the fact
that the mental health PDFs already work
closely together and see each other on a
regular basis. Discussions at PDF
meetings have illuminated how it has been
important for PDFs to help each other by
giving moral support and encouragement
as well as advice on when to avoid getting
pulled too far into the politics of everyday
practice.
In some settings PDFs worked Trust-wide
to identify areas in particular need of
practice development and they worked
strategically to develop learning initiatives
to
meet
service
development
requirements. In other situations PDFs
were required to concentrate their work to
a relatively small practice field, engaging
on a daily basis with staff primarily on one
ward. PDFs have highlighted the value of
having the strategic Trust-wide overview,
while pointing out that being solely
responsible for practice development in a
whole Trust is an unrealistic responsibility
for one PDF. For PDFs who worked Trustwide it has been necessary to focus their
involvement on areas and wards in
particular need in order to make a
significant impact on the practice culture.
Also, PDFs’ discussions have emphasised
the value of not ‘working in a silo’, by
which they referred to only having
responsibility for a single ward and not
having the Trust-wide overview. When
working in only one practice area the PDF
risks getting ‘sucked in’ to the everyday
political and administrative practicalities
and this can reduce the critical outside
perspective which is essential to identify
practice development needs. Hence, the
insider-outsider status of the role is subject
of constant negotiation based on the
existing and emerging Trust needs.
Involvement with University
The last characteristic of the PDF role is
its relationship to the University, which has
supported critical and reflective thinking
and working to develop University
accredited learning. The University has
provided a forum to stimulate and
encourage practice development, applying
academic standards for learning and
evidence-based practice. Furthermore,
through the action research approach the
PDF meetings with the EIHMS team
deepened the peer support (as mentioned
above) by supporting PDFs’ critical
perspective and enabling them to apply a
Variation has also been demonstrated in
the focus of the PDFs’ practice
development work. The majority of the
Trusts involved have directed attention to
practice development through supporting
9
the skill development of professionals
such
as
nurses,
dieticians,
physiotherapists, occupational therapists
and medical staff. In other Trusts meeting
the clinical knowledge needs of healthcare
assistants (HCAs) and working to develop
their practice were identified as being able
to generate the greatest impact to improve
service and patient care.
indicated by Trust needs. All initiatives
have shared the overall aim of designing
and piloting work-based learning systems
to support practice development and
suggesting sustainable frameworks which
can be transferred to other Trusts (see
section 5).
3.3 Competency requirements,
education and experience
The PDF role has not been restricted to
supporting one particular professional
group, but taken a broad approach to
address the emerging needs. This
flexibility and multi-capacity is crucial for
the role to address the demands put on
Trusts to meet changing policy objectives
for service delivery.
The PDF role requires a multi-competent
professional. Dependent on the specific
requirements in individual Trusts, the
postholder would have to demonstrate all
or a selection of following skills and
characteristics:




While
addressing
these
strategic
concerns, PDFs have equally to take
account of the practice culture and staff
morale when facilitating change and
practice development. Experiences from
the PDF project have demonstrated that
the ability to integrate strategic policy aims
with ward level concerns is crucial for
securing the backing for the culture of a
learning environment towards creating
effective
and
sustainable
service
development.




A high level of clinical knowledge.
Practice experience.
Strategic/policy awareness.
Independent working and leadership
skills.
Partnership working and
interpersonal/negotiation skills.
Educational/academic skills.
Research/evaluation/audit skills.
A high level of energy and motivation.
These qualifications and skills enable the
PDF to engage effectively in practice; take
strategic responsibility; take a critical
practice development perspective; engage
constructively
with
clinicians,
Trust
managers and University academics; work
in partnership to design and deliver
educational
programmes;
and
demonstrate learning, practice and patient
outcomes. The personal characteristics of
a high level of energy and motivation is
required for the PDF to engage in all these
dimensions of work while at the same time
demonstrating flexibility to meet changing
Trust needs for service delivery.
Some PDFs engaged substantively with
the EIHMS team to develop a system for
University accreditation of Trust-based
learning programmes (see section 4).
Meanwhile, the mental health PDFs
continued their work to develop a team
approach
to
practice
development
(supported by previous research, e.g.
McCormack and Corner [2003]). This
involved work-based learning programmes
which were followed up by a supported
team
expertise
approach.
Having
completed the programme learners were
supported through regular meetings to
discuss developmental needs and provide
peer supervision. This organisationally
recognised method facilitated them to
disseminate expertise through helping
deliver future modules and offering advice
and supervision to colleagues and
managers (see Appendix M).
The professional characteristics and the
experience with retention (see Figure 2.1)
indicate that the PDF role attracts clinical
professionals with significant career
potentials. PDFs’ line managers have
pointed out the need to develop clear
career plans for the PDF postholder. PDFs
develop skills transferable to a ‘modern
matron’, consultant nurse, allied health
professional and/or lecturer in clinical
practice working with the University,
depending on their own individual
propensities and developments and what
Also, mental health PDFs have been
working to set up a system for involving
service users, clinicians and educators in
practice development work (the Acute
Care
Partnership).
These
different
initiatives reflect various concerns as
10
Key points
 The PDF is actively involved in clinical
work in the Trust.
 The PDF has to be ‘politically aware’
of Trust-wide strategic issues.
 The PDF’s insider-outsider position is
necessary in order to identify problems
and suggest changes.
 Practice development is an ongoing
process which demands continuous
attention and deliberate action to
develop and sustain a ‘learning
environment’.
 PDFs need support in their immediate
work environment and from peers in
similar roles.
 The University/HEI provides a forum to
stimulate and encourage practice
development.
 PDFs work differently in different
Trusts depending on local needs and
priorities. There is no standard ‘job
specification’.
new ways of working the NHS/Trusts
opens to them.
Due to the demands of the role it is,
however, important not only to stress the
requirements aimed at the postholder (in
terms of education, experience and
motivation). For the PDF to work
effectively it is necessary that the
postholder works in a supportive and
stimulating environment. This support
requirement includes: 1) line manager
support, 2) support from peer PDFs and 3)
support from a HEI environment which can
help sustain and develop a strategic
approach to service development.
11
4. Accredited Work-Based Learning
From January 2003 PDFs were required
by the Surrey and Sussex SHA to develop
and pilot Accredited Work-Based Learning
(AWBL) programmes by designing their
Trust-based learning activities in such a
way that they could be recognised by
Universities. This new direction meant a
reorientation to the previous function of the
PDF role from solely addressing the
individual Trust’s needs regarding the
National Agenda. The Surrey and Sussex
SHA was making a strategic investment in
using the PDF role to support the
development of learning programmes
which could be adapted by other Trusts.
programmes, but they were not accredited
by the University.
In the early stages of the development
process, mental health PDFs prioritised to
work with teams and not to providing
individual learners University credits. At
this point mental health PDFs expressed
scepticism towards the stated aim of
securing University accreditation as they
feared that this would mean a focus
towards individual learning and away from
team development with direct and
sustained impact on practice. Their
concerns reflected a common observation
that university, classroom-based (i.e. not
work-based) learning does not always
have optimal impact on practice as
individual learners at times are unable to
implement the new learning in the practice
culture. However, since November 2004,
mental health PDFs have engaged
constructively to negotiate how the AWBL
module can present a useful framework for
future learning provision (see section 4.2).
This sharpened focus arose from the
intention to ensure a flexible approach to
develop skills and improve practice (DoH
2000b, 2004a) that would focus on the real
needs of patients (DoH 2002a, 2004c) and
build a highly competent and adaptive
workforce (DoH 1999, 2002b, 2004b).
From July 2003 EIHMS engaged with
PDFs in an action research approach to
support this new development and provide
the University of Surrey’s expertise in
setting
up
accredited
learning
programmes. The unique challenge was to
develop an University validated and
accredited module with learning provided
in the work place which would, at the
same
time,
integrate
the
Trusts’
requirement for flexibility to respond to
emerging needs for practice development
and service delivery.
The importance of directing the learning
and practice development towards the
team and practice environment has been
sharpened by the above observations. The
work to develop an AWBL framework
emphasised developing an approach
which would both meet Trusts’ needs for
practice development and ensure that the
learning would require the individual
learner, through the work-based approach,
to actively engage with the team practice
to make maximal impact.
PDFs have engaged in a variety of
practice development activities (see
Appendix A for examples) and they have
been involved in developing the AWBL
framework to varying degrees. Three
PDFs have engaged fully over the entire
period and achieved designing and piloting
AWBL programmes to meet their Trusts’
needs (they will be described below). For
issues to do with lack of continuity due to
job change and maternity leave three
PDFs were delayed in developing their
programmes, but are currently in the
process of delivering these. When this
new focus on AWBL was introduced
mental health PDFs had already
developed and run systematised learning
4.1 The EIHMS pilot module
The 2001-2002 support and development
phase of the PDF project identified a need
to develop formal recognition of learning
outcomes achieved through Trust service
and practice development practice. From
the beginning the challenge for EIHMS
and the PDFs was how to recognise
individual learning outcomes achieved by
way of the team development essential to
sustainable practice development and
desired client outcomes.
12
The framework needed to be responsive,
accommodate diversity and flexibility,
whilst also providing robust governance
processes to assure client safety and the
quality of learning support in both the
design and delivery of the work-based
learning process. Quality assurance
processes therefore needed to be in place
that would both satisfy clinical and
academic standards. Assessment of the
learning outcomes for both individuals and
teams is essential to assure competency
for the delivery of the service whether or
not
individual
practitioners
wished
academic accreditation for their learning
achievements. The work-based learning
framework was developed from a Trustbased perspective to embrace learning
within service and practice development to
support clinical / practice/ client outcomes.
One Trust identified the need for academic
Level 1 provision. This was met through
mapping the required outcomes against an
existing EIHMS Level 1 module.
4.2 The pilot programmes
AWBL programmes were designed at
academic levels 2 and 3 and have been
delivered in three Trusts:
 Rehabilitation
and
Promoting
Independence for Older People –
levels 2 and 3 (The East Surrey
Primary Care Trust).
 Managing the Acutely Ill Patient on a
Ward – levels 2 and 3 (The Royal
Surrey County Hospital NHS Trust).
 E
to
F
Grade
Development
Programme for Critical Care – level 3
(The Royal West Sussex Trust).
A pilot module was developed through
collaboration between the PDFs and the
EIHMS team. The work-based learning
framework developed at University of
Brighton provided important inspiration
(see section 2). The approach was one of
flexibility and debate at the PDF meetings
to ensure that all needs would be met.
Each PDF had an opportunity to explore
how work-based learning could be
delivered within their Trust, the target
groups to be involved and the level of
study that would be appropriate.
Rehabilitation
and
Promoting
Independence for Older People – levels 2
and 3
This programme was designed around 6
taught study days, which were facilitated
by the PDF. There was a multiprofessional approach to the teaching and
assessment
component
of
the
programme,
e.g.
allied
health
professionals,
pharmacist,
risk
management team and patients and
carers who had received local services
were co-opted onto the teaching team,
which proved to be very successful. The
learners
were
also
allocated
4
supernumerary shifts in order to practise
their skills under supervision. The method
of assessment was based on the
attainment of competencies (10 credits)
and the production of a portfolio of
evidence (20 credits), which included a
care study, S.W.O.T. analysis, learning
contracts, reflective accounts, reading
logs, clinical assessments, formative and
summative
assessments
to
show
achievement and development. In addition
to this, a high priority was given to the
development of the professional handover.
This was considered to be a key activity
for the learner as it gave rise to
opportunities for team learning and
development in order to agree and set
patient goals and objectives of care,
improve inter-disciplinary team functioning
with the ultimate aim of improving patient
outcomes. The cohort also worked in
action learning sets (ALS), which (as
reported by the PDF) the learners found
In January 2004, pilot modules (see
Appendices B and C) were presented to
the undergraduate Lifelong Learning
Framework Board of Studies for their
consideration.
AWBL pilot modules
Using Work-based Learning to Enhance
Practice, 30 credits, Levels 2 and 3
The modules were approved by the board
members with the stipulation that it should
only be offered to those learners involved
in the project and therefore would sit along
side the framework until the completion of
the project and the evaluative process. By
designing an umbrella module framework
the PDFs could develop their specific
programmes, utilising work-based learning
strategies, which were based on the needs
of their Trusts, their specialist area of
practice, the clinical teams and the needs
of individuals within the teams.
13
valuable to take forward their learning.
(See Appendix D for details).
Managing the Acutely Ill Patient on a Ward
– levels 2 and 3
This programme took a similar approach
as the above, in so much as the design
included a taught programme of 6 study
days but a difference was that this module
was built around the use of workbooks.
The workbooks had to be completed by
the learners outside of the study days but
were reviewed on a regular basis to
ensure
that
their
knowledge,
understanding and levels of competency
developed appropriately and to test what
impact this had to their practice. The
method of assessment was a portfolio of
evidence, which included the completion
of five competencies (which follows the
Trusts competency documentation), with
one reading log to support each
competency. The completed workbooks
were presented as part of this evidence
plus a summative assessment in the form
of an assignment, which was a critical
analysis of an episode of care. (See
Appendix E for details.)

Ashford and St. Peter’s Hospital NHS
Trust (topic: essential skills in
rehabilitation care). This programme
will be aimed at Health Care
Assistants (HCAs) to assist in the
development of their skills in
rehabilitation. It is planned for delivery
early in 2005. This Level 1 provision
will be mapped against an existing
module that is currently being offered
through EIHMS.

Surrey Heath and Woking Primary
Care Trust (Leg Ulcer and Wound
Care – Level 2: 30 Credits). This is a
programme that has been delivered
within the Trust on a number of
occasions but not accredited. The
PDF and the EIHMS team have been
working together to develop this
programme,
along
with
the
assessment strategy. The programme
will be based on 4 half-day study
sessions (over a 3-month period) and
is planned to commence in November
2004 with 10 learners.

Frimley Park Hospital NHS Trust is
currently (April 2005) implementing a
work-based learning programme for
critical care skills. Based on a review
of twenty NHS Trusts' competency
programmes the Greater Manchester
critical care skills programme was
chosen as the preferred model. It
involves as a multiprofessional
programme in caring for patients level
0-3 comprising of core competencies,
skills workshops and workbooks for
evidence. The respiratory module has
been successfully piloted to a small
group across the Trust and the whole
programme has been implemented
within the Critical Care Unit at Frimley
Park. It is the plan to take the
programme Trust-wide, commencing
January 2006. It is the aim that the
programme will be developed to
achieve accreditation with EIHMS,
University of Surrey in line with the
Trust plan to increase level one care
capacity. (For further information
please contact Samantha Keating at
Frimley Park Hospital NHS Trust.)

Mental health PDFs are working with
the EIHMS team to develop an AWBL
programme (Suicide Risk Assessment
– Level 3: 30 Credits) with planned
start in March 2005. This programme
E to F Grade Development Programme for
Critical Care – level 3
This programme took a unique approach
to work-based learning as all the teaching
occurred within the Intensive Care Unit
(ITU), with no taught study days. The
framework was built around fortnightly
meetings between the mentor and learner
(to
explore
learning
outcomes,
achievements, action planning for further
development) plus four supernumerary
days, whereby the learner was given the
opportunity to ‘act up’ in the F grade role,
with the mentor offering clinical support
and
supervision.
The
method
of
assessment was the completion of a
portfolio of evidence which included a
S.W.O.T analysis, learning outcomes, an
action plan, 8 review meeting logs, 4
reflections based on supernumerary
experiences, 8 reading logs, a summative
assessment by the mentor and to
conclude, a final reflection on how the
learner has developed throughout this
work-based learning programme. (See
Appendix F for details.)
Further AWBL programmes are currently
being designed and planned for delivery
in:
14
is based on experiences since 2003
with delivering a non-accredited
programme with a similar content (see
Appendix L for an evaluation of nonaccredited programmes in ‘Suicide
Risk Assessment’ and ‘Relapse
Prevention’). The learning will continue
to be supplemented through the
supported team expertise approach
(as described in 3.2). Programmes
are being prepared for delivery in 2005
on the subjects of ‘Relapse Prevention
in
Psychosis’;
‘Working
with
Delusions’;
‘Self-Harm’;
‘The
Admission Process’; ‘Voice Hearers’;
‘Cognitive Deficits’; ‘Dual Diagnosis’;
and ‘Working Therapeutically with
Aggression’.
match the purpose for which they would
be used. This learning process was time
consuming but essential to the overall
quality of the programme and the
subsequent skills that would be required in
practice. Furthermore, the process meant
a strengthening of the links and
collaboration between the Trusts, PDFs,
multi-professionals, clinicians and the
University.
Most PDFs chose to timetable multiprofessionals to teach elements within
their specialist field of practice. As the
cohort sizes were likely to be small, it was
identified that the PDFs would be the
mentor. However, it was important that
whoever was involved would need to be
supported
in
whatever
way
was
appropriate, i.e. with lesson planning,
mentoring,
assessment
strategies,
academic writing and collating portfolio
evidence.
Trust support
A significant qualification of AWBL
programmes is that they arise from a
needs assessment carried out in the Trust.
PDFs have played an instrumental part in
conducting this needs assessment through
involvement at strategic and practice
levels (as described in section 3). The
success of this wide consultation work
depended
on
a
well-functioning
communication network in the Trust
whereby
members
of
the
multiprofessional team were consulted, along
with managers, colleagues and peers. The
needs assessment included the following
elements to be established:
 Evidence for the need for the learning.
 The extent to which the need might be
best met by an AWBL programme in
the work place, or existing modules on
offer in the Trust or from education
institutions.
 Support from Trust managers for the
AWBL programme.
 Availability of resources (e.g. time,
teachers, mentors, rooms) for the
programme delivery.
 Sufficient numbers of staff or teams
who need the learning and are willing
and able to take part in the AWBL
programme.
University support
The University of Surrey provided
structural support for the AWBL approach
through endorsing the development of the
pilot AWBL ‘umbrella’ module framework
Using work-based learning to enhance
practice (as described in 4.1).
A lead in designing the pilot AWBL module
was taken by the EIHMS team’s AWBL coordinator, Ms. Alison Rhodes, who
provided expertise support for the process
of designing, delivering and assessing
work-based and University assessed
learning. Designing the module and the
individual AWBL programmes was a
parallel and mutually informative process.
Following the action research approach it
was considered prudent to take the lead
from the PDFs, to match their level of
knowledge to an appropriate level of
support. This was provided through
facilitative
and
collaborative
group
discussions during regular PDF meetings
(as described in section 2).
Each PDF was asked to consider the
generic learning outcomes of the AWBL
module and to convert these into their own
programmes. This was achieved through
collaborative discussions at the PDF
meetings. Furthermore, the AWBL coordinator provided individual meetings and
email and telephone correspondence to
assist the AWBL programme design.
While concluding the Trust needs
assessment the PDFs engaged in
collaborative work in the EIHMS group and
with the AWBL co-ordinator to develop the
programme content and structure. This
involved support in exploring the feasibility
of
specific
programmes,
primarily
considering learning and assessment
strategies that would be appropriate and
15
Once the first two programmes had
commenced it became apparent that there
were generic needs that required support
and development from the AWBL coordinator to ensure that the PDFs could
provide the required academic level.
Support and guidance was provided (in
the form of face-to-face individual and
group
meetings,
emails,
telephone
conversations and tutorials) in respect to:
 Reflection and reflective writing: PDFs
were given information on key
principles and AWBL learners were
offered the opportunity to have drafts
of their reflective writing commented
upon by the AWBL co-ordinator.
 Marking and assessment guidelines:
PDF were provided with a marking
workshop at EIHMS and PDFs were
given individual instructions on
assessment criteria.
Cohorts 1, 2 and 4 (see Appendix K for a
more comprehensive presentation).
Learning
Qualities of the AWBL programme, as
reported by learners:
 Enjoyable
 Relevant to practice
 Bridging the theory-practice gab
Learners’ assessment of the AWBL
programme:
 Satisfied with the quality of support
from mentors.
 Reflexive writing facilitated a greater
understanding of learning and practice
issues and created an opportunity to
improve these.
 Some emphasised the need for
support to focus attention to the
learning in the workplace.
 Some emphasised the competencies
as especially useful when doing workbased learning.
 Some reported a need for more time
to support the learning
4.3 Outcomes: learning, practice and
patient care
By the end of 2004 altogether 17 learners
had been involved in the pilot AWBL
programmes:
I’ve really benefited from the course. I
think work-based learning is wonderful
because you’re focusing very much on
what we’re doing here and in a really
enthusiastic setting.
Cohort 1: Rehabilitation and Promoting
Independence for Older People – levels 2
and 3 (The East Surrey Primary Care
Trust): 5 commenced (1 non-submission)
= 4 successfully completed.
It didn’t make it easier, because that would
be the wrong word, but because it was so
relevant, you know, sometimes you sit in
lectures and you just think “I’m never
going to use this” and part of you just
switches off. But when you learn
something and the next day literally you
think, “right, I can do it”. … It’s because we
use it. It’s not something that we just file
away.
Cohort 2: E to F Grade Development
Programme for Critical Care – level 3 (The
Royal West Sussex Trust): 3 commenced
and successfully completed.
Cohort 3: E to F Grade Development
Programme for Critical Care – level 3 (The
Royal West Sussex Trust): 3 commenced
(1 withdrew) = 2 currently on programme
(Dec. 2004).
I think that I’m probably more aware what
I’m doing. I think more about how I do it
and write it.
Cohort 4: Managing the Acutely Ill Patient
on a Ward – levels 2 and 3 (The Royal
Surrey County Hospital NHS Trust): 6
commenced (1 withdrew) = 5 currently on
programme (Dec. 2004).
Benefits form the AWBL programme, as
reported by learners:
 Extended knowledge of clinical
practice and being enabled to apply
learning to clinical work.
 Change and improve practice.
 Greater
reflexive
and
critical
awareness of clinical practice.
 Developing
a
sense
of
accomplishment and satisfaction.
The
evaluation
strategy
involved
questionnaires (see Appendices G, H, I
and J) and a focus group feedback
meeting allowing learners to discuss,
compare and contrast their experiences.
The key outcomes of the evaluation
include responses from learners in
16



Patient care
The learning’s impact on patient care, as
assessed by learners:
 The new knowledge and skills
have had a positive impact on
patient care.
 Positive impact on patient care
was a result of the total effect of
the learning in the workplace and
the implications it had for
delivering best practice.
 Beneficial to have AWBL as a
rolling programme that keep staff
engaged in service development
Transformed the routine clinical
practice into a stimulating opportunity
for development.
Better understanding of the task at
hand in clinical practice and place it in
a bigger picture of service delivery and
patient care.
Better
understanding
for
the
perspectives of colleagues.
Practice
The learning’s impact on practice, as
assessed by learners:
 New knowledge and skills were
applied in the workplace.
 New understandings and skills were
developed while practising them – it
becomes ‘a new habit’.
 Learners shared their new knowledge
with the team, thereby making a
broader impact on practice.
 Learners became more confident and
assertive in insisting on best practice –
becoming ‘agents of best practice’.
 Improved
inter-professional
communication.
 Learners developed greater job
satisfaction due to the positive
stimulation from the learning process.
Learners’ comments
Hopefully, they are constantly raising the
bar, really. We will be learning, the quality
of patient care is just constantly improving
and the more you look at it, the more it
should be improving. The more people go
onto things that are work-based, be it
credit-driven or not… The relevance will
be to what you are doing on a day-to-day
basis. If you’re applying it, patients are
getting a more pro-active [treatment].
Now it’s much more immediate. It’s “I’ll do
it”. You’re already seeing them, the faceto-face contact, but you’re also being
much more professional. “I have the skills
to do this”.
The
achievement
of
greater
job
satisfaction might be of particular
relevance to the Life Long Learning
framework and issues of staff burn-out and
retention, which is currently a major
structural obstacle to achieve satisfying
service delivery in the NHS.
We all want to do a good job. We all like
going to work and knowing when we come
home that we’ve done a good job. The fact
that this is so job-orientated is that you see
what you’re learning.
[W]e’ve learnt it and it’s relevant and we’re
using it already, even before the end of the
course, I was using skills. So even if I
don’t finish it [the programme], it’s made
an impact.
The things that I have learnt are very
practical skills, relevant to my work… And
I’m also passing it on to other people.
Key points
The evaluation of the pilot AWBL
programmes demonstrated following
positive outcomes:
 The achievement of better practice
and patient care.
 Improved interprofessional
communication.
 Greater job satisfaction – with
potential to improve issues of staff
burn-out and retention.
[You need to sometimes be] badgering the
doctor, sometimes you can’t do it [provide
a certain treatment/ intervention] and you
need the doctor to do it and you just have
to keep going on at them [insisting that the
patient gets treated]. So, in fact, they’re
[the doctors] getting better at it and if you
do that, the patients who you’re there for
get better more quickly. It must be more
cost-effective as well.
17
5. A sustainable framework: recommendations
The development and delivery of AWBL
programmes require establishing a
structural framework to facilitate a
constructive collaboration between Trusts
and Universities/HEIs. This is essential to
successfully address Trusts’ requirements
for service delivery and bridge the theorypractice gap to ensure evidence-based
and best practice.
provide the necessary level of support in
these key areas:
1.
2.
3.
4.
Development of AWBL programmes
Collaboration with the University
Delivery of AWBL programmes
The PDF role
Development of AWBL programmes
First of all, Trusts have to conduct a
thorough needs assessment at strategic
and practice levels consulting managers,
colleagues and peers to establish:
 Evidence for the need for practice
development and learning.
 The extent to which the need might be
best met by an AWBL programme in
the work place, or existing modules on
offer in the Trust or from education
institutions.
 Support from Trust managers for the
AWBL programme.
 Availability of resources (e.g. time,
teachers, mentors, rooms) for the
programme delivery.
 Identify sufficient numbers of staff or
teams who need the learning and are
willing and able to take part in the
AWBL programme.
The focus on patients’ needs as outlined
by the Department of Health in Shifting the
Balance of Power (DoH 2002a) and the
NHS Improvement Plan (2004c) requires
an innovative and radical approach to
secure practice development and high
quality
service
delivery.
Service
development has to address the real
issues and be supported by a solid
evidence base, capitalising equally from
practice
knowledge
and
research
evidence. There is an urgent requirement
for a highly qualified and flexible workforce
to take on new and emerging challenges
of best practice healthcare provision (DoH
1999, 2000b, 2002b, 2004a, 2004b).
Close collaboration between NHS Trusts
and HEIs regarding practice development
and learning activities is a necessary
response to this situation. The strategy
reflects the University of Surrey’s vision
statement to be ‘working for the world’
through productive partnerships and it
ensures that practice learning approaches
are improving and responding to the
requirements of the changing workforce
agenda and new ways of working.
Failure to sufficiently address any one of
these
points
might
prevent
the
implementation of the AWBL programme.
It is crucial to the success of work-based
learning initiatives that this ‘ground work’
has been done.
In (future) service developments where a
Trust might consider implementing an
AWBL programme (e.g. those detailed in
appendices D, E and F) which has already
been developed for another Trust the
content and structure of the programme
would have to be re-assessed to ensure it
addresses the specific requirements and
conditions of the Trust. This assessment
work requires close collaboration with the
University to ensure the appropriateness
of the AWBL programme design to the
individual Trust.
This section draws on experiences of
collaborative working through the action
research approach to the PDF role and
piloting AWBL programmes. A framework
for Trust-University collaboration is
suggested through the identification of key
responsibilities within each institution and
by proposing the development of a
partnership model for the future.
5.1 Trust support
Within a sustainable framework for the
development and delivery of AWBL
programmes Trusts are required to
The needs assessment and possible
adaptation
of
existing
programme
18
structures would largely be a Trust
responsibility and carried out by a person
who has the required level of knowledge of
strategic Trust issues while also being
aware of the practice needs of clinical staff
‘on the ground’. However, the work would
require support from the involved
University. The University is responsible
for the quality assurance processes and
the Trust needs to collaborate closely with
the
University
when
the
needs
assessment process is initiated.
words, course work and assessment is an
integral part of the learning.
The PDF role
Experiences from the pilot programmes
document the requirement for a ‘PDF-type’
role in the Trust to support the
development and delivery of AWBL
programmes. Whether or not this role is
called ‘PDF’, it is significant that it provides
the functions identified in section 3, in
order to enable the level of Trust support
as described above.
Collaboration with the University/HEI
The development and delivery of AWBL
programmes requires the Trusts to invest
in collaborative
working
with
the
University. Involved Trust staff need to
have the required professional knowledge
and experience to constructively engage
and negotiate with the University. Equally,
time and opportunities for facilitative
meetings have to be provided to achieve
this. (See also sections 5.2 and 5.3)
An important characteristic of this role is
the active involvement at ward level and
engaging with teams to identify the best
ways to improve service delivery. While an
AWBL approach might be chosen in some
cases, in other situations alternative
methods of change management might
provide more timely and effective
solutions.
One PDF may not be able to provide all
the practice development support in a
Trust. The PDF could involve other senior
clinicians in part-time PDF-type work. For
example, a ward manager could be
responsible for developing and delivering
an AWBL programme in her ward as part
of a practice development initiative. In this
way, the PDF could build up a resource
network of colleagues to provide AWBL
programmes. While
encouraging
a
broader learning environment culture this
strategy would also make the Trust
provision of AWBL programmes less
dependent on a single individual (and,
hence, less vulnerable to sickness, leave
or resignation).
Delivery of AWBL programmes
In order to provide learning in the work
place it is required that the Trusts provide
necessary facilities in terms of:
 Time
for
AWBL
learners
(supernumerary time and study days,
as required).
 Teachers (freeing of clinical staff to
prepare for and deliver teaching).
 Mentors (identify relevant clinical staff
and provide supernumerary time for
them to support learners).
 Support for teachers and mentors
(ensure that learning and support is at
required level).
 Support for AWBL learners (if required
in addition to mentor support).
 Assessment of learners’ course work.
5.2 University support
Some learners might not be interested in
receiving University credits and having
their course work assessed. While
learners of course should have the
opportunity to choose not to receive
accreditation, if they wish so, experiences
from the pilot AWBL programmes indicate
that the learning nonetheless should
present equal course work requirements
as part of the learning process. For
example, when writing a reflection (for the
course assessment) on experiences in
practice,
learners
develop
their
understandings of issues involved, and the
reflective writing might then stimulate
further practice development. In other
The University/HEI is required to support
the sustainable model for AWBL
programmes through:
1. An University quality-assured
framework for work-based learning
with sufficient flexibility to address
Trusts’ needs for staff training and
learning to promptly support emerging
requirements for service development.
2. Involvement with Trusts and clinical
practitioners to identify practice
development needs and participate to
help achieve these.
19
3. Support and guidance for Trusts (i.e.
PDFs) to design relevant AWBL
programmes.
4. Support and guidance for Trusts (i.e.
PDFs) to deliver and assess AWBL
programmes in the workplace.
5. Support and guidance for work-based
learners to meet the requirements of
the AWBL programmes.
6. Support and guidance to conduct
research and evaluation that will help
shape practice development activities
and secure the evidence base for the
delivery of best practice.
base in the particular clinical area. The
University staff should engage in
collaborative work with the Trust
representatives (i.e. PDFs) to provide their
knowledge of the clinical evidence base in
the field to ensure that the AWBL
programme will stimulate best practice.
(See also section 5.3, where this aspect is
further elaborated.)
Delivery and assessment of AWBL
programmes
Experiences from the pilot AWBL
programmes (see section 4.2) have
indicated a number of areas where the
University will be required to support the
delivery and assessment of work-based
learning in Trusts. The University would
have to support and quality assure the
Trust-based staff providing the learning
(i.e. PDFs and other Trust-based
teachers) by offering:
 Formal support sessions to explore
and develop a level of knowledge
regarding:
a) Practice
learning
strategies,
including teaching and learning
methods.
b) Experiential learning approaches
including different models of
reflection and reflective writing.
 A series of assessment workshops
prior to a module commencing, to
analyse assessment criteria, generic
marking scheme relevant to AWBL
and to develop skills of assessment.
 Support in the exploration of different
approaches to assessing learners’
achievements
(i.e.
reports,
presentation, seminars and action
learning
sets),
with
identified
assessment criteria.
 Support in developing individual
programmes
(i.e.
learning
agreements,
learning
outcomes,
timetables and guidelines etc.) to
ensure that each programme meets
Trust requirements.
 Tutorial time for Trust practice
developers
(i.e.
PDFs)
and
supervision regarding their teaching
capability, with the aim to identify
achievements
and
further
development.
 Review of teaching to support the
delivery of the programme.
 Mentor
meetings
to
explore
assessment strategies, to be fully
informed of the Trust role and the
University involvement, building a
University module structure
EIHMS has validated the pilot module
framework Using Work-based Learning to
Enhance Practice and is currently
developing a programme framework for
Negotiated Learning which will form the
future structural component for AWBL
programmes. This structure will include
directions
for
the
Trust-University
partnership
and
detail
assessment
procedures as well as the cost implications
to Trusts of the AWBL support, the issue
of ownership of modules (through the
collaborative
process)
and
the
responsibility
to
develop
the
programme/approach in the light of
evaluation.
Involvement with Trusts and practice
University staff are required to engage
directly with clinical practice and help
identify the most suitable and effective
approaches to improve service delivery
and
staff
competencies.
Working
alongside teams and identifying issues on
the ward allows the University to engage
more
comprehensively
in
practice
development activities and set up AWBL
programmes as required. This approach
will also go some way to meet the clinical
involvement requirement for clinical
lecturers.
Design of AWBL programmes
The University is required to enter into a
partnership working with Trusts to provide
early guidance and support in terms of
designing programmes based on service
development and workforce development
needs identified in the Trusts. This support
should address not only the technical
requirements to the structure of the
learning programme but also the
substantive aspects of the knowledge
20
more
extensive,
partnership.
collaborative
research community. There is an acute
need to reflect ‘local thinking’ in a nationwide and international perspective.
Experiences from the AWBL pilot indicate
that the support need could be met
through:
 A monthly supervision group lead by
an AWBL co-ordinator/liaison lecturer
for a maximum of 6 practice
developers.
 Occasional Individual support for
practice developers provided by the
AWBL co-ordinator (per face-to-face,
email, or telephone).
In some circumstances University staff
may take an active role in leading and
conduction the research in the clinical
setting. In other situations the academics
may collaborate with sufficiently qualified
practitioners to support and guide them to
design and conduct the required research,
evaluation or audit.
5.3 Practice development partnerships
Support for AWBL learners
Both PDFs and learners on the AWBL pilot
programmes identified a need for the
University to provide direct support for the
learners. This should be provided as:
 A one-day introductory meeting at the
University for the AWBL learners to
provide
basic
information
and
guidance. The AWBL co-ordinator
would go through the content and
structure of the learning programme
and explain requirements for the
assessment. Additional information
could be provided regarding reading
logs, critical reading of practice
evidence and reflective writing.
 Different learning activities to support
work-based learning, i.e. face-to-face
tutorial time for learners, e-tutorials,
distance learning material etc.
The pilot described and evaluated in this
report has paid particular attention to the
introduction of the PDF role and action
research collaboration to set up AWBL
programmes. This effort has focused on
developing a common approach and
broadly defined collaboration systems that
would be workable from both Trust and
University perspectives. Experiences from
this process have illuminated a potential
area of development.
Further Trust-University collaboration in
partnerships would be necessary to
secure continued high quality service
delivery through learning and practice
development initiatives in the workplace.
Also, representatives from patient or user
groups may contribute significantly to
identify areas in need of service
development and how to deliver best
practice. Although their total remit might
be broader, these partnerships could have
a particular role in respect to supporting
the development of AWBL programmes as
an element of service and practice
development initiatives.
Research to ensure the evidence-base
University/HEI staff will be required to
engage actively with clinical practitioners
to design and conduct research into the
learning process, developments of best
practice and patient outcomes. First, workbased learning activities will have to be
closely monitored by research and
evaluation that document the quality of
innovative approaches. Second, research
and evaluation initiatives ensure that
practice developments are related to and
assessed against best practice in the field.
Third, by rigorously monitoring patient
outcomes it is ensured that patients’ needs
are at the focus of the learning and
practice development initiatives.
Key functions of these partnerships would
be to provide a forum for clinical
practitioners, area specific lecturers and
patient/user representatives to meet on a
regular basis to:
1. Share knowledge about best practice
(whether theory- or practice-based)
2. Share, discuss and develop innovative
methods of learning and assessment.
3. Discuss learning and practice
requirements in specialised fields of
practice.
4. Develop new learning programmes,
whether University-based or workbased (AWBL programmes).
The integration of a sufficient research and
evaluation strategy is essential not only to
validate approaches to learning and
practice development, but also to
disseminate and share the innovative
approaches in the wider practice and
21
5. Develop research initiatives to
document the evidence base for
learning initiatives, best practice and
service development.
SHA, to develop practice in acute mental
health care and evolve educational
programmes which will service that
development. An action research cycle will
be established, with education running
parallel
with
service
improvement,
emerging from and feeding into the
process.
Educational
relevance
to
practice, practice change to accommodate
new skills and the accumulation and
sharing of best practice evidence will
become interdependent parts of the
system. This partnership project builds on
the experience of the PDF project, placing
practice development at the heart of
continuing professional development work.
The practice development partnerships
would need to be specific to clinical areas
to allow a sharing of clinical knowledge in
particular fields. They would be a natural
forum for the Trust-based role (i.e. PDF)
and University-based role (i.e. AWBL coordinator) to meet to discuss ideas for
AWBL programmes in a broader group of
expert
professionals.
Equally,
the
collaborative work to design AWBL
programmes and research initiatives could
arise from discussions in the partnership.
At EIHMS there are already in existence
Practice Development Units (PDUs) in a
number of clinical areas: Child, Critical
Care
(including
acute
care
and
unscheduled care), Mental Health and
Learning Disability, Midwifery, Older Age
and Public and Community Health
(including chronic disease management).
The overall aims of PDUs are to:
 Provide an interface between EIHMS
and health and social care settings.
 Promote professional and practice
aspects of the collaborative work of
EIHMS, NHS Trusts and health and
social care agencies.
 Develop scholarly practice to support
practice development and practice
learning for professional preparation
and
continuing
professional
development.
 Consider
contemporary
practice
development issues to ensure practice
learning and teaching strategies reflect
current thinking.
 Stimulate practice development and
research activities.
 Develop a resource base of practice
expertise for contemporary learning
and teaching provision in university
and practice settings.
Key recommendations for a partnership
structure involving NHS Trusts,
patients/users, HEIs and SHAs:
 Trusts to provide support through the
establishment of and sufficient support
for PDF type roles.
 HEI to provide support through the
establishment of a flexible module
framework, an AWBL co-ordinator role
and area specific lecturers to engage
in AWBL projects and support
research to ensure the evidence base.
 Practice development partnerships
involving Trusts, HEIs and
patients/users, through ongoing
collaboration in Practice Development
Units (PDUs).
 Commitment from the SHA to fund
and encourage practice development
partnership initiatives.
Summary
The evaluation shows that against health
and social care policy drivers, service and
practice developments provide a context
for a sustainable framework for accredited
work-based learning.
The sustainable framework would facilitate
the negotiation of a quality assured
learning programme (module) between a
NHS Trust and an University as an
element of planned Trust service and
practice developments.
The PDUs present a natural arena for the
development
of
Trust-University
partnerships around AWBL.
The mental health PDFs have been a
driving force in developing the thinking in
this field through their proposal of an 2year pilot Acute Care Partnership. It will be
a partnership of acute units, user and
carer organisations, Surrey and Brighton
universities and the SEDC, reporting to the
It is anticipated that the resourcing for the
learning programme could come from a
variety of sources, for example the
proposed Acute Care Partnership as a
specific funded SHA project and/ or from
22
the continuing professional development
contract. The NHS Trust and University
negotiated work-based learning and
development would involve processes as
illustrated in Figure 5.1
Figure 5.1
NHS Trust and University supported
practice learning and development
Support Structures
Research Centres
Practice learning and
development units
Process outcomes
Workforce development
New ways of working
and learning
Lecturer with clinical expertise
Work based learning facilitators
Support Processes
Practice development
Service development
23
Product Outcomes
Service outcomes
Practice outcomes
Client outcomes
Contemporary practice
based curricula
References
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24
The EIHMS Strategic PDF Group
Dr Pat Colliety, Senior Tutor, Public and Community Health.
Dr John Aggergaard Larsen, Research Fellow.
Ms. Alison Rhodes, Tutor and Director of Studies, MSc Teaching and Learning.
Ms. Sue Ryle, Head of Continuing Professional Development and Postgraduate Programmes.
Professor Pam Smith, Director of the Centre for Research in Nursing and Midwifery
Education.
Dr Margaret Volante, Head of Practice Learning and Education, Centre for Research in
Nursing and Midwifery Education.
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