Health Service Focus

14.01.16

Better training better care: making every moment count

Source: Jan/Feb 16

Patrick Mitchell, director of national programmes at Health Education England (HEE), talks to NHE about how learning from the Better Training Better Care pilots could help organisations in their seven-day service planning.

Health organisations should look at how their education and training programmes align with clinical services and design them together rather than separately, NHE has heard. 

Patrick Mitchell, director of national programmes at HEE, discussed lessons from the Better Training Better Care (BTBC) programme, which involved 16 local NHS trusts implementing pilot projects for medical education and training.               

In February 2015, HEE started uploading a resource that sets out how 10 local pilots could be adopted nationally and also suggests ways of developing local improvement initiatives. These projects have been broken down into themes: 

  • Front door/A&E
  • Handover
  • Improving training programmes and pathways
  • Mental health
  • Multi-professional team working
  • Out-of-hours care (24/7)
  • Rotas and scheduling 

Toolkits 

“That resource is now on our website as a toolkit for people to use, certainly for the 10 out of the 16 that worked well and were replicable,” Mitchell said. The other six pilots were not included as they were too locally focused or expensive. 

He added that a lot of work has been done to share the toolkits, which include a business case, top tips, a case study and other products that were developed by the project teams. 

The BTBC programme was commissioned in 2011 to build on the key recommendations from Sir John Temple’s ‘Time for Training’ and Professor John Collins’ ‘Foundation for Excellence’ work to improve the quality of training and learning to benefit patient care. 

Mitchell said BTBC isn’t about focusing on one particular project, but instead is centred very much one Temple’s recommendation of ‘making every moment count’. 

He added that a few of the pilots looked at how to maximise the availability of teachers, whether consultants or doctors, over a seven-day period. “By changing the way that they worked [through redesigned rotas] as a team/faculty, they were able to have a much better supervision of their trainees. This was without necessarily adding more time into their diaries, but by reorganising themselves.” 

East Kent University NHS FT, in partnership with HEE, for example, redesigned its service model to improve training and patient safety out-of-hours and on weekends. 

The pilot addressed specific issues with regard to training and patient safety; including trainee supervision, lack of opportunity for meaningful learning encounters and assessments, trainees undertaking inappropriate tasks and an increased length of stay at weekends. 

“This led to more trainer-to-trainee contact time, which meant the trainees felt more confident sooner and the trainers understood the confidence and competence of their trainees sooner,” said Mitchell. “The whole ethos around BTBC is saying to organisations: ‘Step back, look at your education and training and look at how it aligns to clinical service. Don’t design them separately, design them together.’”

He added that there is a “bit of pain” in thinking out of the box in how trusts redesign consultant presence, and what that means. “But if you tailor it in, it is a win-win for the trainees and trainers,” said Mitchell. 

The Academy Trainee Doctors’ Group, which brings together a large spectrum of specialty trainee groups, also worked with the BTBC programme to formulate a ‘trainee charter’.

The ‘Charter for Postgraduate Medical Training: Value of the Doctor in Training’ document considers the fundamental question of how to balance a trainee’s commitments to service provision with the wider aspects of the training experience. 

“And NHS Employers are supporting us in ensuring that this does get to employers and medical directors,” said Mitchell. “It is very much a two-way street between those that are educating and managing those in training and the expectations of trainees, which is sometimes forgotten.” 

TEL hub 

A lot of work has also been done on technology-enhanced learning. For example, a project is underway with the Cabinet Office to launch a TEL hub, which will hold all the e-learning, mobile application and simulation material for education and training for England. 

“We are hoping to get the green light on that soon,” said Mitchell. “A huge amount of work has been done on this, and I think it is appreciated that there is a huge amount of replication of people either building new e-learning materials or mobile apps and simulation materials when, actually, it already exists.  The idea of having a Google search equivalent for healthcare, under HEE, for people to go in and see what is already available would be hugely valued.” 

Mitchell said that there are currently 69 packages available on how to wash your hands in the NHS. But if the TEL hub was set up, which allows people to rate material, as they do on TripAdvisor, he is confident there would only be two or three packages used regularly, and people would still be washing their hands correctly. 

“It is around bringing the information available across the technology and enhancing the environment to everybody,” he said. 

FMLM event 

In March, the Faculty of Medical Leadership and Management will be hosting a summit with the BTBC to promote the outcomes and lessons learnt from the BTBC pilot projects. In particular, it aims to identify developmental themes within the project leads, the generalisability of these to all trainees and the opportunities for adopting these practices throughout training.  

A subsequent report will then be used to develop practical ideas for motivating, engaging and training future healthcare leaders to the highest standards. 

“The way we are setting up the conference is very much around the seven-day lens, the cost saving lens, and the patient safety lens,” said Mitchell. “We are saying: ‘Come on leaders, rather than looking at money in isolation from clinical service and education, look at what these pilots have done. What are the leadership lessons learned and what are the aspects of leadership that those projects did that might unlock some of the solutions that you need for the current challenges in the NHS.’”

Tell us what you think – have your say below or email opinion@nationalhealthexecutive.com

 

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