Transcript Slide 1

March 2014
Better Training Better Care
Evidence linking high quality training
to improved patient safety
NACT Annual Conference
January 2015
Patrick Mitchell
Director of National Programmes
Programme history
•
In 2009, Medical Education England (MEE) led two reviews into the quality
of postgraduate medical education and training which led to Sir John
Temple’s report: Time for Training and Professor John Collins’ report:
Foundation for Excellence
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MEE was requested by the then SofS to implement the 66
recommendations through the £3m Better Training Better Care (BTBC)
programme
www.hee.nhs.uk
www.hee.nhs.uk
Our workstreams
1.
Local implementation and pilots
2.
Role of the trainee
3.
Role of trainers
4.
Workforce planning
5.
Improving careers guidance and availability
6.
Integrated technology enhanced learning
7.
Broadening the Foundation Programme
8.
Regulatory approach to supporting Better Training Better Care
9.
Funding and education quality metrics
www.hee.nhs.uk
www.hee.nhs.uk
Better Training Better Care
Aims to improve the quality of training and learning for the benefit of
patient care
Professor Sir John Temple: Time for Training
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‘Making every moment count’
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‘Appropriate supervision’ and/or ‘Consultant present service’
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‘Service delivery must explicitly support training’
Professor John Collins: Foundation for Excellence
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Appropriate supervision for trainees
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Concerns that trainees are working beyond their level of competence
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Redistribution of posts and community experience
Programme formally closed March 2014
www.hee.nhs.uk
www.hee.nhs.uk
Where are we now?
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Completed independent evaluation of the 16 BTBC pilots – led by Matrix
Knowledge
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Completed national evaluation of workstreams two to nine – led by HEE /
Academy of Medical Royal Colleges
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Planning the national spread and adoption phase of the BTBC pilots
through key partners including:
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Faculty of Medical Leadership and Management
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Academy of Medical Royal Colleges
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General Medical Council
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NHS Improving Quality
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NHS Employers
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NHS Litigation Authority
www.hee.nhs.uk
www.hee.nhs.uk
The BTBC pilots
Pilot themes
The objective
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16 projects piloted across different
settings and disciplines
Aim to improve training and
education
Aim to improve patient care
Evidence of sustainability and
adoptability
Demonstrate value for money
www.hee.nhs.uk
www.hee.nhs.uk
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Hand over / care transition
Out of hours 24/7
Communication
Front door (A&E/acute medicine)
Patient and rota scheduling
Multidisciplinary working
Pilots support national issues
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7 day care
Integrated care
Urgent and emergency care
Francis and Berwick
Human Factors
Patient safety
What makes a project successful?
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Leadership
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Trust Board support
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Governance
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Communications
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Academic and lay representation
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Wider engagement and buy in from trainees and trainers, MDT
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IT
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Dedicated project management
www.hee.nhs.uk
www.hee.nhs.uk
Trainees as change agents
Trainees demonstrated outstanding leadership skills championing their pilot
projects during implementation and outside of the pilot environment.
East Kent – EM rota
Trainees displayed
strong leadership and
enthusiasm for the pilots
and trainers reported
strong leadership of FP
doctors and registrars in
handovers.
Trainees felt better
supervision and support
allowing them further
development
www.hee.nhs.uk
www.hee.nhs.uk
Mid Cheshire –
Handover
Trainees moved to other
trusts and requested the
pilot initiative to be
implemented in their new
roles.
Clear leadership in the
handover process was
clear in 100% of meetings
Leeds and York –
Decision making in
psychiatry
Trainees championed the
system and took on a
strong leadership role
from the outset.
100% trainees higher
confidence, 83% felt
benefitted by the change
Improving workplace based
assessments (WBAs)
The pilot projects presented innovative ways to significantly improve WBAs and
productivity by improving training and creating opportunities for WBAs to be
conducted without impacting on commitments to clinical care.
Pennine – EPIC
Reward system
increased WBAs
During ‘double-credit
weeks’, five-fold increase
in the completion of
WBAs.
25% more WBAs
completed than previous
year
www.hee.nhs.uk
www.hee.nhs.uk
North Bristol – Video
feedback for
consultations
Improved trainee
consultation styles and
increased the number of
WBAs in an outpatient
area.
85% of feedback sessions
helped trainee identify a
personal area for
improvement
East Kent – EM rotas
Increase in opportunities
to complete WBAs while
on ward duty and on shift
by means of hot and cold
rota systems
4% increase in ward WBAs
and 27% in shift WBAs
completed
Integration of training
in care
Trainees became more integrated in the delivery of care and in the wider multidisciplinary team. This has had a positive effect on patient care and improved
communications and multi-disciplinary team working.
Mid Cheshire –
Handover
Greater consultant input
at handover meetings,
with registrars taking on
leadership roles in their
absence.
82.6% improvement in
‘out of hours’ tasks
handed over and increase
in staff satisfaction
www.hee.nhs.uk
www.hee.nhs.uk
Dudley – Prescribing
King’s – RAT+
Increased consultancy
support, improved patient
time to treat and
presented opportunities
for nurses to develop.
Significant improvements
in time to treatment and
time to referral
Better working relations
and understanding
between pharmacist and
trainees, with improved
knowledge by trainees in
prescribing and in
national guidelines.
Improved relationships in
pharmacy department
Impacting on culture,
efficiency and effectiveness
Several of the pilots have had a positive impact on culture, efficiency and
effectiveness in the implementation of their pilots.
South Manchester –
Surgery
Reconfiguring theatre
lists exposed trainees to
concentrated training in
specific areas, trainees
developed better skills
and gained confidence in
performing simple
procedures across
specialities
12.7% increase in
supervised operative
training
www.hee.nhs.uk
www.hee.nhs.uk
Leeds and York –
Decision-making in
psychiatry
Mid Cheshire –
Handover
Rota change allowed
more trainees to come on
day duty and have
greater exposure to
training and support, this
improved productivity,
communications and
MDT working
Greater degree of
efficiency in performing
handovers , better quality
information recorded and
an increase in the
number of tasks
completed.
Increases of 37.7%
weekday, 29.1% weekend
and 22.1% night shift
activity
82.6% improvement in ‘out
of hours’ handover and 10%
increase ‘out of hours’
discharge
Integrated Technology Enhanced
Learning (TEL)
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Development of a hub to provide a national picture of where TEL is
happening and provided
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Access to examples and TEL resources that are delivering major benefits
in health education and training
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Share and spread of good practice and innovation
across higher and postgraduate education
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Simulation
Underpinned by the DH TEL framework.
E-learning
www.hee.nhs.uk
www.hee.nhs.uk
M-learning
Broadening the Foundation Programme
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Three main components:
- Curriculum Development
- Improving Selection into the Foundation Programme
- Harmonisation and Improved Delivery
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Redistribution of posts
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Broadening the Foundation Programme report – Foundation doctors to
undertake a placement in the community
Same educational supervisor
100% do a community based placement by 2017
Trainees do not undertake same specialty twice
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www.hee.nhs.uk
www.hee.nhs.uk
Next steps?
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BTBC delivery will focus on:
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National spread and adoption of the BTBC learning through a multi
agency collaborative
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Supporting trainee led ‘Inspire Improvement’
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Developing Technology Enhanced Learning and TEL hub
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Implementing “Broadening the Foundation Programme”
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Role and value of the trainer (including Badge of Honour)
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EDQUIN Development
www.hee.nhs.uk
www.hee.nhs.uk
Questions
Patrick Mitchell
Director of National Programmes
www.hee.nhs.uk
www.hee.nhs.uk