HSE Health & Safety

Executive

Violence management training

The development of effective trainers in the delivery of violence management training

in healthcare settings

Prepared by Zeal Solutions for the Health and Safety Executive 2006

RESEARCH REPORT 495

HSE Health & Safety

Executive

Violence management training

The development of effective trainers in the delivery of violence management training

in healthcare settings

Antonio Zarola BSc (Hons) MSc Zeal Solutions

27 Old Gloucester Street London

WC1N 3XX

Dr Phil Leather BA MA PhD CPsychol AFBPsS Institute of Work, Health & Organisations (I­WHO)

The University of Nottingham 8 William Lee Buildings

Nottingham Science and Technology Park University Boulevard

Nottingham NG7 2RQ

Generally,  in training evaluation research, the delegate becomes the focus of measurement. Unless one can demonstrate that training has achieved the learning outcomes it set out to achieve (ie increased knowledge, capability,  techniques,  skill,  reactions,  etc)  then  evaluations  offer  organisations  little  value.  Without  such evidence of effectiveness key stakeholders are unable to make informed decisions either about the future of training or about the strategies and actions needed to support the transfer of competence. Although delegate based evaluations are critical,  an often overlooked element  in determining  the effectiveness of any  training programme is the issue of delivery, in particular those who deliver violence management training (the trainer). This research set out to identify the competencies that make for an effective violence management trainer and to review practices and procedures associated with the selection, development and management of trainers.

This  report and  the work  it describes were  funded by  the Health and Safety Executive  (HSE) and  the NHS Security Management Service (NHS SMS). Its contents, including any opinions and/or conclusions expressed, are those of the authors alone and do not necessarily reflect HSE policy.

HSE BOOKS

© Crown copyright 2006

First published 2006

All  rights  reserved.  No  part  of  this  publication  may  bereproduced, stored in a retrieval system, or transmitted inany  form or  by any means  (electronic, mechanical,photocopying,  recording  or  otherwise)  without  the  priorwritten permission of the copyright owner.

Applications for reproduction should be made in writing to:  Licensing Division, Her Majesty's Stationery Office, St Clements House, 2­16 Colegate, Norwich NR3 1BQ or by e­mail to hmsolicensing@cabinet­office.x.gsi.gov.uk

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ACKNOWLEDGEMENTS

We would like to thank the Health and Safety Executive (HSE) and the NHS Security Management Services (SMS) for funding this research. Particular thanks go to Josephine Gravell, Jimmy McGrath, Gail Miller and Rick Tucker, for their continued support throughout the project. We are also very grateful to Simon Armitage and Judith Reilly for their help throughout the research process. We also extend our thanks to all members of the Steering Group and thank them for their input and guidance throughout this research.

We also extend our gratitude to all the individuals who assisted and collaborated with us during the earlier and qualitative stages of the research.

We are extremely grateful to all those participating organisations that have helped us in our research and extend this thanks to all the individuals who completed the online questionnaire.

We finally would like to thank Angeli Santos, Kelly Barklamb and Frances Thorne for their continued support and hard work.

ABOUT ZEAL SOLUTIONS

Zeal solutions is a research-based consultancy specialising in demonstrating the added value that applied psychology can bring to the world of work. Rooted in research excellence and solutions delivery, we bring to bear the best knowledge and thinking to business needs in a practical and straightforward manner that adds real value. At Zeal solutions, we take pride in:

o Bringing useable science to bear on all aspects of human psychology at work o Making sure that there is evidence for any solutions advocated o Translating fundamental knowledge into everyday ‘jargon free’ tactics, strategies and actions o Evaluating actions and interventions o Encouraging individual and organizational problem solving o Bringing energy and enthusiasm to everything we do

ABOUT THE INSTITUTE OF WORK, HEALTH AND ORGANISATIONS

The Institute of Work, Health and Organisations (I-WHO) is a postgraduate research institute in the Faculty of Law & Social Sciences, University of Nottingham. It focuses on the contribution that applied psychology can make to occupational and public health and safety, and the management of related health services. Occupational psychology, occupational health psychology and health and clinical psychology are among its defining interests. Its contribution in these areas is recognised by the World Health Organisation and the Institute is a designated Collaborating Centre in Occupational Health.

The Institute’s aims are fourfold. To be:

• A world-class centre of excellence in research in applied psychology and related areas.

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• A quality provider of postgraduate education and training in vocational areas of applied psychology and related subjects.

• Active and influential in policy and related legal research and in policy development. • A centre for the collection, evaluation and dissemination of information on research,

education, practice and policy in its core areas.

The Institute attempts to manage a healthy balance between its commitment to and investment in research, and related activities, and its ability to provide quality postgraduate education and training.

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CONTENTS

EXECUTIVE SUMMARY....................................................................................... vii1. INTRODUCTION .................................................................................................1

1.1 WORK RELATED VIOLENCE AND VIOLENCE MANAGEMENTTRAINING.........................................................................................................................................................11.2 WHO ARE THE TRAINERS.......................................................................................................21.3 THE ROLE OF THE VIOLENCE MANAGEMENT TRAINER ...................................21.4 VIOLENCE MANAGEMENT TRAINER AS A TRAINING SPECIALIST..............31.5 TRAINER SKILLS ..........................................................................................................................31.6 THE SCOPE AND OUTCOMES OF THE RESEARCH...................................................41.7 SCOPE OF THIS REPORT..........................................................................................................4

2. TRAINER COMPETENCIES.............................................................................62.1 THE EFFECTIVE VIOLENCE MANAGEMENT TRAINER ........................................62.2 COMPETENCIES AND COMPETENCE...............................................................................72.3 WHAT CAN COMPETENCIES BE USED FOR..................................................................72.4 THE PROCESS FOR IDENTIFYING TRAINER COMPETENCIES .........................82.5 WHAT MAKES FOR AN EFFECTIVE VIOLENCE MANAGEMENTTRAINER?.........................................................................................................................................................92.6 THE FRAMEWORK STRUCTURE.........................................................................................92.7 THE DRAFT FRAMEWORK ...................................................................................................102.8 HOW DO WE KNOW THESE COMPETENCIES MAKE THE DIFFERENCE? 112.9 VIOLENCE MANAGEMENT TRAINER: DRAFT COMPETENCYFRAMEWORK ..............................................................................................................................................12

3. VIOLENCE MANAGEMENT TRAINER SURVEY..................................193.1 INTRODUCTION ..........................................................................................................................193.2 METHODOLOGY .........................................................................................................................193.3 SURVEY RESPONDENTS .........................................................................................................203.4 MAIN SURVEY RESULTS ........................................................................................................23

3.4.1 Qualifications..................................................................................................233.4.2 Regulation/Accreditation ..................................................................................293.4.3 Training Needs, Delivery and Evaluation............................................................333.4.4 Selection of Trainers ........................................................................................373.4.5 Challenges ......................................................................................................403.4.6 Support...........................................................................................................42

4. DISCUSSION & RECOMMENDATIONS....................................................474.1 SUMMARY OF KEY FINDINGS ............................................................................................474.2 KEY MESSAGES AND RECOMMENDATIONS OF THE RESEARCH.................47

4.2.1 Regulation of violence management training .......................................................484.2.2 Trainer competencies .......................................................................................484.2.3 The role of the violence management trainer and trainer selection..........................504.2.4 Trainer support and development - Externally .....................................................504.2.5 Trainer support and development - Internally ......................................................514.2.6 Research and practice .......................................................................................51

4.3 CONCLUSION................................................................................................................................52

5. TOOLS AND CASE STUDIES........................................................................53

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5.1 INTRODUCTION ..........................................................................................................................535.2 WHAT DO WE MEAN BY A TOOL?....................................................................................545.3 CASE STUDIES ..............................................................................................................................545.4 HOW TO USE THIS TOOL-PACK ........................................................................................54

6. TRAINER SELECTION ....................................................................................556.1 SELECTION AND ASSESSMENT..........................................................................................556.2 SELECTION TOOL 1: SYSTEMS FOR SELECTION....................................................56

7. TRAINER DEVELOPMENT & SUPPORT ..................................................597.1 THE NEED FOR DEVELOPMENT AND SUPPORT......................................................597.2 TRAINER DEVELOPMENT & SUPPORT TOOL 1: PDP SYSTEM........................607.3 TRAINER DEVELOPMENT & SUPPORT TOOL 2: PERSONALDEVELOPMENT PLAN (PDP) ...............................................................................................................62

8. TRAINING METHODS.....................................................................................668.1 METHODS OF DELIVERY.......................................................................................................668.2 TRAINING METHODS TOOL 1: METHODS OF DELIVERY ..................................67

9. TRAINING SYSTEMS ......................................................................................759.1 THE TRAIN THE TRAINER REVIEW TOOL..................................................................759.2 CHECKLIST TO IDENTIFY AND SUPPORT BEST PRACTICE INSELECTING AND DEVELOPING TRAINERS ...............................................................................76

10. CASE STUDIES ..............................................................................................7910.1 INTRODUCTION ..........................................................................................................................7910.2 SELECTING VIOLENCE MANAGEMENT TRAINERS – IDENTIFYING COMPETENCE .............................................................................................................................................8010.3 TRAINING VIOLENCE MANAGEMENT TRAINERS – DEVELOPINGCOMPETENCE .............................................................................................................................................8210.4 SUPPORTING THE TRAINER DEVELOPMENT – SUSTAINING COMPETENCE .............................................................................................................................................85

11. REFERENCES .................................................................................................87

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EXECUTIVE SUMMARY

The provision of violence management training is a central component of the organisational strategy for tackling work-related violence across the Healthcare sector. Previously published research has documented evidence for the effectiveness of violence management training through the national evaluation of such training in Healthcare settings. Often overlooked in assessing training effectiveness is the issue of delivery e.g. the person delivering the material and the methods used to support the delivery of information, knowledge and skills. This research project and report is concerned directly with the violence management trainer and associated systems that are deemed necessary for selecting and developing competent and confident trainers.

The role of the violence management trainer is now becoming increasingly apparent and important in assisting organisations in successfully achieving their corporate objectives associated with work-related violence. Trainers should not only be concerned with developing individual knowledge, skills and capability in dealing with work-related violence but also and arguably more importantly, be concerned with communicating about and demonstrating the value of the various organisational initiatives, practices and procedures that are being planned or are already in place for tackling work-related violence. The national evaluation of violence management training found that the most effective form of violence management training (i.e. most valuable in terms of its impact on health, well-being and other attitudinal and performance outcomes) was the type of training that situated the content of the programme within the everyday organisational context of those in attendance (i.e. the training made sense to the delegate; they could see the relevance of the training with respect to their environment and how training was supported by organisational practice was demonstrated).

It can and should no longer be considered adequate that the violence management trainer is chosen because they are available, or that they volunteer, or that they have experience of a particular clinical area or that they are considered technically competent. Trainers who are involved in the delivery of violence management training need to call upon a range of competencies (behavioural patterns) that are not always appreciated by organisations, managers or indeed trainers themselves. It is important to recognise that short-term training and development programmes alone cannot achieve the general and specific competencies (or skills) associated with this role. It takes considerable time, energy and resource to build up the competence and confidence level to take on the role of a violence management training specialist. However appropriate the process for selecting or designing a particular violence management programme, unless trainers have been selected and developed to meet particular standards the training is unlikely to be effective. The issue of violence management trainer selection and development is the central focus of this report.

To this end the objectives of the research were as follows:

1. To explore practices with respect to trainer, selection, development and management and produce guidance in relation to train-the-trainer practices and procedures in this area.

2. To identify the competencies (behavioural patterns) that make for an effective violence management trainer and produce a competency framework outlining the core competencies required to be an effective trainer in this domain.

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3. To explore the training methods available and compare these to those most often used in violence management training.

Objectives 1 to 3 are delivered in Sections 1, 2, 3 and 4 of this report.

4. To produce tools to support violence management trainer selection and development.

5. To produce case studies of examples of best practice from across the Healthcare sector with regards to violence management trainer selection, development and management.

6. To produce guidance (i.e. monitoring tool) to enable stakeholders to confidently understand and review practices and procedures associated with the selection and development of violence management trainers.

Objectives 4 to 6 are delivered in Sections 5, 6, 7, 8, 9 and 10 of this report.

The key messages, findings and a summary of the key recommendations are as follows:

• The trainer can make all the difference between a successful and unsuccessful learning experience. Competencies have now been identified that are considered necessary for the effective delivery of violence management training. These competencies cluster around the following four key themes: 1) working alliance (i.e. building partnerships); 2) technical training skills (i.e. delivering learning); 3) translation (i.e. knowing and communicating) and 4) drive, development and resilience (i.e. adapting and coping). A competency framework outlining the behavioural dimensions associated with each of these themes is outlined in Section 2 of the report.

• Within the Healthcare sector there is a growing need to co-ordinate, at a national level, action to support the regulation and monitoring of violence management training and trainers. The ‘regulation’ of violence management training and trainers has the potential to contribute to improving the overall quality and standards of such training. However, it is important to recognise that the implementation of a regulatory system per se will not necessarily deliver the outcomes specified above; these outcomes can only be achieved through the development of closer partnerships between the various stakeholders across the Healthcare sector. This challenge is a strategic challenge and one that can only be achieved through a genuine partnership based approach.

• It is important for all stakeholders to take stock and consider the question of “what do we mean when we say to provide violence management training?” What might be considered effective and appropriate violence management training by one trainer, team or organisation may be considered an inappropriate use of resources and an ineffective approach to developing individual capability in dealing with work-related violence by another trainer, training organisation, individual, work group or organisation. The most effective strategy for tackling work-related violence is one that adopts an integrated organisational approach to this workplace hazard. The strategic approach for tackling work-related violence must be one that aligns itself with and is committed to demonstrating organisational learning through practices and procedures that really demonstrate a learning organisation.

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The recommendations are grouped by seven key headings:

1. Regulation of violence management training

Violence management training across the Healthcare sector is not always offered universally or consistently. The nature, frequency, duration and quality of programmes being delivered vary substantially across the sector. With respect to the regulation of violence management training the following is recommended:

1. Appropriate national agencies and bodies across the Healthcare sector must consider the issue of regulation and monitoring of violence management training in terms of both the content of violence management training and in terms of the competence of trainers to deliver such training.

2. A public and transparent consultation process with various stakeholders (e.g. trainers, training providers, managers, governing bodies and agencies, unions, etc.) to explore what is meant by regulation should be initiated.

3. It is recommended that the competencies identified for the effective delivery of violence management training should, once validated, form an integral part of any system to regulate and monitor violence management training and trainers.

2. Trainer competencies

Now that the competencies have been identified an important stage of the development process will be to validate and evaluate the competencies against a range of performance criteria so that the question ‘do these competencies make a real difference?’ can be answered.

4. The validation and evaluation of the framework should comprise: o Developing a comprehensive set of positive and negative indicators o Reviewing the dimensions o Exploring possible levels within the framework o Exploring minimum competence standards to support the overall framework o Mapping the dimensions with other competency frameworks (e.g. NHS

Knowledge and Skills Framework (KSF), National Occupational Standards, etc.) o Gathering performance data from trainers to complete both a concurrent and

predictive validation of the framework o Monitoring the framework to assess implementation and ensure there are no

adverse impacts

3. The role of the violence management trainer and trainer selection

Those given the responsibility of recruiting and selecting internal or external trainers to deliver their violence management training courses are often lacking in support to assist in the selection process. It is recommended that the following be considered with respect to the selection of violence management trainers:

5. National guidance is written to support the selection of violence management trainers and in line with best practice.

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6. The role of the violence management trainer must be formally recognised within all Healthcare sector organisations to enable appropriate resources, systems of support and development to be allocated to the role.

4. Trainer support and development – Externally

With respect to external support and guidance from national agencies and bodies for the role of the violence management trainer the following recommendations are put forward:

7. National guidance and information is required with respect to the development and continuous improvement of violence management trainers. The foundation of this guidance should be the competencies considered necessary for the effective delivery of violence management training.

8. Violence management trainers must be given access to practical tools and usable information that will support their practice and enable them to deliver their training confidently and competently.

9. National guidance and information is needed to support Trusts in developing a robust business case (i.e. through the use of comprehensive needs analysis, violence audits, assessments of organisational control systems, etc.) for practices and procedures (e.g. violence management training, etc.) for tackling, managing and reducing violence management.

5. Trainer support and development – Internally

The barriers and challenges undermining the effective delivery of violence management training are outlined in Section 3. It is therefore recommended that:

10. Violence management trainers should receive periodic supervision meetings from their managers.

11. The development of violence management trainers must be considered within an overall programme of performance review and development. It is not enough to acknowledge that individuals have particular competencies; it is vital that systems of staff development seek to continuously develop violence management trainers that are capable and feel enabled to learn and improve.

12. Where the role of violence management trainer is competing with other job functions a formal job and task analysis should be completed so that duties can be clearly specified, and tasks efficiently prioritised and managed.

13. In addition to any national recommendations that are produced, violence management trainers should be provided with the opportunity to continuously develop the knowledge, skills and abilities considered necessary for their role; the case for which can be made on moral, ethical, legal and professional grounds.

14. Appropriate mentoring systems should be implemented within organisations to offer further support to trainers. Where mentoring systems are implemented the selection of mentors should be considered against competencies of an effective mentor.

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6. Organisational capability in tackling work-related violence

As reported in previous research, the development of collective systems and support is fundamental for managing work-related violence and improving individual and organisational health and performance. It is therefore recommended that:

15. Management support and development is integral to tackling work-related violence. The development and extension of violence management training programmes to support managers should be considered so as to demonstrate the key role managers have to play and to support the transfer of training.

16. Organisations must demonstrate their commitment to learning and improving with regards to work-related violence and aggression. Organisational learning should not be just be considered an individual development phenomenon but also about the way in which information is distributed, shared and understood in an collective manner – it is as much a social process as it is an individual development process.

7. Research and practice

There is a need to ensure that practice to manage and prevent work-related violence is underpinned and informed by rigorous research evidence. The following is therefore recommended:

17. As with the continuous need to evaluate classroom based violence management training, there is an urgent need to complete a rigorous and systematic evaluation of electronic based (e-learning) approaches to violence management training and to communicate the findings of this research to inform and guide practice.

18. Training in violence management often comprises an element of physical skills tuition. There is a paucity of rigorous and comprehensive investigations for the range of physical skills taught in violence management training. There is an urgent need to improve the evidence base (e.g. effectiveness, safety, etc.) for the range of techniques on offer to inform and guide safe practice.

19. Carefully designed research to assess the transfer of training is required to support stakeholders in ensuring training is appropriately designed, delivered and supported so that classroom based learning is extended to the work environment.

20. Should a system of regulation be implemented, a research strategy is required to support the continued development of a scientific and independent evidence base upon which practice can be informed and developed.

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1. INTRODUCTION

1.1 WORK RELATED VIOLENCE AND VIOLENCE MANAGEMENT TRAINING

The cost and impact of work-related violence in the Healthcare sector is well established and documented in other seminal reports12345 . As an intervention, training is often considered a key part of an organisation’s strategy for combating violence and nowhere is this more evident than within the Healthcare sector. Providing staff with violence management trainingi is a proactive response by the organisation towards this psychosocial hazard and should be recognised as one way by which an organisation can demonstrate its commitment to delivering against its duty of care and improving staff welfare and well-being.

Considering the amount of resources (time, money and people) afforded to training, establishing how effective violence management training is within Healthcare settings was a central focus of the recently published national evaluation research1 . It was evidenced from this work that violence management training in general was having a positive but often short-term impact on delegates. In addition, training that was deemed to have the most positive outcomes, in terms of improved staff well-being and greater levels of capability for dealing with work related violence was that which met individual needs and situated the content of the programme within the everyday organisational context of those in attendance (i.e. the training made sense to the delegate; they could see the relevance of the training with respect to their environment and how training was supported by organisational practice was demonstrated).

Although assessing delegate experiences often becomes the focus of measurement in evaluations of training, whether on a national or more local scale, it only provides one part of the overall picture in determining programme effectiveness and impact. However, the need for continuous delegate based evaluations should not be undermined as it should not be forgotten that unless one can demonstrate that training has achieved the outcomes it set out to achieve (i.e. through delegate evaluations and assessments of knowledge, capability, techniques, skill, reactions, etc.) then evaluations offer organisations little value. Without such evidence of effectiveness key stakeholders are unable to make informed decisions either about the future of training or about the strategies and actions needed to support the transfer of competence.

An often-overlooked element in determining the effectiveness of any training programme is the issue of delivery (as shown in Figure 1). The concept of training delivery is fundamentally about the in-vivo training process and how this can influence, positively and/or negatively, training outcomes. There are at least two main components to the concept of training delivery; 1) the person delivering the training (i.e. the trainer) and 2) the methods used to support the delivery. The key focus of this research report is the violence management trainer.

i Violence Management Training is used to refer to the entire range of training programmes on offer to staff in Healthcare settings to better manage work related violence and aggression. Including, for example, de-escalation skills training, physical skills training such as breakaway techniques, etc.

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Figure 1: Diagram to demonstrate the key role of delivery in the training cycle

1.2 WHO ARE THE TRAINERS

Within and across the Healthcare setting there are marked differences in terms of the where ‘violence management training’ is located within the organisational structure and the resources committed to support this function. In some settings (organisations) violence management training is located within the training department and the violence management trainer is classified as a ‘professional’ trainer delivering violence management training alongside other programmes. In other settings, the functions and facilities for overseeing work-related violence are aligned to the health and safety department and trainers are often outsourced or, if not employed full time in a violence management trainer position, staff are chosen or volunteer to deliver violence management training. Often the delivery of violence management training for many internal trainers comes as an additional role/duty and must compete with a full- or part-time Healthcare role. There are of course other variations but the issue here is not one of exhaustively listing the various structures and locations of training functions, departments and trainers, instead the greatest concern is the consequence or outcomes of such variations. The lack of role definition, clarity and formal structure can lead to tensions and frustrations associated with, for example, 1) the lack of recognition and value of the violence management trainer role and function; 2) the lack of appropriate support for trainers, managers of trainers and for front-line staff; 3) inconsistent standards of training; 4) delivery of training that does not meet need; 5) a lack of appropriate allocation of resources and 6) a general lack of understanding about the demands that are made upon the violence management trainer in completing their duties.

1.3 THE ROLE OF THE VIOLENCE MANAGEMENT TRAINER

It is well documented that the role of the trainer can make the difference between a successful or unsuccessful learning experience6 . With specific reference to violence management within Healthcare settings, the role of the trainer is becoming increasingly apparent and important in

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supporting organisations in managing and preventing this psychosocial hazard. The training on offer and the trainer are together considered essential for delivering and communicating about the various organisational initiatives, practices and procedures that are planned or in place for tackling work-related violence. In addition, a key function and objective of both the training and the trainer is to transfer to the learner knowledge, skills and/or abilities that are deemed to be necessary for effective management and prevention of work-related violence.

1.4 VIOLENCE MANAGEMENT TRAINER AS A TRAINING SPECIALIST

The violence management trainer, as with any professional trainer, should be considered a training specialist. This recognition is required so that all those who are committed to contributing to the health, safety and welfare of both individuals and organisations are valued for the contributions they make. The demands made upon the violence management trainer are both specialist and general in nature. Trainers are expected to maintain their own professional development in terms of their knowledge of the violence domain (e.g. guidance associated with the legal context, national initiatives and guidance with regards to particular issues or techniques that are trained, etc.) as well develop and maintain their more general competencies to enable them to be an effective violence management trainer.

There are of course other demands often made of the violence management trainer within Healthcare settings which can extend the trainer role to one more aligned to that of a consultant (i.e. within the Healthcare sector trainers are often report being seen as consultants to the organisation with respect to the management of violence and aggression or being called upon to offer support before and during violent incidents as well as provide supportive services post incidents). This list of demands (tasks or functions) is not exhaustive but illustrative of the scope and expertise that can be associated with the role of the violence management trainer.

It is important, therefore, to recognise that short-term training and development programmes alone cannot achieve the general and specific skills associated with this role. It takes considerable time, energy and resource to build up the competence and confidence level to take on the role of a violence management training specialist. It is vital that organisations across the Healthcare sector adopt a sensible selection policy and consider appropriate training and meaningful career paths, development programmes and reward systems for violence management trainers.

1.5 TRAINER SKILLS

Often when violence management training is selected and developed as an in-house solution, the skills demanded of trainers are often overlooked. The assumptions are that those who are either full time trainers or who put themselves forward to fulfil a training role are ‘omni competent’ and that all that is needed is an instructional or technical competence or a particular kind or level of experience to be able to train others. This perception is both limiting and potentially dangerous. Technical competence is necessary but cannot be seen as sufficient for the effective delivery of violence management training. In support of this statement, and as part of the national evaluation research, it was discovered that training programmes with identical content designs were not always achieving similar positive outcomes. Although the outcomes of any training programme can be influenced by many factors (e.g. individual differences associated with delegate motivation and abilities, environmental factors and conditions, management support, resources, the content of training and the delivery methods used during training) the role of the trainer was shown and is known to be integral to this process.

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Trainers who are involved in the delivery of violence management training, as with most forms of training programme, are likely to call upon a range of competencies (behavioural skills and patterns) that are not always appreciated by organisations, managers or indeed trainers themselves. However appropriate the process for selecting or designing a particular violence management programme unless appropriate systems are in place to enable trainers to be selected and developed to meet particular standards the training is unlikely to be effective. The issue of violence management trainer selection and development is the central focus of this report.

1.6 THE SCOPE AND OUTCOMES OF THE RESEARCH

The objectives and outcomes of this research were as follows:

1. To explore practices with respect to trainer, selection, development and management and produce guidance in relation to train-the-trainer practices and procedures in this area.

2. To identify the competencies (behavioural patterns) that make for an effective violence management trainer and produce a competency framework outlining the core competencies required to be an effective trainer in this domain.

3. To explore the training methods available and compare these to those most often used in violence management training.

4. To produce tools to support violence management trainer selection and development.

5. To produce case studies of examples of best practice from across the Healthcare sector with regards to violence management trainer selection, development and management.

6. To produce guidance (i.e. monitoring tool) to enable stakeholders to confidently understand and review practices and procedures associated with the selection and development of violence management trainers.

1.7 SCOPE OF THIS REPORT

Section 2 of the report provides background information about the research and findings on the key competencies of violence management trainers operating within the Healthcare Sector.

Section 3 of the report documents the key findings from an online survey targeting violence management trainers and the managers of these trainers within Healthcare settings.

Section 4 of the report provides a succinct discussion of the key issues and messages raised by the research and offers recommendations for future action.

Section 5 of the report provides an overview of the tools (see Sections 6 to 9) to support the practice and procedures associated with the selection, development and management of violence management trainers in Healthcare settings.

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Section 6 of the report provides a tool to support decision making with regards to the selection of violence management trainers.

Section 7 of the report outlines a tool for violence management trainer support and development.

Section 8 of the report provides a tool to support training method selection to support the delivery of violence management training.

Section 9 provides a checklist tool to enable stakeholders (managers, trainers, inspectors, regulators, etc.) to consider some of the key practices and procedures associated with developing competent and confident violence management training specialists.

Section 10 provides three case studies of best practice from across the Healthcare sector associated with violence management trainer selection and development.

The overall aim of this report and all of its constituent parts are to support the continuous need for improved quality and standards as well as to foster communication and collaboration between organisations. There is a genuine need for coordinated thinking and action planning to enable sustainable and valuable change in solving and minimizing impact of hazards such as workplace violence. This community-based approach will assist in the future development of innovative and transferable solutions supporting and changing the way we attempt to tackle, manage, prevent and learn from such issues.

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2. TRAINER COMPETENCIES

2.1 THE EFFECTIVE VIOLENCE MANAGEMENT TRAINER

The concept of competency should rest at the very heart of human resource management in any organisation7. Competency approaches are useful as they are essentially about performance and concerned directly with factors contributing to high levels of performance and ultimately individual and organisational effectiveness. However, it is important to clarify at the outset that identifying key behaviours and implementing competency-based systems does not result in effective and high performing individuals per se. Individual effectiveness is as a complex as trying to achieve organisational effectiveness and therefore requires continuous and sustained efforts to learn, support and develop at all levels.

As highlighted in the introduction, trainers within the Healthcare sector are often selected or chosen on the basis of some form of technical competence or an ability to achieve a particular level of technical competence (e.g. to obtain a certificate or diploma of some kind). This model of selection appears to be one that functions on the basis of ‘if an individual can demonstrate they have certain kinds of knowledge, qualifications or have had particular experiences the ‘instant’ trainer is made’. This is not to denounce the importance of technical expertise, but a concern with the blanket ‘one size fits all’ approach to trainer selection. The development of a technical expert is futile if the trainer is unable to engage with delegates and communicate in an efficient manner. As suggested above in the introduction, sometimes individuals who have attained the necessary technical skills and qualifications are not always as effective in their delivery of violence management training. It is therefore important to consider the competencies of an effective violence management trainer and pay closer attention to the selection and development of such trainers.

To be able to establish more precisely ‘against what criteria should we select and develop violence management trainers?’ it is important to identify the qualities that make for an effective violence management trainer. This is precisely one of the key aims of this research project. In addition to identifying common criteria against which trainers can be selected, developed and managed, the identification of competencies also provides an opportunity to agree a common language for describing effectiveness. This means that those who manage or deliver violence management training in different settings will have a common understanding of what an effective trainer looks like or what it means to be effective when delivering violence management training.

The competency approach to the selection and development of violence management trainers is also one which does not align itself to any particular train the trainer course or programme of development; instead it sets out those behavioural patterns that are perceived to be associated with the high performance of any violence management trainer in any organisational setting. The competency approach to violence management trainer selection and development can also improve the level of consistency against which performance can be assessed and developed. Those in a position to assess and support the development of trainers will have a more reliable and valid understanding of what effective performance looks like thus improving the level and quality of development provided to trainers in this domain.

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2.2 COMPETENCIES AND COMPETENCE

For the purposes of clarification, the term competence is not to be confused with competency. Competence is often used to relate to a system of minimum standards (e.g. obtaining a National Vocational Qualification (NVQ)) or is demonstrated by performance and outputs, and involves the description of tasks, functions and objectives. Competency on the other hand is much more a person related concept that refers to the dimensions of behaviour lying behind effective, successful or competent performance (see Box 1 below). For example, it is to do with how a trainer goes about achieving the required learning outcomes of the violence management training programme; or what it is trainers do to meet the specific objectives of a violence management programme, etc.

Competence and Competencies

• Competencies are “behavioural repertoires”, while competence is a state of attainment.

• Competence is about achievement and is always backward-looking. A statement of competence is a statement about where a person is now, not where they might be in the future.

• Competencies can be used in a backward-looking (e.g. 360 degree feedback), concurrent (e.g. assessment centre) or forward-looking way (i.e. competency potential) to predict what they should be able to achieve.

• People demonstrate their competence by applying their competencies in a goal-directed manner within a work setting.

Source: Kurz & Bartram (2002) 8

Box 1

The factors or ingredients contributing to an effective course/programme of learning are therefore not solely associated with what is taught (i.e. content of the programme), but fundamentally about how it is taught (i.e. the process of training)6 . Considering the increasing significance of the workplace trainer, and in particular, the workplace violence management trainer, it becomes increasingly important to ensure that training providers, internal or external to any organisation, are attracting, selecting and developing trainers who are likely to effective in the delivery of such training.

2.3 WHAT CAN COMPETENCIES BE USED FOR

As noted above, the use of competencies helps to introduce a common language and framework against which human performance can be managed, assessed and developed. As shown in Figure 2, competencies and competency-based systems have the potential for integrating Human Resource (HR) activities such as recruitment and selection, career management, reward and performance management. Such systems offer a coherent and integrated approach to the management of people and can offer a framework against which violence management trainers can be monitored, managed, assessed and developed.

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Figure 2: The value of competencies

2.4 THE PROCESS FOR IDENTIFYING TRAINER COMPETENCIES

Focusing on the Healthcare sector, information was collected on the competencies of violence management trainers across the UK. In total 62 interviews and 8 focus groups were held with trainers (internal and outsourced) and managers of trainers from across the Healthcare sector, members of these groups represented more than 32 Healthcare organisations across the public and private Healthcare sector. As outlined in Figure 3 (moving from left to right), a variety of qualitative psychological methods where used to collect competency-based information. The principle behind the data collection approach was one that utilised a multi-method (triangulation) approach to the competency identification so that a comprehensive analysis of behaviours could be achieved. It is important to use a multi-method approach to competency analysis as this offers the opportunity to improve such analysis by synthesising the results of multiple methods into a coherent and valid interpretation - this is technically known as incremental validity. Single methods only capture a small slice of what is often a complex reality and the analysis of complex organisational phenomena (e.g. behaviours and systems) demands a degree of variety in the data collection methodologies to ensure they capture the complexity they attempt to understand. The outcome of this process is essentially to identify what are the key competencies (i.e. the behavioural patterns) that are important for the delivery of effective violence management training.

Figure 3: Illustrating the competency identification & development process

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2.5 WHAT MAKES FOR AN EFFECTIVE VIOLENCE MANAGEMENT TRAINER?

Both the academic- and practitioner-based literature make a number of recommendations in terms of the general competencies required to be an “effective” trainer. However, key to the strategy of this research was to adopt both a top-down and bottom-up process for identifying the competencies considered important for the effective delivery of violence management training. This was achieved by holding interviews and focus groups with delegates/learners themselves, trainers as well as the managers of trainers across various Healthcare settings. Future validation of the identified competencies will be completed to gather evidence and explore the competencies in greater detail.

Figure 4 provides the draft framework of the competencies considered important for the effective delivery of violence management training. A detailed description of each competency and the associated ‘key’ indicators is provided below.

Figure 4: Competencies of the violence management trainer

2.6 THE FRAMEWORK STRUCTURE

The competency framework is made up of 14 dimensions and follows a hierarchical structure, with a small number of broad factors at the top and a larger number of dimensions at the bottom. The dimensions make up the behaviours considered important, all other things being equal, for a violence management trainer to perform successfully. The competency dimensions are grouped into four themes:

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1. Working Alliance (WA): WA1: Orientation to peopleWA2: Climate: working relationshipsWA3: Principles and values

2. Technical Training Skills (TTS) TTS1: Preparing the learning environment TTS2: Managing the learning environment TTS3: Delivery style TTS4: Engaging learners TTS5: Monitoring and feedback TTS6: Managing interpersonal and group dynamics

3. Translation (TRL) TRL1: Developing knowledgeTRL2: Knowledge application

4. Drive, Development and Resilience (DDR) DDR1: Meeting challenge DDR2: Passion DDR3: Commitment to learning and improvement

The cyclical nature of the competency framework in Figure 4 is meant to demonstrate that no hierarchy is intended in the main factors shown. All factors are considered to be critical to supporting the effective delivery of violence management training. Although, as one would expect, some behavioural patterns/factors may be called upon more readily during different stages of the process of delivering a training course (e.g. the dimensions of the working alliance may be needed at the very beginning of a training programme when the trainer is seeking to build a bridge between the delegates and the trainer and between the delegates themselves).

2.7 THE DRAFT FRAMEWORK

The competency framework is a working draft and is both about the development and application of competencies. The framework does not prescribe any specific qualifications that an individual trainer must possess and be assessed against. There are of course particular technical training skills that this framework does refer to, however the list of technical skills is not intended to be exhaustive and will remain under constant review through validation procedures to ensure future areas of development are considered and included as and when appropriate.

The framework is grouped by a small number of factors. Each factor has a description that indicates ‘what it is’ and ‘why it is important’. Beneath each factor are a smaller number of components and each component has three associated draft dimensions/indicators (e.g. actual behavioural patterns).

The draft framework should be seen as a baseline against which the violence management trainer is to be developed. The framework at this stage of development is broad and generic. It will cover the roles and functions of all violence management trainers (i.e. it is not aligned to any technical or specialist skill or ability within the violence management training field). Future developments will focus on identifying more specific competencies associated with particular areas of expertise (e.g. physical skills tuition).

To support communication and interpretation of the draft framework three indicators for each dimension have been provided. In addition, only positive indicators have been included as

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negative indicators and strategies for developing the competencies will be published during the second stage of development. A tool to be used by trainers and managers of trainers for the purposes of personal and professional development and/or performance appraisal and monitoring is provided under Section 7.

2.8 HOW DO WE KNOW THESE COMPETENCIES MAKE THE DIFFERENCE?

It is important to recognise that the competencies identified must undergo a process of validation (i.e. concurrent and predictive validation) to confirm that these competences are indicative of and lead to high performing practice. The outcome and process of validation will then enable developers, trainers, managers and others to differentiate between effective and less effective trainers in the violence management domain. It was therefore deemed important not to provide an overly complicated picture of the competencies identified and produce a framework that at this stage enables trainers and their managers to consider the competency areas identified and examine how they fit within any ongoing plans for development and improvement. This framework is considered to be the first ‘working draft’ and will be subject to further validation and evaluation over the next year.

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2.9 VIOLENCE MANAGEMENT TRAINER: DRAFT COMPETENCY FRAMEWORK

WORKING ALLIANCE (WA)

What it is: Refers to the nature, level and quality of interaction and collaboration between the trainer and the learner. At least three factors are important for the strength of the working alliance. The first is associated with the bond that is established between the learner and trainer – this we call orientation to people; the second factor relates to the learning climate that is established through issues associated with respect, equality and involvement – this we call climate: working relationship and the third factor is associated with the underlying professional and ethical principles and values that motivate the trainer and are considered critical for transforming delegates and achieving the training objectives and outcomes.

Why is it important? The stronger the working alliance the more positive the outcomes of training will be. WA1: ORIENTATION TO PEOPLE

• Trainer makes learners feel comfortable and at ease both by what they say and do (i.e. welcoming learners into the classroom, smiling at delegates, etc.)

• Trainer is approachable, speaking with learners in an informal and supportive manner; sometimes using humour in a way that supports interactions and engagement

• Trainer is eager to make learners feel safe and remove any anxiety about the training by taking the time to discuss what the training involves

WA2: CLIMATE: WORKING RELATIONSHIPS • Trainer fosters ownership in learners through examining learner needs during training

and demonstrating how the training will address these needs • Trainer considers delegate knowledge and experience to be integral for the success of the

training involving all learners and treating them as equals • Trainer is willing to share their knowledge and experiences and does not use knowledge

in a way that fosters a power imbalance between the learner and trainer WA3: PRINCIPLES AND VALUES

• Trainer approaches the training with the health and safety of the learner, client and organisation in mind

• Trainer focuses on the primary prevention of incidents and stresses the importance of rapport building and effective communication and considers physical interventions as a last resort

• Trainer has a genuine desire to make a difference to individual and organisational practices with respect to tackling work-related violence

DEVELOPMENT STRATEGIES • Practice greeting behaviours and removing any potential barriers between learners and

the trainer (e.g. walking around the room, smiling, shaking learner hands, greeting with a smile, including all learners, etc.)

• Hold informal discussions with delegates both about the course and any relevant non course issues

• Make clear the overall aims the training • Clearly set out the objectives and learning outcomes of the training

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• Let delegates know that their experiences are valid and integral to the success of the training

• Spend time asking delegates about their expectations of the training • Spend time understanding issues related to delegate fears and anxiety about the training

and provide information to remove and/or reduce delegate anxiety • Develop awareness of the delegate perspective by considering how the learner might be

thinking and feeling about the course itself • Practice openly discussing any new learning and knowledge with colleagues • Access and understand any relevant codes of practice or ethics given by the original

training provider or overseeing governing body / agency associated with the course/programme of delivery and sector

• Access and understand any relevant guidance issued by governing bodies (e.g. Health and Safety Executive (HSE), NHS Security Management Services (SMS), National Institute for Mental Health in England (NIMHE), Welsh Assembly, Scottish Executive, Strategic Health Authorities, Health Councils, etc.) with regards to safe and competent practice in violence management training

• Review and follow any specific guidelines provided by the original training provider with respect to health and safety risk assessments

• Access and understand material and guidance associated with the principles and values of the client organisation

• Review training programme content and determine if key principles of prevention are clearly specified during delivery

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TECHNICAL TRAINING SKILLS (TTS)

What it is: This competency refers to the technical training skills considered critical for any violence management trainer to possess. These competencies refer to the trainer’s ability to make use of tools, tactics and strategies to support the translation of knowledge (i.e. knowledge application) and enable delegate learning both in the classroom and transfer environment.

Why is it important? Technical training skills are critical to ensuring a positive learning environment can be developed, monitored and sustained. TTS1: PREPARING THE LEARNING ENVIRONMENT

• Trainer proactively engages in assessing training needs (at the individual and organisational level) and in the design and development of the training programme(s)

• Trainer reviews delegate information prior to the training to consider any context specific issues or special/knowledge or skill requirements

• Trainer ensures training materials, facilities and delegates are prepared well in advance of training

TTS2: MANAGING THE LEARNING ENVIRONMENT • Trainer obtains delegates expectations at the very start of the course and manages them

throughout • Trainer demonstrates an ability to proactively manage delegates and keep to time to

enable the expected activities and workshop components/modules to be delivered and completed

• Trainer schedules in ample time for breaks, reflection, action planning and workshop evaluations

TTS3: DELIVERY STYLE • Trainer is able to adapt their delivery style (e.g. language used, pace and speed of

delivery and demonstration) to suit the composition of the group • Trainer is flexible in their approach to delivery (e.g. ordering of content, type and amount

of group work) and can successfully achieve the course objectives and outcomes in line with the needs of the learner

• Trainer appears confident in their ability (e.g. relaxed body posture, calm teaching style, clear communication style, etc.) to present the material and transfer information to others

TTS4: ENGAGING LEARNERS • Trainer demonstrates active listening by paraphrasing and clarifying delegate responses

to support discussions and exploration of issues • Trainer will involve all delegates by asking open questions and seeking responses to any

topics or issues under discussion • Trainer does not just give answers but is eager to support and help learners to arrive at an

answer or solution to a problem by using open and probing questions to allow the delegate to think through and explore an issue for themselves

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TECHNICAL TRAINING SKILLS (TTS) (continued)

TTS5: MONITORING AND FEEDBACK • Trainer proactively monitors delegates (e.g. through observations, discussions, use of

questioning techniques, etc.) to establish levels of learning • Trainer appreciates the differences in delegate knowledge, skills and abilities and will

utilise a range of tactics (e.g. individual and group work, mixed pairings, discussions, etc.) to ensure delegate learning is facilitated and/or performance standards are achieved

• Trainer will provide both developmental and motivational feedback to support learning and development

TTS6: MANAGING INTERPERSONAL AND GROUP DYNAMICS • Trainer is able to manage disruptive learners constructively by speaking with them in

private, establishing the cause of their behaviour and seeking to engage them within the learning session

• Trainer is able to balance group interactions and ensuring the contributions of less vocal delegates are considered and valued

• Trainer oversees and manages delegate interactions sensitively by ensuring delegates do not lose face in front of other learners

DEVELOPMENT STRATEGIES • Obtain delegate list in advance of training and access and review learner specific

information that will assist the training • Set out a route map for the training (& learning) • Clearly indicate the structure and progression of the training at the beginning and at

appropriate points throughout • Review training delivery methods and assess if the methods used facilitate and are

supportive of achieving the learning outcomes • Make use of non-verbal and verbal communication to assist the rapport process • Make use of the ice-breaker activity to assist with delegate engagement • Use questioning techniques to assist in the learning process • Manage questions effectively and in a way that makes the delegate feel listened to and

important • Use reflective questioning to help delegates take more responsibility for learning • Sensitively identify and coach delegates who appear to be struggling with the core

concepts or techniques (i.e. do not single out any delegates who are struggling with any concepts or techniques) provide alternative techniques or think of alternative ways to communicate a concept

• Provide praise and recognition for achievement (i.e. focus on delegate strengths and not weaknesses)

• Monitor group dynamics to ensure efficient learner development • Consider mixing delegate groups to ensure dynamics are balanced

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TRANSLATION (TRL) What it is: Translation refers to the trainer’s ability to convert sound knowledge into useable tactics and strategies for the effective management and prevention of work-related violence and to communicate, demonstrate and translate these tactics and strategies into the day-to-day work reality of the delegates.

Why is it important? Without translation delegates are unlikely to engage fully with the material. As a consequence, little change is likely in delegates’ knowledge, attitudes, beliefs and behaviours. TRL1: DEVELOPING KNOWLEDGE

• Trainer demonstrates knowledge and understanding of the aetiology of violence and any content area related to their specific programme of training (e.g. legal context, non physical skills, physical skills, post incident reactions and support, etc.)

• Trainer demonstrates awareness and understanding of any national developments, policies and guidance in relation to work related violence both in general terms and specifically for the sector in which they operate

• Trainer is able to demonstrate an awareness and understanding of the delegate work context (e.g. the nature and frequency of violence staff groups face) as well as any corporate practices and procedures associated with managing and preventing work-related violence (i.e. evidence of the management controls that are in place to manage work-related violence before, during and after incidents)

TRL2: KNOWLEDGE APPLICATION • Trainer facilitates delegate learning through repeated practical/oral demonstrations • Trainer introduces scenarios and relevant examples and experiences to facilitate and

support delegate understanding and learning • Trainer does not use jargon and will use language (e.g. words, terms) that make sense to

delegates and supports their comprehension and development DEVELOPMENT STRATEGIES

• Read and understand relevant organisational literature and other relevant information (i.e. corporate and health & safety documents, relevant policies, risk assessment reports, incident reports, etc.)

• Become familiar with the delegate context through use of trainer tools such as training needs assessments, interview or focus group type methods

• Access current and rigorous (i.e. peer reviewed) sources of appropriate research and practitioner based literature

• Engage in learning and development discussions with other trainers (internally or via credible forums)

• Sensitively learn from delegate experiences, recording key issues to assist in the contextualisation and delivery of training

• Become fully familiarised with the training materials and core principles of the training • Practice expression of ideas, concepts and model explanations • Reinforce key learning points throughout the delivery of training • Practice using prescribed training materials and aids in a manner which adds to delegate

understanding • Place demonstrations, individual and group exercises in context for delegates by picking

out key learning points

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DRIVE, DEVELOPMENT AND RESILIENCE (DDR)

What it is: Drive refers to the trainer’s ability to motivate delegates and facilitate a step change in attitudes, beliefs and behaviour. Violence management training is an emotive subject. Trainers have to develop and demonstrate an ability to constructively manage learner emotional challenges and demands, overcome learner apathy and motivational issues as well as constructively deal with negativity and contradictory views. Trainers must demonstrate a belief and passion for the topic and be driven to develop and contribute to individual, team and organisational knowledge and learning.

Why is it important? One major obstacle to be overcome is a degree of learned helplessness and negativity with respect to managing violence. Delegates need to be challenged and taken out their comfort zone as a way of enabling them. Trainers must continuously seek to develop their competencies and their resilience to enable them to effectively meet the demands of the role.

DDR1: MEETING CHALLENGE • Trainer is able to use concrete examples of the actions and initiatives already underway

within the organisation to positively tackle work-related violence • Trainer is be able to demonstrate evidence of the value of current initiatives that are

already underway • Trainer is willing to challenge negative staff views in a supportive and encouraging

manner DDR2: PASSION

• Trainer is energetic and enthusiastic about what they are doing • Trainer focuses on achieving training objectives and outcomes and believes that the

results are achievable • Trainer demonstrates a genuine interest in the topic (e.g. wider reading, discussions,

publications) and is committed to making a difference to peoples lives DDR3: COMMITMENT TO IMPROVEMENT AND LEARNING

• Trainer is open to change and is proactive in their own development by continually striving to enhance and improve their own knowledge, skills and abilities through research and practice

• Trainer contributes to individual, team and organisational learning through knowledge development and sharing

• Trainer is open to feedback and constructive criticism and will use this information to improve their own learning and professionalism

DEVELOPMENT STRATEGIES • Develop sound knowledge of organisational actions and initiatives in relation to work-

related violence • Gather information and any evidence relating to the successful implementation of any

control measures within the organisation and sector for tackling work-related violence • Record key challenges that are raised during training by delegates and develop response

strategies. Review response strategies with other trainer colleagues internally or externally

• Build links between training and delegate work environment to assist in the change process

• Use appropriate (i.e. non denigrating or dismissive) language throughout training

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• Develop skills of facilitation and develop the working alliance between trainer and delegate

• Complete personal development plans to support continuous development • Hold regular meetings with supervisor/manager to support reviews and enable practical

problem solving • Attend and/or hold regular formal and informal meetings with other trainers to assist in

knowledge development, knowledge sharing and peer support

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3. VIOLENCE MANAGEMENT TRAINER SURVEY

3.1 INTRODUCTION

The process for identifying and developing the core competencies of an effective violence management trainer is one that requires a focused, often limited and in depth analysis with individuals and groups. This process is justified, and highly recommended for the purposes of identifying core competencies, but the decision to collect rich qualitative information comes at the expense of obtaining a wider perspective from those who operate in the field in general. A decision was therefore taken to develop a survey to obtain opinions from the wider community on some of the key issues that were raised during the qualitative sessions (see Methodology below). An online survey for trainers and training managers within the Healthcare sector was published during April 2006. The results of this survey that are specifically related to the objectives of this report are documented below.

3.2 METHODOLOGY

As a preliminary stage to the development of the online survey, a series of focus groups and interviews were held with members from Healthcare Trusts across the UK (England, Scotland and Wales). Ten focus groups and five interviews were held with members from eight Healthcare Trusts across the UK. The members of the focus groups were restricted to trainers and managers of these trainers.

A member of the research team facilitated each focus group. Discussions were facilitated around 8 principal areas of concern:

1. Trainer knowledge, skills, abilities & other characteristics (KSAOs) – questions exploring what KSAOs are required to be an effective violence management trainer within Healthcare settings *.

2. Trainer selection – questions exploring the process of recruiting and selecting trainers in this area *.

3. Trainer support – questions exploring the sources and types of support available and required to an effective trainer in this area.

4. Trainer development and management – questions exploring the continued professional development and management of trainers.

5. Trainer rewards and recognition – questions exploring the types of reward and/or recognition deemed appropriate for the role of the trainer.

6. Training process – questions exploring how training is managed before, during and after training.

7. Training content – questions exploring how content is chosen, how it is designed, developed, maintained, delivered and updated.

8. Issues and challenges – questions exploring the future in terms of challenges, concerns or the changing role of trainers in this area.

As a result of time constraints not all areas of enquiry were explored within each focus group. On occasions where time was of a premium the participant group were offered control in terms of deciding what would be the principal issues to discuss. Exploring trainer knowledge, skills and

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abilities (item number 1 above) and trainer selection (item number 2 above) were the two areas most frequently selected by Trusts as key to their concerns.

To facilitate exploration and information gathering about the principal areas a series of interactive activities were developed. This process ensured all members of the group contributed their views and assisted in the accurate recording of information. The focus groups were also designed to be informative and developmental for the participants (i.e. an outcome of the focus group was to develop knowledge and thinking about the key issues covered). Further information about the focus group content and structure can be obtained from the authors.

Participants were assured that the information supplied by them in the focus groups would remain anonymous at all times, the purpose being solely to help guide and inform stage two (i.e. the development of a valid and meaningful questionnaire intended for distribution to all trainers and managers across the Healthcare sector). Participants were also given various means of contacting the project team should they wish to raise any further issues after the conclusion of the focus group.

The exact process of questionnaire development involved translating the focus group material into items for the questionnaire. To obtain a more informed view of the principal issues many of the items on the questionnaire were open ended. The questionnaire distribution was managed by Zeal Solutions – an independent research based consultancy specialising in work and business psychology services. Because of time constraints a decision was taken to distribute the survey online for a period of two weeks. The survey was launched on Friday 7th April 2006 and closed on Friday 21st April 2006.

A total of 236 questionnaires were returned, however the distribution strategy of the survey makes it difficult to calculate any form of response rate from this figure because the questionnaire was disseminated to potential participants via e-mail utilising several existing sources (e.g. databases). In addition, respondents were also asked to support the distribution process by forwarding the link to the online survey to any other members within the Healthcare sector. At this stage the authors wish to thank, once again, all the participants who completed the questionnaire and all the individuals and organisations who supported the distribution process at such short notice.

3.3 SURVEY RESPONDENTS

Of those who responded to the survey (236), 99% (233) of the respondents were either violence management trainers or managers of violence management trainers within the Healthcare sector. 1% (3) respondents indicated that they were not violence management trainers in this sector and were subsequently excluded from the survey. As this survey was only targeting trainers and managers of trainers within the Healthcare sector the data and information presented below represents the views of the 233 respondents included in the final sample. Tables 1 – 7 below provide a brief summary of the composition of the survey respondents.

Table 1: Gender composition of the sample Gender Male Female

Total Undisclosed

Frequency 152 79

231 2

Percent 65.2 33.9 99.1 0.9

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iti l ici

8

7

1

2

1 n

1

1

Table 2: Compos on of the samp e by ethn ty Ethnicity Frequency Percent

British 212 91.0 Irish 3.4 White Any other White background 3.1

White and Black Caribbean White and Black African 0.4

White and Asian

Mixed

Other mixed Indian 0.9 Pakistani Bangladeshi

Asian or Asian British

Other Asian Caribbean 0.4 AfricaBlack or Black British Other Black Chinese Chinese or Other Ethnic

Group Other ethnic group 0.4

Total 232 99.6 Undisclosed 0.4

Table 4: Primary location of the sample Location Frequency Percent UK: All 6 2.6 UK: North East 22 9.4 UK: North West 24 10.3 UK: East Midlands 16 6.9 UK: East Midlands 5 2.1 UK: West Midlands 29 12.4 UK: Eastern (East of England) 23 9.9 UK: London 10 4.3 UK: South East 39 16.7 UK: South West 18 7.7 Wales 15 6.4 Scotland 22 9.4 Northern Ireland 2 .9 International 1 .4

Total 232 99.6 Undisclosed 1 0.4

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iti leTable 3: Sector compos on of the sampSector Frequency Percent Private 86 38.39 Public 216 96.43

Table 5: Status Of Employment: Trainer Role Role Status Frequency Percent Employed full time as a VMT within the organisation 66 29.5

Employed part time as a VMT within the organisation 10 4.5

Employed as a trainer but this is in addition to main role with the organisation

95 42.4

Employed in a company specialising in VMT 14 6.3

Employed in a company offering general training (including VMT)

5 2.2

Self-employed trainer 20 8.9 Other 14 6.3

Total 224 100

Table 6: Duration in VMT role* Years Frequency Percent 1 to 5 75 33.5 6 to 10 81 36.2 11to 15 38 16.9 16 plus 30 13.4

Total 224 100 *Rounded to nearest year

Table 7: Area in which VMT is delivered Location Ambulance & Paramedic Children Elderly General / Acute Learning Disabilities Mental Health Other

Frequency 29 76

100 101 109 152 53

Percent 12.9 33.9 44.6 45.1 48.7 67.9 23.7

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3.4 MAIN SURVEY RESULTS

The online survey contained questions covering six areas that were explored during the preliminary qualitative stage of the research:

1. Qualifications 2. Regulation / Accreditation 3. Training Design, Delivery and Content 4. Selection of Trainers 5. Challenges 6. Support

A summary of the findings from survey is provided below structured according to the six areas of focus.

3.4.1 Qualifications

This section of survey was concerned with exploring the training violence management trainers have received as well as obtaining information with regards to the processes in place to support trainer development through updates and refresher programmes.

The training that violence management trainers have received with respect to their role is extremely diverse in terms of the type (i.e. content focus and structure) and level of qualifications achieved. The programmes attended also varied widely in terms of overall programme duration (i.e. how long it took to complete the course) and the assessment processes in place to demonstrate competence as a violence management trainer. The courses/programmes referenced by respondents can be categorised under the following themes/headings:

1. General Vocational Training (e.g. City and Guilds, S/NVQs training, etc.) 2. General Higher Educational Training (e.g. Cert Ed, Certificate, Diploma, Degree, Post

Graduate, etc.) 3. Violence Management Training linked to vocational qualifications (e.g. City and Guilds,

S/NVQs training, etc.)* 4. Violence Management Training linked to higher education (e.g. Physical Skills Instructor

Training, Conflict Management Trainer Training, etc.)* 5. Violence Management Training not linked to any vocational or higher educational

training (e.g. Physical Skills Instructor Training, Conflict Management Trainer Training, etc.)

6. Specialised Training (e.g. Weapons, Hostage Negotiation Training, etc.) 7. Short Programmes Of Training (e.g. Workshops, Familiarisation Seminars)*

* Many of the courses and programmes listed were tailored to the Healthcare sector.

Where training comprised attendance at a ‘train-the-trainer’ programme, the duration of these programmes also varied from those that were a half day in duration to more extensive programmes lasting up to one year. The systems of competence (i.e. performance) evaluation and the criteria against which performance as a ‘violence management trainer’ was assessed also

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differed extensively between programmes. For example, some trainer training programmes did not have any form of performance assessment whereas other programmes utilised more rigorous systems of assessment making use of course work, work place assignments, practical demonstrations, written examinations and follow-up observations in-situ.

Overall, the majority of trainers (90%) consider the training they have received for their role to be very or quite relevant (see Figure 5). 4% of respondents reported the training they have received to be somewhat relevant and 6% of respondents reported the training they have received as being a little or not at all relevant for their role.

76%

14%

4%

3%

3%

Very relevantQuite relevantSomewhat relevantA little relevantNot at all relevant

Figure 5: Overall, how relevant do you consider the training you have received to be for your role as a violence management trainer?

A further content analysis was completed on the information provided by those respondents (6%) who considered their violence management trainer training to be ‘a little’ or ‘not at all’ relevant. The following themes were identified from the comments made about the training:

• Where the train the trainer training comprised a short ½ day course/programme • Where the content of the training was aligned to another sector (e.g. police based

training) • Where trainers felt they were not supported post training to develop and tailor their own

programmes • Where the training trainers received did not include relevant examples or demonstrations

relating to their own context • Where training was overly academic and not deemed to be practical and useful

As shown in Figure 6, 87% of respondents indicated that they had received some form of refresher or update training to support knowledge, skill and ability maintenance. 13% of respondents indicated that they had not received any form of refresher training to support their continuous development.

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87%

13%

YesNo

FIGURE 6: Have you received refresher training or training updates?

Those respondents who had received some form of refresher training were also asked to indicate how often they received this type of training and provide some detail about the content of such training. Information on the duration and frequency of refresher training where it was provided (N = 141 cases) is summarized in Table 8 below.

Table 8: Duration of violence management train the trainer refresher training

DURATION 1 day 2 days 3 days 4 days 5 days

Less than once a year

0.0 2.7 0.0 0.0 0.0

FREQUENCY (%)* Once a year Twice a year

27.9 10.2 7.5 2.0 24.5 0.0 4.8 0.0 17.0 0.0

Three times a year 2.0 1.4 0.0 0.0 0.0

* Note that some respondents also reported attending regular monthly meetings as part of their internal processes for refreshing knowledge. These were not included in the table.

An analysis of the comments made with respect to the topics covered during refresher/update training revealed a number of common elements as shown below. It should be noted that not all topics are covered in every refresher/update programme attended by the respondents.

REFRESHER TRAINING – CONTENT THEMES

Violence Management Knowledge • Full update and review on training content • Updates on the policy and practice in the organisation • Updates on any relevant national policy and guidance • Updates and review of physical skills • Updates and review of non-physical skills • Updates and reviews on models of violence and aggression (e.g. theory)

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• Updates on legislation • Seminars on specialist topics (e.g. diversity, communication skills, etc.) • Current research in violence and aggression

Technical Training Skills • Review of delivery methods and techniques (e.g. presentation slides, etc.) • Lesson planning

Peer-to-Peer Learning • Reflections and discussions regarding any corporate/organisational issues • Reflections and discussions regarding delegate perceptions, attitudes and motivation • General sharing of information and innovative ideas

In general, the majority of comments made about refresher training by respondents were positive. Trainers consider refresher training to be an important opportunity to take stock and review current practices and procedures, share good practice and new ideas, and consider this an opportunity to receive and provide support to each other. Where respondents reported being dissatisfied with the refresher training they received this seemed to be as a consequence of the refresher training being:

• Too short in duration or not providing enough time for delegate reflection • Context free rather that context specific (i.e. just provided general knowledge that was

not situated into the context of the trainer) • Seen as more transactional in nature (i.e. more concerned with ticking a box and charging

the trainer to keep them ‘alive’ on a register) rather than being transformational in approach (i.e. helping to further develop and consolidate core competencies of the trainer)

Finally, respondents were also asked if anything was needed to improve the professional development of violence management trainers. A content analysis of the comments made revealed the following six themes:

1. National regulation and standardization (i.e. national register, national syllabus) 2. Competencies and formal qualifications (i.e. improve trainer knowledge, technical skills

and abilities, minimum qualifications, better links with higher education) 3. Continued professional development (i.e. refreshers/updates, portfolio of evidence) 4. Research and evidence (i.e. more independent research, improved evidence on physical

techniques) 5. Increased opportunities of networking (i.e. access to local, regional and national forums) 6. Support (i.e. financial and human resource, mentoring and management support)

A sample of the comments associated with each of these themes is given below to support interpretation and understanding:

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COMMENTS: IMPROVING PROFESSIONAL DEVELOPMENT

National regulation and standardization

“We need a regulated national system, where quality and content can be assured”

“A national system of regulation to obtain consistent standards and enable auditing and monitoring of tutors to ensure standards are maintained”

“There should be a national register with standardized training, assessments and updates”

“A national system of regulation with a specific code of practice. This body should then audit trainers and organisations to ensure they are maintaining a set standard and the course content is being sufficiently delivered”

“There needs to be some clear standards put in place to protect us from those without an appropriate background and understanding of Healthcare”

Competencies and formal qualifications

“Trainers must possess more formal qualifications (e.g. teaching), this will help support the need for greater acknowledgement of the role and its importance for protecting staff health and safety”

“Competency based assessments of trainers with clear information and guidance on further development”

“Demonstration by trainers of pre-existing competencies or the potential to develop these before being allowed to train”

“Nationally agreed qualifications, background and experience for violence management training in health and social care”

“Train the trainer courses provide a good overview of a physical or non physical technique, but they do not spend enough time developing trainer and teaching skills and abilities”

Continued professional development

“There is a need for all trainers to have a portfolio/evidence of continuing professional development, this should be nationally recognised”

“Refresher training to ensure we are saying the right things as legislation changes”

“Continued professional development should be a requirement for all those with a responsibility of facilitating learning which helps people to remain safe at work”

“Trainers should possess a credible and in depth portfolio which contains nationally recognized qualifications. This should also contain information on how they continue their professional development”

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“Regular refresher training coupled with regular assessment by independent bodies”

Research and evidence

“A major problem associated with the lack of standards and subsequent accreditation, is the paucity of evidence based research on the best interventions to use and which particular situations to use them in”

“Continuous robust research and evidence is needed so we can benchmark activities, forexample, what training works and what doesn’t work”

“Access to high quality research from higher education to support the delivery of our training”

“An independent forum for accessing and communicating national research”

“Would like to see more research included within theoretical component of courses”

Increased opportunities of networking

“National networking so we can compare training across sectors / areas”

“Important to set up regional trainer groups to support each other. It means trainers who mightwork in specialist areas have someone to turn to if they have a query they can’t answer”

“Better networking between areas and joint work to learn from one another”

“Closer links with other instructors, organisations delivering training would be beneficial andregular meetings with other professionals to maintain links and offer support”

“Trainers within organisations need to see the benefits of sharing their experiences and learningfrom each other. This will help us when we attend external events and conferences”

Support

“As a trainer obtaining sound informational support will help me to deliver my courses”

“Access to forums so experiences can be shared and lessons learned, sometimes you can feel as if you are in this role alone”

“Greater support (i.e. recognition) from managers and the Trust that this is an important and worthy role”

“More funding so we can employ more trainers. We have no chance of meeting national targets as we currently stand!”

“Improved supervision and mentoring systems for new trainers, it is a difficult and challenging role and more senior trainers often do not have the time to offer support”

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3.4.2 Regulation/Accreditation

There is a great deal of market choice when it comes violence management training. Despite the many advocates for it – and the increasing number of those willing to deliver it – violence management training remains a poorly regulated business with very few examples of rigorous and systematic evaluations9. As part of the survey, respondents were also asked their opinions on issues of regulation of violence management training and trainers across the Healthcare sector. As shown in Figure 7, a majority of respondents (88%) agreed or strongly agreed with the statement that all violence management training programmes should be accredited and regulated. Similarly, as shown in Figure 8, a majority of respondents (93%) agreed or strongly agreed with the statement that all violence management trainers should be accredited and regulated.

71%

17%

8% 1%3%

Strongly agreeAgreeNeutralDisagreeStrongly disagree

FIGURE 7: Please indicate your level of agreement with the statement that "all programmes of violence management training should be accredited & regulated".

72%

21%

4% 1%2%

Strongly agreeAgreeNeutralDisagreeStrongly disagree

FIGURE 8: Please indicate your level of agreement with the statement that "all trainers of violence management training should be accredited & regulated".

Analysis of the comments made by those respondents who agreed with both statements regarding the regulation and accreditation of training programmes and trainers revealed the following four themes:

1. Standardisation, consistency and support

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2. Improving quality, outcomes and promoting professionalism 3. Knowledge enhancement and networking 4. Return on investment and protection

Comments made by respondents across the four themes have been extracted to assist with interpretation (see below):

COMMENTS: REGULATION OF TRAINING & TRAINERS (SATISFIED)

Standardisation, consistency and support

“It will create a standardized package of training, so you know from one organisation to another the core standards will be the same. It will allow us to employ people straight into post knowing they have achieved a recognized level of competence in the area of managing violence and aggression”

“It is important to regulate and accredit training so all programmes are delivered to a national standard and all training is seamless regardless of which organisation people are working in”

“All trainers will be singing from the same hymn sheet, it will allow trainers to develop qualifications within a clear framework and appeal to a wider range of staff”

“I believe that it would set clear boundaries about what should be taught to staff, including issues such as de-escalation and risk assessment that will hopefully prevent or reduce the incidents of aggression and violence. The techniques themselves also need to be ensured that they are both effective but also are safe depending on the level of aggression being demonstrated. It is not always appropriate to deal with a confused elderly aggressor in the same way as a younger healthy rugby player who is threatening to kill you.”

“Stated outcomes and competency profile nationally agreed (could be modular to reflect areas of practice). Use of Force would be clarified and techniques could be pressure tested and agreed through evidence-based practice. Ultimately it would also act as a legal stop point if something goes wrong”

Quality assurance and professionalism

“I believe that such regulation and accreditation will mean that those of us within this role will also be better recognised as professionals who care about the patients as much as the staff rather than just bully boys who like a bit of a fight”

“Ensuring the standards of the instructors are of a certain level and that the Students and Managers are receiving accurate and relevant training to their requirements”

“Make it more professional, structured and stop unqualified and inexperienced trainers becoming involved”

“It would make this type of training more professional and be seen to be professional. It will place a demand on the trainer to become a rounded learner centered teacher”

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“I think it would demonstrate quality assurance. It would surely be beneficial to patient/client care should we all be accredited”

Knowledge enhancement and networking

“Promote networking and knowledge sharing. Free organisations from working in isolation”

“Encourage the sharing of best practise and encourage people to work together”

“Enable a more robust support framework for trainers to be established and will help tomaximize learning opportunities through the sharing of information and networking”

“It would ensure that people who deliver training in this field could share experiences,knowledge and lessons learned within a shared/common language of understanding”

“It would provide a sound basis against which further research could be conducted and evidencecollected to support both the development of trainers and the training we provide”

Return on investment and protection

“It will help protect us from unqualified persons facilitating this type of work”

“Accreditation & regulation would in one fell swoop get rid of the large numbers of individuals whose practices can only be described as on a par with ‘cowboy builders’”

“By ensuring the standards of the instructors are of a certain level it will mean that delegates are receiving accurate and relevant training that will meet their requirements, all in all we will be getting a better return for our investment”

“It will ensure high standards of training will be achieved and maintained nationally and "weed out" inappropriate training organisations. This to me seems the only way forward as quality and standards of training differs greatly nationally”

“Reduce the number of private organisations using poorly trained staff to deliver courses for profit, with no support or after care for purchasers or purchasers clients”

The key concerns reported by those respondents who disagreed with the statements regarding the accreditation and regulation of violence management training programmes (4% of respondents see Figure 7) and trainers (3% of respondents see Figure 8) were associated with concerns about:

1. The lack of flexibility within the system of regulation leading to a deficiency in tailoring of training to client needs

2. The quality and experience of those who might operate and regulate such a system

A sample of comments relating to both of these concerns is provided below:

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COMMENTS: REGULATION OF TRAINING & TRAINERS (DISSATISFIED)

“In principle, I would agree, but in practice, this creates a rigid and inflexible training programme, rather like the expectations behind the National Syllabus. A one-size fits all is not good training policy.”

“It will become unnecessarily obstructive to creativity and flexibility to provide bespoke programmes within differing services and/or for different individual's needs”

“Accreditation and regulation brings consistency and standardisation helping to ensure quality. However, it can also lead to a restriction of freedom to develop flexible and appropriate solutions for a specific group of clients, and also leads to delays in embracing new valid ideas and concepts”

“I am more than happy to have any course I present quality tested but I believe we have got to be very careful not to become too rigid in content and lose the idea that bespoke training is often of far more use to the customers”

“Management of violence is little different to other types of behavioural training, which are not accredited to date. Why are we focusing on this type of training in particular? Some trainers I have used in the past have no qualifications whatsoever and have delivered high quality programmes. Other highly qualified training and development professionals have left me cold! I am sorry for sounding so negative about this, but I have experience of being assessed by very poor, unsuitable, inexperienced staff. I feel that some of the people setting the standards in some organisations ought to take a look at themselves”

“Regulated by whom? Who will regulate and how can you be sure that those expected to regulate have the required competencies to do so? This is already a problem in other sectors where inspectors make subjective comments in their reports about what is and what is not suitable training without any training themselves in the areas they are proposing to regulate”

Finally, respondents were asked how important the need to accredit violence management training and violence management trainers was. As can be seen from Figures 9 and 10 a majority of respondents consider the need to regulate violence management training (85.3%) and trainers (89.3%) in some way as important (includes very and extremely important).

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35.3%

42.0%

4.9%

8.0%

0.4%2.7%

6.7%Not at all ImportantOf little ImportanceOf some ImportanceQuite ImportantImportantVery ImportantExtremely Important

FIGURE 9: In your opinion, how important is the need to accredit and regulate programmes of violence management training?

47.3%

10.7%

31.3%

2.7% 4.5%3.6%

Of little ImportanceOf some ImportanceQuite ImportantImportantVery ImportantExtremely Important

FIGURE 10: In your opinion, how important is the need to accredit and regulate violence management trainers?

3.4.3 Training Needs, Delivery and Evaluation

The training cycle often commences with some form of assessment of training need. As was reported in the national evaluation of violence management training1, training that had the greatest value and impact was closely aligned to the perceived needs of the delegate and the organisation. In the online survey, 61% of respondents reported that they had been involved in identifying the training needs of their delegates (see Figure 11 below).

33

61%

39%YesNo

Figure 11: Have you ever been involved in assessing training needs for violence management training?

Respondents who had been directly involved in identifying the training needs of their delegates were also asked to provide further details of how the training needs were identified and/or assessed. A summary of the practices and procedures used to assess training needs is given below in Box 2.

VIOLENCE MANAGEMENT TRAINING HOW ARE TRAINING NEEDS ASSESSED?

1. Conducting a risk assessment / clinical audit 2. Reviewing incident reports 3. Consulting staff & managers (includes health & safety, occupational

health, etc.) 4. Workplace observations 5. Reviewing staff performance appraisals 6. Reviewing national guidance and research 7. Consulting service users 8. Discussions with trainers 9. Reviewing course evaluations

Methods are listed according to the frequency with which it was referenced (most frequent first).

Box 2

A further objective of this research was to examine some of the methods being used to deliver violence management training. Figure 12 below lists the methods respondents said they used during training. The delivery methods most frequently referred to were Group Discussions (98.7%), Scenario Based Learning (93.8%) and Lectures (92%). The methods least likely to be used for this type of training included pre-course work (17.4%) and post-course work (23.2%) and e-learning (8.9%). Although e-learning was not shown to be a frequently used method of

34

delivery, many respondents reported concerns regarding information and guidance regarding the use and effectiveness of e-learning, a summary of the concerns raised are provided beneath Figure 12.

8.90

17.40

23.20

24.10

40.60

75.00

92.00

93.80

98.70

0 10 20 30 40 50 60 70 80 90 100

E-learning

Pre-course work

Post-course homework

Other

Written work

Problem solving

Lecture

Scenario based learning

Group discussions

Met

hods

of d

eliv

ery

Percentage of respondents using this method of delivery

Figure 12: What methods of training do you use to deliver violence management training?

Where ‘other methods of delivery’ was selected respondents were prompted to provide details of the methods they use. These methods included:

• Videos • Practical demonstrations • Role play – verbal diffusion and physical intervention skills • Quizzes • Group tasks • Modelling techniques

COMMENTS: E-LEARNING

“We have a copy of the conflict resolution training as an e-learning programme but there are concerns about how best to use this package and make the most of this tool”

“E-learning can and should be seen as a method for delivering this type of training; however more evidence is needed about how effective this method is”

“We use a blended approach to our training, delegates complete an e-learning programme before they come to training and then we discuss and reflect on experiences. More information about how best to design blended learning using online learning would be very useful”

35

The range of training programmes being delivered within the Healthcare sector is shown in Figure 13 below.

52.68

58.93

69.64

83.04

98.66

0 10 20 30 40 50 60 70 80 90 100

Other

Negotiaton Skills

Control & Restraint

Breakaway

Verbal De-Escalation

Prog

ram

me

type

Percentage of respondents delivering this type of training

Figure 13: What type of violence management training do you deliver?

Where respondents selected ‘other’ programmes of training the majority of the comments referred to the delivery of physical skills training not aligned to the philosophy and principles behind the traditional ‘control and restraint’ type of programme (i.e. the delivery of physical skills training using non pain compliance). Other frequently mentioned themes included the theory based training around understanding why people become angry and aggressive; customer care training; risk assessments for violence; stress awareness training and other specialist courses that referred to equipment use and weapons.

Respondents were also asked ‘if’ and ‘how’ they evaluated the training they deliver. As can be seen from Figure 14, a majority of respondents (92%) indicated that they ‘do evaluate’ their training in some way.

92%

8%

YesNo

FIGURE 14: Do you evaluate your training?

An analysis of the comments made regarding how training is evaluated identified the following list of approaches to evaluation in use by respondents:

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• Post course evaluation – questionnaires* • Post course evaluation – delegate qualitative feedback • Formative evaluation – during workshop • Pre and post course – questionnaires • Follow up assessment – questionnaires with delegates • Follow up assessment – discussions with delegates • Follow up assessment – discussions with managers • Knowledge tests • Written examinations • Competency assessment** • Peer review – internal • Peer review – external

* Most commonly reported form of evaluation **Competency assessments were mentioned in relation to physical skills training only. The exact nature of the competency assessment (i.e. breadth and depth) was not provided.

Finally respondents were asked ‘what do you look for as evidence that your training has been a success?’ Although a majority of responses tended to focus on assessing outcomes at the end of training (also known as summative evaluations) many responses referred to assessing delegates during training (a type of formative evaluation). Responses were therefore categorised under five headings, as follows:

1. Delegate responses during training – assessing delegate engagement, participation and interaction

2. Delegate reactions – assessments via questionnaire regarding enjoyment, relevance, etc. 3. Learning through training – assessments of changes in knowledge, skills and attitudes

and any other specific learning outcomes 4. Transfer – discussions with delegates, service users and appropriate managers to

determine any changes in approaches, behaviours and responses in dealing with work-related violence

5. Impact – assessing any direct impact of training through assessments of incident and reporting statistics and assessing reports of staff related physical injuries from assaults

3.4.4 Selection of Trainers

As highlighted above, the demands made of the violence management trainer are wide and varied. Trainers often play a dual role comprising 1) developing staff capabilities in dealing with violence and aggression but also 2) act as an important source of information and communicating about and demonstrating how the organisation is proactively preventing and managing work-related violence and supporting staff when incidents do occur. It is important therefore, that those who are chosen to fill such an important position have the knowledge, skills and abilities to perform confidently and competently in this role and they too are fully supported in their own continuous development.

Within the online survey, 122 (52.4%) respondents indicated that they had been involved in the recruitment and selection of violence management trainers. Subsequently, these (122) respondents were asked to provide information on the selection methods used and indicate how

37

effective they considered these methods to be for the selection of violence management trainersii. Arranged in the order of how often the technique was referenced, as can be seen from Table 9 below, and in line with best practice10 , respondents seem to be conducting some form of analysis of the job and/or organisation as a precursor in the process of selecting a trainer. Although not a selection method per se, the design of selection systems and the making of hiring decisions should follow/come after some form of analysis of the job in question (highlighted in green in Table 9 below). In terms of specific methods of selection (shown in orange 1-13 in Table 9), the three techniques considered to be most effective (calculated by summing together quite effective and very effective responses) for the selection of the violence management trainer in order of perceived effectiveness were:

1. Presentation (64.1% of respondents considered this method to be quite or very effective) 2. Application Forms (43.5% of respondents considered this method to be quite or very

effective) 3. Interview Structured: Panel (41.4% of respondents considered this method to be quite

or very effective)

Table 9: In your opinion how effective are these methods of recruitment and selection (%) Not very A little Somewhat Quite Very Not used effective effective effective effective effective

Prior analysis of organisational needs 2.2 1.1 18.5 42.4 27.2 8.6 Prior analysis of the requirements of the job 1.1 3.3 17.4 41.3 28.3 8.6 itself 1. Employment reference 6.5 8.7 30.4 18.5 16.3 19.6 2. Curriculum vitae 5.4 8.7 27.2 27.2 8.7 22.8 3. Application forms 2.2 7.6 23.9 27.2 16.3 22.8 4. Presentation 9.8 29.3 34.8 26.1 5. Interview: structured: panel 4.3 13 20.7 20.7 41.3 6. Interview: unstructured: one to one 1.1 9.8 18.5 16.3 54.3 7. Group discussion 2.2 4.3 9.8 16.3 13 54.3 8. Tests for specific skills (i.e. general ability 1.1 2.2 12 13 7.6 64.1 tests, literacy and/or numeracy tests) 9. Interview: structured: one to one 3.3 1.1 13 13 69.6 10. Interview: unstructured: panel 1.1 4.3 9.8 8.7 76.1 11. Personality questionnaires 1.1 5.4 6.5 6.5 80.5 12. Assessment centre 2.2 3.3 1.1 4.3 4.3 84.8 13. Other (please specify) 1.1 3.3 6.5 89.1

64% of the 122 respondents who had been involved in the selection of violence management trainers reported that further support was needed to improve the selection of trainers. A content analysis of the comments made by these respondents identified three key themes with regards to what is needed to help improve the current situation:

1. Competencies of trainer 2. Appropriate selection methods 3. National regulation

For the purposes of this research no performance based information or data was used to validate perceptions regarding the effectiveness of a particular method of selection. The effectiveness of a method of selection must be validated against objective and appropriate criteria.

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ii

A representative sample of comments associated with each of these themes is given below to support interpretation:

COMMENTS: SUPPORTING TRAINER SELECTION

Competencies of trainer

“Having a better idea of what is required to be an effective trainer in this area would help”

“There should be a basic level of competence that is required to be a trainer in this area”

“More information about what is needed, knowledge, skills and attitude wise, to be a competentviolence management trainer”

“Being better able to identify the key competencies of an effective trainer (e.g. presentation skills)and then linking this with appropriate selection processes”

“All trainers should have recognisable qualifications that help to give a baseline for those selecting courses or trainers to deliver courses”

Support in selection methods

“We need to have a more rigorous process for interviews and presentations to ensure the appropriate candidates are selected to attend trainers’ courses. Trainers to be assessed for their suitability not just appointed because they are a trainer or have achieved a qualification”

“Professional help to ensure the selection systems we use are reliable, valid and fair”

“Improving selection by exploring appropriate job criteria (e.g. experiences of working in Healthcare settings or delivering training in this or similar sectors)”

“An interview protocol with supporting guidance to assist in the selection of trainers”

“A more stringent approach to assessing positive attitudes and other trainer competencies that are conducive to the job/role”

National regulation/standardisation

“The national register will hopefully incorporate some minimum standards/requirements and help in improving the selection process and criteria to be used in the selection of violence management trainers”

“A formal national register of trainers delivering training in Healthcare settings and access to their portfolio to support decision making”

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“If you had a national system you could check trainers (or providers) maintained their standards”

“Standardise trainers, this would enable Trusts/organisations to seek trainers from outside their Trusts rather than rely on internal trainers. This would allow Trusts to seek the best person for the job”

“Helping to ensure there is a standard level of qualification through a national register would help to support the selection process”

3.4.5 Challenges

In this section of the survey respondents were asked about the perceived barriers/challenges they face with regards to delivering effective violence management training. A content analysis of the comments made identified eleven themes as shown in Table 10 below.

Table 10: Barriers/

/

()

()

()

()

(j )

()

( - -)

7

()

5

()

4

( ) 3

( ) 2

challenges to effective violence management training

Barrier Challenge: How often this comment was made:

Resources e.g. budgetary, time constraints, environmental issues, etc.

79*

Motivation, attitudes & perceptions e.g. delegate expectations of training, negativity towards training, etc.

77*

Training process & content e.g. training attendance, content issues, etc.

62*

Organisational and management support e.g. valuing health and safety, board support for training, etc.

53*

Culture & resistance to change e.g. violence seen as part of the ob, etc.

11

Health and safety issues e.g. inappropriate facilities, delegate physical fitness, etc.

11

Trainer skills & support e.g. co trainer competence, cotrainer support, etc.Continued professional development e.g. time for CPD, improved refreshers, etc.National regulation e.g. uncertainty about regulation and implementation

Role conflict e.g. training role as an add on

Legal issues e.g. fear of litigation, legal knowledge

* Considering the frequency with which these issues are mentioned further comments have been extracted from the surveys to support interpretation:

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COMMENTS: BARRIERS TO DELIVERING VIOLENCE MANAGEMENT TRAINING

Resources

“Obtaining training rooms that are of the appropriate size and have appropriate training facilities. Frequently I have to use meeting rooms & then move heavy furniture by myself as no support has been identified within the organisation for furniture removal”

“Not enough trainers to support the delivery of this training or not being able to utilise all available trainers and resources effectively due to political issues (i.e. trainers that are being managed by other senior staff and not centrally)”

“There is a lack of funding and I’m unable to purchase any additional packages to help with delivery or obtain any further training for myself”

Motivation, attitudes and perceptions

“Hostility from staff who do not feel enough is being done to support them when faced with violent situations so they often challenge the benefit of receiving violence management training”

“The challenge is to engage people who feel that they been sent on a mandatory training programme that they do not consider as being relevant to their roles”

“Staff are often cynical and it takes a great deal of effort to convince delegates that the Trust will take robust action against violent offenders”

Training process and content

“Getting staff released for training and refresher training”

“Bridging the theory to practice gap. What is taught on the mats in a controlled and safe environment is often very different to the clinical reality”

“Services seem to struggle to identify the needs of their staff. There often seems to be confusion about the appropriate courses for staff”

Organisational and management Support

“Resistance from some senior managers to send staff on training or annual refreshers within specified time span”

“The biggest challenge appears to be getting the support and backing of the Trust board. It does not appear to be recognised by the Trust what impact appropriate violence management training has on the effectiveness of care provision”

“Lack of progress from organisations in developing systems to support individuals in the management of violence. Organisations that pay lip service to staff safety. Both of these situations

41

6.03

12.50

20.26

32.76

28.45

3.45

9.05

43.97

27.59

15.95

0 20 40 60 80 100

Very dissatisfied

Dissatisfied

Neither satisfied nordissatisfied

Satisfied

Very satisfied

Percentage of respondents

ExternallyInternally

lead to cynicism from delegates about the organisation and management and this is a huge obstacle to overcome in and out of training”

3.4.6 Support

In this section of the survey respondents were asked about their levels of satisfaction with the support they receive from 1) within their organisation (internally) and 2) from bodies/agencies outside their organisation (externally) with respect to their role as a violence management trainer/manager. As shown in Figure 15 a majority of respondents (61.21%) are either very satisfied or satisfied with the support they receive internally as a violence management trainer/manager. Although a high proportion of respondents (43.54%) were either very satisfied or satisfied with the support they receive from outside agencies/bodies a marginal majority of the respondents (43.97%) were ambivalent about this source of support.

Figure 15: Levels of satisfaction with internal and external sources of support

Support Internally

A content analysis of the comments made by those respondents who were satisfied (including very satisfied) with the support they received from within the organisation (internally) for the role of the violence management trainer revealed five themes (types) of support as shown in Table 11.

-

)

Table 11: Frequency with which the following positive internal support themes were referenced

Satisfaction with support internally How often this theme was referenced

Recognition and value 31

Continuous performance reviews & regular supervision & communication 29

Peer support 27

Support for continuous professional development (CPD 21

Support for training preparation, development & delivery 14

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A sample of comments related to these themes is provided below to assist with interpretation:

COMMENTS: SATISFACTION WITH INTERNAL SUPPORT

Recognition and value

“Corporate recognition of the importance of the training. Budget available to fund training venues and backfill for trainers”

“My organisation views me as the lead in the field of aggression management and calls on me as and when needed. I feel the organisation values my experience, skills and knowledge and my role has developed because of this. I have very good support from my line manager and support and respect from other managers in the organisation on decisions made with regards training”

“The Trust recognises that violence & aggression impacts greatly on staff well-being and the associated economic costs this incurs. As a result funding has been made available to provide training to staff combined with highlighting the problem through community education initiatives”

Continuous performance reviews & regular supervision & communication

“Monthly supervision that allows reflection and support on management issues. Annual appraisal that helps to identify achievements and sets new goals and development opportunities”

“The support I receive is on a very informal basis, I know that I can approach my managers or colleagues at any time with any query and will get support”

“Good communication links with Directors and Senior Managers. Involvement in every aspect of planning”

Peer support

“Regular team meetings. The knowledge that if you have a difficult training session, help is at hand to de brief. The team gives each other excellent support”

“I am able to discuss training difficulties within my peer group setting and am always offered support in discussing ideas and ways of solving any difficulties”

“There is a lot of support from senior trainers especially. This improves my confidence in my abilities which I feel is relayed in the delivery of the training package”

Support for CPD

“Time given to refresh myself in terms of knowledge and ability and to attend various conferences and workshops in this field of work”

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“I get support to attend annual updates, relevant conferences and time to research and develop. This makes me feel valued and without this I would struggle to do my job”

“Support to select and educate a range of trainers with complementary skills, investment in trainers to ensure they are all up to date with refreshers, support to attend annual conferences and to retain membership of any relevant professional bodies”

Support for training preparation, development & delivery

“I am always released for training from my primary role as a Staff Nurse”

“Opportunity to visit units on a regular basis so that an understanding of specific needs can be ascertained”

“Being released from my primary role as a Challenging Behaviour Nurse Therapist at times when my training input is required”

Receiving ‘recognition and value’ for the violence management training role and being given ‘support for training preparation, development and delivery’ were the two key issues referenced by respondents who were dissatisfied with the support they received from the within organisation for their role as a violence management trainer. A sample of comments associated with these two themes is included below:

COMMENTS: DISSATISFACTION WITH INTERNAL SUPPORT

Recognition and value

“At present the overall feel is that the organisation feels that as long as training is being completed then they are ticking a box and that that is acceptable. There is very little support or recognition at all levels of the value and importance of the role of the violence management trainer or the training we deliver”

“I have had numerous managers none of whom have had an interest in the area. I need to be managed and supported by someone with an interest in violence and aggression management”

“Low prioritisation of violence management training when matched against other essential/mandatory requirements”

Support for training preparation, development & delivery

“The lack of commitment to ensure training is delivered. No back fill monies to release staff. The role is a full time post not a secondary role”

“Training is not formally included in my present role and therefore not supported with appropriate time to plan and deliver training well, or to do update training as I need”

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“Inconsistency with the role as at times you will be involved in decision making but the majority of time you will not be asked or involved in decisions regarding the training. Due to budgetary constraints the organisation will decide what training the trainers will have. There is just a lack of empowerment over your own specialized area of work”

Support Externally

A content (thematic) analysis of the comments made by those respondents who were satisfied (including very satisfied) with the support they received from outside the organisation (externally) revealed two themes as shown in Table 12 below.

-/

/

Table 12: Frequency with which themes were referenced Satisfaction with support externally How often this theme was referenced Information guidance updates 28 Coaching mentoring & technical support 21

A sample of comments associated with the two themes in Table 12 are provided below:

COMMENTS: SATISFACTION WITH EXTERNAL SUPPORT

Information / guidance updates

“V&A Advisory group that is a governance group-this informs other Trust groups and advises on best practice issues, reviews policy and procedures as well as being tasked with project work”

“I receive regular information and updates from my training provider. This information covers things like what’s happening in the violence management field, trainer skills and techniques as well as more general updates about training in general”

I obtain regular updates and information from national bodies across the sector (e.g. SMS, NIMHE, HSE and others). I can receive responses to any queries that I might have with regards to the national agenda and how this may impact on my area. Local Security Management Specialist (LSMS) from another Trust is available for support and Area Security Management Specialist (ASMS) is also available for support. I suppose that these people make you feel less alone in what you are doing and help to reduce your frustration levels”

Coaching/mentoring and technical skills support

“Answers to training and technical skills queries & advice when an assault occurred from my training provider and other providers”

“I have regular contact with my training provider including an internet group where trainers in this field can exchange views and ideas and get support from each other and the provider organisation”

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“I can gain access to a local senior tutor for advice, support and coaching if I need it. Regular tutor updates and a yearly conference helps to keep tutors updated in national changes that are relevant to carrying out this training”

The lack of information and guidance associated with violence management training was the main concern for respondents who were dissatisfied with the support they received from outside their organisation (externally). Comments associated with this theme are included below:

COMMENTS: DISSATISFACTION WITH EXTERNAL SUPPORT

Information / guidance updates

“Guidelines and standards are often handed out without any financial resources to implement them. Sometimes guidance is conflicting and there are often too many people involved in developing ideas so these are often overlooked or too complicated to deal with”

“We are in need of more information about the subject other than the national syllabus. Each Trust has had to devise a training package and this would have been better if some help centrally had been given. The alternative is to buy in training which under the present financial climate is not an option”

“Instead of going out to research topics there should be more readily available information”

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4. DISCUSSION & RECOMMENDATIONS

4.1 SUMMARY OF KEY FINDINGS

As has been consistently noted throughout this report, the role of the violence management trainer is central when it comes to supporting the organisation in achieving its stated objectives with regards to tackling work-related violence. However, violence management training and those who deliver such training is largely an unregulated system. Within the Healthcare sector there is a growing need to co-ordinate, at a national level, action to support the regulation and monitoring of violence management training and trainers. What was clear from the findings of the online survey was that ‘regulation’ of violence management training and trainers has the potential to contribute to improving the overall quality and standards of such training through:

1. Helping to standardise training across Trusts; 2. Improve the consistency with which training is delivered; 3. Enable improved support for training departments, managers and trainers; 4. Improve perceptions of the role violence management training has to play; 5. Develop awareness and recognition of the violence management trainer role; 6. Improve knowledge and efforts for sharing knowledge; 7. Increase the value and impact of training; and 8. Protect vulnerable organisations from poorly designed training interventions and

trainers.

However, it is important to recognise that the implementation of a regulatory system per se will not necessarily deliver the outcomes specified above; these outcomes can only be achieved through the development of closer partnerships between the various stakeholders across the Healthcare sector. This report has served to demonstrate the need to do more in relation to violence management training; not only is there a greater need for recognition but also a greater need to influence organisations to embrace higher standards and optimise the use of their resources in the delivery of violence management training. This challenge is a strategic challenge and one that can only be achieved through a genuine partnership based approach.

The recommendations that follow have sought to identify some of the key issues associated with delivering against this strategic challenge with respect to violence management training across the Healthcare sector.

4.2 KEY MESSAGES AND RECOMMENDATIONS OF THE RESEARCH

The messages and recommendations will be considered under following headings:

• Regulation of violence management training • Trainer competencies • The role of the violence management trainer and trainer selection • Trainer support and development • Organisational capability in tackling work-related violence

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• Research and practice

4.2.1 Regulation of violence management training

Violence management training across the Healthcare sector is not always offered universally or consistently. The nature, frequency, duration and quality of programmes being delivered vary substantially across the sector. The need for some form of regulation is clear. However it is important to also heed the concerns of those who do not agree with the regulation and accreditation of violence management training and trainers (see Section 3). With respect to the regulation of violence management training the following is recommended:

1. Appropriate national agencies and bodies across the Healthcare sector must consider the issue of regulation and monitoring of violence management training in terms of both the content of violence management training and in terms of the competence of trainers to deliver such training.

2. A public and transparent consultation process with various stakeholders (e.g. trainers, training providers, managers, governing bodies and agencies, unions, etc.) to explore what is meant by regulation should be initiated. Key to this consultation process is identifying what are acceptable quality criteria that organisations and individuals would need to demonstrate to operate within the sector. It is also important that this consultation process would serve to answer, as a minimum, the following questions: 1) what is the purpose and function of any regulatory body? 2) What are the objectives of the regulating body? and 3) How will regulatory functions operate and be governed on a daily basis (i.e. the operational practices, procedures and processes)?

3. It is recommended that the competencies identified for the effective delivery of violence management training should, once validated, form an integral part of any system to regulate and monitor violence management training and trainers.

4.2.2 Trainer competencies

As highlighted at the start of section 2, the role of the trainer can make the difference between a successful or unsuccessful learning experience8. However, possessing the ability to stand up and talk does not make for an effective violence management trainer. One common finding in both the academic and practitioner based literature is the general acknowledgement that trainers require a combination of subject expertise (or technical skills) and personal attributes (or interpersonal skills). Possessing a balance between these attributes is important for the promotion of successful learning.

The role of the violence management trainer across the Healthcare sector is changing and trainers must now be seen and see themselves as:

• Being proactive in demonstrating the role they and the training itself has to play; • Actively contributing towards developing organisations that are considered collectively

capable in achieving their stated objectives with respect to work-related violence; • Recognised specialists able to demonstrate their capabilities to innovate and create

interventions that support individual and organisational learning and development; • Partners who are fully integrated within the organisational systems and structures

contributing beyond the classroom environment and into the daily working lives and performances of all individuals.

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It can and should no longer be considered adequate that the violence management trainer is chosen because they are available, or that they volunteer, or that they have experience of a particular clinical area or that they are considered technically competent. This is not to say that these factors are not important or that they do not contribute to the effective delivery of violence management training (e.g. technical competence is critical for trainer credibility), but more to say that these factors are not sufficient for the effective delivery of violence management training across the Healthcare sector. It is critical that the selection, development and management of the violence management trainer are grounded in evidence and systems (i.e. the competencies) that are considered important for identifying and supporting the effective delivery of such training.

One key objective of this research was to begin to identify the core competencies associated with the effective delivery of violence management training – these competencies were outlined in Section 2. The next stage (See Stage 2 in Figure 16) of development of the competencies will be to explore any minimum competence standards that should support the overall framework (i.e. any links with specific qualifications). It is therefore recommended that the following action be taken to enable the draft competencies to be formally integrated within selection, development and regulation systems of violence management trainers across the Healthcare sector:

4. Validating and evaluating the framework (as shown in Figure 16) comprising*: o Developing a comprehensive set of positive and negative indicators o Reviewing the dimensions o Exploring possible levels within the framework o Exploring minimum competence standards to support the overall framework o Mapping the dimensions with other competency frameworks (e.g. NHS KFS,

National Occupational Standards, etc.) o Gathering performance data from trainers to complete both a concurrent and

predictive validation of the framework o Monitoring the framework to assess implementation and ensure there are no

adverse impacts

Figure 16: Stage 2 Competency Validation

* The research team from Zeal Solutions in partnership with the Institute of Work, Health and Organisations will be seeking to formally validate the framework.

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4.2.3 The role of the violence management trainer and trainer selection

Those given the responsibility of recruiting and selecting internal or external trainers to deliver their violence management training courses are often lacking in support to assist in the selection process. Evident from the both the survey results and the qualitative workshops was that although there was a great deal of good practice in operation (e.g. prior analysis of job needs and use of appropriate selection methods) there are definite knowledge and practice gaps in terms of designing and utilising the most appropriate and effective (fair, reliable and ethical) systems for the selection of violence management trainers. It is recommended that the following be considered with respect to the selection of violence management trainers:

5. National guidance is written to support the selection of violence management trainers and in line with best practice (see Section 6) the guidance should include:

o A national job description and person specification for the violence management trainer role within the Healthcare sector

o Guidance to support Healthcare sector organisations in tailoring the job descriptions and person specifications to suit their own organisational contexts following a job/task analysis

o Guidance to support Healthcare sector organisations to develop, implement and monitor selection systems for violence management trainers

o Improved methods of selection to support the effective selection of trainers (see tools in Section 6)

6. The role of the violence management trainer must be formally recognised within all Healthcare sector organisations to enable appropriate resources, systems of support and development to be allocated to the role.

4.2.4 Trainer support and development - Externally

There is clearly a great deal of positive action being undertaken to tackle work-related violence across the Healthcare sector. With respect to external support and guidance from national agencies and bodies for the role of the violence management trainer the following recommendations are put forward:

7. National guidance and information is required with respect to the development and continuous improvement of violence management trainers. The foundation of this guidance should be the competencies considered necessary for the effective delivery of violence management training.

8. Violence management trainers must be given access to practical tools and usable information that will support their practice and enable them to deliver their training confidently and competently.

9. National guidance and information is needed to support Trusts in developing a robust business case (i.e. through the use of comprehensive needs analysis, violence audits, assessments of organisational control systems, etc.) for practices and procedures (e.g. violence management training, etc.) for tackling, managing and reducing violence management.

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4.2.5 Trainer support and development - Internally

Research on the concept of support is very clear; where employees feel supported they are also more likely to report improved psychological well-being, higher job satisfaction and better overall job performance11 . The barriers and challenges undermining the effective delivery of violence management training were outlined in Section 3. It is therefore recommended that:

10. Violence management trainers should receive regular (i.e. at least monthly) supervision meetings from their managers.

11. The development of violence management trainers must be considered within an overall programme of performance review and development. It is not enough to acknowledge that individuals have particular competencies; it is vital that systems of staff development seek to continuously develop violence management trainers that are capable and feel enabled to learn and improve.

12. Where the role of violence management trainer is competing with other job functions a formal job and task analysis should be completed so that duties can be clearly specified, and tasks efficiently prioritised and managed.

13. In addition to any national recommendations that are produced, violence management trainers should be provided with the opportunity to continuously develop the knowledge, skills and abilities considered necessary for their role; the case for which can be made on moral, ethical, legal and professional grounds.

14. Appropriate mentoring systems should be implemented within organisations to offer further support to trainers. Where mentoring systems are implemented the selection of mentors should be considered against competencies of an effective mentor.

4.2.6 Organisational capability in tackling work-related violence

As reported in previous research1 , the development of collective systems and support is fundamental for managing work-related violence and improving individual and organisational health and performance. It is therefore recommended that:

15. Management support and development is integral to tackling work-related violence. The development and extension of violence management training programmes to support managers should be considered so as to demonstrate the key role managers have to play and to support the transfer of training.

16. Organisations must demonstrate their commitment to learning and improving with regards to work-related violence and aggression. Organisational learning should not be just be considered an individual development phenomenon but also about the way in which information is distributed, shared and understood in an collective manner – it is as much a social process as it is an individual development process.

4.2.7 Research and practice

There is a need to ensure that practice to manage and prevent work-related violence is underpinned and informed by rigorous research evidence. The following is therefore recommended:

17. As with the continuous need to evaluate classroom based violence management training, there is an urgent need to complete a rigorous and systematic evaluation of electronic

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based (e-learning) approaches to violence management training and to communicate the findings of this research to inform and guide practice.

18. Training in violence management often comprises an element of physical skills tuition. There is a paucity of rigorous and comprehensive investigations for the range of physical skills taught in violence management training. There is an urgent need to improve the evidence base (e.g. effectiveness, safety, etc.) for the range of techniques on offer to inform and guide safe practice.

19. Carefully designed research to assess the transfer of training is required to support stakeholders in ensuring training is appropriately designed, delivered and supported so that classroom based learning is extended to the work environment.

20. Should a system of regulation be implemented, a research strategy is required to support the continued development of a scientific and independent evidence base upon which practice can be informed and developed.

4.3 CONCLUSION

Although not restricted to any specific contexts of society, the most important context for training is the occupational one12 . Across parts of the Healthcare sector violence management training has now been given mandatory status and is considered central to the strategic action for tackling work-related violence. However, it is important for all stakeholders to take stock and consider the question of “what do we mean when we say to provide violence management training?” From both the online survey and the qualitative investigations within Healthcare Trusts it was discovered that guiding principles, objectives, outcomes, design and methods of delivery often varied substantially between and even within organisations. What might be considered effective and appropriate violence management training by one trainer, team or organisation may be considered an inappropriate use of resources and an ineffective approach to developing individual capability in dealing with work-related violence.

It is necessary for all stakeholders (e.g. training providers, trainers, delegates and national bodies of regulation) to consider first what they mean by the term “violence management training?” Do they consider violence management training to be concerned with the “systematic acquisition of specific discrete skills, rules, concepts or attitudes?” 8 Or are organisations also concerned with the need for such training to “demonstrate results through improved performance in the transfer environment?” 8 Is violence management training considered to be “a standalone tool that can be accessed or used to ‘tick a box’ whenever it is necessary?” Or is training considered to be “integral to the systems of individual and organisational learning and development?”

It is to this final issue of organisational learning and development that we wish to return. The most effective strategy for tackling work-related violence is one that adopts an integrated organisational approach to this workplace hazard13 . The strategic approach for tackling work-related violence must be one that aligns itself with and is committed to demonstrating organisational learning through practices and procedures that really demonstrate a learning organisation. From the systems for selecting and developing trainers, through practices and procedures for informing and engaging managers, to controls in place to protect the safety and well being of front line staff the organisation must demonstrate its capability to learn. This capability to learn is grounded in the organisation being able to create, acquire and transfer knowledge to its people, but it must also have systems in place to modify practices, procedures and behaviours reflecting learning from new evidence, new knowledge and new perspectives.

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5. TOOLS AND CASE STUDIES

5.1 INTRODUCTION

Section 6 through to section 10 comprises a series of tools that focus on key issues raised during the research. These sections together should be viewed as a tool-pack that has been developed to provide further support and guidance to those with a responsibility or interest in delivering or managing violence management trainers within Healthcare settings.

The key principle behind this tool-pack is to support the development and capability of those who deliver violence management training and provide further guidance, advice and support for those who have a direct responsibility for selecting and developing violence management trainers within Healthcare settings. One key objective of the research was to identify the key qualities (competencies) considered necessary for the delivery of effective violence management training. However, identifying the competencies does not mean that all trainers will be capable of displaying these competencies. Developing capable trainers must be the ultimate goal of any training provider and manager. It is to this end that this tool-pack has been developed. This tool-pack aims to enhance violence management trainer capability through the provision of tools (i.e. information, advice, guidance, checklist, techniques and case studies) designed to improve all aspects of training practice and delivery.

The information contained within this tool-pack is structured around five core themes and is grounded in the findings from the research (see Figure 17).

Figure 17: How this tool-pack is structured

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5.2 WHAT DO WE MEAN BY A TOOL?

This document has been written to act as an introductory and practical guide to support thinking and decision making with regards to selecting and developing effective and capable violence management trainers within Healthcare settings. There are many different views of what is and what is not a tool; the tools included in this document have been developed to support problem solving and to foster discussion to enable strategic thinking, planning and decision making with regards to the selection and development of violence management trainers.

5.3 CASE STUDIES

As shown in Figure 17, case studies have also been included within this tool-pack. The case studies serve to demonstrate examples of ‘good’ or best practice in relation to violence management trainer selection and development. The case studies should also be regarded as a tool as they provide first hand experiences of actions taken by organisations within the Healthcare setting to improve their training delivery. As with the national evaluation research project1, the case studies included in this report have been developed to reflect organisational realities and aim to support organisational as well as individual learning and development.

5.4 HOW TO USE THIS TOOL-PACK

This tool-pack has been designed with two purposes in mind 1) to provide the reader with sound background information and knowledge to the themes specified in Figure 17 and 2) to provide some tools and techniques to assist in the selection, management, development and delivery of effective violence management training.

This tool-pack is structured as follows:

• Section 6: Trainer Selection: a tool to support decision making with regards to the selection of violence management trainers.

• Section 7: Trainer Support & Development: tools for violence management trainer support and development.

• Section 8: Delivery Methods: a tool to support training method selection to support the delivery of violence management training.

• Section 9: Training Systems: a tool in the form of a checklist to enable stakeholders (managers, trainers, inspectors, regulators, etc.) to consider some of the key elements of associated with developing confident and competent violence management training specialists.

• Section 10: Case Studies: examples of best practice from across Healthcare settings associated with violence management trainer selection and development.

This workbook can be used in many different ways and has been developed so that sections can be accessed and read independently or sequentially depending upon specific circumstances or requirements.

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6. TRAINER SELECTION

6.1 SELECTION AND ASSESSMENT

For the purposes of this report, selection and assessment is defined as any process whereby the individual is taking steps to join a post/role within an organisation. This would include completing forms and providing information to the organisation on which they can base their selection decision. It will also include providing information to assist the individual to familiarise themselves with the selection process and its individual constituents.

Effective recruitment and selection of violence management trainers is critical to the successful day-to-day delivery and functioning of this workplace intervention. It is imperative that organisations have the appropriate procedures in place to find those people who are able to make a positive contribution to the aims of the organisation. The processes and methods of selection reported to be in use by those directly involved in the selection of violence management trainers varied considerably (see Section 3). What is important is that the systems used for attracting and selecting candidates operates within best practice guidelines (see Figure 18) and follows a process which ensures the systems of selection are effective (i.e. utilising reliable and valid methods of assessment), ethical (i.e. take into consideration issues associated with positive regard, keeping candidates informed, etc) and fair (i.e. that the recruitment and selection procedures are aligned to the true spirit of equal opportunities). The scope of this tool-pack does not allow for an exhaustive overview of what is necessary in the effective recruitment and selection of violence management trainers, however, general guidance is provided with regards to key issues associated with selection systems and information is provided to support the use of more common methods of selection.

Figure 18: Three key aspects of best practice in the selection process

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6.2 SELECTION TOOL 1: SYSTEMS FOR SELECTION

The selection and assessment of any personnel involves a number of stages. It requires practices aimed at gathering reliable information and evidence, planning, assessment and decision-making. Therefore, and before any form of selection decision is made, choices have to be made with respect to the system and procedures to be used to attract and select potential candidates for a position. The selection system and procedures to be followed are shown in a series of stages in Figure 19 below. The guidance that follows will list key issues for consideration under each stage rather than provide an in-depth discussion and review of each stage.

Figure 19: Best practice model in selecting candidates for a role

1. Job Analysis – before recruiting for a new or existing position or post it is important to invest time in gathering information about the nature of the job. This requires gathering information through the use of, for example, observations, interviews, questionnaires, etc. to examine:

a. The jobs overall purpose; b. The tasks, roles and responsibilities of the current role and any future developments; c. The specific competencies associated with the role; d. The outputs required by the job holder; and e. How the position fits within the overall organisational structure.

2. Job Description – there is no one set format for the job description. However, job descriptions should provide the candidate with the following information:

a. Job title; b. Location of the job; c. Person whom the person in the job is responsible; d. Main purpose of the job; e. Responsibilities; f. Relationships with people; and g. Salary/Pay and conditions of service.

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3. Person Specification/Job Profile – outlines the personal qualities needed for the position. In general, specifications should include: skills, aptitude, knowledge and experience, qualifications (which should be only those considered necessary to do the job) and personal qualities relevant to the job, such as the ability to work with people. The competencies outlined above in Section 2 can be included in this process.

4. Choosing Assessment Methods – each organisation and/or individual involved in the recruitment of personnel will have some preference for particular selection methods. There are a great deal of different methods available and some are considered more effective at gathering the necessary information and evidence for supporting effective, fair and ethical selection decisions. Whichever method is chosen it is important that decisions can be justified on the basis that the methods used are the best for identifying those who are likely to be successful in the job and against the person specification. It is important that decisions are not made just on the basis of using one selection method. It is recommended that organisations consider using more than one method of selection to build up a reliable and valid picture of the violence management trainer – the use of more than one method of selection is known as incremental validity and is shown in Figure 20 below (e.g. presentation and a semi-structured interview would provide a more reliable and valid picture of a candidate than using only one of these methods alone). Best practice in the area of selection methods also suggests that standards should be followed and applied when choosing selection methods (see Box 3).

Figure 20: Demonstrating how multiple selection methods promote incremental validity

5. Select and Hire Candidate(s) – it is important that the decisions to hire or not to hire are based on an objective assessment of the evidence collected during the selection process. It is important that decisions taken can be justified against the criteria that have been specified. This means that information that is collected from candidates during the selection process must be recorded accurately and objectively. This is why it is often better to use more than one selection method so that different perspectives and qualities of an individual can be assessed.

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STANDARDS TO BE APPLIED WHEN CHOOSING SELECTION METHODS

• The information provided should be as accurate as possible • Selection methods should provide information about the qualities that have been

identified as important for the job • Assessments based on the method should be indicative of candidate likely job

success • The information produced by a method (e.g. interview information) should not be

unfairly influenced by characteristics that are not relevant to job success (e.g. gender or ethnic origin)

• The method should be acceptable to candidates and consistent with the organisation’s norms and culture

• The method should be cost effective

Source: Robertson (1996) 10

Box 3

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7. TRAINER DEVELOPMENT & SUPPORT

7.1 THE NEED FOR DEVELOPMENT AND SUPPORT

The continuous improvement and development of the violence management trainer is critical for successful performance. Successful performance should not just be aligned with delivering training that achieves positive delegate outcomes but must also consider other elements associated with the motivation and overall psychological well-being of the trainer. The focus of this tool is the trainer’s personal development, the foundation of which is based on the competencies identified under section 2. However, as was also mentioned in section 2, the goal of this tool, as should be the goal of any training system is the development of violence management trainers who consider themselves to be capable of performing and delivering in their respective roles.

The generic personal development process that is recommended should be taken forward together with the support of the line manger or another person acting in that capacity.

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7.2 TRAINER DEVELOPMENT & SUPPORT TOOL 1: PDP SYSTEM

The development and support of violence management trainer is critical to the successful performance and overall training function within any organisation. The personal development system shown in Figure 21 is one that is centred on the core competencies and aligns itself to the continuous and professional development of competent and capable violence management trainers.

Figure 21: System for violence management trainer development & support

The development review process is built around 4 key stages:

1. Assessing the current position – it is important to analyse the current situation and assess developmental needs. Reviewing the core competencies is the starting point for the development process. Important to the success of the development process is the collection of reliable and valid evidence to support the continuous development of the trainer. The evidence to be collected can comprise, for example, self-assessments peer assessments, manager assessments, learner reviews and evaluation, information obtained from a job analysis, etc. This information can be collected using questionnaires, analysing archival data, conducting interviews or through observations. The information gathered from this process should directly inform the personal development plan.

2. Personal Development Plan (PDP) – on the basis of the evidence gathered a personal development plan should be created in partnership with the trainer and the line manager. The PDP is essentially a project plan for an individual’s development. It is essentially about a) building the business case for what is needed, b) prioritising needs and ensuring learning needs and actions are relevant, c) documenting how needs will be met and objectives achieved, d) establishing a timescale for achieving the objectives, e) planning future reviews and f) specifying who is responsible for any actions. It is critical during the planning stage of the PDP that other issues are considered which may act as barriers or facilitators to achieving the stated objectives (e.g. business planning cycles, the availability of funding, operational constraints, change initiatives, etc.). It is important that the issues are considered early on

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during the planning process to facilitate implementation. Regardless of the nature and structure of the PDP, the outcomes of this process must be to enable and strengthen the capabilities of the trainer.

3. Implement – the process for implementing the PDP requires forward planning and continuous communication and support between the trainer and the line manager. It must be recognised that implementation does not always mean attendance at a training programme. Development needs can be met by using a wide variety of activities, such as project work, being mentored or coached by others on the job, attendance at conferences, through private study, research, production of articles, observing others (i.e. a senior trainer) deliver a violence management training programme, and so on. Implementation is however about taking action to deliver against the PDP. To support implementation it is recognised that individuals may require further support, through coaching, mentoring, feedback and regular formal/informal meetings with line managers and their peers.

4. Evaluate Performance – it is essential that performance against the PDP is continuously monitored and evaluated to assess whether or not objectives have been achieved. It is critical that appropriate evidence is gathered throughout this process. Evidence can vary in terms of depth, breadth and accuracy. For the purposes of the PDP specific or more general evidence can include, for example, evaluations of training, client feedback, any other continuous professional development activities, peer evaluations, etc. Evaluations of the PDP should comprise a joint review between the trainer and the line manager. The structure of the review should be such that key achievements are discussed, challenges highlighted, lessons learned documented and new actions considered. The evaluation of performance is seen as feeding the cycle and initiating the PDP process once again.

To enable individuals to develop into capable trainers three important functions are highlighted that must support the continuous development of trainers:

a. Feedback – it is essential that trainers receive regular feedback on their performance and development both generally and specifically in line with any PDP to support development and motivation.

b. Coaching / mentoring – often momentum can be lost as a result of personal and/or environmental barriers. It is important that trainers can access coaches/mentors to provide continuous support to enable problem solving.

c. Support – it is important that trainers are offered support both internally as well as externally. Internally support can be commensurate with feedback and coaching, however it is also associated with receiving recognition and reward for the role they fulfil. Externally the support for trainers may come from, for example, specific training providers and national forums, however, it is essential that agencies and bodies who oversee matters across the Healthcare sector are able to offer consistent, clear and accessible guidance to enable individuals and organisations to achieve specific outcomes.

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7.3 TRAINER DEVELOPMENT & SUPPORT TOOL 2: PERSONAL DEVELOPMENT PLAN (PDP)

PDPF1: 1 of 3 PDP FORM 1 - RECORDING DEVELOPMENT NEEDS

Name (trainer):

Role (title and location):

Period this development plan covers: From: To:

Name (manager supporting the review):

General post/job requirements (list key tasks and duties): Personal objectives and targets for period (to be agreed and recorded):

Date completed:

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PDPF1: 2 of 3

What are the development needs? (please record the development needs here, the core competency the need is related to, evidence for why it is needed and how the need is linked to achieving any objectives listed above): Development need: Competency related to: Evidence for need: Objective(s): 1.

2.

3.

4.

5.

6.

Competencies to be developed (please describe how the development need is linked to improving any specific competencies):

How, when and who will take action to enable the need be met? (please describe the actions that will be taken to meet the identified need(s)): Development need number: Action(s) to meet need: Date action will be taken: Who will take action?

1.

2.

3.

4.

5.

6.

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PDPF1: 3 of 3

What evidence or information is needed to show the need has been met? (please describe the information/evidence/outcomes that will be used to demonstrate the need has been met):

Target completion date: (please record the date by which the actions will be completed or the next review period):

What support is available to you (internally or externally)? (please record any relevant internal or external sources of support that will help you achieve your actions):

What might stop you achieving and meeting this development need? (please describe any potential barriers to be overcome)

What will help you to overcome any of the identified barriers? (please describe any possible sources of support that will help you overcome the identified barriers)

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PDP FORM 2 - MONITORING PERFORMANCE AND RECORDING OUTCOMES PDPF2: 1 of 1

What actions have been taken and when? Action(s) I have completed: Date completed: What was the key outcome or lesson learned from the action:

How did these actions support you in meeting the development need?

How have you applied your learning from taking these actions?

Has anything stopped you from taking further action to support your development?

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8. TRAINING METHODS

8.1 METHODS OF DELIVERY

There are essentially two components to training delivery; the first is the person who delivers the training (i.e. the trainer), and the second concerns the methods that are used in the delivery process. The tool under this section is concerned with the latter – the methods used to promote learning. There are many training methods and new methods or variations are constantly being added. The purpose of this tool is not to list all methods but to focus on the most commonly used methods within the violence management training domain. Information referencing the general advantages and disadvantages of the more commonly used delivery methods will be provided. This tool has been developed to support decision making with regards to the design, delivery and overall planning of violence management training. The following methods will be considered:

• Lectures and presentations • Demonstrations • Case studies • Role play (or Scenarios) • Discussions • Small group tasks and activities (including educational ‘games’) • Individual work • E-Learning

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8.2 TRAINING METHODS TOOL 1: METHODS OF DELIVERY

1. Lectures and Presentations

Lectures are the most formal training method and are effectively a formal presentation, requiring the audience to sit still and listen to the presenter. Questions are usually left until the end of a session, where a discussion of the material presented in the lecture may follow.

Advantages Disadvantages • Can provide quick and effective transmission of information from

one person to a number of other people. • Allows facts to be presented in a clear, logical order, including

summaries and introductions of various topics. • Provides an efficient way of providing information within a

specified time period. • Examples can be illustrated through visual aids. • Combines the use of auditory and visual information sharing

techniques. • Techniques can be applied to presentations to help maintain the

audience’s attention (e.g. highlighting key points; providing interim summaries; using ‘signposting’ techniques to indicate direction and structure).

• Providing the traditional ‘Question and Answer’ session at the end of the presentation allows formal presentations to be integrated with a more interactive approach.

• Tends to be a formal approach. • Despite the opportunity for ‘Question and Answer’ sessions, the

learner is required to take on a passive role throughout the presentation.

• People’s attention tends to wander after approximately 20 minutes or so of sustained listening.

• It can be difficult deciding how much information to give people – it is a fairly common mistake for presenters to give too much information during lectures.

• Success of presentations depends to a large extent upon the communication skills of the presenter, and the ability of the presenter to pick up and act upon non-verbal cues within the audience as a form of feedback.

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TRAINING METHODS TOOL 1: METHODS OF DELIVERY continued

2. Demonstration Demonstrations involve practical activities, usually carried out by the trainer, showing the group (or individual) the correct way to carry out a particular task. Demonstrations usually involve the participant in some way, and this involvement can be of the ‘do it with me’ or the ‘watch me first’ variety. Printed material or handouts to verbalise the information presented in the demonstration can provide a useful addition to demonstration methods.

Advantages Disadvantages • Demonstrations provide a useful representation of how a number of

pieces of information ‘fit together’. • Demonstrations can act to simplify what may seem (or sound) like a

complicated process. • Demonstrations can encourage the trainees to use, or to be

confident in attempting, the skill or action being demonstrated. • Demonstrations can help to alleviate doubts about the

product/technique being discussed. • Demonstrations can highlight efficient ways of performing a

technique or skill. • Demonstrations can highlight the possible consequences of acting

or performing in certain ways.

• The trainer should be careful not to assume that trainees have understood the demonstration, and it is important to allow opportunities for them to ask questions.

• If the trainees do not have a clear understanding of what it is that is about to be demonstrated to them, and why this demonstration is relevant, the task can become confusing.

• The speed or pace of demonstrations is often difficult to get right, yet this is important – going too fast can confuse participants, whereas going too slowly can cause observers to become bored and lose their motivation in the training programme.

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TRAINING METHODS TOOL 1: METHODS OF DELIVERY continued

3. Case studies Case studies are usually presented in written or visual form, and tend to describe a problem situation in which participants must decide what action to take to diagnose, analyse, solve or manage that problem.

Advantages Disadvantages • Case studies are intended to simulate reality and, provided that

appropriate planning and preparation has been put into developing the case study, they can help to bring real life situations into the learning environment.

• The learning environment provides a ‘safe’ arena for trainees to use trial-and-error methods, and to make mistakes without having to be concerned over the consequences.

• Case studies can enhance interest, participation and motivation. • Case studies provide an effective way of testing existing knowledge

and assessing levels of learning. • Case studies allow trainees to transfer the theories they have learnt

into practice. • The underlying principles and processes within cases can be

identified, allowing for a detailed understanding of the situation.

• The material presented in the case study needs to be topical, well researched and highly relevant to the group of trainees, otherwise this method will not achieve its purpose.

• The learning objectives and outcomes of the case study need to be clear – if they are not, this can cause problems among trainees who fail to see the purpose of the task.

• The case studies can appear detached from reality. It is therefore useful to follow the administration of a case study with a discussion about real-life examples that are related in some way to that case study.

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TRAINING METHODS TOOL 1: METHODS OF DELIVERY continued

4. Role play

In role-plays, trainees (or trainers) are asked to take on certain roles and to act out hypothetical scenarios, usually spontaneously.

Advantages Disadvantages • As with case studies, role-plays are intended to mimic real life

situations, and allow practice of certain skills in a relatively safe environment.

• Trainees are given the opportunity to practice using different behaviours, to see which behaviour can be most usefully applied in a given situation.

• Other participants can observe role-plays and learn from the things their course mates do particularly well, and also from the things they do not do so well.

• Feedback can be provided by both the trainer and other course members, which can act to facilitate useful discussions.

• If video technology is applied, participants can be given the opportunity to observe their own behaviours and reflect upon their actions.

• This approach is very participative, and can be great fun. • Role-plays help to promote the importance of feelings as well as

knowledge. This can help to provide insight into the attitudes and feelings of others.

• Role-plays may not appeal to some people, who may view the process as ‘play acting’, unreal, or time wasting. It is important not to let the ‘drama’ of the situation steer away from the overall objectives of the task.

• If the role-play situation is not well planned and delivered, it is possible that it could create an embarrassing, unsuccessful situation.

• Some individuals may be embarrassed, scared, or lack confidence in their ability to take part in a role-play, particularly one that will be observed by the group. People should be able to opt out of participating in this task, and take the more passive role of an observer if they wish to do so.

• The point of the task may not be clear, unless a thorough discussion or debriefing session is conducted after the exercise has been completed.

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TRAINING METHODS TOOL 1: METHODS OF DELIVERY continued

5. Discussions

In these situations, the trainer will usually start and facilitate a discussion, but will not add their own opinions, knowledge or expertise until the group have been given a fair chance to have their say. Discussions are planned for and managed, and are usually triggered by a specific question or activity. Discussions usually serve a specific purpose or aim to meet certain objectives, so the trainer must facilitate the group effectively to help ensure that these objectives are met.

Advantages Disadvantages • Sharing knowledge, concepts and experiences with other learners

can be a valuable and enjoyable experience, particularly among adult learners.

• Discussions can work very well when progress is monitored throughout the process, and fed back to the group at the end.

• Discussions can provide a useful way of monitoring attitudes. • Discussions can help members to gain confidence in some of their

ideas and concepts. • Discussions can help to clarify learning points for some individuals,

and when used in certain situations can be an effective way of providing useful answers to real-life problems.

• Some group members will find it harder than others to become involved in the discussion, and some trainers may find it difficult to effectively facilitate such situations without disrupting the flow of the discussion.

• Discussions are not necessarily an effective way for trainers to convey information.

• If the size of the group is either particularly large or particularly small, discussion methods can be problematic. It is useful to split particularly large groups (e.g. groups of 20 or more participants) into two smaller groups. In such cases it may be useful to assign specific roles to participants such as ‘facilitator’ and ‘chair’.

• Discussions can easily move away from the original point, and it can be difficult to get people back on to the ‘right track’.

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TRAINING METHODS TOOL 1: METHODS OF DELIVERY continued

6. Small group tasks and activities (including educational ‘games’)

Small group tasks can include problem-solving; practical skills; physical activities; or discussions. Educational games may focus on problem-solving or decision-making teamwork.

Advantages Disadvantages • This method encourages and promotes active communication and

learning. • People can learn from other individuals within their group. • People who might feel nervous about getting involved in large

group discussions may feel more confident participating in a smaller, safer environment such as a small group.

• Games can be enjoyable, while at the same time providing practice of certain skills to promote learning.

• Games can also encourage the development of inductive and deductive thought processes.

• Objectives need to be clear, otherwise the point of the task may be lost and the aims may not be met.

• In case the purpose of the activity is unclear, thorough discussion and feedback must take place at the end of the task.

• Group activities, particularly games, can get out of hand if people are not supervised and monitored throughout the process.

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TRAINING METHODS TOOL 1: METHODS OF DELIVERY continued

7. Individual work

Most courses will include a certain degree of individual learning, such as reading through the training manual or answering questions to written revision materials. This may involve evening work, such as reflection on the day’s training or preparation for the following day.

Advantages Disadvantages • The more opportunities a person is given to use or practice a skill,

the more they are likely to learn. • Evening work can be effective, provided that the learner is given a

specific task and instructed in terms of what they are expected to do.

• Provision of supervised practice can be a very useful learning experience, and a good opportunity for people to develop their skills.

• If the trainer is not careful, he or she may become too involved with the supervision of particular individuals and may lose control of the group as a whole.

• Some participants may become over-competitive, which is a situation that needs to be carefully managed by the trainer (e.g. by taking the person to one side for a private word).

• Individuals may become disheartened if they are unable to perform effectively on the first attempt; it is the trainer’s role to keep such people motivated and to persuade them not to give up.

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TRAINING METHODS TOOL 1: METHODS OF DELIVERY continued

8. E-learning

With the increasing levels of technological advancement in today’s society, E-learning is likely to become an increasingly common training method. This method is concerned with using the computer to deliver a range of training, including interactive training modules; access to additional materials; and methods of tracking individual performance.

Advantages Disadvantages • People can learn at their own pace, at their own convenience, and in

the comfort of their own homes. • Delivery of information is both flexible and active. • Training can be customised to suit the needs of individual learners. • E-Learning is generally a cost-effective method (although the

development phase of programmes can be expensive). • Performance can be tracked from a centralised point. • Modules can be added or removed from the system as and when

necessary. • E-Learning can be supported or followed-up in person, to provide

practice opportunities and additional support systems for learners.

• Accessibility is restricted, as not everybody has access to a computer.

• Many people lack the skills, the confidence, or the desire to take a course that is based on the computer.

• Such methods are inappropriate for the training of skills which require physical or personal connections between individuals.

• Materials need to be continually refreshed and updated, which can be a time consuming task.

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9. TRAINING SYSTEMS

9.1 THE TRAIN THE TRAINER REVIEW TOOL

This tool has been designed to support those responsible for selecting and/or developing their own trainers. The tool has been designed in a checklist format that can be used as part of a formal/informal interview or discussion with the appropriate representatives from the organisation being inspected. The ultimate aim of this tool is to provide both the reviewer and organisations with support to improve the quality and standards of train the trainer policies and practices.

Although the questions have been worded in a direct/closed fashion (i.e. they will elicit short yes, no answers), users are advised to elaborate on each of the questions by using open-ended questions. It is important that a comprehensive understanding is achieved with regards to the systems and processes in place to support the selection and development of trainers.

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9.2 CHECKLIST TO IDENTIFY AND SUPPORT BEST PRACTICE IN SELECTING AND DEVELOPING TRAINERS

the /

(

SELECTING TRAINERS Has a job analysis been conducted for the trainer position? Yes No Partly Comments:

Is a job description for the trainer position available? Yes No Partly Comments:

Is a person specification for the trainer position available? Yes No Partly Comments:

Has new position been advertised in the appropriate internal external documents? Yes No Partly

Comments:

Have appropriate selection techniques been chosen, and are these in keeping with company policy and national standards?

Yes No Partly

Comments: Has the relevant employment legislation been considered in this process? E.g. Discrimination Legislation).

Have those who are selecting trainers been properly trained in the use of the selection methods? Yes No Partly

Comments:

Is evidence on candidates recorded accurately and objectively and in line with current legislation? Yes No Partly

Comments:

Does the candidate have any previous relevant training experience? Yes No Partly

Comments:

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( )

to a

( )

a

(

( ) to t

a

DEVELOPING TRAINERS: STANDARDS OF APPRAISAL Are appraisal and assessment systems in place within the organisation?

Yes No Partly

Comments:

Do appraisals and assessments take place on a regular basis? Yes No Partly

Comments: If yes, how frequently do they occur?

Is performance assessed according competency framework?

Yes No Partly

Comments: If no, how is performance assessed?

Are existing National Standards used as basis for appraising and assessing performance? Are these standards supported by the organisation’s own quality standards?

Yes No Partly

Comments:

Are disciplinary procedures in place for trainers who fail to follow the required standards? Yes No Partly

Comments: If yes, how does this disciplinary procedure work?

DEVELOPING TRAINERS: CONTINUING PROFESSIONAL DEVELOPMENT CPDAre programmes in place encourage and supporcontinuing professional development? Do these programmes provide opportunities to:

Yes No Partly

1. Practice and refresh learned knowledge/skills? (i.e. ‘refresher training’). 2. Update knowledge/skills and develop new knowledge/skills?

Comments:

Are CPD opportunities regulated through system of certification? Yes No Partly

Comments:

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to

)

Are reward systems in place for trainers who perform particularly well, or achieve certain levels of attainment? Yes No Partly

Comments:

Are trainers supervised during training sessions as a means of assessment? Yes No Partly

Comments

Do trainers receive detailed feedback on their performance? Yes No Partly

Comments:

Are trainers encouraged start and maintain personal development plans? If yes, are these plans consulted when deciding on appropriate future training?

Yes No Partly

Comments:

Within the organisation, are support groups available for trainers? (E.g. discussion forums? Yes No Partly

Comments:

Any other comments:

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10. CASE STUDIES

10.1 INTRODUCTION

Three case studies are provided to help tell the story of the experiences of some Healthcare organisations. Considering the broader themes of the research (e.g. support, development and growth) from which this tool-pack stems, and with a view of transferability, the case studies have been developed in a manner that supports the learning of the intended reader group. The purpose of using case studies is to present scenarios that are both realistic and informative in that they may assist others in solving their own problems.

To support the development and transfer of competence, with regards to selecting, managing and developing effective violence management trainers, case studies have been written in a manner that does not just provide answers. Rather, they look to raise questions and allow the reader to reflect on the actions and decisions taken, review the outcomes, and benefit from reading about some of the factors that served as barriers and/or facilitators in these organisational projects. It is imperative that organisations (and individuals within them) are supported in developing their thinking in a way that builds confidence and capability. It is with the purpose of developing capability that these case studies have been written.

It is hoped that, with time, further case studies will be published to relevant websites so that the sharing of experiences might assist in the process of learning and development. For the protection of the Trusts these case studies have been anonymised. The disclosure of the Trust, in any future case studies published to the websites, will be at the discretion of each individual Trust. Should you wish to write and submit a case study then please do not hesitate to contact the authors who have developed a case study tool to assist in this process.

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10.2 SELECTING VIOLENCE MANAGEMENT TRAINERS – IDENTIFYING COMPETENCE

10.2.1 Background

The delivery of violence management training is central to the strategy for tackling work related violence within this General Acute NHS Hospital Trust in the UK. As part of the ongoing review of the actions being taken to meet the strategy and deliver against external targets it was realised that there was an urgent need to find and recruit three new violence management trainers to enable this Trust to train all its staff in violence management training (specifically conflict resolution training) by 2008. The process for attracting and selecting the trainer was delegated to the manager and an existing team of trainers responsible for co-ordinating and delivering violence management training across the Trust.

10.2.2 What was done

Initially a meeting was convened by the manager with all the existing trainers to consider how best to plan the recruitment and selection process. Because of resource constraints (time and money) a decision was taken to search for candidates internally across the Trust. The team agreed that to support the process of finding the new trainer a clear and realistic overview of the role was required. The development of the role description was facilitated first by asking the existing conflict resolution trainers to list the key tasks and duties they complete. This list was subsequently reviewed by all trainers to ensure the tasks, functions and duties associated with the role were included and accurately described. Following the production of the task list all team members were asked to consider some of the key attributes (knowledge, skills and abilities) required to perform in the role. Each team member was asked to both identify the key attribute and indicate what it was about this attribute that was so important for the role in question – approximately 26 key attributes were identified. All the identified attributes were collated and a discussion was facilitated by the manager to assist in reducing the list and producing those attributes considered critical for effective performance in the role. The attributes were grouped under the following headings: qualifications (general and trainer specific), knowledge (systems and practices within the organisation for tackling work related violence, domain specific knowledge such as national guidance etc.), interests (general and any more specifically associated with the role of a trainer), technical skills (e.g. communication, interpersonal skills) and personal qualities (team player, enthusiastic, committed, work ethic, etc). A job description was developed which included the attributes that were considered important for the role. This was publicised internally using the Intranet and other more formal routes of communication.

A total of 16 applications were received for the role and an initial sifting of the applications was completed based on the key attributes identified for the post. 8 candidates were invited to attend a selection interview and presentation for the role. Because of time and resource constraints responsibility for interviewing candidates was shared across available team members; four trainers carried out two one on one interviews each and the selection process was run over two days. The interview lasted approximately 50 minutes. The interview was fairly unstructured but a key objective of this process was to find out more about the candidates skills, interests and motivation in applying for the role. As part of the selection process candidates were also asked to

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prepare and deliver a 10-minute presentation on a topic of their choice. All candidates were warned in advance about the need to deliver a presentation.

Following the interviews all team members came together to review the 8 candidates they had seen. A discussion was held about each of the candidates and a decision was made which identified three trainers considered to best fit the key attributes seen as important for this role. A letter was written to all candidates who attended the interview, whether they were successful or not successful, informing them of the decision and, where appropriate, of the next steps.

10.2.3 What were some of the barriers/challenges you faced?

o Lack of technical expertise and support in the design and implementation of selection procedures

o Lack of time to allow for more than one person to attend the presentation o The unstructured nature of the interview resulted in interviewers asking many different

questions and focusing on different issues o The lack of structure and focus during interviews consequently made it difficult to collate and

make sense of the information following the interview o Some of the new trainers are finding it difficult to be released from their other main duties to

support training delivery

10.2.4 What would have helped to overcome these barriers?

o Being trained in how to properly select trainers o Having access to tools to support the selection of trainers o Having a list of competencies so we know what to look for during interviews o Having some idea of how to develop a proper job description for the role o Being able to talk to experts (occupational psychologists) who understand the technical issues

of recruitment and selection o Being able to review systems of selection in operation in other organisations o Being able to discuss experiences of selection with other Trusts o Being able to check that the decisions we have made are right and fair

10.2.5 Lessons learned

o Interviewing trainers can be difficult and if there is no set structure interviews can go off on a tangent which makes it really difficult to review and compare candidates

o Understanding the role before finding a trainer proved very important, without thinking about what a trainer has to do in the role crucial information about the attributes of an effective trainer may have been missed

o There is more to selection of a trainer than assessing someone’s experience. Managers (or those who are involved in the selection of trainers) must be trained and made aware of the issues by experts in the field

o Having some form of structure and plan for the selection of trainers saved time and money

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10.3 TRAINING VIOLENCE MANAGEMENT TRAINERS – DEVELOPING COMPETENCE

10.3.1 Background

This case study reports on an ongoing training re-design project in this Ambulance Service in the UK, it is the second part to the case study previously reported in the national evaluation research1 . As part of the re-design project it was considered essential by both the training provider who designed the training and the management team within the Service to ensure that trainers who were selected to deliver the programme of training were developed according to competencies considered important for the effective delivery of this training. This meant that not only did trainers have to demonstrate particular competencies but also that 1) objective evidence was gathered on their competencies so that feedback and support could be tailored to individual needs and 2) information could be gathered about the key challenges and barriers trainers faced in developing these competencies so that mechanisms could be implemented to help trainers overcome these barriers.

10.3.2 What was done

Following the completion of a training needs analysis for violence management training, a train the trainer programme was designed with a series of core competencies in mind. The core competencies were identified through research conducted by the training provider in the violence management trainer domain but also through a tailored research project within the Trust. The research within the Trust used a series of techniques to identify 1) what delegates (staff) considered to be important attributes or qualities of trainers they considered to be effective; 2) what the trainers themselves considered important for the effective delivery of training and 3) what managers believed were important behaviours for effective delivery of violence management training. The evidence gathered from this process was validated against the research that had been conducted by the training provider. A range of competencies were identified that were considered to be critical for the delivery of training in this service.

The training the trainer programme was structured so that trainers had to individually complete pre-course work before arriving at the training programme itself they also received a one on one interview with a lead trainer from the training provider to ensure all concerns and issues about delivering training in this topic were identified. The pre-course work was structured around 1) self-assessment which was essentially about supporting trainers in identifying their own strengths and areas of development in relation to the core competencies and 2) preparation for the train the trainer event which was focused on core reading, reflective exercises, knowledge development and knowledge organisation. The pre-course work and interview was also fundamental to initiating, developing and supporting thinking about work-related violence and considering in advance of attending the training specific strategies and tactics for the effective management of conflict. The information gained from the pre-course work was integral to the train the trainer workshop and informed the design and focus of specific developmental activities.

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The train the trainer programme was structured and designed with the Trusts specific needs in mind. A range of delivery options were offered to the Trust in advance of delivering the training so that the various developmental needs of the trainers could be accommodated. The Trust decided to opt for a train the trainer programme whereby the trainers themselves would lead the delivery of the key training modules that would essentially be delivered to the services employees. Following the delivery of the key modules all trainers received feedback, modelling, coaching and briefing by the training providers. The training providers also gathered evidence and completed observation and feedback sheets on each of the trainers; this information was subsequently used in the provision of detailed written and oral feedback to each trainer. Once trainers had completed the two-day workshop they were provided with a post course action plan to support development and delivery of training. In addition, each trainer was given access to a personal trainer and to an online resource of specialist information to support the development of trainer competencies. Before delivery of the training each trainer received a one on one coaching session that looked at exploring trainer development and supporting the trainer in terms of delivering the training and developing their competencies. Trainers were subsequently monitored during the delivery of a live training programme by their personal trainer. Following the delivery of the training, the personal trainer spent time with the trainer providing feedback and coaching with regards to any issues that were raised during the session. Following the live observation, trainers were signed off against the core competencies and received a certificate of completion. Although there are no ties to the training provider in terms of maintaining levels of competency, the Trust has opted to for the training providers development programme for violence management trainers which is focused on supporting trainers in the continuous development of their competencies (CCD). Access to the resources and structure of the CCD is provided free to the Trust and attendance at any specialist workshops is provided at discounted rates.

10.3.3 What were some of the barriers/challenges you faced?

o As the programme does not provide physical skills training some trainers felt concerned about the staff perceptions about the practical value and utility

o Some trainers were fearful of the train the trainer process as this level of investment and development is very new and unheard of

o Some trainers were unable to get time from their managers to complete pre-course work, alhtough it wasn’t a great deal operational constraints didn’t help

10.3.4 What would have helped to overcome these barriers?

o Challenging the views of some of trainers early on in the process with regards to the need for physical skills training

o Management spending more time developing their staff in an appropriate and professional way rather than opting for short term, quick, tick box solutions

o More time should have been spent outlining the process with managers of part-time trainers who were selected to deliver the training but who also have to complete other operational duties

10.3.5 Lessons learned

o Learnt that training a trainer is not a short exercise if you want to do it properly

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o Developing trainers with key competencies in mind helps to focus activities and is very useful when it comes to feedback and development

o There is still a great deal of work to do to tackle myths and perceptions with regards to the role of violence management trainers and the process by which trainers need to be chosen and developed and the resources needed to do this effectively

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10.4 SUPPORTING THE TRAINER DEVELOPMENT – SUSTAINING COMPETENCE

10.4.1 Background

The role of the trainer is considered to be critical to supporting this Trust in Scotland to succeed in the delivery of its strategy for preventing and tackling work-related violence. Although many of the trainers are geographically dispersed across a number of hospitals the role and functions of the trainers are co-ordinated centrally. Importantly there has been a drive within the Trust to recognise the importance of the violence management trainer and recognise the specialist skills they have to offer. Trainer development is viewed as paramount to the continued learning of the individuals and the organisation and continuing professional development is considered to be a valuable investment not an unnecessary cost.

10.4.2 What was done

A review of current practices and procedures for trainer development was conducted during the spring of 2005. The review was facilitated by the training manager following a bi-annual meeting with all violence management trainers. The review focused on assessing the demands of the role and determining trainer development needs and how best to meet these needs. The review process involved carrying out focus groups with trainers as well as conducting one on one interviews with trainers to assess training needs. As a result of the review it was clear that there were generic training needs for all the trainers but also more specific training needs that were associated with the level of experience of the violence management trainer. The more generic training needs were associated with technical training skills (e.g. use of technology, planning and preparing training sessions, etc.) and the specific skills for the novice trainer were associated more with managing delegate apathy, being seen as a credible trainer and developing confidence in delivery of training. For the more experienced trainer, training needs were associated with developing more sophisticated levels of domain knowledge as well as developing knowledge and skills associated with mentoring other trainers as well as consulting and influencing people within the organisation. Most trainers also believed there was a need for more regular meetings and communication (e.g. at least monthly) involving all trainers and that these meetings needed to be well structured but allow attendees to contribute to the agenda before each meeting. Trainers also felt that interim performance appraisals every 3 months were important to support development and that personal development plans were an important part of this process. Trainers also considered it an important part of their development to have access to a mentor or a supervisor (either internal or external to the organisation) with knowledge of the violence domain to enable them to informally discuss and personally reflect on their training experiences. Finally, attendance at refresher training was critical to maintaining their professional status and competence as a violence management trainer.

As a result of the review a meeting was held with all the trainers where findings were summarised and options were explored against the reality of organisational constraints. The outcome of this process was a modified development process for trainers that all trainers had signed up to. An implementation plan was developed that focused on modifying the current system, keeping the parts of the system that were seen as positive and working well and implementing new practices

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that would complement the current system and add to development. One of the most successful outcomes of this process is the regular trainer communication days where managers and trainers come together to discuss experiences, innovate and support knowledge and training updates. It has also resulted in the team feeling more cohesive and feeling that they contributions are appropriately recognised and valued.

10.4.3 What were some of the barriers/challenges you faced?

o Before the new system could be implemented approval had to be sought from a management committee that added a significant amount of time to the process

o Not all trainers were happy about the pending changes, there was a fear that the new system might have been too much like ‘big brother’ rather than a supportive coach

o Trainers were often worried about the general lack of management support and consider this central to supporting them in delivering their training. There is a wider need to change the culture and perspective of violence management and this must include the view and behaviours of managers

o It took quite a bit of time to co-ordinate trainers and ensure that all views were heard and documented

o It took some time to work up a new reporting and supervision structure, this is not the only priority and it can very difficult to balance activities

o One of the greatest challenges is receiving adequate support for the role I do as someone who manages those who train in violence management training

10.4.4 What would have helped to overcome these barriers?

o Access to information and guidance about effective systems for developing, mentoring and supervising violence management trainers

o More support for supervising trainers in general o Clearer guidance and support from senior management (Trust board) about the importance of

violence management training function but also the role everyone has to play in tackling this issue

10.4.5 Lessons learned

o The importance of regular communication with training staff o How easy it is for trainers to feel isolated when they are delivering training o The importance of providing support to staff and spending time genuinely listening to

concerns and development needs o A greater understanding of what it is like for trainers when delivering this type of training o The role managers have to play in influencing front line staff attitudes, behaviours and

thinking about violence management in general

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11. REFERENCES

References have been arranged in the order in which they are referred to in the report.

1. Zarola, A. & Leather, P. (2005). Violence and aggression management training for trainers and managers: A national evaluation of the training provision in healthcare settings. Health and Safety Executive: Contract Research Report 440.

2. NAO (2003). A Safer Place to Work: Protecting NHS Hospital and Ambulance Staff from Violence and Aggression. Report prepared by the comptroller and auditor general. HC 527. London: National Audit Office.

3. WAO (2005). A Protecting NHS staff from violence and aggression. Report prepared by the auditor general for Wales.

4. Budd, T. (1999). Violence at Work: Findings from the British Crime Survey. London: Health and Safety Executive.

5. Di Martino,V., Hoel, H. & Cooper, C. (2003). Preventing violence and harassment in the workplace. Luxembourg: Office for Official Publications of the European Communities.

6. Goldstein, I. L. & Ford, J. K. (2002). Training in organizations: Needs assessment, development and evaluation (Fourth ed.). Belmont, CA: Wadsworth.

7. Armstrong, M. A handbook of human resource management practice. (2001). Kogan Page: London.

8. Kurz, R. & Bartram, D. (2002). Competency and individual performance: modelling the world of work. In Robertson, I. T., Callinan, M. & Bartram, D. (2002). Organizational effectiveness – the role of psychology. Wiley: Chichester.

9. Beech, B. & Leather, P. (2006). Workplace violence in the healthcare sector: a review of staff training and integration of training evaluation models. Aggression and violent behavior, 11(1), 27-43.

10. Robertson, I.T. (1996). Personnel selection and assessment. In Warr, P. (1996). Psychology at work. Penguin: London.

11. Rhoades, L. & Eisenberger, R. (2002). Perceived organizational support: A review of the literature. Journal of applied psychology, Vol. 87, No. 4, 698–714.

12. Patrick, J. (1992). Training: research and practice. Academic Press: London.

13. Leather, P., Brady, C., Lawrence, C., Beale, D., & Cox, T. (1999). Work-related violence: Assessment and intervention. London: Routledge.

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Published by the Health and Safety Executive 09/06

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