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NHS EDUCATION FOR SCOTLAND

INVITATION TO SUBMIT A COMPETITIVE WRITTEN QUOTATION

FOR

Effective Practitioner Initiative: Supporting Implementation (2013-2014)

Reference: C001069

CWQ PACK


COMPETITIVE WRITTEN QUOTATION

This Competitive Written Quotation (CWQ) Pack contains detailed instructions concerning the submission to be made by parties interested in submitting a competitive written quotation for this project, and details of the criteria that will be used in selecting the successful bidder.

The document consists of four parts:

Part 1: Submission Instructions

Part 2: Specification

Part 3: Evaluation Criteria

Part 4: Format for Response & Equality Questionnaire

Appendix 1: Effective Practitioner Initiative: Supporting Implementation and Evaluation

Appendix 2: Schedule of Rates

CWQs should be submitted in accordance with the instructions detailed within this document. NES will not consider any other form of bid. Any received bids which do not contain all of the requested information may be rejected at NES’ discretion.

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PART 1: SUBMISSION

INSTRUCTIONS

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1. NHS EDUCATION FOR SCOTLAND (NES) OVERVIEWThe NHS Education for Scotland (NES) is a Special Health Board, responsible for supporting NHS services to the people of Scotland through the development and delivery of education and training for all NHSScotland staff.

Everything we do is based on eight fundamental principles:

• be open, listen and learn• work together with others to benefit patients• look ahead and be creative• always aim for quality and excellence• promote equality and value diversity• understand and respond quickly and confidently• work to a clear common cause, and• give people power and lead by example

Our vision is “Quality Education for a Healthier Scotland”. Our mission is to provide educational solutions that support excellence in healthcare for the people of Scotland. Headquartered in Edinburgh, NES is a national organisation with regional offices in Edinburgh, Glasgow, Aberdeen, Dundee and Inverness. We have a staff complement of around 700. Additional information on NES’s role is available from our website: www.nes.scot.nhs.uk

2. SUBMISSION INSTRUCTIONSThis Invitation to Submit a Competitive Written Quotation (CWQ) contains details of NES’ background, objectives, detailed instructions concerning the submission to be made by interested parties, and details of the criteria that will be used in selecting the successful bidder. This CWQ pack is accompanied by a detailed specification and core information which must be included in the Response.

2.1 Completion of CWQ• It is the responsibility of bidders to ensure that they have read and understood all

documentation included in the package.• Bidders are responsible for ensuring that they have completed the quotation fully and

accurately and that prices quoted are arithmetically correct for the units stated. Any corrections/amendments made by the bidder should be initialed by them. Amendments to the quotation will not be permitted after submission, unless requested by NES.

• All costs, including travel and associated costs, incurred in relation to this bid are to be borne by the Bidder.

• CWQs must be submitted on the basis called for in this document. Additional alternative offers may be considered and should be submitted separately clearly stating which item(s) in the schedule they are offered against or in addition to.

• Full details or specification of any items of equipment included in the bid should be provided together with any brochures/product literature.

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http://www.nes.scot.nhs.uk/



• NES does not undertake to accept the lowest or any offer. Each item in the schedule will be treated separately except as indicated and NES may decide to share awards for any item between several suppliers.

• Facsimile copies will not be accepted• A Lead Officer should be identified for the bid and details specified in the submission.• All correspondence must be in English.

2.2 Process for Questions/ClarificationsThis CWQ process should be viewed as a confidential activity. As such, we ask that you treat NES’s data and this CWQ with full confidentiality. All questions regarding this material should be directed to:

Carol CurranProject OfficerNHS Education for ScotlandNMAHP, Floor 2102 Westport Edinburgh, EH3 9DNE-mail: [email protected]

Please reference ‘Effective Practitioner Initiative: Supporting Implementation (2013-2014)’ in all correspondence.

Please do not provide any proprietary information in your questions

In the interests of fairness, all questions and answers will be shared with all Bidders. NES will post a list of questions and answers in response to any queries received on our website at www.nes.scot.nhs.uk/about-us/tenders.aspx.In order to facilitate this process, please submit questions by 13:00h on 19th July 2013. Responses will be posted on 23 July 2013.

Any contact made directly with any other employee of NES regarding this CWQ is a violation of the terms of the CWQ response criteria and may be cause for disqualifying a Bidder at the sole discretion of the contract manager.

2.3 Proposal DeadlineIn order to allow appropriate time for analysis, selection, implementation, and communication of the selected Bidders, your cooperation is requested in meeting all of the specified deadlines. It is our intention to respond to all reasonable requests for additional information and to reasonably cooperate with Bidders in the development of their quotation.

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http://www.nes.scot.nhs.uk/about-us/tenders.aspx

mailto:[email protected]



Therefore, it is imperative to submit your quotation by the time and date in section 2.12 . NES may reject any bid which is late and does not fully comply with the stipulated requirements unless the Bidder can prove that the bid was dispatched in sufficient time to meet the specified deadline.

2.4 TimetableNES intends to follow the schedule below in performing the evaluation and supplier selection process. The timetable below identifies the indicative dates:

Activity Indicative Timescales

CWQ issued: 9 July 2013

Questions to be submitted by: 13:00 on 19 July 2013

Question responses from NES by: 23 July 2013

CWQs returned to NES by: 13:00 on 13 August 2013

CWQ evaluation by NES Panel: 23 August 2013

Notification of Award: 25 August 2013

2.5 CollusionBidders must not submit an offer in collusion with any other person, company or body, which may have the effect of distorting or increasing the cost of the goods or service provided under the contract.

If in the opinion of NES a bid is submitted on that basis, the bid may be rejected.

2.6 MarketingAll marketing or similar activities by the Bidder associated with the bid must cease upon submission of the bid and only resume following notification from NES of the outcome of the CWQ process.

2.7 ConfidentialityAny material of a confidential nature submitted by a bidder should be clearly marked. NES will respect the confidentiality of material provided. Similarly, all material provided by NES in relation to this CWQ must be regarded as confidential.

2.8 InducementsNES has a strong belief in propriety and ethics. A Bidder attempting to offer an inducement to any member of staff is likely to be excluded from the CWQ process.

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2.9 OfferThe offer must be open for acceptance for a period of 90 days, from the date for last receipt of CWQs.

2.10 PricesPrices and rates quoted within the CWQ should be on a fixed basis for the contract period and must be in Pounds Sterling, exclusive of Value Added Tax. Prices should remain fixed for ninety days from the CWQ close date.

2.11 Agreement ImplementationThe successful Bidder will be required to enter into a formal contract with NES, under NES’s Terms & Conditions. The final contract will be subject to Scot’s law. NES’s Standard terms and conditions are available from www.nes.scot.nhs.uk/about-us/tenders/templates.aspx

2.12 Delivery of Responses

An electronic copy of the submission and supporting information must be submitted not later than 13:00 on 13 August 2013:

E-mail: [email protected] In accordance with these tender Ts&Cs, NES does not undertake to consider any tenders received after this date unless the tenderer can demonstrate reasonable mitigating circumstances

3. WITHDRAWAL OF COMPETITIVE WRITTEN QUOTATIONSCWQs may be withdrawn at any time before the award of Contract, providing such intention is expressed in writing to the relevant Officer within NES.

4. COMPETITIVE WRITTEN QUOTATION OPENINGCWQs will be securely stored and remain unopened until the closing date specified within this document. Emailed tenders will be stored in a restricted access, secure mailbox and remain unopened until the closing date specified within this document.

CWQs will be opened at the above address, in the presence of authorised officers, as soon as possible after the CWQ submission closing date.

5. DISCLAIMERThe information in this CWQ is provided for information only. No representation, warranty or undertaking, express or implied, is or will be made and NES shall have no responsibility or liability as to or in relation to the accuracy or completeness of this CWQ or any other written or oral information made available to any party responding to this CWQ. No information contained in this CWQ will form the basis of any warranty or representation made by or on behalf of NES to any Tenderer.

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mailto:[email protected]

http://www.nes.scot.nhs.uk/about-us/tenders/templates.aspx



PART 2: COMPETITIVE

WRITTEN QUOTATION SPECIFICATION

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SPECIFICATION

1. TITLE Effective Practitioner Initiative: Supporting Implementation (2013-2014).

2. CONTEXT The Effective Practitioner is a national initiative providing work-based learning resources and support for levels 5 and 6 (Career Framework for Health) Nurses, Midwives and Allied Health Professionals across NHSScotland. It recognises and values the critical role this group of staff play in the day-to-day running of NHSScotland.

Effective Practitioner assists practitioners to meet the three Quality Ambitions within the Healthcare Quality Strategy for NHS Scotland through the delivery of safe, effective, and person-centred care. It also enables practitioners to evidence their ongoing development for NHS KSF reviews, professional revalidation and continuing professional development purposes.

There is strategic support through the NMAHP Directors, NHS Board Leads for Effective Practitioner, and Education Leads within the NHS Boards. A network of nationally funded practice educators, practice education leads and practice education facilitators support managers to raise awareness of this new initiative and to promote use locally.

There has been considerable activity since the launch in 2011. This has included baseline evaluation; raising awareness activity; and further development of content.

During 2012/2013 five health boards tested the use of funding for small local projects (n=13) which used the Effective Practitioner to support delivery of one or more of the quality ambitions of person centred, safe and effective care. The outcomes and experience of the funded projects were shared at a national event and four projects were subject to indepth case study evaluation to show how Effective Practitioner could be used. The national event shared progress to date and provided an opportunity to vision for the next three years.

The projects have been received positively and NHS Education for Scotland has invited Health Boards through the Board Leads to progress further funded projects. This is to provide more evidence of how the Effective Practitioner resource can be embedded in practice to enhance care through focussed learning projects/activities.

Lessons learned from the funded test site projects included the benefit of additional support to project leads and teams who were new to Effective Practitioner. This support helped to clarify learning outcomes, select appropriate resources; use the resources effectively and report on outcomes.

Lack of time was a common reason for delay in completion of the projects. The national event included a workshop entitled “releasing time to learn” – we aim to use the principles of this model to support teams to find ways to address the issue of time.

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3. SERVICE TO BE PROVIDED

The consultant(s) will be required to deliver consistent messages about Effective Practitioner in line with those developed by the National Steering Group and Effective Practitioner team.

The changing nature of healthcare needs, emerging evidence and dynamic policy drivers all require up-to-date, relevant and accessible educational support and with this in mind those supporting implementation should be aware of the current policy context in NHS Scotland.

The consultant(s) will work closely with the NES Educational Project Manager and project team to agree the detail of this work as it progresses.

The focus of supporting implementation will be:-

a) Supporting teams to progress local projects using lessons learned from the national evaluation and previous project reports

b) Assisting teams to select appropriate learning resources to develop their practicec) Assisting teams to maximise time available introducing the principle of releasing time to

learn.d) Assist individuals to evidence their learning for Personal and Professional Development

purposes.

NHS Education for Scotland would also like to undertake a brief follow up evaluation of the Funded projects from 2012-2013.

4. TASKS TO BE PERFORMED

The following services are to be provided:

Work with NHS board leads for Effective Practitioner, Practice Educators and Practice Education Leads to identify areas where additional support will be beneficial.

Provide focussed support to leads of funded projects to engage and use the Effective Practitioner web resource.

Assist leads to apply the principles of Releasing time to Learn to maximise time available for work based learning.

Undertake a brief follow up evaluation of the funded projects in 2012-2013 to ascertain the extent to which the learning has impacted on practice; embedded and sustained.

Submit interim and final reports on this work, see section 7: Timescales for Completion of Objectives.

NB: In line with NES’s commitment to Equality and Diversity, all resource development must be prepared in line with NES’s Inclusive Education and Learning Policy.

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5. RESOURCE REQUIREMENTS

NES anticipates there will be a minimum requirement of 30 days for this work with additional days by mutual agreement up to a maximum of 65 days.

NES will provide funding to the successful bidder on acceptance of a full breakdown of costs supplied in the proposal, in addition please complete Appendix 2: Schedule of Rates.

No guarantee can be given as to the number of days that the successful bidder will be required to provide. In any event NES shall not be bound to order any of the requirements nor to accept or pay for any services other than those actually ordered.

For bidders whose rates include travel expenses NES will reimburse properly incurred expenses for visits to non mainland Scotland locations should they be required. NES will require evidence that the most economic form of transport was secured.

Prices and rates quoted within the CWQ should be on a fixed basis for the contract period and must be exclusive of Value Added Tax. Prices should remain fixed for ninety days from the CWQ close date.

NES will retain all Intellectual Property associated with this project and any subsequent reports and associated materials.

6. MONITORING

The individuals providing additional support will work closely with the Educational Projects Manager responsible for the Effective Practitioner Initiative. They will submit 4-weekly project schedules and workplans as well as interim and final reports as detailed in the schedule below that will inform reports to the NES-appointed national Steering Group at agreed intervals.

7. TIMESCALES FOR COMPLETION OF OBJECTIVES

The work should commence in September 2013 and must be completed by March 2014. There will be some flexibility required as Boards will identify suitable teams at different times.

Meeting with Projects team /Contract meeting

Week commencing 26 August 2013

Commence work 2 September 20134-weekly project schedule and workplan Every 4 weeks for the duration of the workDetail of planned activity 30 September 2013Submit interim report 29 November 2013Submit draft final report 3 March 2014Submit final report 10 March 2014

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8. REFERENCES FOR BACKGROUND READING (where applicable)

Effective Practitioner Web Resourcehttp://www.effectivepractitioner.nes.scot.nhs.uk

Effective Practitioner Initiative: Supporting Implementation and Evaluation 2012-2013 (Blake Stevenson 2013) – Appendix 1

Career Framework for Healthhttp://www.skillsforhealth.org.uk/workforce-transformation/customised-career-frameworks-services/

CURAMhttp://www.scotland.gov.uk/Resource/Doc/254463/0075344.pdf

NHS Knowledge and Skills Frameworkhttp://www.msg.scot.nhs.uk/index.php/pay/agenda-for-change/knowledge-skills-framework-ksf/311

Healthcare Quality Strategy for NHS Scotland (May 2010)http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf

NES Inclusive Education and Learning Policyhttp://www.nes.scot.nhs.uk/about-us/equality-and-diversity/inclusive-education-and-learning/inclusive-education-and-learning-policy.aspx

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http://www.nes.scot.nhs.uk/about-us/equality-and-diversity/inclusive-education-and-learning/inclusive-education-and-learning-policy.aspx

http://www.nes.scot.nhs.uk/about-us/equality-and-diversity/inclusive-education-and-learning/inclusive-education-and-learning-policy.aspx

http://www.scotland.gov.uk/Resource/Doc/311667/0098354.pdf

http://www.msg.scot.nhs.uk/index.php/pay/agenda-for-change/knowledge-skills-framework-ksf/311

http://www.scotland.gov.uk/Resource/Doc/254463/0075344.pdf

http://www.skillsforhealth.org.uk/workforce-transformation/customised-career-frameworks-services/

http://www.effectivepractitioner.nes.scot.nhs.uk/



PART 3: EVALUATION CRITERIA

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SCORING CRITERIA AND EVALUATION

Proposals will be evaluated against each other in an objective manner. Each category of questions and all business requirements have been carefully determined by NES. The evaluation team will score each Bidder’s response using the criteria shown in the following table.

NES reserves the right to accept any CWQ, in whole or part, or to negotiate further with one or more Bidder. The Bidder(s) selected will be chosen on the basis of best value for money. This means suitable quality, delivery, level of risk and response to customer needs at best price. Any respondent who submits an incomplete response or who does not respond to this CWQ within the requested guidelines and formats may be eliminated.

SCORING:0 Question not answered. No evidence provided1 Significantly fails to meet requirements. Inadequate evidence provided2 Fails to meet requirements in some respects. Limited evidence.3 Meets requirements in some respects. Moderate evidence provided.4 Meets requirements in full with good supporting evidence5 Superior proposal exceeding required standards. Exceptional evidence

Fraction scores shall not be used.

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Criteria Description Weighting

Experience and reputation in undertaking similar work and adequate qualifications and experience of the team

See Part 4, Layout Heading 1,2 and 3

Proposal demonstrates evidence of previous work undertaken in the past 3 years relevant to this project including the names(s) of clients who can be approached for references. Testimonials may be provided where relevant. The proposal contains details of the educational and professional qualifications, skills and experience relevant to this project of the person(s) who would be responsible for providing the service.

35%

Understanding the purpose of the work, context and background and proposes a methodology that meets all the requirements of the tender specification

See Part 4, Layout Heading 4

The proposal clearly demonstrates understanding of the context of NES’s work within NHS Scotland and of this particular requirement eg background or legislative requirements or drivers. Proposal demonstrates that all the requirements of the specification have been addressed and understood and that the proposed methodology is appropriate and capable of successfully delivering the project.

35%

Risk Management and Quality Assurance. Have main risks been identified and adequately addressed?

See Part 4, Layout Heading 5 and 6

The proposal provides evidence that the main risks involved with the project have been identified and adequately addressed. Details of the bidder’s risk management and quality assurance methodology are also outlined.

10%

Offers value for money


The proposal is competitively priced and represents good value in the context of the goods/services to be delivered over the life of the contract. Costs are clearly demonstrated and justified. Best value bids will demonstrate an appropriate combination of cost + quality.

Tenderers should provide their own breakdown of costs but must submit Appendix 2. NES reserves the right to exclude any Tenderer unable to provide costs.

10%

Equality & Diversity, Compliance with legislation

See Part 4, Layout Heading 8 and 9

The proposal demonstrates compliance with relevant legislation. Where appropriate, policies are in place for Equality and Diversity and Health & Safety. Please note that, where appropriate, it is a prerequisite that all NES suppliers are registered under the Data Protection Act.

10%

Public Liability Insurance


Tenderers must be able to demonstrate they hold (copy of certificate), or are willing to commit to obtaining a minimum Public Liability Insurance of £1,000,000 GBP during the life of the contract. NES reserves the right to exclude any Tenderer unable to meet this condition.

Pass/Fail

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PART 4: CWQ RESPONSE &

EQUALITY QUESTIONNAIRE

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2.PROPOSAL LAYOUTBidders are invited to submit a response to this CWQ in the format detailed below. It is important that the standard numbering scheme laid out in this document is followed. In addition, please ensure that each page of your quotation is numbered in sequence and includes your company name and logo.

2. HEADINGSYour proposal should adopt the following format:

SECTION 1 BACKGROUND AND HISTORY OF ORGANISATION

SECTION 2 EXPERIENCE IN UNDERTAKING SIMILAR WORK (REFERENCES)

SECTION 3 STAFFING TEAM TO BE INVOLVED IN DELIVERY

SECTION 4 PROPOSED APPROACH TO SATISFY THE SPECIFICATION

SECTION 5 IDENTIFIED RISKS ASSOCIATED WITH THE PROJECT AND RISK MANAGEMENT PROCESSES TO ADDRESS THEM

SECTION 6 QUALITY ASSURANCE PROCEDURES

SECTION 7 PRICE TO BE CHARGED INCLUDING FULL DETAILS OF COSTINGS

SECTION 8 COMPLIANCE WITH LEGISLATION (H&S, DPA*)

SECTION 9 E&D QUESTIONNAIRE

SECTION 10 PUBLIC LIABILITY INSURANCE

*nb, Where appropriate, NES requires that all contractors/suppliers be DPA registered. To check whether this is applicable for your organisation please refer to: http://www.ico.gov.uk/for_organisations.aspx

If you consider that DPA registration is not a requirement, please include a statement indicating why you believe this to be so.

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http://www.ico.gov.uk/for_organisations.aspx



3. EQUALITY AND DIVERSITY QUESTIONNAIRENES will use your answer to the following questionnaire to evaluate how your organisation deals with equality, taking into account the scale of the proposed contract, the degree of relevance the contract has to NES’s duty to promote equality and the size and capacity of your organisation. NES are looking to ensure that suppliers do not discriminate unlawfully and are able to meet the quality standards of the contract.

Please answer every question fully, providing sufficient information to enable NES to make a fair and accurate assessment. A finding of unlawful discrimination against your organisation by an employment tribunal or court will not be taken as grounds for disqualification if it can evidenced that steps have been taken to prevent discrimination recurring, eg, by improving policies and practices.

Please supply evidence to support your answers to questions, evidence could include examples or copies of documents such as:• equal opportunities policy;• documents containing instructions to staff or outlining arrangements for advertisements,

recruitment, selection, access to training and opportunities for promotion;• copies of recruitment advertisements;• extracts from staff handbooks or other materials that demonstrate your organisation’s

commitment to equality.

More information about Equality & Diversity within NES is available on the NES website at: www.nes.scot.nhs.uk/about-us/equality-and-diversity.aspx

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http://www.nes.scot.nhs.uk/about-us/equality-and-diversity.aspx



1.

What is the size of your firm? Please state total number of:a) Partners or directorsb) Employees (including all full-time and part-time employees, apprentices, and other trainees):

a)

b)

2.

In the last three years, has any finding of unlawful discrimination on the grounds of age, disability, gender reassignment, marital or civil partnership status, pregnancy or maternity, race, colour, religion or belief, sex or sexual orientation in the employment field been made against your organisation by the employment tribunal, the employment appeal tribunal, or any court, or in comparable proceedings in any other jurisdiction?

YES/NO

3.In the last three years, has any finding of unlawful discrimination in relation to non-employment matters been made against your organisation by any UK court, or in comparable proceedings in any other jurisdiction?

YES/ NO

4.In the last three years, has your organisation been the subject of formal investigation by the Equality and Human Rights Commission (EHRC) on the grounds of alleged unlawful discrimination or failure to comply with any relevant equality duties?

YES/ NO

5.

If the answer to questions 3 or 4 is yes or, in relation to question 4, the EHRC made a finding adverse to your organisation, what steps have been taken as a result of that finding?

6.

In the last three years has any contract with your organisation been terminated on grounds of failure to comply with:a) Legislation prohibiting discrimination; orb) Contract conditions relating to equal opportunities in the provision of services?

YES/ NO

7.

If the answer to question 6 a) or b) is yes, what steps have been taken as a result of that termination of contract?

8.

Briefly explain what steps have been taken to prevent discrimination and promote equality in your employment function and the delivery of your services. You may wish to refer to policies, procedures, staff training, working processes, abiding by codes of conduct, etc. as relevant to the size and function of your organisation.

Please enclose a copy of your Equal Opportunities Policy/Equal Opportunities Statement.

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NHS EDUCATION FOR SCOTLANDAppendix 1

APPENDIX 1

Effective Practitioner Initiative: Supporting Implementation and Evaluation

NHS Education for Scotland

Blake Stevenson’s Final Report

June 2013

Contents

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1 Introduction and context 1

2 Research evidence 5Online survey 5Case Studies 10Evidence from key stakeholder interviews 28Additional evidence 28

3 Synthesis of findings 35Practitioners at level 5 & 6 have greater awareness of EP and have improved skills and/or learning through use of EP 35Practitioners at level 5 & 6 have changed their practice as a result of using EP 36Senior Charge Nurses and Senior AHPs are able to use EP to support development of individual staff and teams 37Teams have changed practice as a result of using Effective Practitioner 38Key stakeholders’ expectations of Effective Practitioner are met/exceeded 38

4 Conclusions and Issues to consider for the future 40Conclusions 40Issues for consideration in the future 41

NES Note for CWQ: These page numbers have not been updated to reflect this document.

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1 Introduction and Context

NHS Education for Scotland (NES) launched the Effective Practitioner initiative in June 2011. There is a web resource which provides a range of work-based learning activities and resources for Level 5 and 6 nurses, midwives and allied health professionals. During 2011-12 a range of awareness – raising activity took place across health boards to introduce the web resource to as many practitioners as possible.

During 2012/13 NES funded five health board areas to undertake more focused work, which linked with Scottish Government Quality ambitions of safe, effective and person-centred care, using Effective Practitioner resources within clinical teams. At the same time NES offered support to other health boards to develop their use of Effective Practitioner to improve practice.

NES commissioned Blake Stevenson Limited, an organisation which provides research and organisational support, to provide the funded NHS Board projects and other health boards with support as requested. Blake Stevenson developed and implemented an evaluation process for the impact that Effective Practitioner was having in both the funded areas and more generally as requested by NHS Education for Scotland.

NHS Education for Scotland requested applications from health boards for funding to support the use of Effective Practitioner within teams to improve practice. It selected five health boards to undertake funded projects.

The focus for the funded work is shown in Table 1.1 below. Within each funded area there was more than one project, with the specific project agreed between NES, the health board and Blake Stevenson for inclusion as a case study for evaluation purposes is shown in bold.

The focus for the funded work in these health boards is shown in Table 1.1 below. Within each funded area there was more than one project and the specific project agreed between NES, the health board and Blake Stevenson for inclusion as a case study is shown in bold.

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Table 1.1: Funded projects

Health Board Focus of Funded Projects1 Clinical decision making in an acute stroke unit

Supporting dementia education and learning within an Accident and Emergency unit (Hospital a)

Supporting dementia education and learning within an Accident and Emergency unit (Hospital b)

2 Supporting staff bank members

Developing practitioners in Integrated Care Assessment and Support (ICAS) teams

Clinical decision making3 Improving care quality in maternity services

Improving person-centred care in an orthopaedic ward

Supporting carer involvement in end of life care4 Telehealth

Implementing caseload supervision in the Impact Team

Reflective practice in action in oncology5 Muscular skeletal pathway

NES commissioned Blake Stevenson Ltd, a research and organisational support organisation, to provide support to both the funded projects and to other health boards that requested it. NES also asked Blake Stevenson to develop and implement an evaluation process to investigate the impact that Effective Practitioner was having in both the funded areas and more generally.

We agreed an evaluation framework which aimed to evidence the following outcomes:

practitioners at level 5 & 6 have greater awareness of EP;

practitioners at level 5 & 6 have improved skills and/or learning through use of EP;

practitioners at level 5 & 6 have changed their practice as a result of using EP;

Senior Charge Nurses and Senior AHPs are able to use EP to support development of individual

staff and teams;

teams have changed practice as a result of using Effective Practitioner; and

key stakeholders’ expectations of Effective Practitioner are met/exceeded.

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The agreed evaluation methods included:

an online survey with practitioners who have been introduced to Effective Practitioner in either

year;

the development of in-depth case studies with four of the funded projects; and

follow up interviews with some of the key stakeholders who had been interviewed in 2011/12.

In addition Blake Stevenson reviewed the final reports from all the funded projects.

The next chapter of this report provides the evidence from the online survey, the four in-depth case

studies and follow up interviews with key stakeholders. It also includes some additional evidence that

has been gathered during the course of the support and evaluation work. Chapter 3 provides a

synthesis of the findings in relation to the evaluation outcomes. Chapter 4 draws conclusions and

provides suggestions for going forward.

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2 Research evidence

This chapter sets out the evidence from the various aspects of the research: the online survey;

the four case studies from the funded projects;

follow up interviews with selected stakeholders; and

some additional evidence that has been gathered during the course of the support and evaluation

process.

Online survey

We undertook an online survey with practitioners whom we have met over the course of the last two years, mainly with those with whom we had undertaken a baseline survey in 2011-12. Eighty two practitioners completed the survey.

We provide a summary of the findings from the online survey in this section. The full analysis is available if required.

Use of Effective Practitioner

Most respondents have used Effective Practitioner. Fifty-nine per cent (48) reported that they have used the resource, while 41% (34) said that they have not. The percentage of respondents who reported using Effective Practitioner is lower than the 82% of respondents in the baseline survey who said they intended to use the resource.

Use of Effective Practitioner is not restricted to the resource’s target audience of practitioners at lever 5 and 6. Fifty-nine per cent of respondents to the survey who have used Effective Practitioner and who specified their Agenda for Change Pay Band are band 5 or 6. However, nearly a third (30%) are band 7, 9% are band 4 and 2% are band 8. (Note – the Effective Practitioner is targeted at NMAHP’s at Level 5 and 6 of the Career Framework for Health- this developmental framework which differs from the Agenda for Change Pay Banding).

Around a quarter of respondents who have used the resource have used it at least once a month. Twenty per cent who answered this question said they use it every month, 4% every week and 2% every day. Most, however, use it less frequently. Forty-nine per cent said they use it less than every three months and 24% every two or three months.

The most common method of using the resource is online. Over four-fifths (81%) who answered this question reported using the resource online, while 12% said they used a mixture of online and offline approaches and 7% said they print materials and use them offline.

Most respondents who use Effective Practitioner use the resource while at work (as reported by 93% of those who answered this question). Sixteen per cent said they use it at home.

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How has Effective Practitioner helped respondents?

When asked which elements of Effective Practiotioner were the most useful, 46% of respondents who answered this question stated that the signposts to other resources were useful, 41% said that learning activities were useful and 41% identified self-assessment tools as a useful element.

We asked respondents about which areas of practice Effective Practitioner has helped them with. Fifty-seven per cent of respondents who answered this question reported that the resource helped them with learning, teaching and supervision, 46% said it improved their evidence-based practice, 31% leadership and management and 29% clinical practice.

Respondents reported that Effective Practitioner helped them in connection with KSF. Eighty-one per cent of respondents who answered this question said that the resource had helped them in this way, 32% said that it helped them to create and develop their Personal Development Plan and 14% said it helped with maintaining professional registration.

Qualitative responses show that respondents found Effective Practitioner useful as a tool for study and for Continuing Professional Development. Respondents gave examples of using the resource to develop their skills and knowledge in specific areas such as leadership, catheter management, teaching techniques, caseload supervision, telehealth, patient safety and dementia. A few also mentioned that the resource helped them to prepare for an appraisal. A number of respondents also identified Effective Practitioner as a useful resource to signpost colleagues and students to.

Comments from respondents include the following:

“I have found it (Effective Practitioner) easy to use, the information is up to date. (It is a) valuable resource, I recommend it to colleagues and students”

“It’s easy to access and easy to use and meets my needs”.

“(Effective Practitioner has) a wide collection of excellent resources and links”

“(Effective Practitioner is) a useful and helpful tool”

Barriers to using Effective Practitioner

Our survey indicates that a lack of time was the main barrier which prevents or limits practitioners’ use of Effective Practitioner. We asked respondents who had not used the resource for the reason(s) why they had not used it. Seventy-four per cent of the respondents who answered this question said that a lack of time was a reason why they had not used it. As one said, “there is no time to complete any form of CPD within working hours”. Fifteen per cent said that they had no reason to use Effective Practitioner, 7% felt it lacked useful content, 4% had difficulties in navigating the web resource and 4% were not aware of the resource.

Some respondents said that they access the CPD support they need from other sources, and this reduces the likelihood of them accessing Effective Practitioner. Comments from respondents include the following:

“I get a lot of similar info/support from CSP (Chartered Society of Physiotherapy) website, no time to do both justice”.

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“I feel I would not use this tool as support due to the fact that I already access sites on the internet to aid my professional development”.“I already have support with CPD through my professional body”.“I have other online tools to use for mandatory training which I’m behind in using”.

Similarly, most respondents who have used Effective Practitioner said that more time would help them to make more use of the resource. Seventy-one per cent who answered a question about what would support them to make more use of the resource said that more time would help. Comments from respondents include the following.

“I found it easy to navigate; I just need more time to access the resource”.“I think it is really good… just not had time as yet to use it properly”.“It looked like a great system and I was keen to get going with it, however that does not seem to have happened, mainly due to lack of time”.

Forty-one per cent said that reminders to use the resource would help them to make more use of it. The importance of this is highlighted by a comment from one respondent that he/she had forgotten about the resource until he/she received our survey. Another said that “a gentle reminder is always useful”.

Other forms of support that would help people make more use of Effective Practitioner include: more or easier access to computers (16%);

more useful content (14%);

support from other people such as managers and educators (9%);

help in navigating the web resource (9%); and

more or easier access to printing facilities (7%).

Ratings of Effective Practitioner

Respondents gave Effective Practitioner mixed ratings with the majority being positive. Sixty-four per cent who answered this question rated it as very good or good but 28% described it as average and 8% as poor.

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Improving Effective Practitioner

Respondents made various suggestions for improving Effective Practitioner including the following. Providing more profession-specific information. One commented that he/she felt the resource was

“biased towards nursing”, another said that he/she could not find any information relevant to

his/her specialty of pelvic health, and another said that it would be helpful if Effective Practitioner

could provide more information specifically about care for children and young people.

A few respondents commented that there is a lot of information on the web resource and this can

be off-putting. As one said, “there is a lot of info on the web resource – it’s hard to know where to

start”.

Simplify learning activities – one respondent commented that “I have started to use it on many

occasions however the learning activities are lengthy and have put me off”.

Support people to access Effective Practitioner – one respondent suggested that putting an icon

on practitioners’ computer desktops with a direct link to Effective Practitioner would make it easier

to access the resource, particularly among those who lack confidence in using computers.

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Case Studies

We have analysed the information gathered from the four selected funded projects and present this in summary form in the boxed sections below.

Case Study 1Supporting clinical decision making in an Acute Stroke Unit

The overall aim of this project was to support understanding and use of Effective Practitioner in relation to clinical decision-making skills within the Acute Stroke Unit. Effective Practitioner was to be used to support the embedding of the SKINN bundle of care by selecting learning activities for staff to undertake, keeping a clear focus on pressure area care. Funding was used initially to allow the project lead to have ‘time out’ to identify the most appropriate learning activities and develop a plan of how to take it forward.

Intended Outcome Increased understanding of Effective Practitioner and how it can be used to

support practice and contribute to the objective of the unit.

Desired Impact Working together as a team, staff will be able to identify any gaps in practice or

service delivery

Staff will have the appropriate knowledge and understanding of Effective

Practitioner as a tool to support their learning and development needs whilst

contributing to the implementation of care bundles and individualised patient

care.

The project lead with the support of the Practice Educator identified appropriate learning activities from Effective Practitioner and these were then collated in the shared drive for staff to access. They thought that the tools for recording learning whilst useful, were lengthy and decided to develop a more simplified tool for all staff to record learning. The Practice Education Facilitator spent time on the ward on a number of occasions, going through the web resource with them.

How was Effective Practitioner used to support the projectEffective Practitioner was used to identify learning activities relating to: Learning in the workplace

Clinical decision making

Evidenced based care learning activities, (looking at pressure ulcer prevention)

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Clinical practice activities – food, fluid and nutrition, enhancing person centred

care.

The Practice Educator and project lead asked staff to work on the learning activities when they had time on the ward.

What has the impact of the project been? The project experienced a number of challenges. Staff had difficulty accessing activities on the shared drive, and so it was decided to make up packs for the relevant staff, downloading and printing the activities. Winter clinical pressures combined with staff shortages meant that the project lead (Band 6 charge nurse) was unable to be released from clinical practice to work with staff and support them to complete the learning activities. Funding for back fill was not a solution due to the shortage of specialist staff and bank staff etc. When staff are under pressure there are conflicting priorities and mandatory training for example takes precedence. This case study has highlighted some of the practical difficulties that can arise within work-based learning. The impact on practice has been limited.

Learning for the future“On reflection, taking cognisance of the fact that Effective Practitioner as a resource was new to the team, combined with the clinical pressures within the ward, I wonder did the project aim too high trying to target a wide number of staff?” (Practice Educator). It may have been useful to have focused the project initially on only a few staff members, using PDSA type methodology, one nurse - one patient. In addition, the timing of the projects was a major factor. Although initially started in July, within clinical areas projects take a long time to get off the ground as clinical pressures always take priority and although the clinical areas are always busy, finishing the projects during the winter pressure time proved problematic. Although this project was not completed within the timescale, it is anticipated that it will carry on.

Feedback from staff is that during a shift they do not have any time for continuing professional development.

Case Study 2

Developing effective practitioners to reshape care

The Effective Practitioner project is based within the Integrated Community Assessment Support Service (ICASS) team within a CHP. The team has been established for several years but is rapidly developing and changing to meet the needs of patients within the health and social care integration agenda. Integration has brought many challenges particularly around communication between practitioners; transition of care; and at times unnecessary hand offs.

Focusing on the ‘Effective’ and ‘Person-centred’ ambitions of the Healthcare Quality strategy, the EP project aimed to support the ICASS team to better adapt to their evolving purpose and working relationships and to become more effective within their individual roles and as a team.

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A Band 7 Physiotherapist was seconded to develop and lead two Effective Practitioner development workshops with the ICASS team and to provide additional 1:1 development support around using EP, as required. The Band 7 Physiotherapist worked alongside NES and Blake Stevenson to create this bespoke development programme for the team using resources from Effective Practitioner as a core element. Specific activities of the project were:

Workshop 1: to explore EP and work-based learning, and to use EP to explore

individual roles and identify learning activities and areas of interest.

1:1 support from Band 7 practitioner available to staff for six weeks until the

second workshop to help them get to grips with EP and work-based learning.

Workshop 2: to explore work areas chosen by the team (evidence-based

practice and person-centred care).

Eleven staff (ten AHPs and one community nurse representing bands 4-7) from the ICASS team attended the first workshop which was three hours long; eight team members engaged in discussions and use of EP in between the sessions with four taking up the 1:1 support available; and 12 staff attended the second three- hour workshop which took place six weeks after the first workshop.

Intended Outcomes

The intended learning outcomes of this project were:

to develop the 70/20/10 model of work place and experiential learning;

to understand the role of others in the wider multidisciplinary team to develop

deeper knowledge and understanding of their role;

to improve methods of giving feedback within the team allowing peers and

colleagues to communicate in a supportive and constructive way; and

to embed cultures whereby practitioners see a person, not just a patient.

Desired Impact (shorter term) Improved understanding within Multi Disciplinary Team and more effective

communication between, and confident collaboration with, colleagues.

Increased safety and effectiveness as a result of improved communication

between practitioners.

Desired Impact (longer term)

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Consistent person- centred approaches with an emphasis on outcomes

focused individualised care.

Greater value placed on workplace and experiential learning resulting in the

delivery of more care and less time spent away from the workplace.

How was Effective Practitioner used to support the projectThe EP self-assessment tool was used to identify initial learning needs so that the EP resources used during the project could be targeted to identified need. Staff also used the self-assessment forms from the Effective Practitioner web resource during the second workshop to discuss potential benefits/usefulness of Effective Practitioner in relation to PDP/KSF reviews.

In the first workshop, practitioners were introduced to EP using an ‘introductory quiz’ developed by the project lead. Staff had to find answers to the quiz by searching and navigating the Effective Practitioner web resource and by the use of clinical scenarios that encouraged staff to look for relevant resources and evidence-based practice. This worked very well and was fun, stimulating and engaging for staff and a useful introduction to the web resource and what it has to offer.

Following workshop 1, staff were encouraged to use the EP resources to carry out a piece of reflective personal learning (using the self-assessment tool as a guide). This resulted in many staff successfully using the learning activities from the web resource and the online record of learning forms or engaging in some of the learning activities from the web resource.

The learning activities were also used during workshops to engage staff in group discussion and interaction, with the main focus on person-centred care and evidence-based practice. The learning activities were found to be very useful in introducing a topic area and stimulating discussion.

Staff were also encouraged to use the EP search functions (Managed Knowledge network (MKN) and site search) during the project to identify relevant evidence-bases to underpin their practice.

EP was primarily used online at a computer throughout the duration of the project, always during work hours.

In their project evaluation forms, one practitioner said they used EP to help maintain their professional registration, two said they had used EP to create and develop their PDP, and five said they had used EP to provide evidence for their KSF.

What has the impact of the project been? The project set ambitious outcomes. Some of these have been achieved, but others are harder to evidence.

The Effective Practitioner project has resulted in enhanced staff engagement and inter-disciplinary communication within ICASS and supported individual team members to gain a better understanding of the role of others within a multi-

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disciplinary team. The project allowed the team time to discuss and focus on their approaches to staff communication and feedback, workplace learning and ongoing personal and professional development. The team has not experienced significant improvements in respect of these areas as a result of the project; however the project brought these issues to the forefront of staff’s attention and facilitated useful and fruitful discussions around them.

There are a number of staff within the ICASS team who at the start of the project lacked confidence in using computers/internet to search for information or evidence-bases for their clinical practice. Using Effective Practitioner during the project has provided a good opportunity for staff to engage in practical use of computers and relevant web resources and has built confidence and skills in this aspect of their work.

Many staff have also benefited from engaging in discussion with their peers around evidence-based practice and person-centred care, in particular, allowing them to identify their own strengths and weaknesses or confirming their own beliefs and opinions. Staff provided positive feedback to the workshops and identified the benefits of group work and reflection in particular, finding the Effective Practitioner sessions ‘informative’, ‘interesting’ and ‘thought-provoking’.

Through using the self-assessment tools from Effective Practitioner, staff have been able to identify and guide themselves towards further learning in relation to clinical practice, non-clinical development and general team dynamics.

The project outcomes relating to embedding a culture of person-centeredness and improving the patient experience and patient safety have been harder to evidence as a result of the project, although the hope is that the work staff have done around person-centred and effective care and their continued use of Effective Practitioner will contribute to achieving these outcomes.

In terms of the Band 7 practitioner seconded to lead the project, they have achieved a number of personal learning outcomes related to supporting the learning and development of others and have gained experience in leading a project from initial planning to evaluation and working alongside NES and other project leads.

How did use of Effective Practitioner facilitate this impact? The Effective Practitioner project offered the ICASS team time to explore how they could work more effectively as a multi-disciplinary team and time to assess and reflect on their approaches, individually and as a team, to providing person-centred care.

The EP self-assessment was a useful tool to help the team identify initial areas of interest for development – person-centred care and evidence-based practice and to set the direction of the workshops. The associated learning activities and links and resources around these two areas supported useful discussion and debate within the team about their strengths and weaknesses and approaches and encouraged the team to reflect individually and collectively on these practice areas.

The self-assessment tool from Effective Practitioner has further supported staff to

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identify and direct themselves towards further learning in relation to clinical practice, non-clinical development and effective team working.

Practitioners said the following about how use of Effective Practitioner during the project had helped them:

“to structure my thoughts around reflective practice”

“reflecting on patient visits I’ve done”

“consideration of best techniques when teaching”

“Leadership activity 3 and reflection helped me to focus on identifying

areas for development/improving such abilities”

“I haven't used it for any specific area of practice but it has increased my

awareness of the resources and how I would go about looking for evidence

if/when I needed”

“Greater awareness of resources out there for learning”

“Knowledge of Scottish patient safety”

Learning for the futureThe elements of this project that worked particularly well were:

Using a fun and interactive activity (the introductory quiz) to help practitioners

familiarize themselves with the web resource and what it has to offer.

Using the EP learning activities as a stimulus for reflective group discussion

and debate around specific topic areas.

Allowing a multi-disciplinary team dedicated time to learn together.

Having a motivated project lead and involving practitioners who were motivated

to learn and engage with the resource.

Buy in to continue to raise awareness of Effective Practitioner after the project

is completed

Having dedicated resource to release practitioners.

In terms of successfully meeting the project outcomes, one challenge was that not all ICASS team members were able to attend all elements of the project. This was disappointing to team members who were able to attend because the focus of the project was very much on team development. Future projects may wish to consider how to ensure all team members can attend team development sessions.

Lack of time and competing priorities will likely present a barrier to future use and embedding of EP and therefore the following activities are being undertaken to

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sustain the impact of this project and support continued use of EP:

maintaining awareness of EP amongst ICASS teams and other staff post-

project;

implementing Effective Practitioner into general staff induction protocols; and

continue to use the Band 7 practitioner who led on the project as an

advocate/ambassador for the resource who can offer support and guidance to

other teams wishing to use EP.

The ICASS team suggested the following potential improvements for the EP web resource as it develops:

learning activities to be less generic and to have more activities that focus on

common areas of patient care for example: patient assessment, record-

keeping, preventing hospital admission;

more clinically relevant scenarios on the web resource;

self-assessment form to link more clearly to areas of EP web resource that will

support identified development need; and

clearer links on front page to access forms (self-assessment, record of learning

etc.)

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Case Study 3

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Driving quality in Maternity Services through women’s and families’ stories The project involves five midwives (four from hospital wards and one community-based ward) and the Practice Development Midwife in seeking feedback from women and families who have received maternity services in order to try and improve the quality of the services. The project aimed to support the midwives to find tools from Effective Practitioner that would help them in seeking the feedback from women and families.

The project participants have had two sessions to date. The first took place in November 2012 and was an introductory day to Effective Practitioner and identification of tools that might be useful for their project (patient stories and communication tools). Following on from this first session the participants had some concerns about how they would handle “difficult conversations” if some of the women they interviewed became emotional/felt traumatised by what they had been through and so the second session involved a midwife counselling specialist in working with the six midwives on ways to deal with difficult conversations. The participants are now in the process of gathering stories and the third meeting will involve them in examining and drawing out themes from these. They hope to complete this by the end of April 2013.

Intended Outcomes To raise awareness of the Effective Practitioner (EP) web resource and the

benefits and support it could offer staff if used.

To evaluate the EP resource through staff feedback.

Specific outcomes:Using the learning resources within the Effective Practitioner web resource Midwives and Maternity Care Assistants will examine methods that they find most appropriate for gathering stories from women and families within their care.

Feedback within these stories will be analysed by the group and strategies formulated to determine what tools and how best to use them to drive care quality improvements across Maternity Services.

Desired Impact

Short Term:Raising awareness of the importance of capturing care experiences to highlight the quality of care.

Mid Term: Women and families will feel engaged with Maternity Services and have a way of feeding back that at present is unavailable to them.

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Midwives will be better able to have directed and focussed communication with women regarding their care stories.

Long Term:Issues arising from the content of women’s and families’ stories will be examined and utilised to drive forward quality of care within the Maternity Services.

How was Effective Practitioner used to support the projectFirst session (November 2012): an introduction to the Effective practitioner web resource for six midwives who had signed up to be involved in the project. This was to allow them time to trawl the web resource and evaluate its usefulness to themselves as practitioners. The first session lasted a whole day: the first half of the day was an introduction to the web resource allowing the participants to navigate round it and see all the resources available; the second half of the day was used to access the person-centred resources with a specific look at the content around patient stories and communication tools.The second session (February 2013) involved a midwifery counselling specialist working with the participants on how to handle difficult conversations. This took place in a room without a computer which meant that EP could not be directly used.What has the impact of the project been? To date the impact has been on the staff involved mainly rather than women and their families. They have become familiar with the EP resources and have had specialist input on communication skills from the midwifery specialist counsellor.

The Midwifery Practice Developer has undertaken three conversations with women to gather their stories and she reported that the women appeared to have been pleased to have the opportunity to provide feedback. The main theme in terms of service improvement from these has been around how women feel in the post-natal stage in terms of the level of staffing (having been used to a much higher level of staffing in the pre-natal stages).

How did use of Effective Practitioner facilitate this impact? The Patient Stories and Communication resources have been identified as useful for the purpose of gathering women’s feedback. The Feedback Cards have been used in the interviews undertaken to date.

Working together around Effective Practitioner stimulated good discussion for the group who comprise four midwives in the hospital and one based in the community.

Learning for the futureThe participants would like to see the content and examples specifically for midwives on EP increased. They think it would be good to have a Favourites section so that people can save the resources they want to return to later.

There are difficulties in accessing computers and none of the computers in the clinical areas have sound cards so the videos and podcasts cannot be listened to unless you go to the computer suite.The informal conversations between the Practice Developer and project participants between the sessions have been important too. The group discussion at the first session was important and provided an opportunity for participants to reflect on their work.

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There are always difficulties in bringing people who work on different shifts together and this has provided a real opportunity for that.

Case Study 3Project DescriptionImplementing Caseload Supervision in an IMProved Anticipatory Care and Treatment (IMPACT) Team

The IMPACT service is aimed at people with long-term conditions or a complex range of conditions, in particular those who have had several emergency admissions to hospital. By using an anticipatory approach, the focus is to improve the quality of life for patients and their carers, improve self-management strategies, give enhanced support in order to reduce hospital admissions, and support early hospital discharge. Each patient has a named case manager who liaises with health care professionals, specialists and other agencies. They will also develop a self-management plan in partnership with the patient and in conjunction with the patient’s GP.

The IMPACT Team is a fairly new team made up of band 6 and 7 nurses who all work in ‘zones’ and have individual caseloads. The roles are new to everyone and the team identified the need for caseload supervision to ensure a consistent and high quality service delivery across the team. The team identified the need for Caseload Supervision. The aim of the project was to use Effective Practitioner to support and enable all team members to participate in a consistent, structured and robust approach to Caseload Supervision.

Intended Outcomes increased awareness of how Effective Practitioner can support learning and

development, both as individuals and as a team

increased understanding and ownership of the approach to Caseload

Supervision within the team.

increased confidence in using/ participating in the Caseload Supervision

approach and ensuring discussions have solution focused outcomes

increased confidence in constructively challenging practice within the team

supported by an open, honest, transparent culture

increased awareness of learning needs and tools to gather evidence/record

learning and development.

Desired Impact

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increased confidence in clinical decision making.

a consistent structured and robust approach to Caseload Supervision will be

embedded in practice to support staff and service governance that will

contribute to the delivery of safe and effective, person centred care.

The approach to Caseload Supervision will support the team to influence the

future development of the Impact Team service.

How was Effective Practitioner used to support the project

Staff had already attended a workshop which introduced them to the Effective Practitioner initiative. A number of meetings were held with the team. Over the course of these meetings staff: discussed and identified their needs relating to caseload supervision to ensure

team approach

examined a recording form that had been developed.

The initial session was to introduce the team to the project, provide an overview of the Effective Practitioner resource and how Effective Practitioner may be used to support the implementation of Caseload Supervision in practice. Supporting tools were identified e.g. recording learning and development forms and learning activities that may be used to support potential continuing professional development (CPD) needs identified through Caseload Supervision.

Participants agreed to explore the Effective Practitioner web resource to identify any tools or resources that may support Caseload Supervision and consider any common CPD themes that may evolve as a result of Caseload Supervision.

At the second session, although there were some problems with team time pressures and staff shortages some of the team had looked at the web resource had given more thought to the purpose and format of caseload supervision sessions. The team identified the Effective Practitioner Support and Supervision Form in the Recording learning and development section as one that would meet their needs and one that was easier to use than their current one. They also identified the Reflective Account Form as one which would help them prepare for caseload supervision meetings. This allowed staff to think and reflect on a situation which they could bring to the supervision session. All staff are now using the Support and Supervision Form and the Reflective Account Form is optional.

The second session focused on the nature and purpose of caseload supervision sessions and as a result of this session and further team discussion, a decision was made to try 1:1 sessions.

Support was provided by the Practice Educators and Blake Stevenson consultant. The Practice Educator developed a ‘crib sheet’ at the outset, which helped direct staff to the most appropriate resources, and everyone found this invaluable as it helped them focus on relevant areas.

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What has the impact of the project been? The project has for the most part achieved its intended aims and outcomes. Staff have increased their awareness of how Effective Practitioner can support learning and development, both as individuals and as a team, although time pressures meant that they didn’t have as much time to spend on the web resource as they would have liked. Through the various discussions and debates, there appeared to be an increased understanding of Caseload Supervision and an agreed approach within the team. “Reflection is now part of what we do, it’s the norm”. The project approach helped ensure ownership by the whole team. It is difficult to say if confidence in using/ participating in the Caseload Supervision approach has increased as only one session had been completed but there is certainly an agreed approach and ‘buy-in’. As reported by the team lead and observed by the consultant, there certainly appeared to be increased confidence in constructively challenging practice within the team supported by an open, honest, transparent culture. Staff were also more aware of available tools to gather evidence/record learning and development

There were also some unintended outcomes. “The whole experience provided an opportunity to sit down together and discuss a topic. People were open and honest and it provided an insight into people’s thinking.” The experience helped focus the team and look at where they were going. It enabled them to make some decisions about supervision, for example a decision to try 1:1 sessions rather than team sessions. The forms have been passed on to another team who found them very useful and had not previously been aware of Effective Practitioner. The IMPACT team themselves are using the reflection tool in other settings.

In addition, during the time of the project, clinical tutorials, in partnership with a GP were started. Staff are asked to bring and discuss case studies and they are now using the Reflective Account Form to help them prepare.

Although it is difficult to measure impact at this early stage there is some self-reported evidence that the project has and will have an impact. This is most evident in the impact on reflective practice, colleagues and team relationships. A student nurse who attended one of the sessions commented on the team cohesiveness and how everyone was able to speak. The open approach that was used helped empower the team and individuals, ensuring that decisions made were team decisions. The process of caseload supervision and the accompanying discussion and reflection, supports decision making and helps staff to identify learning need which will ultimately have a positive impact on patient care.

How did use of Effective Practitioner facilitate this impact? There are many competing time pressures for the team and having the “crib sheet” which directed them to the most appropriate resource was seen as crucial. The Effective Practitioner project created an opportunity for the team to explore the purpose and process of Caseload Supervision with supporting facilitation and Effective Practitioner resources. Effective Practitioner helped facilitate this by providing readymade, easily to use tools and templates.

Learning for the futureThe main barriers to using EP to support project aims and outcomes are time pressures meaning that they don’t have the time to explore the web resource in detail in a short space of time. This can be overcome by ensuring that participants

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are directed to the most appropriate resources. Some can be ‘put off’ by not finding an immediate or obvious answer to a problem or information on a particular topic. The web resource can appear overwhelming to some, so focusing on one area and directing people appears to be the most appropriate approach. The project lead reported that the resources was very useful and had used the managing team’s section and leadership resources via the web resource.

Using it as a team meant that people supported one another, identified resources and shared them. “Doing things for your colleagues brings people together. At the start we were not sure if we are approaching the project in the right way, but we didn’t want to be too prescriptive. I would recommend this approach and the Effective Practitioner web resource to others. But I would suggest, don’t panic as there is a lot of information. Look at it in bite size pieces and pick out even a tiny bit.”

Evidence from key stakeholder interviewsWe have conducted four interviews with key stakeholders to follow up on their views now that Effective Practitioner has been in place for approaching two years.

Key points emerging from these interviews include: the many ways in which Effective Practitioner is being embedded through use by senior nurses

and AHPs, the Practice Educators and Practice Education Leads and within teams;

there are various aspects of the resource that are liked such as the easy access (no login), the

bite-sized learning activities, the podcasts (one stakeholder uses them in teaching situations);

suggestions made for improvements which are included in the section at the end of this chapter;

there is a strong sense that in the future there will be further effort to embed it and use it to

improve learning and practice, in particular through the medium of SCNs and Senior AHPs; and

there is clearly a lot of activity being stimulated by Practice Educators and Practice Education

Leads and a sense that they have an important role to play in helping practitioners navigate the

web resource and work out how to use it for effective learning and practice.

Additional evidenceThere is additional evidence from other areas and projects as to how Effective Practitioner has been used and suggestions as to what would facilitate its further use. These are summarised here.

Using the Self Assessment tool

A health board used case examples to help practitioners use the web resource, for example: “Gemma has worked as a staff nurse in your area for 4 years; she is a degree student and has completed Flying Start. She works 37.5 hours week. Gemma is coming up to her KSF review and you decide to use the Effective Practitioner self-assessment tool as a way of checking how she is getting on.”

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The group is then asked to look at the completed self assessment form for Gemma and answer the following questions: How would you support this practitioner’s development in the areas they have marked as amber or

red?

What evidence would you expect from the practitioner where they have scored themselves green?

You disagree that they are green, how would you address this with them?

How could this learning be supported in your clinical area?

The group then works with EP resources and discusses how they could be used to support staff.

Planning a Professional Development Day

A health board has planned a professional development day for nurses using EP to look at accountability of care and quality improvement elements (through learning activities) and then to lead on from this to focus on developing quality of case notes (responding to issues raised in a recent case note audit).

They are also planning to use leadership activities to develop band 5s in A&E but this has been put on hold due to an upcoming OPAC inspection

Training on EP has been given out to all mentors across the NHS Board so that they can pass on to those they work with. Some mentors have been using the learning, teaching and supervision activities as evidence for their triennial review and re-validation

Dementia learning activities and associated resource links have been used very widely –as there is a big focus just now. It has been used to help prepare staff for the OPAC inspection. Dementia Champions are also using this element of the resource to support staff to increase knowledge, awareness, understanding and capabilities around dementia care.

Practice Development Nurses report using the resource to pull together a programme around dignity and compassion and were able to find everything they needed to do this on the EP web resource.

Seeking service user feedback

The aim of one project is to skill up NMAHPs so that they feel confident using techniques to gather patient feedback. This will involve semi structured interviews using emotional touch points as a means of taking the patient through their journey/experiences. The focus is on fracture clinic patients (as part of the MSK pathway) as it means that patients will be able to explain their experiences of primary and secondary care services hopefully leading to improvements in practice.

Service Improvement

In another health board, the Nursing and Midwifery Practice Educator and the AHP Practice Education Lead have developed a model of Advanced Practice Sessions using Effective Practitioner with team leaders and those who can influence practice. Twelve practitioners (four nurses and seven AHPs, one nurse has dropped out) have been involved and attended the first session in January. Participants

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were asked to come with an outline for an area of their service/practice that they wished to change. The two session leaders have given 1:1 support in between the sessions (with the second session due to happen late March/April) to help participants develop and think through their project and change approach. The projects are addressing very practical change issues such as improving patient pathways in a given clinical area and examining referral processes in another.

A lot of the work is about change management and the practitioners have found the learning resources on leadership, team building and change management on EP very useful. This is a model that is highly replicable given appropriate support from practice educators/practice education leads.

Supporting Carer Involvement

A project around supporting carer involvement in end of life care was progressed in a health board. The project focused on enhancing holistic end of life care of patients through carer involvement in a gynaecology hospital ward.

The project team (charge nurse, two staff nurses and a clinical support worker) met to discuss what they wanted to achieve. They did not use Effective Practitioner at this point as “we were a bit in the dark about what bits to use.” They then spent a morning with the Blake Stevenson consultant, who gave a ‘hands on’ overview of the Effective Practitioner web resource and how it could be used for their project. A number of ideas were generated and a number of tools and resources identified, the most obvious section being the Palliative and end-of-life care section. However on further exploration the most useful resources were identified in the Person-centred care section with resources such as “How do you Feel? and Patient Stories. One patient story showed how relatives had been ‘pushed out’ and this highlighted the change in practice they were aiming to achieve. The team spent the rest of the day gathering and collating information, then over a number of weeks adapted and personalized certain tools to use.

The tools will be put into practice in May of this year. The process however “definitely opened eyes, not just with registered staff but at all levels”. They are more aware of Effective Practitioner and how it can support learning and development. For example “I previously was aware it was there, but still tended to ‘Google’, but now I am going to use it more.” The nursing team is using it more and what the team learned is being cascaded down to other staff. “It is now part of their information package.”Initially they felt that finding what they wanted in Effective Practitioner was difficult and before the facilitated session they hadn’t seen things and certain areas of the web resource. They felt that more ‘quick links’ would be useful, for example for assessment, patient stories etc. The project however has made them more aware of Effective Practitioner and how it can support learning. It has supported their knowledge and understanding of end of life care and helped facilitate the development of strategies and tools which will improve practice in relation to end of life care through carer involvement.

Using Effective Practitioner

In one health board, as well as awareness raising sessions the Practice Educator reports using EP in a number of ways:

“We had a couple of nurses who were keen to deliver some education. The Senior Charge Nurse

(SCN) approached me and we supported them through the learning, teaching and supervision

learning activities. We then observed the teaching and they used the reflection tools to reflect on

how it had gone.

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We are linking into KSF review training and have been asked to attend sessions (signposting to

Effective Practitioner and giving leaflets).

We plan to hold learning activity workshops and are working with SCNs to identify the appropriate

ones for their staff.

EP was used in a session on critical incident learning (reflection)”

Session with Senior Charge Nurses/ Senior AHPs

In another health board a session sought to help SCNs and Senior AHPs facilitate learning for their staff using EP. This was linked to the capabilities in the SCN and Senior AHP learning and development frameworks.

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Suggestions made in various sessions for improvements to the EP resource

Re- look at the self assessment form. It needs to be updated to match the learning activities, for

example, if you identify a learning need it is not immediately clear where to go next. It also needs

new things in there like accountability etc.

Consider sections on falls, alcohol, record keeping/report writing and documentation (mentioned

several times), tissue viability (i.e., specific topics that people find useful)

Better search engine with more quick links – people feel they spend a lot of time searching for

what they want - but not sure exactly what.

Better links to KSF – e.g. ability to search the other way/reverse menu – i.e., via KSF dimensions.

The learning activities are a useful way of sparking group discussions and getting people talking to

each other about learning needs and improving practice. However, practitioners in one project feel

the activities are too vague and generalised and that more clinically relevant scenarios would be

useful.

Learning activities need to be re-designed – currently the clinical practice learning activities are in

a newer format and the activities under the other pillars are in an older format.

Don’t like the photo of the girl on the front with the earrings – unprofessional, not very clinical

looking, not appropriate image for front page.

Front page could be clearer and easier to navigate – quite busy just now. Perhaps buttons on the

front page to link to self-assessment and recording learning tools.

Webcasts on how to use parts of the web resource to help direct learning.

More examples for those working in social care.

Telehealth: improvements for this element have been offered by one board following their

telehealthcare project.

Think about adapting and sharing the quiz used to help people navigate the web resource and find

out what was on it (series of questions they had to use EP to find the answers to) – was fun and a

good team activity.

Planning to do a local flyer or equivalent about how EP has been used by various teams to provide

inspiration/case study for others. This might be useful to have on EP web resource.

Although there is the guide to getting started, perhaps a better explanation/ guide to searching –

what it is and what it’s not. In particular, doing sessions on evidence based practice – people

expect to be able to find evidence on various very specific topics (mainly medical).

The next section of the report provides a synthesis of the findings from this evidence.

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3 Synthesis of findings

The evaluation set out to examine six outcomes:

practitioners at level 5 & 6 have greater awareness of EP;

practitioners at level 5 & 6 have improved skills and/or learning through use of EP;

practitioners at level 5 & 6 have changed their practice as a result of using EP;

Senior Charge Nurses and Senior AHPs are able to use EP to support development of individual

staff and teams;

teams have changed practice as a result of using Effective Practitioner; and

key stakeholders’ expectations of Effective Practitioner are met/exceeded.

This chapter summarises the findings in terms of each of these. It also pulls out some of the learning from the overall process of this further period of support for embedding Effective Practitioner and work-based learning.

Practitioners at level 5 & 6 have greater awareness of EP and have improved skills and/or learning through use of EP

Around 100 practitioners have had the benefit of more in-depth work around using Effective Practitioner through both funded and non-funded projects. This does not take account of more general awareness raising activities that have continued throughout the year in some Board areas or the “ripple effect” of those who have been involved in some sessions taking their learning out to others.

The evidence from the survey, case studies and additional support suggests that there is greater awareness of EP but that the key focus in 2012-13 has been in assisting practitioners to gain improved skills or learning through use of EP. The case studies demonstrate that EP has been used to develop learning and skills in a range of different subject areas including aspects of clinical practice such as stroke treatment through to more general communication and leadership skills. The importance of effective communication within teams and across interdisciplinary teams has been highlighted.

Effective Practitioner has been used for learning around specific topic areas such as telehealth, end of life care and dementia. For some practitioners the more specific the topics and resources available the better and they would like to see more of the very specific learning resources. Practitioners have been able to use tools that are new to them such as the Reflective Account Form, the Support and Supervision Form and emotional touch points.

There is evidence that practitioners are using the resource for their own professional development in terms of completing PDPs and gathering KSF evidence.

For some practitioners the learning has also been around computer confidence and becoming more comfortable with accessing the resource.

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Practitioners at level 5 & 6 have changed their practice as a result of using EP

There is some evidence of practice having changed or being in the process of changing. From the funded projects there is evidence of a focus on better communication in relation to team working and person-centred care; and in improvements to caseload supervision.

The model developed in one health is interesting as it is specifically about identifying areas of practice that individual practitioners identify as needing to change and then supporting those practitioners to use EP to help implement change. Some of the learning from this model has identified that change inevitably can take longer than hoped and that starting with small steps and where benefits can be easily gained is useful. The eleven change projects in on Board are still in the process of being implemented but the intention is to start again with another cohort of twelve from the summer.

Senior Charge Nurses and Senior AHPs are able to use EP to support development of individual staff and teams

There is clear evidence that SCNs and Senior AHPs have developed skills and understanding about how to use EP to support individual staff and teams. One of the key support roles fulfilled by Blake Stevenson during this year has been to support senior staff to examine how to use EP to work with and help develop their teams.

Some of the tools that have been reported as most useful in this respect are the self-assessment form, the Record of Learning, the Reflective Account Form and the Support and Supervision Form. There is anecdotal evidence of senior staff taking these forms and using them in different settings to the original one in which it was introduced to them. For example, one SCN requires all nurses under her supervision to come to a supervision session with the self-assessment form and an area identified that they would like to work on.

One of the areas where there appears to have been development during this year is in the use of reflective practice both for individuals and for teams. Many of those interviewed in the funded projects have commented that the opportunity to sit down as a team and reflect on practice together has been invaluable.

It is clear that in several of the funded project situations new ideas/paperwork have been generated or existing ones on EP adapted. For example the quiz; a crib sheet; the adaptation of the record of learning. The sense from those involved is that it takes time to navigate the web resource and that anything that can help others access what they need more easily is helpful.

Teams have changed practice as a result of using Effective Practitioner

There is some evidence of change in practice as a result of using Effective Practitioner but it is also quite early to quantify this: several projects have stated that the change in practice is still to come but that the beginnings of change have taken place.

Examples from the funded projects include:

the development of a reflective practice approach in an oncology team.

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a new approach to support and supervision.

a better understanding of dementia in acute hospital setting.

a more person-centred approach to maternity care.

better involvement of carers in end of life care, and

better communication in a multi-disciplinary setting hopefully leading to better patient care.

Key stakeholders’ expectations of Effective Practitioner are met/exceeded

Those who have engaged with Effective Practitioner can see that it can help practitioners learn and improve practice. It is also true that not all health boards have engaged in the same way and that there have been competing pressures on time and energy to embed Effective Practitioner. One stakeholder reported that she did not have particular expectations but that the key is to get people to engage with it and then they see what it can offer. If this happens then it meets her expectations.

This embedding takes time and as has been shown in the case studies and other project evidence it requires support and direction to assist practitioners to engage. Several stakeholders have commented that the resource can be a bit overwhelming particularly if people are pressed for time and that “helping people navigate it for themselves” is essential.

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4 Conclusions and Issues to Consider for the Future

Conclusions

The year 2012-13 has provided an opportunity for practitioners to get to know and use Effective Practitioner in more depth. There have been challenges as well as successes in terms of the funded projects and other health boards which did not receive funding have also had significant achievements.

One of the key points to emerge from the evaluation and the support offered throughout the year has been the need to help people work out how to use Effective Practitioner for the specific issue or practice area they wish to address. Once practitioners are helped to see which element within the web resource can help them they are able to move forwards more easily themselves.

The role of SCNs and Senior AHPs has come to the fore this year: they can play a critical part in bringing EP to the attention of Band 5 and 6 nurses and in helping them use it to improve their practice. Increasingly Practice Educators and Practice Education Leads are focusing on these senior practitioners who can influence practice and bring about change.

Throughout the year the issue of time and the lack of it has featured many times: being able to take time for team development meetings; having the time to access the EP web resource; the pressures on time during the winter months when even with funding for backfill there can be shortages of staff to provide the backfill. This issue is not going to be easily resolved and the model of working through more senior staff to reach level 5 and 6 staff while they are at work appears to be an appropriate one.

The support to better communication that working together on an issue using Effective Practitioner can provide has been demonstrated in several areas. This has potential impact on practice within teams and also across teams in health and importantly, given the integration agenda, between health and social care. The process of working together on identified issues has in itself reaped benefits in some instances.

There are still issues of access to computers, to the internet and in some situations the project lead has printed out the elements they wanted to use to get round this issue. There are no easy solutions to this issue.

Using Effective Practitioner to reflect on practice within teams brings a range of benefits not least the opportunity to think about what could be improved. Although it is early days it is hoped that this will lead to real practice improvements that impact on patients and their carers.

Issues for consideration in the future

The following issues for consideration emerge from the work undertaken during this year:

there are specific improvements to the web resource that have been suggested (see end of

chapter 2) that could be considered;

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working through the Practice Educators and PELs to ensure that they share some of the ideas and

ways in which they have been working;

it might be useful to develop postcard-sized handouts (or have these on the front of the web

resource) about how to use the web resource for specific issues/with ideas for what to do: the

main support that Blake Stevenson has provided this year has been helping people with ideas of

how to use the web resource with teams/individuals;

exploring ways of how to reinvigorate those Boards where EP has taken a back burner this year;

and

communicating about ideas/sharing new ideas of how EP is being used as often as possible.

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Appendix 2: Schedule of Rates

Suppliers are required to complete the table of rates below; you may use or add as many additional roles as required:

Roles Day Half dayDirector £ £Senior Consultant £ £Consultant £ £Project Manager £ £Administration £ £Other: Please Specify £ £Other: Please Specify £ £Do your rates include travel expenses? * Yes No

All rates to exclude VATAll rates to be in GBP

Suppliers are required to complete the table of rates below, you may use or add as many additional roles as required:

Other Costseg materials £

£££

All rates to exclude VATAll rates to be in GBP

* For bidders whose rates include travel expenses NES will reimburse properly incurred expenses for visits to non mainland Scotland locations should they be required. NES will require evidence that the most economic form of transport was secured.

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scottish healthcare supplies · web viewproposal demonstrates evidence of previous work undertaken...

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