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Paired Learning/Vanguard Programme Evaluation Report 26 April 2013

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1 Paired Learning/Vanguard Programme Evaluation Report 26 April 2013

2 Contents Section 1. Introduction Section 2. Evaluation findings Section 3. Service improvement projects and outcomes Section 4. Programme improvement suggestions Appendices Appendix 1 - Participants in the evaluation/feedback process Appendix 2 - Interview questions Appendix 3 - On line survey questions

3 Section 1 - introduction

4 Objectives, processes and data sources for this evaluation
The objectives of this evaluation were set out in the original brief as follows: ‘The aim of the evaluation is to develop an understanding of the benefits and challenges of participating in the programme for the participants, sponsors and their organisations; to learn lessons, celebrate success and to inform future leadership development programmes in the Region’. Evaluation process/data The evaluation process and the findings presented in this report take into account the following elements: NHS Institute for Innovation and Improvement evaluation data Semi-structured telephone interviews at the end of the programme with: The Programme Sponsors (x2) The Programme Manager Programme facilitators from the Region (x3) Participants (all invited; x19 conducted) Project sponsors (x6) An on-line survey to all participants at the end of the programme (all invited; x14 completed) Review of participant assessment presentations and posters (x22) Review of the assessment process and outcomes Notes: A full list of names of those interviewed and completing the on-line survey, together with the questions used are shown at the Appendices. A document containing all the participant posters is attached separately with this Report Full interview notes and survey data have been provided to the Project Manager

5 Background and programme aspirations
The Paired Learning programme was commissioned within the overall frame of the Emerging Leaders initiative under the sponsorship of Chris Bain, Chief Executive, Rotherham &Doncaster and South Humber NHS Foundation Trust David Wilkinson, Postgraduate Dean, Yorkshire and Humber Deanery. Fiona Sullivan was the Project Manager It was organised and delivered in collaboration with the Institute for Innovation and Improvement who designed and delivered the ‘NHS Vanguard Programme’ elements. Vanguard had run successfully in 2011/12 , with six participants from Yorkshire and the Humber involved. The programme was offered again this year and interest was expressed by both Yorkshire and Humber and the Southern region The integration with the ‘Paired Learning’ focus was unique to the Yorkshire and Humber programme It arose from reflections on Emerging Leaders and was aimed at strengthening relationships and networks between clinicians and mangers in the Region and to build leadership sills for service improvement. The intention was that a manager and clinician ‘pair’ would work closely together on the programme - supporting each other in their project work and overall learning Publicity literature targeted applicants as follows: ‘The Yorkshire and the Humber Deanery and the Yorkshire and Humber SHA have teamed up to develop a new six month Paired Learning Scheme to help leaders deliver service improvements. We will pair up ‘emerging leaders’ , circa Bands 7 and 8 manager and clinicians (circa ST5 and 6) as ‘buddies’ in order to support leadership development and encourage collaborative work on service and quality improvement activities for the benefit of patients’. I believe passionately in this type of development Chris Bain I was very committed to the principle of clinicians and managers working together – as early as possible David Wilkinson The aim was to build on the Vanguard foundations – and really to strengthen our clinician-manager relationships and networks Fiona Sullivan

6 Overview of the programme and its elements
The programme ran over a six month period from September 2012 to April 2013 There was a heavy emphasis on ‘virtual’ delivery – with webinars (covering service improvement themes and tools) and Virtual Action Learning Sets delivered entirely on line These were organised at fixed times and participants were expected to achieve a 70% attendance level Participants met face to face at launch, assessment and final celebration events (alongside Sothern Region participants) Participants were individually responsible for organising their project work – in conjunction with their project sponsor. Sponsors attended an on line coaching webinar and had access to all the learning materials and sessions Participant pairs were responsible for organising the most effective ways of working together through the programme. Collective Events – Launch and Celebration Webinars (x9)– pre-reading and web resources Virtual Action Learning Set (x9) Paired learning Sponsored project work Assessment One to one preparatory discussions Programme Elements

7 Profile of programme participants
Recruitment 25 participants from Yorkshire and Humber were selected for the programme drawn from a wide range of disciplines and localities Participants were paired in advance of the programme (a clinician with a manager) Some pairs were proposed through the application process Most were matched centrally after application – with efforts made to reflect potential common/shared interests for project work Most pairs did not working in the same organisation A full list of participants and pairings is shown at Appendix 2. Completed 3 participants dropped out before the final assessment process The remaining 22 participants successfully completed the programme and were awarded the innovation practitioner certificate Awards Alastair Mew, Senior Commissioning Manager, Sheffield and Laura Wakely, Vitreoretinal Fellow, York were awarded Best in Region.

8 Section 2 - Evaluation findings

9 Overall feedback from participants
Would you recommend this programme? YES This evaluation aims to look at the programme in detail but it is perhaps useful to begin with the final question in both interviews and the on-line survey asking participants it they would recommend the programme to colleagues. Of 19 participants interviewed the overwhelming majority answered that they would recommend it – and many would do this strongly . The on-line survey data (with a smaller response size) reflects this majority view. Many expressed a hope that the learning from the programme can be amplified and shared widely - and a number offered support and suggestions for doing this. But within this very positive feedback there were also improvement suggestions which are provided at Section 4. It was very useful.. very powerful…should be commonplace…part of the fabric…and I hope that managers and clinicians who have been on it take it forward…that we don’t lose the talent developed here

10 Recommending the programme - comments from participant and sponsors
Participants (x19) This programme would be beneficial to people from any area; I have already recommended it to others. I hope it continues to run I would recommend this programme to middle grade, operational people. Am I glad I did it? I think so – it helped me to debate some ideas in my own mind I would definitely recommend it. A good programme. I am enthusiastic about it. It should be highly recommended… I would definitely say to doctors yes its worth doing… a lot of common sense but worth doing…I feel very, very grateful I would recommend it – you can see how much effort has been put in; there is a body of learning about NHS improvement… science behind it…methodology…you can do it in a meaningful way…make more of improvement projects; a very rewarding experience; be good if it could continue This type of training needs to be more widely available in the NHS; more about being a leader (not another ‘management’ course) - participative leadership, engaging people; Band 6 and 7 should be exposed to this kind of course; I would absolutely recommend it I would recommend it; it does all come together… a journey; I don’t know whether Public Health will have access to this sort of programme in future? I would definitely recommend it.. thought it very worthwhile.. increased my skills and confidence…good for junior doctors to have on your CV…; I will definitely use the improvement tools to help implement change; made me aware of what motivates people in work etc I would recommend the programme – but just be aware of the time commitment I have already written an article about the programme for the British Society of Rheumatologists; I think every new NHS consultant should have to go through this. .. it is bread and butter for the role I would recommend it strongly to clinicians – without hesitation – think they found it fantastic; maybe reframe for manager like me with better matching of experience between managers and clinicians. However overall my impression has been very positive; I have learned a lot – particularly from the challenge of my VALS facilitator I would recommend this programme; I’ve done a few management programmes and thought what was that all about? This time I’ve come away with models I’m using… I’m actually quoting things …. readings etc I would certainly recommend it to others – but make sure they understand the time commitment – was a bit of a struggle juggling childcare to make sure I could attend

11 Recommending the programme - comments from participants and sponsors (cont)
I would recommend the programme but make sure you understand the time commitment; I would really like there to be a VALS in this region – keep something going I would recommend it to others; in fact we are going to try and run a type of programme with junior doctors in my area – got the backing of the Trust Improvement Team; running short lunch time improvement sessions to give people tools and approaches; then going to give them projects and I will help and guide them with these; if this works well then I’m sure other Directorate Managers will be interested to do something like it too I would recommend it – with the caveats for improvement I would definitely recommend it; I’m the trainee rep from Yorkshire on the Royal College of Physicians training committee; happy to help in any way I can; I hope it happens again I absolutely would recommend the programme; I think the pitching is pretty good; do people know it exists? how to keep the profile going ? I would still have opted to go on it (even though did not complete) …very well pitched in terms of what the NHS needs to do ….value for money, improvement, quality Sponsors (x4) I would love for it to continue ; it would be a real shame if it falls by the wayside… it has been really helpful for her and for the team I think it has been well received I think this programme is a wonderful gift for clinical trainees and I would recommend it . If you do it (centrally) that would be fantastic… but if not we would do it locally … I am willing to help push it forward as a ‘link person’ … there may be ways the Deanery can channel funding to this? I would recommend it – definitely there is value in the tools and techniques it exposes them too ; but be careful with expectations of delivering an ‘earth shattering’ project in this time frame I really think this should be pushed more for consultants …they come into the role with very little idea of how things work or how to change things…. They are used to working in clinical teams but don’t know the intricacies of how to get other people motivated.. how managers work Yes I would recommend this programme – it should have a future; I hope it is not another NHS ‘good idea’ then we never see it again; I think it is really valuable for someone who is newly appointed to a senior manager role – I would certainly recommend the Vanguard model

12 Overall usefulness and benefits of the programme
The online survey indicated that the majority rated the programme as very useful or useful. No one thought it had not been useful. The interviews explored the specific benefits which participants felt the programme had brought. These typically fell under three major headings: Tools to use on this project and beyond: Helped to push projects forward Relevant to day to day work Sustainable learning because putting it to use Practical and useful resources to go back to Understanding the people issues of projects ‘My project developed more in the last 6 months than it had in the last 3years’ Personal development: Building confidence Stepping back and reflecting Space to explore issues Being challenged in the VALS Tough managing the time commitment The amount covered in 6 months ‘Glad I did it’ Relationships and networks: Access to other perspectives Sharing ideas Hearing about other people’s projects Great support from the VALS Understanding the NHS structure better Having a sponsor to give access to the system

13 Impact on areas of work Given the focus of the programme on building relationships, working in teams and across boundaries, the on-line survey invited ratings of the programme’s impact in a number of specific areas. Responses on the chart below show that areas of greatest impact were: Clinician-manager partnerships Working in a team Initiating projects Project managing Areas of lowest impact were understanding hierarchies and commissioning which may reflect the organisational turbulence at the time of the programme.

14 Feedback on the webinars
Seminar Focus area 1 The NHS Change Model 2 Sustainability 3 Measurement for improvement 4 Innovation and creativity in practice 5 Creating contagious commitment (1) 6 Creating contagious commitment (2) 7 Demand and capacity 8 Human dimensions of change 9 Mindset for change I was sceptical about the whole management thing - overdoing common sense; as the programme went on I became more and more convinced of the importance the teaching was inspirational The interviews, on-line survey and Institute evaluation information show that the majority of participants valued the webinars but varied in their views on the most useful content areas - with needs, interests and relevance to project work varying across the group. Some participants (particularly the more experienced managers) were familiar with the NHS Change Model and associated innovation approaches and tools and saw the webinars as an opportunity to refresh their knowledge. By contrast, all the material was new to some of the clinician participants . A number of interviewees commented on the value of hearing Helen Bevan at seminar 1 . The Institute’s evaluation survey data on this seminar completed by 11 Yorkshire and Humber participants appears to reinforce this (chart above); Julia Taylor on Creating Contagious Commitment was also commended by a number of interviewees Participants were very impressed with the quality of the resources made available to them - ‘great reading materials’; ‘access to experts’; ‘a privilege’ A small minority of interviewees thought the webinars were too long (1.5 hours) with duplication/repetition of pre-reading One participant valued the passion of the presenters but was wary of over-deference to a single approach to service improvement

15 Feedback on the VALS Almost all of those interviewed commented that the VALS was a key strength of the programme – well facilitated and offering fresh perspectives, support and encouragement. I was very encouraged by my group - brought a range of perspectives – like a breath of fresh air I thought the VALS were the best aspect – very supportive The VALS was really beneficial – everyone had ‘air time’ but using a structured questioning process I would state my challenges and they would give an impartial view; give ideas – pity but we are not continuing to meet The VALS was brilliant ; I’m a bit gung ho so the VALS was really good at giving other perspectives.. sometimes better to hold back a bit…a nice diverse mix of clinicians and commissioners Seeing clearly some of the hostility between doctors and managers A really good VALS facilitator she made me do stuff; challenged my approach; some deep learning; made me reflect on how I approach things Sometimes I wanted ideas to make my project more effective; but more importantly I got to hear about other projects – and understand them There was an absolutely wonderful moment towards the end when a girl who was sceptical at the outset had done a fantastic project… came out of herself… there was real excitement in the group… a highlight VALS group rallied round if you were struggling with your project; used good questioning; also offered suggestions and tools from their experience VALS – a great bunch of people; great facilitation – could have been a nightmare! VALS worked well; a very good facilitator

16 Feedback on the paired learning element
The paired learning element divided opinion amongst participants A few saw it is one of the strengths of the programme offering a source of support for project ideas and general encouragement However many felt the time commitment from other elements of the programme was already intense and because the VALS gave regular access to a clinician-manager network and project challenge/support many participants could not see the added-value in the paired learning element for the further time pressure it created For those paired with someone in another organisation the practicalities of finding time to meet were an inhibitor – although most made contact by phone and e mail There was also felt to be less guidance and structure than for other aspects of the programme; and some participants were confused because members of their VALS (from Southern region) were not paired Higher satisfaction with the paired learning element came where there was a good ‘bond’ of shared interest within the pair - eg working in the same organisation or on a similar project. Here it was felt that strong relationships were established. Definitely paired learning was a useful part of the programme – but we both work part time so hard to carve out time together Pairs are critical to the programme … can’t have doctors who do everything alone…can’t have managers who do everything alone… Maybe the success of pairing depends on having shared ground with your partner Idea was great but in reality I got most help from my sponsor ; you are so busy with your day job, the programme and the project that you just don’t have time to help someone else out He helped me when I was having a problem with commissioners on my project I suppose you get out of it what you put in and we might have made more effort We never really found the time to work together as a pair; we met in the VALS and got on well but not outside it The paired element was a bit of a funny one - not really sure what we were supposed to do

17 Assessment process and outcomes
The final assessment of the programme was based on a number of elements: a 10 minute powerpoint presentation to demonstrate programme learning linked to the service improvement project. (assessment criteria were set out in detail as shown on the table below) a poster summarising the learning from the programme and its application 70% attendance at webinars and VALS sessions All 22 participants successfully passed (with one required to re-present) and were awarded the innovation practitioner certificate Most of interviewees felt that the assessment process was clear and fair One felt the process was weighted against those without previous experience of presenting in this way, that 10 minutes was a very short time to present on hundreds of hours of project activity and that the pass/fail approach was inappropriate for a programme that does not have external accreditation A manager who passed the first presentation thought the process could have been more rigorous The assessment criteria for the presentation were clearly set out eg… The primary purpose of the presentation is the certification of the emerging leader. However, sponsor attendance (not to co-present but to observe) at this presentation would support engagement and demonstrate the partnership nature of the programme, and at the end of the presentation questions may be put to sponsors to explore their assessment criteria. Is the purpose of the business critical project clear? Is the aim well defined and described, e.g. What by When? (3) Alignment with QIPP (3) Is onward sharing of learning included to demonstrate the spread of this learning beyond the pair to a wider audience with specific actions. (2) This slides demonstrates the transfer of learning into practice… The 5 areas demonstrated should be taken from the 9 web seminars. Assessment criteria includes: Have at least 5 elements of the NHS Vanguard programme curriculum been highlighted in relation to transfer to practice ? Your business critical project outcomes will be summarised here. Assessment criteria include: Project achieved planned goals? Project success is not necessary to attain marks in this section. Clear evidence that the project has progressed within the lifespan of the project. (4) Have either goals been achieved or If goals have not be achieved what learning has been shared, or anticipated date of achievement clear (4) I can’t say I enjoyed it but it was good to be clear what was expected

18 Feedback on programme practicalities and quality
Most participants welcomed the virtual nature of much of the programme and the travel time this saved Where technical problems were encountered support was available to sort things quickly The chat facility on the webinars was not widely used although it was noted by a number of participants that this gave the opportunity to raise issues live if you wished to Participants were generally very complimentary about the quality of resources, support and administration However a number of participants commented on the volume of e mails and big attachments which were sent out One interviewee felt it was ‘over-administered’ One project sponsor questioned the cost of providing all the materials to him in hard copy I would like to say the resources available – slides, seminars, information were fantastic, amazing I loved the virtual part of it … very cost effective… you can develop a relationship using a webcam! You could do all this without leaving your office

19 Section 3 - Service improvement projects and outcomes

20 Overview of the project work and sponsor role
Project progress Many interviewees commented on the value that the programme brought to their service improvement project by: bringing focus and attention to the way they were approaching their project work offering tools and theories for practical application bringing new ideas and challenge from the members of the VALS group and pairings strengthening relationships with the sponsor For a number of participants this meant that their project progressed faster and more effectively than they believe would have been the case without the programme The role of the sponsor (participant perspective) The majority of interviewees commented positively on the support they received from their sponsor – although the level of their input varied some meeting weekly whilst others less frequently For many the sponsor was already the line manager working closely on the project - but the programme brought additional focus to the project review and learning activity The role of the sponsor (sponsor perspective) The sponsors valued the structure offered by the programme, the tools offered and relevance to the project work They generally agreed that that the programme had significantly increased the confidence and skills of the participant in their project activity and increased their understanding of the system as a whole As sponsors they valued the development offer available: For their coaching role Giving them access to all the webinar materials But In reality sponsors did not have time to attend many of these The following pages give a summary of the projects undertaken and what has been achieved to date. All of the project posters are provided as an attachment to this report. The programme allowed more reflective time together than we would have in our normal line management relationship. I used to go behind her to meetings. But after the first project meeting she said she couldn’t make the next one … she wanted me to go on my own… the programme allowed this to happen

21 Improvement projects and outcomes to date (1)
Participant Project overview/aims Outcomes Ian Anderson - Specialist Neurosurgical Registrar, Leeds Reducing the number of last minute cancelled operations in neurosurgery Early improvements in LMCO rates More patients discharged before 11am bed meeting More patients receive appropriate paperwork Initial pathway created with A&E and radiology for MRI of patients who may not need admission Morna Cooke - Senior Commissioning Manager, Wakefield Children’s specialist equipment – improving budget management , patient experience and outcomes Actual spend below budget Faster supply; better meeting patient needs Improved maintenance Improved staff engagement with the issues; less wasted time Gemma Cuss – Ophthalmology Directorate Manager, York Integrated Vitreoretinal pathway - quality for patients through services closer to home; reduced cost; increased income from improved coding Reduced waiting times through increased capacity. One attendance reduced per patient to allow capacity for more patients Patient satisfaction – patients report that although prepared to travel for surgery they want outpatient appointments close to home. Reduced cost of the service by £67 per patient ; reduced dependence on Locums costing £200 more per session Srilatha Dampetla – ST 5 Endocrinology, Scarborough Transitional Clinic for young people with diabetes moving to the Adult Clinic to ensure a smooth process Full team working together from beginning of March Due for audit after 12 months to compare results Sarah Dawson - Service Manager Planned and Unplanned Care, NE Lincs Urgent Care Dashboard - support GPs to use the information to proactively manage patients accessing urgent care services; share best practice; develop further All GP practices have access and have received training Development of the Urgent Care Dashboard based on practice feedback Development of best practice Improved care for patients where the information is used and acted upon Clinical Lead needed for sustainability

22 Improvement projects and outcomes to date (2)
Participant Project overview/aims Outcomes Nikki Dunlop – Commissioning Manager, Hull Align GP practices with care homes and introduce a proactive approach to support management of Long Term Conditions and contribute to reduction in emergency admissions Real engagement from the GP Practices along with a commitment to provide clinical input into the service A joint forum with representatives from Care Homes, Local Authority and in the future GPs Support from the Community Geriatricians to be a part of the project Consultation and engagement with the LMC Developed networks with other areas and shared good practice Next steps to finalise the Local Enhanced Service and to roll out across the GP Practices in April 2013 Tom Hall – StR in Public Health, East Riding Develop and implement a structure and process for discharging the new public health responsibilities of East Riding of Yorkshire Council A vision for Public Health developed and owned by staff Team leading and driving commissioning Services based on outcomes Vision articulated to the Council Public health processes adapting to the Council’s structure Freedom of direction Angela Harris - Lead Nurse Urgent Care, YAS High quality care at end of life – improve paramedic knowledge of EOL; reduce 999 calls and emergency admission; share best practice Presented at national /regional ambulance service networks Questionnaire to paramedics; focus groups in care homes EOL training package developed; in stat man from April Working with CCGs Reduced number of call s from selected care homes Gemma Hayden - Project Lead Communication Partners, Rotherham To improve NHS services for people living with LTC by working with volunteers – empower patients; more for less; get rid of NHS revolving door; influence future of volunteering so part of NHS community teams Reduce visits required from AHP and other NHS services Client maintains and even improves health and wellbeing when rehab complete NHS Vanguard produces booklet about project Other NHS services adopting innovations

23 Improvement projects and outcomes to date (3)
Participant Project overview/aims Outcomes Siobhan Horsley - Health Improvement Practitioner (Maternal and Infant Health), Sheffield To define a public health approach to support reduction in A&E attendance by 0-5 year olds Multi-agency stakeholder event defined common purpose Enhanced approach to provision of Common Childhood Conditions information Communications plan to support self-care and access to health visitor or GP for common childhood conditions: targeted at general population, parents and health professionals Use of data for planning clear actions for community provision; planned analysis of A&E attendance trends by GP practice; better unity of research projects Ambreen Kalhoro - Specialty Trainee, Bradford Using virtual clinics for low-risk diabetic retinopathy patients – reduce patient waiting; realise staff potential; meet Trust objectives Reduced wait time Engaged staff to run pilots Gained organisational support for large scale change Built team commitment for longer term implementation Victoria MacFarlane - Business Manager Cardiac surgery & Neurosurgery, Leeds Reduce the number of last minute cancelled operations in neurosurgery - Improve theatre scheduling; prevent late starts in theatres; prompt patient discharges; prevent inappropriate admissions Theatre scheduling now two weeks in advance – aim for three; more notice for patients. Start first case in theatres leading to better use of theatres and fewer cancellations due to no theatre time Inpatient Flow project started – better discharge planning and escalation of delays Number of Last Minute Cancelled Ops remained stable despite bed reduction Tony Margetts – Substance Misuse Manager, East Riding Drugs and alcohol commissioning moves to public health - cost effective, evidence based services; continuity of service Understanding of the change and commitment of stakeholders retained strong and weak ties Services have continued “steady hand at the tiller” Opportunities and developments taken during transition In a position to move forward to make improvements and develop new services

24 Improvement projects and outcomes to date (4)
Participant Project Outcomes Alastair Mew - Senior Commissioning Manager, Sheffield Develop foot and ankle surgical pathways to maximise the use of an award winning community based clinical podiatric surgery unit The new pathway ensures: Equity of care Evidence based best practice is followed Conservative treatments are trialled where appropriate Wherever clinically appropriate care takes place closer to home in a community setting Patients can move seamlessly between community and secondary care as best meets their individual clinical needs Mani Nallasivan- SpR Rheumatology, Hull and East Yorkshire Commissioning a new early Psoriatic Arthritis clinic in Hull Pathway meeting and CCG discussion- 20 members Collaborative partnership-NHS commissioning Board Trust agreed this initiative- 8th Feb Yasir Parviz – SpR Cardiology, Sheffield Repatriation of patients from tertiary cardiology centre Repatriate patients within 24hours Maximise beds Improve service – waiting times; readmissions Low mortality Cost effectiveness Muhammad Riaz -SpR Anaesthetics, Hull and East Yorkshire Quality, patient experience and cost improvement in Surgical Admissions Lounge High quality standard information given to the patient well in advance 600 – 800 minutes of nursing time saved equivalent to nurse/day (£21,176 - £40,157 /yr) Reduced incidence of DVT, pressure sores, falls etc Increased number of smoking cessation referral's (1/day at present) Keir Shillaker - Head of Planning, Bradford Prioritizing Capital Developments - to develop a tool that can be used by BTHFT to assess and prioritise capital funded developments in a meaningful way Prioritisation of resources – better decisions – developed: Capital Project Group Risk Assessment Framework 2 Year Capital Process Strategic outline proforma Reduces wasted time & ‘toing and froing’ …Then rolled out to IT and Estates

25 Participant projects and outcomes to date (5)
Sachin Thakur - ST6 Acute Medicine, Hull and East Yorkshire To implement the pneumonia care bundle in order to reduce mortality by start of 2013 Successfully implemented in A&E Ongoing implementation in AMU Ongoing audit to measure baseline and reaudit to measure improvement Sustainability model to ensure continued success of the project Laura Wakely - Vitreoretinal Fellow , York Service improvement in Vitreoretinal Surgery Clinic waiting times calculator and patient questionnaire ed to whole department (50) Departmental teaching session (20) on using operating note templates – all eye consultants accredited for access and partnered by junior doctor for ongoing support Management tools uploaded to hospital intranet (500) for dissemination in the context of future local leadership training James West - Paediatric Registrar, Doncaster Improving patient / parent satisfaction in Paediatric Outpatients – reduce DNAs Questionnaire to assess satisfaction Identified process breakdown areas Improve appointment reminder service; surge in follow-up appointments Results fed back to staff Adnan Zahid – Project Manager, YAS Implement risk data management system across Yorkshire Ambulance Service Developed culture of learning, feedback and openness Half of users are trained Sustainability of training through e learning package Robust process to ensure data quality and integrity More codes to capture clinical incidents and near misses Remove time consuming redundant processes; single database

26 Section 4 - Programme Improvement suggestions

27 Improvement suggestions/future programmes
Communication and targeting: Communicate more clearly about the actual time commitment (an overwhelming view) so that participants realise that whilst it is largely ‘virtual’ the timings of session are fixed Allow a longer lead time for the application process to help people plan the time commitment Target clinician/manager pairs from the same organisation/project area to improve the effectiveness of this element Encourage early career participation for clinicians Delivery: Timing of webinars mid-Wednesday not ideal for clinicians – general preference to run things early or late in the day Webinars 5 and 6 both on Creating Contagious Commitment could be combined Reduce the number of VALS The above time reductions could increase time available for the paired learning element Content: Tailor content to the different learning needs of clinicians who may never have come across the webinar material before v experienced managers who may be very familiar Include More input from practising NHS Trust leaders/senior managers Include stronger review of the paired learning element at the final assessment Administration: Reduce the number of e mails Offers of support for future programmes: A number of interviewees (participants and sponsors) made offers of support to keep a programme of this kind running Some are already sharing learning locally - or are considering ways of doing this

28 What future for the programme?

29 appendices

30 Appendix 1 – Participants in the evaluation/feedback process
Name and involvement Programme Sponsors (interviewed) Chris Bain, Chief Executive, Rotherham &Doncaster and South Humber NHS Foundation Trust David Wilkinson, Postgraduate Dean, Yorkshire and Humber Deanery Programme Manager (interviewed) Fiona Sullivan – NHS Yorkshire and Humber Programme Facilitators (interviewed) Carol Borrill, Head of Organisational Psychology/OD, Sheffield Claire Hannon, HR Operations Manager, Bradford Paul Hughes , e learning Manager, Leeds Programme Participants (interviewed) Morna Cooke - Senior Commissioning Manager, Wakefield Gemma Cuss - Ophthalmology Directorate Manager, York Srilatha Dampetla - ST 5 Endocrinology, Scarborough Sarah Dawson - Service Manager Planned and Unplanned Care, NE Lincs Nikki Dunlop - Commissioning Manager, Hull Tom Hall - StR in Public Health, East Riding Angela Harris - Lead Nurse Urgent Care, Yorkshire Ambulance Service Gemma Hayden - Project Lead Communication Partners, Rotherham Siobhan Horsley - Health Improvement Practitioner , Sheffield Ambreen Kalhoro - Specialty Trainee, Bradford Jim Khambatta – Snr Commissioning Mgr, N Yorks (did not complete programme) Victoria MacFarlane - Business Manager Cardiac surgery & Neurosurgery, Leeds Alastair Mew - Senior Commissioning Manager, Sheffield Mani Nallasivan - SpR Rheumatology, Hull and East Yorkshire Muhammad Riaz - SpR Anaesthetics, Hull and East Yorkshire Keir Shillaker - Head of Planning, Bradford Teaching Hospitals Sachin Thakur - ST6 Acute Medicine, Hull and East Yorkshire Laura Wakely - Vitreoretinal Fellow , York James West - Paediatric Registrar, Doncaster Programme Participants (on-line survey) Ian Anderson - Specialist Neurosurgical Registrar, Leeds Lynn Kerry, Commissioning Manager Hull CCG (did not complete programme) Tony Margetts, Substance Misuse Manager, East Riding of Yorks Council Participants who were invited but did not respond to this evaluation (either interview or on-line) Yasir Parviz - SpR, Cardiology, Sheffield Teaching Hospitals Adnan Zahid – Project Manager, Yorkshire Ambulance Service Kerry Lynn - Commissioning Manager Hull CCG (did not complete programme) Mohit Sharma - ST6 Acute Medicine Sheffield Teaching Hospitals (did not complete programme) Sponsors for participant projects (interviewed) Ian Carr, Head of Chidren’s Integrated Services, Wakefield Dr McMurray, GP and CCG Medical Director, Dr Ganesh Gopalakrishnan , Consultant Anaesthetist Paul Harriman, Development Manager, Sheffield Dr Elaine Baguley, Consultant Dr Julian Mark, Medical Director, YAS

31 Appendix 2 – Participant pairings
Name and role Morna Cooke - Senior Commissioning Manager, Wakefield Gemma Hayden - Project Lead Communication Partners, Rotherham Gemma Cuss - Ophthalmology Directorate Manager, York Laura Wakely - Vitreoretinal Fellow , York Srilatha Dampetla - ST 5 Endocrinology, Scarborough Jim Khambatta – Senior Commissioning Manager, N Yorks and York cluster (did not complete programme) Sarah Dawson - Service Manager Planned and Unplanned Care, NE Lincs Sachin Thakur - ST6 Acute Medicine, Hull and East Yorkshire Nikki Dunlop - Commissioning Manager, Hull Angela Harris - Lead Nurse Urgent Care, Yorkshire Ambulance Service Tom Hall - StR in Public Health, North Yorkshire CC Tony Margetts, Substance Misuse Manager, East Riding of Yorks Council Siobhan Horsley - Health Improvement Practitioner , Sheffield James West - Paediatric Registrar, Doncaster Victoria MacFarlane - Business Manager Cardiac surgery & Neurosurgery, Leeds Ian Anderson - Specialist Neurosurgical Registrar, Leeds Ambreen Kalhoro - Specialty Trainee, Bradford Alastair Mew - Senior Commissioning Manager, Sheffield CCG Mani Nallasivan - SpR Rheumatology, Hull and East Yorkshire Muhammad Riaz - SpR Anaesthetics, Hull and East Yorkshire Adnan Zahid – Project Manager, Yorkshire Ambulance Service Keir Shillaker - Head of Planning, Bradford Teaching Hospitals Yasir Parviz, - SpR, Cardiology, Sheffield Teaching Hospitals Kerry Lynn - Commissioning Manager Hull CCG (did not complete programme) Mohit Sharma - ST6 Acute Medicine Sheffield Teaching Hospitals (did not complete programme)

32 Appendix 3 - Interview questions
Overall benefits/impact of the programme What do you see as the main benefits of this programme For you? For your organisation? How have you changed your practice as a result of the programme? How has the programme enabled this change? What are the key pieces of learning you will take away from the programme? How will you continue to apply these now the progamme is over? Approach/ format of the programme (NB You are asked on the on line questionnaire to rate the effectiveness of each element of the programme but I would like to explore in more depth the overall strengths, weaknesses and suggestions for improvement) What are the challenges of participating in this programme for The individual? Their organisation? What do you see as the particular strengths of this programme? And the weaknesses? How effective have the various elements of the programme been? Most useful? Why Least useful? Why? What could be done in the future to improve the progamme/minimise the weaknesses? Relationships – Paired learning; mixed-group learning; sponsorship What have been the benefits of participating in a programme with a group of professionals from mixed disciplines? What have been the benefits of being paired with a professional from a different discipline to your own? What have been the benefits of being on a programme with someone involved in your project? Any suggestions for making the paired learning relationship more effective? How has your sponsor been involved? What have been the benefits of having a sponsor? Any other comments/suggestions for improvement

33 Appendix 4 – On line survey questions
Reflecting on your experiences of the programme, please rate the impact it has had on how prepared you feel in each of the areas of work below (1=No impact; 2=Some impact; 3=Significant impact; 4=Outstanding impact) Working alongside senior management colleagues Working alongside clinical colleagues Working in clinician-manager partnerships Working in a team to deliver a service Communicating with all members of my department Communicating with all stakeholders Leading multi-professional teams to improve services Developing a business case to support a development plan Initiating a project (gaining commitment) to improve local services Project managing a quality improvement initiative Measuring outcomes of projects Understanding how management decisions are made Understanding the professional hierarchies within clinical teams Understanding how services are commissioned and funded Please tell us the most useful/essential webinar topics of the programme Please tell us any improvement suggestions you have for any element of the programme


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