Carrie Jackson and claire thurgate Embedding the CPD Impact Tool in Faculty Programmes: a snapshot pilot of its potential application Carrie Jackson and claire thurgate

Jackson, Manley, Wright and Martin STUDY Aim To devise and test a CPD outcomes tool that identified mechanisms for measuring impact of learning on individual, team and organisational effectiveness in relation to improvements in quality of care and patient experience outcomes in the workplace Background: 2015 HEE study Jackson, Manley, Wright and Martin The study obtained ethical clearance from the University’s Research Ethics and Governance Committee ref. 13/H&SC/CL67

CPD is the systematic maintenance, improvement and continuous acquisition and/or reinforcement of the life-long knowledge, skills and competences of health professionals. It is pivotal to meeting patient, health service delivery and individual professional learning needs. The term acknowledges not only the wide ranging competences needed to practise high quality care delivery but also the multi- disciplinary context of patient care” (Executive Agency for Health Consumers EAHC report 2013: 6 Rationalising resources for CPD requires clear understanding of what strategies work for whom, why and under what circumstances (Pawson and Tilley 1997) Defining CPD

DESIGN Multiple case study design was chosen to enable development and refinement of a tool for evaluating impact of CPD in the workplace in the healthcare system Data collection and synthesis underpinned by realist synthesis, a theory driven process that enables understanding of what works for whom, how and under what circumstances (Greenhalgh et al 2011). Realist synthesis fits well with the case design –focus on‘how’ and ‘why’ questions and enable use of multiple sources of data to holistically understand phenomena in real life situations (Rycroft-Malone 2010).

Methodology and Methods Realist synthesis and evaluation (Pawson and Tilley 2004)

Project Outputs The overarching framework for understanding effective CPD Four transformation theories Impact indicators useful for determining the impact of CPD A range of ways to evaluate achievement of CPD impact

The Conceptual framework Conceptual framework incorporates four ancillary CPD purposes that focus on individual and team journeys of transformation in their work and workplace, specifically the transformation of: The individual’s professional practice Skills to meet a continually changing context Knowledge, so that it is used and blended with other knowledge in practice through knowledge translation approaches The workplace culture The Conceptual framework

Four theories linked to transformation in CPD Integrated with a specific set of outcomes Transformation of individual practice Transformation of workplace /context Transformation of knowledge /knowledge mobilisation for practice Transformation of skills to meet society’s changing

Theory 1: Transformation of individual’s professional practice through CPD The theory of transforming individual professional practice infers that:   Work based CPD that is learner driven and founded on self-awareness and self-assessment within an enabling context that provides facilitated support and reflection, increases confidence, efficacy, role clarity and the individual’s positive attitude towards change creating opportunities for role and career development.

Theory 2: Transformation of skills through CPD to meet society’s changing healthcare needs A concern for social justice underpins CPD with focus on providing equity of opportunity for all learners irrespective of their personal characteristics or social background  as well as collective responsibility to provide healthcare services that are inclusive and fit for purpose in meeting the needs of everyone in society  System and teams’ skills gap assessment informs CPD for transforming skills to meet changing healthcare needs evidenced in, better service user experiences, effective teams, opportunities for career progression for individuals, effective use of human resources and better organisational outcomes in terms of integration and partnerships

Theory 3: Transformation of knowledge through CPD to enable knowledge translation Focuses on knowledge, its uptake and use in practice Knowledge translation =process of analysing sharing and ethically applying knowledge to achieve the overall purpose of immediate workplace culture in which people work CPD in workplace contexts that support engagement with and active sharing of different types of knowledge in everyday practice focuses on blending multiple types of knowledge to inform professional decision- making, skills in facilitating dialogue, active enquiry and evaluation and fostering leadership evidenced by knowledge rich cultures such as knowledge development, active inquiry, innovation and creativity

Theory 4: Transformation of workplace culture through CPD to implement workplace and organisational values and purpose   Addresses the immediate workplace culture and the implementation of shared values within the workplace, across the organisation and the health economy Workplace culture significantly  shapes  professional development and knowledge translation theories and therefore has implications for both the impact of CPD, its content and focus. Hypothesizes that: in a context of organisational readiness, CPD that promotes developing and implementing shared values, evaluating the experiences of service users and staff relating to these values and leadership skills in developing effective workplace cultures achieves improved service user and provider experiences as well as effective teams and effective organisational   leadership.

Individual and Team Impact Indicators Self-efficacy (self-awareness and self-confidence) Shared vision and values Role clarity Interdisciplinary team working Collaborative decision–making Peer learning and review A sustained person centred safe and effective culture

Service and Organisational Impact Indicators Shared vision and values for the service/organisation Integrated team working Patient at the heart of decision making Patient experience Systems of shared governance Person centred, creative and innovative learning culture Organisational awareness and intelligence Systematic mechanisms for capturing best and poor practice Patient safety metrics Effective staffing levels

4 Hypotheses to be tested CPD that is work based and provides facilitated support and reflection and include 360 degree feedback will increase self confidence and self awareness and role clarity CPD that focuses on providing up to date knowledge about effective, safe practice will achieve knowledge translation if participants are supported to address their leadership and workplace contexts and cultures

4 Hypotheses to be tested CPD that focuses on expanding skills to meet a changing service will be reflected in outcomes around better integration of service provision CPD that focuses on living organisational values across different boundaries will increase team effectiveness and organisational effectiveness

Key Messages Positioning CPD within the transformation agenda Focusing on workplace as main resource for learning context of CPD Needs facilitators of whole systems integrated learning development, improvement inquiry and innovation (New 5 I’s model of PD) Tool can provide evidence based self assessment framework for revalidation & educational passport Integrated into indicators of effectiveness in Education Outcomes Framework for workforce development Indicators integrated into HEI CPD programmes

Our 2 centre Collaborative project A pedagogic study to measure the effectiveness of an impact indicators framework for CPD learning on practitioner development in the workplace (Making the link between learning, development, improvement and inquiry in the workplace) AIM to evaluate the effectiveness of the CPD Impact Tool developed by the ECPD for Health Education England in level 6 and 7 workplace learning modules HEIF Award 2016 2 Centre collaboration Our 2 centre Collaborative project

1. Explore the application of the individual and team impact indicators within a negotiated workplace learning module in relation to learning processes, assessment strategies and learning outcomes 2. Understand how useful the impact indicators are as a measure of learning development and improvement for level 6 and 7 learners 3. Identify the benefits and challenges of implementing the tool for academic facilitators of learning 4. Identify the potential ways in which the tool might benefit the Faculty in marketing CPD programmes in relation to demonstrating impact on improving practice for the future 5. Make recommendations for how the tool might be further embedded within the wider CPD curriculum Project Objectives

Piloted in 1 cohort of students undertaking the negotiated workplace learning modules (Level 6 and 7) commencing in August 2016 The project will link the impact indicators to the module’s learning outcomes and explore the measurement of impact through: Pre- and post-test evaluation using a cognitive mapping tool Claims, concerns and issues framework pre and post. Focus group discussion with the students Documentary analysis of assignments Consensus workshop with providers and commissioners METHODS

Findings CCI data Staff focused Sharing knowledge from practice Patient centered Encourages EBP and innovation Links to Trust values Enables high challenge high support Makes appraisal descriptors real Good practice framework Findings Self Assessment Data Growth of confidence in effectiveness in role Demonstrate impact as a practitioner Evaluate impact as a practitioner