The Impact on Practice (ImP) Project: A framework to maximise the impact of continuing professional education on practice Liz Clark, Jan Draper and Shelagh Sparrow

2 Self-report data on the impact of learning on practice ‘I’ve developed an end-of-life care package for patients in my clinical area.’ ‘Improved practice in our deep vein thrombosis service has impacted on patient care and this has been a result of my learning.’ ‘Undertaking this module has enabled me to demonstrate to my employer that I am knowledgeable practitioner who is able to offer some new-found knowledge into work- based situations.’ ‘I now find it much easier to approach my ward manager about implementing a change in the ward environment.’ ‘My learning has made me challenge and question my nursing style.’ ‘I’ve got my dream job, thanks to the support, confidence and the amazing degree you helped me achieve. I still find it hard to believe that I’m actually doing what I’ve only dreamed about doing for so long. It’s a brilliant feeling to be able to go home at night with my head still buzzing with ideas of ways to improve older people’s care.’

3 Background and context (1)  Project funded by the Higher Education Funding Council for England (HEFCE) as part of the Higher Education Innovation Fund (HEIF3)  Rhetoric of the benefits of lifelong learning on patient care ‘Every aspect of healthcare delivery and strategies for health depends on the education and skills of individual staff. Investment in their learning and personal development is, in a real sense, spending on patients and is essential to the future quality of the health service.’ Funding learning and development for the healthcare workforce (Department of Health, 2002, p.7) ‘The delivery of high quality education and training is an essential part of delivering high quality patient care.’ A high quality workforce: NHS next stage review (Department of Health, 2008, p.13)

4  Yet little evidence of direct impact of continuing professional education (CPE)  Limitations of existing evidence base. Studies tend to: –be programme-specific, typically confined to a single locality; –be short-term and small-scale; –be over-reliant on self-perception (learner satisfaction) and focus on teaching and learning strategies rather than on changes in behaviour; –use retrospective methods (errors of recall and bias); –assume or imply benefits to patients/service users rather than assess them directly.

5 Background and context (2) In-depth conversations with employers, patients and post- registration students prior to the project: Employers: important, timely issue; any approach must be manageable and not programme-specific; should not involve formal research activity Patients/Service users: want reassurance that health professionals have the necessary knowledge and skills to provide good care Students: keen to articulate and demonstrate benefits of their learning following registration

6 Methods used to develop the framework  Structured literature review (health and social care and education literature); emerging themes: –organisational culture, including support for change –role of the manager –link between the education provider and organisation  Contributions from an expert Advisory Group  Two interactive conference presentations (Vancouver and Dundee)  Conversations with stakeholders to develop/refine the framework: –commissioners of education –managers –health and social care educators –service users/representatives from patient organisations –learners

7 Characteristics of the ImP framework  It is underpinned by theoretical insights from the education and health and social care literature  It is easy to understand  It is user friendly  Key stakeholders were involved in its development and refinement  Its usage does not involve research activity  It is sufficiently flexible to be applicable ultimately to health and social care

8 The ImP framework (1) The four core domains of the ImP framework are:  education provider  learner  manager  organisation

9 The ImP framework (2)

10 Feedback on the ImP framework ‘I think that it is a sophisticated tool... I like its simplicity. I could use this and would not be intimidated or put off from using it.’ Commissioner of education ‘It isn’t going to be a framework that sits on a dusty shelf and gets referenced – it has the potential to be a really useful tool.’ Educator ‘I don’t feel that I have anything other than admiration and excitement about this.... I do not have anything else useful to contribute except having the added leverage of people being aware and being able to ask how this is being implemented.’ Patient organisation representative An online version is currently being developed and will be widely disseminated

Next steps…  Assess the usefulness of the ImP framework in practice – longitudinal research – participative approach – a range of different organisations (using organisations as cases)  Explore the possibilities of realist evaluation (Pawson and Tilley)