Work Placement Portfolio

WORK PLACEMENT

PORTFOLIO

FOR

ANDREW MARSHALL

Third Year Work Placement Student

BA (Hons) in Business Studies (Matric No: 200812384)

WORK PLACEMENT SPONSOR

Service Manager

UNIVERSITY PLACEMENT TUTOR

Alan Hutton

June 2009 to May 2010

Andrew

Sticky Note

This is a redacted, composite of my graded Work Placement Portfolio that I created at the end of my work placement with NHS Lothian. This portfolio was awarded a grade of 80%.

1. Work Placement Report

2. Background to NHS Lothian

3. Learning Objective Statement

4. Appendices

Table of Contents

WORK

PLACEMENT

REPORT

LEARNING OBJECTIVE STATEMENT

FOR

ANDREW MARSHALL

Third Year Work Placement Student BA (Hons) in Business Studies

WORK PLACEMENT SPONSOR Service Manager, NHS Lothian

UNIVERSITY PLACEMENT TUTOR

Alan Hutton Senior Lecturer in Economics


CONTENTS Page

Induction 02

Projects/Tasks/Work Routine

Project 01 – Discharge Lounge Utilisation 03

Project 02 – Real Time Use of Trak System 04

Project 03 – Delayed Discharges (OT Financial Assessment) 05

Project 04 – Admission and Discharge Predictor Model 06

Project 05 – Streamline Emergency and Elective Flows 07

Project 06 – A&E Breach Analysis 08

Project 07 – Discharge Policy 10

Project 08 – General Practitioner (GP ) at the Front Door Pilot 11

Project 09 – Primary Assessment Area (PAA) Pilot 12

Project 10 – Patient Transport Project 13

Personal Development and/or Learning Incidental to the Job 15 Student: Andrew Marshall Time Period: June 2009 to May 2010 Work Sponsor: NHS Lothian Education Sponsor: Glasgow Caledonian University

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Learning Objectives Directly Related to the Job Timescale Evidence/Description Confirmation/Sign-off Signature

Student Tutor Supervisor INDUCTION Meet Capacity & Site Management Team

Week 01 Induction sheet (Appendix 1)

Meet middle and senior managers of the hospital management team

Week 01 Induction sheet (Appendix 1)

Meet with Line-manager to discuss job role and description

Week 01 Overview of team, hospital & organisation, key issues, organisational goals and my role in helping to achieve these • Job description (Appendix 2)

Discuss and formulate key objectives for the placement

Week 02 SMART Objectives for Key Results (Appendix 3)

Attend Corporate Induction package (three days)

Weeks 03 and 04

Overview of organisation, H&S and employee benefits etc • Training Passport (Appendix 4) • Induction Handbook (Appendix 5) • Fire training certificate (Appendix 6) • Induction timetable (Appendix 7)

Complete online module induction package

Within first 03 months

Compulsory online modules for all employees (though tailored to staff groups) • Certificate of Achievement (Appendix 8) • Module timescale (Appendix 9)

Set-up desk (working area and IT systems)

Weeks 01 and 02

• Ensure relevant software installed on computer and working

• Obtain passwords for computer and software packages

Meet with University Placement Tutor (student and line-manager)

Within first 03 months

• Aid successful transition from university to working environment

• Ensure initial learning objectives, tasks and projects are viable and conducive to the work placement ethos

• Provide information on work diary and learning objective statement

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Student Tutor Supervisor Project 01 – Discharge Lounge Utilisation Gain overview of discharge lounge and services provided, and understand pressures and key issues

Weeks 02 and 03

• Meetings with: o Discharge lounge management team o Discharge lounge staff o Key users of discharge lounge services

• Induction sheet (Appendix 1)

Produce report ‘Review of Discharge Lounge Service’ (Appendix 10)

Weeks 06 and 07

• Presented to Discharge Lounge Management Team, Capacity & Site Management Team and Director of Delivery

• Research for report helped gain understanding of pressures/key issues

• Identified good practice and areas for Action Plan

Patient Satisfaction Survey (Appendix 11)

Weeks 06 and 07

• Develop survey to gain feedback from patients • Collation and analysis of findings • Incorporation of findings and recommendations

into ‘Review of Discharge Lounge Service’ report

Progress Meetings Ongoing through project

Held update meetings, as required, to ensure effective communication between project members

Comparator Organisation (NHS Glasgow Visit)

Week 13 • Meeting with NHS Glasgow to see how they do things, identify similar issues and exchange ideas

Action Plan (Appendix 12) Weeks 17 and 18

• Develop Action Plan to identify objectives and key actions required

• Meeting with Discharge Lounge Management Team to discuss Action Plan

• Take forward key actions

Awareness raising Weeks 18, 19 and 27

• Contact IT to develop intranet and internet website to inform key users of the service (Appendix 13)

• Develop poster to inform key users and distribute to relevant areas (Appendix 14)

• Workshops to inform staff users of services provide by Discharge Lounge

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Student Tutor Supervisor Project 02 – Real Time Use of Trak (Patient Management) System Project outline Week 07 Meeting with Service Redesign Manager to gain

understanding of current situation and future aspirations

Identify key areas and pressures

Week 07 and 08

• Meetings with various staff to understand key areas and pressures that affect the real time use of the Trak system

• Collate data in easy to view informal format, noting key points

Staff Survey Weeks 10-12, 17-20 and 22

• Identify questions to be asked in survey with team members

• Develop and draft survey format using Microsoft Word

• Discuss and feedback for survey with team members

• Proofread and finalise survey with team members • Disseminate survey to staff through email and

paper versions • Awareness raising through:

o Everyone email o Charge Nurse monthly forum o Clinical Management Teams (CMT)

• Develop survey audit tool using Microsoft Excel • Collation of survey returns using audit tool • Produce report based on results of survey and

disseminate to Hospital Management Team • Presentation of results to Hospital Management

Team using Microsoft PowerPoint

Project amalgamation Week 22 • At this point a decision was made to amalgamate this project with the discharge policy and predictor model projects

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Student Tutor Supervisor Project 03 – Delayed Discharges (OT Financial Assessment) Project outline and understanding of delayed discharge issues

Week 11 • Meeting with service manager, delayed discharge team

Meet key agency management representatives (During meeting 02 it was decided this was not a viable project)

Weeks 13 and 23

• Gain initial thoughts on project value and outline key outcomes

• Meeting 01 with AHP Head of Service, NHS Lothian

• Meeting 02 with; AHP Head of Service; General Manager, Edinburgh Community Health Partnership; & Area Manager, Social Services, City of Edinburgh Council

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Student Tutor Supervisor Project 04 – Admission and Discharge Predictor Model Gain overview of current predictor model

Week 02 and 03

• Gain understanding of purpose of predictor model • How/what information is gathered for predictor

model • Presentation of data • Interface between predictor model and Trak

(patient management) system • Interface between predictor model and Business

Objects (patient data collation software)

Research and data collection Ongoing through project

• Identify and collate data collected now and how • Identify and collate data required for updated

version

Other organisation Week 08 and 12

• Meet with another organisation to discuss how they predict their patient flows

• Identify key points/issues • Discuss advantages and disadvantages of various

prediction elements • Discuss current methods used and why

Update Predictor Model Weeks 11-19, 22-24, 30 and 33

• Develop predictor template using Microsoft Excel • Collate various predictor elements into one model

template • Ensure functionality of template is fit for purpose • Test and reassess predictor template as required

Roll-out and awareness raising Presentation (Appendix 15) Help sheet (Appendix 16) Updated BO Report (Appendix 17) Workshop Flyer (Appendix 18)

Weeks 38 to 42

• Workshops for staff to: o Discuss the purpose and role of the predictor

model o How the predictor model is populated o Outline how the predictor model works o Areas that may impact on the predictor

model, how and why • Extra sessions provided to interested parties (i.e.

waiting times team and other hospital sites)

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Student Tutor Supervisor Project 05 – Streamline Emergency and Elective Flows Project outline and understanding of delayed discharge issues

Week Meeting with Head of Service, General Surgery

Background research Week 08 • Identify significant impacts and Impact points matrix developed (Appendix 19)

• Develop flowchart of current process

Comparator organisations (other tertiary/regional referral centres)

Weeks 10, 11 and 12

• Contact other organisations to gain insight into their processes

• Identify best practice and processes

Waiting list management Week 11 • Meeting with Waiting List Manager to discuss: o Purpose of waiting list and how it fits in with

the elective workloads o Waiting list process and allocation o Clinic and theatre allocation o Interface between Waiting List Team and

Capacity & Site Management Team

Data collection Weeks 11, 12 and 13

• Research other organisations, using: o Email and internet systems, telephone and

fax • Identify relevant data for task (using flowchart

and feedback from Head of Service, general Surgery))

• Use Trak system(patient management software) • Use business objects (data collation and reporting

software for Trak system)

Produce report ‘Review of General Surgery Flows’

Weeks 14, 15 and 16

• Collate information required for report • Draft report • Proofread report and finalise • Present report to General Surgery Management

Team

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Student Tutor Supervisor Project 06 – A&E Breach Analysis Project outline Week 18 Initial outline and purpose of project and my

potential role, meeting with: • Service Manager, Capacity & Site Management • Service Manager, General Medicine • Clinical Nurse Manager, A&E

Development of audit tool Weeks 18, 19 and 25

A mechanism for collating data and subsequent reports/presentations • Identify data required • Develop draft audit tool using Microsoft Excel • Proofread and finalise form

Development of data capture form

Weeks 18 and 19

A mechanism for capturing data required for the breach analysis • Identify data required • Develop draft form using Microsoft Word

(Appendix 20) • Proofread and finalise form

Liaise with A&E Kaizen Team Week 22 The Kaizen Team facilitates organisational change and liaison was important to ensure I did not duplicate work already carried out • Liaise on an as required basis using:

o Email and telephone systems

Liaise with Clinical Nurse Manager, A&E

Weeks 18 to 25

Liaison as required with Clinical Nurse Manager, A&E, for data collection and upkeep of good working relations using:

o Email and telephone systems and face-to-face

Data collection and research Weeks 18, 19 and 25

Carried out data collection and research using the following: • Trak system (Patient management system) • Business Objects (data collation and reporting

software for Trak system) • Microsoft Excel audit tool and data capture form

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Collate audit data/findings Weeks 18, 19 and 25

Collated audit data/findings using the following: • Trak system (Patient management system) • Business Objects (data collation and reporting

software for Trak system) • Microsoft Excel audit tool, PowerPoint and Word

Produce report on audit data/findings

Week 25 • Identify data required for report • Draft a report using Microsoft Word • Proofread and finalise report • Disseminate report to hospital management team

and other relevant parties using email system

Presentation of audit findings at Kaizen Event

Week 25 • Produce a presentation using Microsoft PowerPoint (Appendix 21)

• Disseminate presentation to hospital management team and other relevant parties using email system

• Present at Kaizen Event

Participation in Kaizen Event Week 26 • Be an active participant in the Kaizen Event • Kaizen timetable

Other projects Week 26 Asked to participate in another project as a result of work conducted for the A&E Kaizen Event (Project 09 – Primary Assessment Area (PAA) Pilot)

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Student Tutor Supervisor Project 07 – Discharge Policy Project outline Week 11 Gain overview of current discharge philosophy

through meeting with Service Manager, Capacity & Site Management Team

Discharge Survey (Appendix 22)

Weeks 11 to 15

• Develop survey using Microsoft Word • Re-draft after feedback from team • Distribute survey via email, post and restroom • Develop audit tool using Microsoft Excel • Collate and analyse survey data

Action Plan (Appendix 23) Week 15 Develop Action plan with team members to identify actions and objectives for the discharge policy

Review current version of discharge policy

Week 15 Review of current discharge policy to gain understanding of areas for inclusion, editing and deletion (as appropriate)

Policy meetings Ongoing through project (monthly)

Monthly meetings to: • Update staff on policy progression • Provide a forum for feedback • Discuss ideas

Patient Journey Form (Appendix 24)

Weeks 16 to 20

• Develop Patient Journey form using Microsoft Word

• Collate using data from survey and team • Promulgate for feedback • After discussion it was decided to discontinue

this line of development

Discharge Toolkit (Appendix 25)

Weeks 16 to 26

• Develop discharge toolkit using Microsoft Word • Promulgate for feedback • Re-draft as required • Preparation for pilot

Policy/Procedure (Appendix 26)

Week 30 • Develop discharge policy/procedure based on staff consultation, survey data and best practice.

• Feedback on policy/procedure and re-draft as required

• Submit to Clinical Policy Group

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Student Tutor Supervisor Project 08 – General Practitioner (GP) at the Front Door Project outline Week 23 Initial outline and purpose of project and my

potential role

Meeting with Project Lead Week 24 Meet with Project Lead to gain better understating of project and discussed potential role • Aid with evaluation of project

Development of data capture form

Week 27 Create data capture form (Appendix 27) using Microsoft Word

Development of evaluation tool

Week 27 • Identify headings from data capture form • Develop evaluation tool using Microsoft Excel

Collation of data capture forms (as submitted)

Duration of pilot

Collate data using evaluation tool

GP Service Report (Appendix 28)

Week 32 • Produce report based on results of evaluation tool, using Microsoft Word

• Present report to Edinburgh CHP and General Medicine Management Teams

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Student Tutor Supervisor Project 09 – Primary Assessment Area (PAA) Pilot Project outline Week 26 General outline for the project was discussed during

the A&E Kaizen (Project 06)

Project meetings Ongoing through project

Meetings held on a regular, as required, basis to: • Discuss purpose and role of the project • Objectives of the project • Allow comments/feedback for team members • Identify issues that may impact on success of the

project • Allocate team member roles • Identify/prepare equipment required • Draft and review operational policy

Project audit Weeks 29 and 33

• Identify prior work that may help with project • Contact medical staff member who has carried

out an audit which links with the project • Discuss with staff member the results of their

audit • Staff member to present their findings to the

project team

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Student Tutor Supervisor Project 10 – Patient Transport Project Project outline Week 26 Meeting with Associate Director, General Medicine,

to gain overview of project (role and purpose)

Project meetings (team) Monthly Project team meetings to: • Provide a point of liaison between NHS Lothian

and the Scottish Ambulance Service (SAS) • Discuss purpose and expectations of project • Allocate team member roles • Identify areas required for project

Data collection Weeks 26 through 38

• Identify data/information required • Develop audit tool using Microsoft Excel

Project meetings (information gathering)

Weeks 27-34

• Identify areas that use transport • Identify and contact appropriate staff members • Discuss role and purpose of project • Discuss/introduce audit tool

Produce a Business Case (Appendix 29)

Weeks 39 to 41

• Produce business case based on results of evaluation tool and data collation, using Microsoft Word

• Develop viable and cost-effective options for transport provision

• Present report to Director of Delivery

Liaise with Transport Lead As required

• Inform transport lead of purpose and aims of the project

• Arrange meeting to discuss progress

Liaise with Operational Working Group

Bi-monthly

• Discuss roles and responsibilities • Discuss/identify key objectives and outcomes • Report on current progress • Development of ideas/options • Resource identification

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Liaise with alternative (private) transport providers

Week 43 • Inform providers of purpose and aims of the project (business letter format)

• Provide information to providers on the tendering process

• Feedback from providers regarding current and future transport aspects

Patient Transport Booking and Authorisation Process Survey (Appendix 30)

Weeks 44 to 47

• Develop survey using Microsoft Word • Develop data collation tool for survey using

Microsoft Excel • Collate data from survey (as submitted)

Process mapping Weeks 44 to 47

• Develop (current state) process map from analysis of survey data

• Develop (future state) process map for transport project, in conjunction with survey data

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Personal Development and/or Learning Incidental to the Job Timescale Evidence/Description Confirmation/Sign-off Signature

Student Tutor Supervisor PERSONAL DEVELOPMENT/ LEARNING INCIDENTAL TO THE JOB Business Objects (software which interfaces with Trak system)

Ongoing Developed, streamlined and produced more accurate/new reports due to self-developed knowledge of software (Appendix 17)

Trak System (patient management system)

Ongoing • Initial training course provided a foundation level of knowledge.

• Continued use of Trak and a good working relationship with Trak Manager helped to increase knowledge of system, identifying anomalies to improve Trak.

Microsoft Office package Ongoing • Had a basic understanding of Excel before placement.

• Use of Excel to update predictor model required development of skills to facilitate this.

Diary management Ongoing • Employer sponsor allowed me to manage my own diary.

• Forward planning of work was required to ensure best use of time

• Effective diary management ameliorated the effects of project time pressures and, subject to tutor priorities, allowed each project to have sufficient time allocated

Communication skills Ongoing • Communication with staff was by the following methods: Email, PPT, excel, word and/or telephone

• Effective communication with staff was required to ensure parties understood objectives, priorities, roles, responsibilities and timelines

Relationship building Ongoing • Relationship building within the organisation was essential.

• Builds trust, confidence and improves working relationships.

• Allowed easier access to information, both ways

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Report writing As required

• Report writing is essential to allow the effective transmission of information in an appropriate manner.

• Further developed the skill of writing objective and neutral reports.

• Proofreading reports to ensure the content, language and information is apt and appropriate to the topic of the report.

Language (medical terminology)

Ongoing • Use of appropriate language was essential for building credibility within the organisation.

• Due to the nature of Healthcare, understanding and using medical terminology was expected and poor use/grasp reduced face value.

• Greater use allowed better interactions, relationship building and general communications

Diplomacy and tact Ongoing • Ability to keep a confidence and speak in an appropriate manner to individuals/groups regardless of their level within the organisation.

• Tactful conversations build confidence in the other party and subsequent interactions.

Learning and Training As required

• Provide informal training to team members and other staff to develop knowledge and understanding of:

o Business Objects software o Trak (Patient Management) software o Microsoft Excel

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BACKGROUND

TO

NHS LOTHIAN

BACKGROUND TO NHS LOTHIAN Organisation Overview NHS Lothian serves a population covering the City of Edinburgh, West Lothian, East Lothian and Mid-Lothian and is still a relatively young organisation. It was established in 2001 as the ‘umbrella’ organisation for all Lothian health services, with strategic planning and leadership provided by Lothian NHS Board. NHS Lothian’s principal health organisations are the Lothian NHS Board, University Hospitals Division (UHD) and Community Health Partnerships (CHP). The Royal Infirmary of Edinburgh (RIE), the Western General Hospital (WGH) and St John’s Hospital (SJH) are the three main hospitals within the UHD. The RIE, located at Little France, is a major acute teaching hospital. With a 24-hour Accident and Emergency (A&E) department, it provides a full range of medical and surgical services for patients from across Lothian and specialist services for people from across the South East of Scotland and beyond. The £190 million hospital officially opened in 2003 as a modern, purpose built replacement for the old and out-dated Victorian building at Lauriston Place, and has more than 900 inpatient beds. It is home to Scotland’s biggest maternity unit – some 6000 babies are born at the RIE’s Simpson Centre for Reproductive Health each year – and Scotland’s busiest A&E department. Specialist services include cardiac surgery, kidney, liver, pancreatic and bone marrow transplants. The RIE is home to the Scottish Liver Transplant Unit. The organisation is structured into several directorates to aid service delivery, with ‘similar’ clinical services grouped together under these directorate banners. These directorates include:

• Cancer, Clinical, Head & Neck (e.g. laboratory support) • Medical and Associated Services • Surgical and Associated Services • Women’s, Children’s and Neurosciences • Corporate Services (i.e. the Executive board and support services) • Capacity and Site Directorate

My department, The Capacity and Site Directorate, is discussed further in the next section.

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Department Overview The purpose of the Capacity and Site Directorate (CSD) is to ensure there are enough beds, or capacity, for the patients utilising NHS Lothian’s services – patients with certain medical conditions can only use certain types of bed which is driven by the specialty the bed falls under – and the adequate staffing, by suitably qualified staff, relating to those beds. The CSD has a strategic as well as an operational remit for the oversight of NHS Lothian’s bed capacity, with responsibility for staffing issues relating to this ‘bed capacity’. Strategic management control is through a, below board level, Director of Service Delivery, with operational control provided by a Service Manager. This arrangement is unique within NHS Lothian, as other directorates have at least two other levels of management in-between. The CSD team does not directly control bed capacity or the associated staff. It operates within a regulatory/partnership framework, providing strategic and operational oversight. Another integral element is supporting the ‘flow’ of patients into and out of the various hospital sites within, and outwith, NHS Lothian. These flows include:

• Emergency admissions: acute type patients, typically presenting to the A&E department;

• Elective admissions: patients requiring an interventional operation or procedure that requires a stay in hospital; and

• Discharges or transfers: the timely and safe movement of patients either to:

o Their home or permanent place of residence o Further care facility (i.e. nursing home) o Another hospital within or without NHS Lothian

Personal Overview As part of my role I was co-located with, and collaborated very closely with, the Service Manager within the RIE. Although my job description (Appendix 2) was very comprehensive, it was also flexible. This dynamic aspect allowed and I to adapt to changing organisational needs and concentrate on high impact strategies – negating the need for iterative role change negotiations.

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LEARNING

OBJECTIVE

STATEMENT

WORK PLACEMENT REPORT

FOR

ANDREW MARSHALL

Third Year Work Placement Student BA (Hons) Business Studies

WORK PLACEMENT SPONSOR Service Manager, NHS Lothian

UNIVERSITY PLACEMENT TUTOR Alan Hutton

Senior Lecturer in Economics


Contents Page

1.0 Introduction 2

1.1 This Report 2

1.2 The Organisation (NHS Lothian) 2

2.0 Workplace Experience Description 2

2.1 Event 1: The Discharge Lounge Service 3

2.2 Event 2: NHS Lothian Discharge Policy 4

3.0 Evaluation 5

3.1 What Did I Get Out Of It? 5

3.2 How Does It Link In With The Degree? 5

3.3 Career Aspirations 7

3.4 Positive Points To Note 7

3.5 Problem Areas That Arose 8

4.0 Summary 9

5.0 Appendices

Appendix A: Skills Development during Work Placement 10

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1.0 Introduction 1.1 This Report This report is a both a description of my work placement experiences and a critical reflection of those experiences. It is designed to provide you [the reader] with an understanding of what work I [Andrew Marshall] carried out during my twelve months with NHS Lothian (NHSL), and how those experiences:

• Link with my first and second year university learning • Have impacted upon myself, within a professional context • May change my future performance in the workplace

1.2 The Organisation (NHS Lothian) NHS Lothian is still a relatively young organisation and was established in 2001 as the ‘umbrella’ organisation for all Lothian health services, with strategic planning and leadership provided by Lothian NHS Board. NHS Lothian’s principal health organisations are the Lothian NHS Board, University Hospitals Division (UHD) and Community Health Partnerships (CHP). The Royal Infirmary of Edinburgh (RIE), the Western General Hospital (WGH) and St John’s Hospital (SJH) are the three main hospitals within the UHD. The RIE, located within the South East area of Edinburgh, was my primary location for the duration of my work placement, with regular travel to the other sites. My sponsor department, the Capacity and Site Directorate, was headquartered at the RIE.

Director of Delivery, was my initial work placement sponsor with line management provided by Service Manager of the Capacity and Site Team (CST). A detailed description of NHS Lothian is provided in Section Two of the Work Placement Portfolio. 2.0 Workplace Experience Description The work provided for me by the CST ranged from data collection and analysis to policy formulation and drafting. I worked closely with

on a daily basis, from which we formed a close working relationship. I also worked with other senior managers within NHSL due to the strategic nature of the CST, and this provided me with exposure to all areas of the business. This work placement opportunity provided me with many varied projects1; with two of these significant events described in further detail below.

1 Please refer to the Learning Objective Statement

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2.1 Event 01: The Discharge Lounge Service The first major piece of work I contributed to was a comprehensive review of the Discharge Lounge Service2. This involved:

• Data collection (staff interviews, patient audit, and statistics); • Liaison with staff (managers and shop-floor); and • Report writing with recommendations and ways forward.

The idea behind the work was to increase the use of this service to improve patient discharge from the hospital, which would aid the legally binding:

• 4-hour emergency access target for the A&E department; and • 18 week referral to treatment (RTT) targets.

Although I authored this piece on my own, the Discharge Lounge Manager ( helped significantly with background knowledge and future ideas. This developed a close bond between us which would prove useful for future projects and work in general. As the operational manager was very supportive of my ideas and plans, however the strategic manager,

was less enamoured. This caused some friction between us but I worked in professional manner to ameliorate this. Fortunately was a strong advocate for me and this also helped to get past barriers with . It could be extremely difficult, and frustrating, at times to get Paul to see ‘reason’ on certain matters – significantly testing my diplomatic skills. In January 2010 left NHSL and became the strategic manager for this service. After an update and review, bestowed and I carte blanche with regards to re-designing the Discharge Lounge Service. As this was the first piece of work I performed and at the start of the work placement, I needed to build my credibility within NHSL in order to achieve my objectives. I also used the initial interviews to gain a general understanding of the organisation and the perception of staff, which differed from the management cadre. Understanding the perceptions of staff, managers and gaining an insightful perspective on the organisation enabled me to tailor and realise appropriate service re-design goals that would be sustainable and realistic. Using this approach, in all my projects, enabled to me quickly gain the trust and respect of my colleagues in NHSL, leading to further opportunities and other networking events.

2 Learning Objective Statement, page 03

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2.2 Event 2: NHS Lothian Discharge Policy In November 2009 I was asked by if I wished to collaborate on another piece of work3. Policy formulation and writing is an important skill for senior managers, and I envisaged that this project would provide me with skills and experience crucial to the future jobs market. In short this policy was looking at how, when and where patients should be discharged to, ensuring it was carried out in a consistent, dignified and timeous manner. Initial agreement was to look at the various discharge pathways used by each area, such as:

• Which staff members were involved in the discharge, and their role; • Patient involvement in their own discharge, including relatives and

carers; • Purpose and perception of discharge by staff and patients (through

interviews and audit) • Identifying best practice and differences in practice

It was decided to form a committee of appropriate staff to aid the formulation of the policy and provide expert advice and opinion relevant to their area. The idea was to meet monthly to discuss ideas and update the group on progress to date. However, this would prove to be problematic. Initially members appeared enthusiastic but after the first two sessions we found that different representatives would attend. Although we sent out information prior to the meetings, reps would invariably not read these or were last minute replacements. As a result everyone would need to be re-briefed on progress reducing the value of the meeting. Also, different team members (of the same team) would present different departmental aspirations – group and individual consensus was often difficult to obtain. What at first (to me) appeared to be straight forward quickly became a Sisyphean task. The sheer number staff who wanted ‘their say’ became inflated and it was decided to cease the monthly meetings in order to move the project forward. As a result we progressed quickly to a final draft which was promulgated for consultation with relevant staff members. After amendments, the policy was presented to the Clinical Policy Group (they oversee all new policies and procedures in NHSL). This was the policy situation when my work placement came to an end.

3 Learning Objective Statement, page 10

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3.0 Evaluation 3.1 What Did I Get Out Of It? After 16 years in the Army it was beneficial to bestow my CV with commercial knowledge and practice. It can be difficult to illustrate military workplace experiences and this work placement has provided prospective employers with an identifiable benchmark. Appendix A provides an illustration of the skills development achieved throughout this work placement. I have further developed my influencing and negotiation skills, which were in considerable use throughout the work placement. Although the NHS works in a collaborative manner, it has many ‘departments’ and this can make co-ordination and communication problematic. Having effective organisation and time management skills was extremely important in order to facilitate work commitments and meetings. Not withstanding patient safety, compromise was a watch word during my time at NHSL. This is where effective negotiation with, and influencing of, managers and staff became crucial. As a student within NHSL I had no authority to compel or push ideas through, and so, I realised very quickly that in order to ‘get things done’ I would need to understand the key personalities and groups so that I could achieve, or at least in part achieve, my objectives. As a result of my networking, and close working with several senior managers, I was subsequently asked to help on projects I otherwise would not have had access to, or been asked to partake in. 3.2 How Does It Link In With The Degree? There were several elements of my degree course that proved helpful or crucial in my time with NHSL. Practical use of the Quantitative Business Modelling (QBM) module helped me work through the Predictor Model project4; I probably would have struggled to complete this project without this prior knowledge. Essay and exam writing aided me in the preparation and drafting of reports and policies. Understanding of the question (problem), identifying the problem and finding information (interviews and data collection), drafting and developing the main body of the report, and identifying recommendations (viable solutions) where integral to achieving these objectives. Although I have previous presentation experience, the presentations required in years one and two (at university) would have laid a solid foundation for the presentations within the work placement year. Coherent, planned and well-produced presentations are crucial for the effective transfer of knowledge and information in a timely manner – especially in time sensitive environments.

4 Appendices 15 to 18 and Learning Objective Statement page 6.

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The team-working elements of the coursework and seminars, in year two, also helped; in my time with NHSL I was required to work with a multitude of different internal and external individuals and groups. I believe it is important for future employees to identify that team-working is not just about face-to-face interactions. For example, some elements of my projects involved contact with team members via email only. Therefore, the careful construction and drafting of emails (either queries or responses) should be considered given the possibility for misinterpretation or misconstruing of meaning. This can obviously impact on working relationships and the work produced. Some people believe the Army is very autocratic and involves a lot of shouting, and on occasion this would be correct. However, there are many occasions where the Army is democratic and very supportive – more so than public and private entities. It was interesting to see how similar, and exceedingly dissimilar, the NHS and the Army were at times. The managing people at work module provided useful insights into some of the aspects of NHS management and potential ways to ameliorate them. Managers and staff were surprised when I mentioned the above. For example, the NHS is very hierarchal just like the Army and staff always have an eye on the next promotion, again like the Army. Therefore staff can rise very quickly without the experience to back it up and, in some cases, it shows. NHS ‘committee’ meetings can also be quite arduous to attend as there is too much debating, occasionally to little debating, and not enough action – it was not unusual to have 2 or 3 meetings on the same thing without actually moving forward. In contrast, the Army would meet, discuss, decide and then act, reporting back only to update or notify of changes. When I chaired meetings I kept to stringent meeting criteria, allowing staff to put forward their views without monopolising time and achieving actions to complete for the next meeting. With other individuals it could be difficult to see where the meeting was going or time would be consumed debating issues not overly relevant to the purpose of the meeting. I obviously have experience of structured meetings from my Army career and realise the importance of a structured versus unstructured meeting – i.e. the effect on flow and outcomes. If I did not have this prior experience my meetings may have been different and some preparation work during years one and two at university may assist other students to ensure they are effective in this important, but often overlooked, area.

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3.3 Career Aspirations My original career aspiration when joining this degree programme envisaged the field of Human Resources (HR). With the then jobs market in mind, I ‘chose’ a work placement in the NHS because I believed this would provide me with a rounded and challenging twelve months; a well founded belief. I would still like to take a career in HR, within the NHS, as they also provide candidates with Masters level qualifications; one of my future objectives. This is a contributing reason, given the cost, but not the sole reason. A career in the NHS would be rewarding but very challenging, especially given the recent announcements regarding funding streams. HR would be at the heart of any organisational change and/or development, and effective communication and negotiation skills would be required to facilitate this. 3.4 Positive Points to Note The work placement provided me with a variety of projects to work on and as a consequence I developed my skills and experience. The work I was given had real value to the organisation and contributed to savings and improved service. Once I had proved myself, there was an expectation by my managers that I would ‘get the job done’. Although staff mentioned that they were open to new ways of working and/or new ideas, it could be quite a challenge to convince said staff of looking at problem/issues in a different manner and alternative solutions. Again, once I had ‘proved’ myself to staff – it was not unusual to have to convince each individual group involved in a project – it became somewhat easier to put forward alternative ideas/solutions without being shouted down. Having worked in managerial positions in the Army and being involved in projects, I already had a foundation for my work placement. Once my line-manager gauged my work/skill set she managed me at arm’s length. Although I prefer to work autonomously, it was nice that had the confidence to allow me to do this. NHSL also had the confidence to let me visit other organisations unescorted and I vouched to repay this confidence with high quality work. NHSL has also stated that they would be prepared to accommodate future work placement students as a result of the positive experience during my placement.

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3.5 Problem Areas That Arose Like any other job there are ups and downs. Fortunately I mainly had ups but certain personalities were obdurate with everyone not just me. In these instances the professionalism gauge was tweaked up. I always had in the back of my mind, in difficult or potentially difficult situations, that I was representing NHSL and not myself. Therefore, I should move forward in a professional and somewhat conciliatory manner. One particular manager could be very obdurate and tested my diplomacy and tact on several occasions. This manager’s words contradicted their actions and personal motivations were difficult to identify. Co-operation was one-sided and innovative means were needed in order to bypass these artificial barriers. I am a proponent of the 6 P’s (Prior Preparation and Planning Prevents Poor Performance) and this is an artefact of my military career. However, my line-manager did not, in the main, follow this tenet. As a result in several meetings my line-manager was presented with ‘new’ information on the day, which had been disseminated days prior. This often reflected on me and I felt embarrassed and annoyed. I diplomatically approached my line-manager in our weekly one-to-one meetings about the relevance of meeting up five minutes before meetings to discuss the agenda and revisit important elements. This was agreed but fell by the wayside at the first hurdle and subsequently I responded by ‘stage managing’ future meetings to ameliorate this dilemma. Currently business research methods (BRM) is taught to students during their fourth year, mainly for the purposes of their dissertation. Most of my work with NHSL involved data collection (primary and secondary) and some knowledge of BRM prior to the work placement, I believe, would aid students. Again my previous career provided me with the BRM skills required during this work placement but most students may not have this luxury.

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4.0 Summary I can say with conviction that I enjoyed and benefited from my time with NHSL, I developed new skills and further refined existing ones. The NHS is a difficult environment due to push/pull factors from a plethora of groups, organisations and government. For me, this provided a challenging and exciting work environment with a variety of demanding and diverse projects. University modules provided me with the foundation skills required for the various projects I was engaged in. I was also provided with the opportunity to further develop existing skills. The work placement has provided me with real skills and experience which will be useful when applying for jobs in the near future – the main reason for applying to Glasgow Caledonian University. Compromise is something everyone has to do at some stage in their lives and, naturally, impacts upon the NHS. The development of influencing and negotiating skills is required for a successful career in the NHS so that one knows when to compromise and by how much; without diluting your objectives too much. Overall this was a successful and very useful twelve months, helping to achieve the aims I set myself when first applying for the business studies course.

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APPENDICES

5.0 Appendices Appendix A

SKILLS DEVELOPMENT DURING WORK PLACEMENT • Relationship building: creating positive relationships, first impressions,

personality traits, initiating dialogue, building rapport, credibility and trust and barriers to effective self-presentation

• Information gathering and collection: primary and secondary sources • Interviewing: structured, semi-structured, telephone and email, information

required, question base, purpose and length • Meetings: agenda, purpose, length, who to invite, how to invite, minute taking

and trouble shooting • Influencing: • Negotiating: Negotiation is a method by which people settle differences. It is a

process by which compromise or agreement is reached while avoiding argument. • Verbal communications: one-to-one, telephone, group and presentations and

cross cultural communication • Written communications: letter, email, report, leaflets, posters and cross

cultural communication • Report writing: presentation, language, diagrams and pictures, data analysis,

summary, introduction, main theme, logical flow and recommendations • Presentation: using PowerPoint, Word, blackboard, flipcharts and other visual

devices • Data analysis: data to gather, how to gather, source, relevance, interpretation of

results and presentation of results • Group working: listening to others, team roles, group dynamics, conflicts,

collaboration, purpose of team and social skills • Listening to others: tone, pitch, wording, body language and understanding

other viewpoints. A good listener will listen not only to what is being said, but to what is left unsaid or only partially said. Listening involves observing body language and noticing inconsistencies between verbal and non-verbal messages.

• Assertiveness: passive and aggressive and purpose • Confidentiality: patients, data protection and co-workers • Problem solving: identify problem, why problem, solutions, all information

available and other options • Decision-making: decision making is the act of choosing between two or more

courses of action • Reflection: what did you do and what could you do differently • Interpersonal: Interpersonal communication is the process by which people

exchange information, feelings and meaning through verbal and non-verbal messages.

• Time management: workload, diary management, smart objectives, self-motivation, time-wasting, prioritising, action planning, travel to different sites and personal effectiveness

• Emotional intelligence: empathy, responding to others and understanding other viewpoints

• Managing change: why change, who does it affect, implementing change, sustaining change, project management and identifying show stoppers

• Information technology (IT): Microsoft packages and in-house software • Receiving feedback: line-manager, colleagues, workshop attendees,

interviewees, other organisations, policy groups & review boards • Budget control: understanding financial governance, finance sources and

allocations

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Documents

Work Placement Portfolio