NHS Productivity: Weathering the Storm - Patrick Mitchell

Weathering the stormDelivering greater value:

Better Training, Better Care

Patrick Mitchell- Director of National Programmes

- 18th September 2014

www.hee.nhs.ukwww.hee.nhs.uk

Programme history

• In 2009, Medical Education England (MEE) led two reviews

into the quality of postgraduate medical education and

training which led to Sir John Temple’s report: Time for

Training and Professor John Collins’ report: Foundation for

Excellence

• MEE was requested by the then SofS to implement the 66

recommendations through the Better Training Better Care

(BTBC) programme


Our workstreams

1. Local implementation of “Temple” pilots

2. Role of the trainee

3. Role of the medical trainer

4. Medical workforce planning

5. Improving medical careers guidance and availability

6. Integrated technology enhanced learning

7. Broadening the Foundation Programme

8. Regulatory approach to supporting Better Training Better Care

9. Funding and education quality metrics


Better Training Better CareAims to improve the quality of training and learning for the

benefit ofpatient care

Professor Sir John Temple: Time for Training

• ‘Making every moment count’

• ‘Appropriate supervision’ and/or ‘Consultant present service’

• ‘Service delivery must explicitly support training’

Professor John Collins: Foundation for Excellence

• Appropriate supervision for trainees

• Concerns that trainees are working beyond their level of

competence

• Redistribution of posts and community experience Programme formally closed March 2014


Where are we now?• Completed evaluation of the 16 BTBC pilots – led by Matrix

Knowledge

• National evaluation of workstreams two to nine – led by HEE /

Academy of Medical Royal Colleges

• Planning the national spread and adoption phase of the BTBC

pilots with the support of key partners including:

o Faculty of Medical Leadership and Management

o Academy of Medical Royal Colleges

o General Medical Council

o NHS Improving Quality

o NHS Employers

o NHS Litigation Authority


The BTBC pilots

The objective

• 16 projects piloted across different settings and disciplines

• Aim to improve training and education

• Aim to improve patient care• Evidence of sustainability and

adoptability • Demonstrate value for money

Pilot themes

• Hand over / care transition• Out of hours 24/7• Communication• Front door (A&E/acute

medicine)• Patient and rota scheduling • Multidisciplinary workingPilots support national issues

• 7 day care• Integrated care• Urgent and emergency care• Francis and Berwick• Human Factors• Patient safety


What makes a project successful?• Leadership

• Trust Board support

• Governance

• Communications

• Academic and lay representation

• Wider engagement and buy in from trainees and trainers, MDT

• IT

• Dedicated project management


Mid-Cheshire Hospitals NHS Foundation Trust –Enhanced Training & Education in Handover & Supporting Electronic Solution

• Provide training to develop key handover skills such as leadership, task prioritisation and time management

• Support handover • Modify the structure, standardise the

handover process and utilise the good practice guidelines.

Estimated £160k

savings over 3 months

Demonstrated an 83% improvement in ‘out of hours’ tasks being handed over

and completed after the interventions

Statistically significant 10%

increase in ‘out of hours’ discharge rates, without any negative effects on

length of stay


East Kent Hospitals University NHS Foundation TrustHot & Cold Teams – Enhancing trainee experience, improving patient care

• Provide enhanced support/training for trainees, especially at weekends

• To improve the care and safety of patients

Hot and cold rotas provided the

necessary support and improved

training opportunitiesfor trainees during

the weekends

12% increasein discharges per

week day. Plus 20% increase in Saturday and 6% increase in Sunday discharges

Cost savings were estimated at £670k

for one site.Net monetary

benefit in 1 year of over £0.5 million


Royal Berkshire NHS Foundation Trust Addressing the apparent gap between learning opportunities from every day recognised problems by ‘Making Every Moment Count’.

• Embedded quality improvement (QI) as normal practice

• provided high quality training for the trainee and multi-disciplinary team (MDT)

• developed a model of learning in the simulation environment around the processes, challenges and impact of incidents and complaints.

Quality indicator (QI) measures 86% of trainees scored

above their stage of training

Supervisors felt there was a positive

impact on organisational structure and

practice

93% of trainees faired above the

expectation for their stage of training in

areas of change implementation


Leeds & York Partnership NHS Foundation Trust Maximising and enhancing training opportunities and clinical time with patients by changing working patterns.

Increase in productivity for

weekday evenings by almost 38% and weekends by 30%

• Increased consultant-supervised patient contact

• integrated trainees into multi-disciplinary teams (MDT) through revision of the OOH Care Pathway

• improved the quality and outcomes of referrals

• increased curriculum competencies • reviewed and developed resources

available to support training.

Improved MDT working and

improvement in behaviours and commitments in

the MDT100% of trainees felt more confident


Trainees as change agentsTrainees demonstrated outstanding leadership skills championing their pilot projects during implementation and outside of the pilot environment.

Mid Cheshire – HandoverTrainees moved to other trusts and requested the pilot initiative to be implemented in their new roles.

East Kent – EM rotaTrainees displayed strong leadership and enthusiasm for the pilots and trainers reported strong leadership of FP doctors and registrars in handovers.

Leeds and York – Decision making in psychiatryTrainees championed the system and took on a strong leadership role from the outset.

Trainees felt better supervision and support allowing them further

development

Clear leadership in the handover process was

clear in 100% of meetings

100% trainees higher confidence, 83% felt

benefitted by the change


Improving workplace based assessments (WBAs)The pilot projects presented innovative ways to significantly improve WBAs and productivity by improving training and creating opportunities for WBAs to be conducted without impacting on commitments to clinical care.

North Bristol – Video feedback for consultationsImproved trainee consultation styles and increased the number of WBAs in an outpatient area.

Pennine – EPIC Reward system increased WBAs During ‘double-credit weeks’, five-fold increase in the completion of WBAs.

East Kent – EM rotas Increase in opportunities to complete WBAs while on ward duty and on shift by means of hot and cold rota systems

25% more WBAs completed than previous

year

85% of feedback sessions helped trainee identify a

personal area for improvement

4% increase in ward WBAs and 27% in shift WBAs

completed


Integration of training in careTrainees became more integrated in the delivery of care and in the wider multi-disciplinary team. This has had a positive effect on patient care and improved communications and multi-disciplinary team working.

King’s – RAT+ Increased consultancy support, improved patient time to treat and presented opportunities for nurses to develop.

Mid Cheshire – Handover Greater consultant input at handover meetings, with registrars taking on leadership roles in their absence.

Dudley – PrescribingBetter working relations and understanding between pharmacist and trainees, with improved knowledge by trainees in prescribing and in national guidelines.

83% improvement in ‘out of hours’ tasks handed

over and increase in staff satisfaction

Significant improvements in time to treatment and

time to referral

Improved relationships in pharmacy department


Impacting on culture, efficiency and effectiveness

Leeds and York – Decision-making in psychiatry Rota change allowed more trainees to come on day duty and have greater exposure to training and support, this improved productivity, communications and MDT working

Mid Cheshire – Handover Greater degree of efficiency in performing handovers , better quality information recorded and an increase in the number of tasks completed.

South Manchester – Surgery Reconfiguring theatre lists exposed trainees to concentrated training in specific areas, trainees developed better skills and gained confidence in performing simple procedures across specialities

Several of the pilots have had a positive impact on culture, efficiency and effectiveness in the implementation of their pilots.

83% improvement in ‘out of hours’ handover and 10%

increase ‘out of hours’ discharge

Increases of 38% weekday, 30% weekend and 22%

night shift activity

13% increase in supervised operative

training


So technology….?



Integrated Technology Enhanced Learning (TEL)

• Share and spread of good practice and

innovation across higher and postgraduate

education

• Underpinned by the DH TEL framework.E-learning

Simulation

M-learning

• Development of a hub to provide a national picture of where TEL

is happening and provided

• Access to examples and TEL resources that are delivering

major benefits in health education and training


Next steps?BTBC delivery will focus on:

• National spread and adoption of the BTBC pilot initiatives

• Supporting implementation of our trainee led ‘Inspire Improvement’

projects

• Developing Technology Enhanced Learning and “TEL hub”

• Ensuring all foundation trainees spend one placement in the community

• EDQUIN Development


Questions?

Health & Medicine

NHS Productivity: Weathering the Storm - Patrick Mitchell