VOL: 102, ISSUE: 04, PAGE NO: 32
Jane Reid, MSc, PGCEA, BSc, DPNS, RGN, is health and social care dean, Somerset Academy
Ashley Davidson, MSc, RGN, is senior nurse cardiology, East Somerset NHS Trust;Liz Robb, PGCEA, BA, RGN, RM, ADM, is director of nursing and clinical governance, East Somerset NHS TrustSomerset Academy serves the whole of Somerset. The goals of the academy board are to facilitate the quality of practice learning for undergraduates, develop multiprofessional education across organisations in the health and social care community, and encourage interprofessional education and development of all staff who contribute to the delivery of patient care or the support services that underpin patient care.
Somerset Academy serves the whole of Somerset. The goals of the academy board are to facilitate the quality of practice learning for undergraduates, develop multiprofessional education across organisations in the health and social care community, and encourage interprofessional education and development of all staff who contribute to the delivery of patient care or the support services that underpin patient care.
Observations by risk managers, the clinical governance team and trust trainers suggested that the standards and rigour of recording induction and mandatory training could be improved and that the organisation required more flexible approaches to staff updates. Discussions with staff suggested that documentation was sometimes incomplete.
An organisation's risk management strategy should incorporate a range of elements (Box 1). Failure to meet statutory requirements for health and safety education in manual handling, fire safety, infection control, resuscitation, security; and the management of violence and aggression can affect the quality of patient care and the safety and well-being of staff. Core standard II within Standards for Better Health emphasises that induction/mandatory training is a fundamental organisational responsibility and central to ensuring the quality of patient care (Department of Health, 2004).
Given that education and training records are a primary source of information to be examined when complaints are received, inaccurate and incomplete records leave an organisation vulnerable to litigation. Inadequate records can be interpreted as a lack of commitment and a breach of statutory responsibility. In legal terms, if induction and mandatory training are not recorded, they are assumed not to have happened. This was clearly of concern to the trust.
Working on the assumption that induction/mandatory updates may not be taken up whatever their design unless staff are motivated to do so, we sought to complement the work of the clinical governance team and their requirement to promote compliance and partnership of all staff.
The National Patient Safety Agency (2002) endorses such an approach, suggesting that the factors contributing to serious incidents need to be understood by analysing the root causes. Understanding why things happen is important, as system failure is often the result of breaches in managerial and organisational processes. The priority is to learn from the situation and reduce risk. Since we were familiar with the work of Langley et al (1996) in relation to securing improvement, we adopted a PDSA (Plan, Do, Study, Act) approach.
The 'planning' stage involved investigating the variables associated with induction/mandatory education, while the 'doing' stage involved conducting the investigation and developing a solution. This was achieved through a number of means, including:
- Undertaking a survey of staff uptake of induction/mandatory education;
- Observing existing induction/mandatory training activity within the trust;
- Consulting with trainers on the challenges and successes in delivering existing activity;
- Undertaking an audit of trust records of induction/mandatory training to determine their accuracy and contemporaneous status;
- Consulting with managers on the challenges of releasing staff for training;
- Assessing staff learning styles and access to learning resources.
The 'studying' stage involved summarising what we had learnt and identified from the investigation, which revealed:
- Inadequate communication and organisation between the education team and clinical governance department regarding updates completed by staff;
- A lack of understanding about where responsibility lay for the mandatory education and training;
- A lack of ownership and accountability by managers for the release and support of staff to undertake updates;
- An over-reliance on training days to achieve the requirements, which failed to take account of the diversity of staff learning styles/preferences.
It was recognised that if we were to improve compliance and uptake, staff needed to be offered flexible and learner-centred options.
In developing the learning materials to be accessed via intranet, CD-ROM or workbook, we operated from the premise that flexible learning involves giving staff the opportunity to take more responsibility for their learning by engaging in learning activities that meet their individual needs. The priority for all was to give staff the freedom to determine which approach best suited their preferred style of learning.
The greatest benefits of using technology were the opportunity to reach staff whose access to training had been limited through shift patterns and the cost-effective and time-efficient use of resources.
To complement the theoretical elements of the programme, it was decided that all staff would be expected to participate in a basic life support (BLS) workshop and clinical staff would be required to observe their practice of BLS skills.
The final element introduced to cement the links between the education and governance teams concerned an assessment. A questionnaire incorporating programme evaluation was devised.
To ensure the organisation satisfies future clinical negligence schemes for trusts (CNST) and risk-pooling schemes for trusts (RPST), requirements for record-keeping, staff applications for training, knowledge assessment results and observed practice were linked to a modular database. We piloted the revised learning materials to ensure they satisfied statutory requirements and staff found them user friendly.
The 'acting' stage of the PDSA cycle involved producing a report on our findings for the director of education and training leads and making a formal presentation to an invited audience from the trust. This detailed the steps we had identified that were likely to improve staff uptake of induction/mandatory education, the results of the pilot and the responsibilities of all parties.
To facilitate commitment and ensure staff are clear about their responsibilities, learning contracts were designed, outlining time requirements, support entitlements for staff and the requirements for further updating. The learning contracts require negotiation between the staff member and her or his manager. The document also provides evidence for participants' CPD portfolios.
Building on a learner-centred philosophy, staff are responsible for their learning, within a framework of support, responsibility and accountability. Heads of department and line managers play a key role in monitoring whether staff have completed the programme through individual performance review.
The trust's modular database has been adapted to track participants through their learning and will alert managers to those who have failed to apply for or complete training as required. This provides a real-time picture of compliance/non-compliance that can be monitored and acted upon.
The project has been well received by staff across the trust and is an illustration of how the academy model has benefited the trust (Box 2, p33). The outcomes were achieved because the health and social care dean was afforded the opportunity to work closely with the education and training team and all were empowered to challenge the status quo.
The trust's learning experience
East Somerset NHS Trust has an open and inclusive learning culture, so the response to this project was to welcome the investigation and its potential to initiate change as it paralleled the framework for clinical governance as outlined in An Organisation with a Memory (DoH, 2000).
To improve compliance among staff who may have previously avoided or ignored responsibilities for mandatory updates, an amnesty period was established. It was agreed that any members of staff completing their mandatory training within six months of the project's launch would be assumed to have a complete mandatory training history.
While there is further work to do in establishing this new approach, an audit was undertaken three months after the changes began and significant improvements in compliance and uptake have already been observed. The initiative is being rolled out across the trust and we have secured interest in it from neighbouring trusts.
- This article has been double-blind peer-reviewed.
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