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Innovation

Training to promote multidisciplinary working

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Multiprofessional working is central to good care and Health Education England has introduced a programme to make it central to all healthcare interventions

Abstract

The Better Training Better Care programme incorporates recommendations from Sir John Temple’s report Time for Training and John Collins’ review Foundation for Excellence to improve multiprofessional training and working. This article describes some of the programme pilots under way in the UK and looks at how they can be disseminated through the rest of the health service to improve patient care throughout.

Citation: Bayliss-Pratt L (2013) Training to promote multidisciplinary working. Nursing Times; 109: 21, 12-13.

Author: Lisa Bayliss-Pratt is director of nursing, Health Education England.

Introduction

Teamworking leads to better outcomes for patients. It is widely accepted - not just in the NHS - that when different disciplines with the right mix of skills work together, the results are better. This is important in healthcare where results are all about providing the best and most effective treatment for the patients we serve. It is frustrating, however, that we do not seem to have broadly accepted that fact and embedded it within the service. Luckily, my role in Health Education England allows me to get involved with the Better Training Better Care (BTBC) programme.

The BTBC programme and pilots

The aim of BTBC is to deliver the recommendations from Time for Training (Temple, 2010) and Foundation for Excellence (Collins, 2010). The former looked at the impact of reduced working hours on the quality of medical training while the latter reviewed the medical foundation programme - the two years immediately following medical school for junior doctors.

Both of these have a clear medical focus, but the two main components of BTBC let us look at the wider benefits of multiprofessional working. The programme will identify, pilot, evaluate and disseminate examples of good education and training practice to ensure training provides safe, effective and improved patient care.

BTBC includes nine workstreams (Box 1); in the first - the 16 local pilots - there has already been positive feedback from nurses. In this workstream, BTBC provided £1m to 16 NHS trusts to pilot projects that meet recommendations outlined in the two reports. Nurses involved in the pilots say they enjoy their work more and feel they are members of a team that uses their combination of different skills and abilities to provide the best possible service for patients.

Box 1. The nine BTBC workstreams

  1. Local implementation and pilots
  2. Role of the trainee
  3. Role of trainers
  4. Workforce planning
  5. Improving 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

In one pilot - East London Foundation Trust - nursing and medical staff are working together on a simulation project where they can learn from things that have gone wrong and make sure they avoid making the same mistakes in future. The great strength of work like this is that it is providing real, evidence-based examples of how different professions can work together as a team (Box 2).

Box 2. Case study one: East London foundation trust

Sometimes, things can go wrong, which affects not only the patients and their carers, but also other team members. East London Foundation Trust is piloting a serious-incident prevention simulation-based training project that aims to enable nursing and medical staff working in mental health multidisciplinary teams to learn from simulated serious incidents.

The training has been developed in-house by a project team consisting of both doctors and nursing staff, and uses anonymised information from trust internal serious-incident reviews. These reviews inform the learning points included in the clinical simulation scenarios. Two scenarios based around inpatient care issues will be role played during each training session by six course delegates – three members of nursing staff and three doctors in postgraduate training.

Each scenario will embed various care and service delivery problems and produce learning points for discussion in the subsequent debrief sessions, which will be facilitated by senior nursing (modern matrons) and medical (consultant psychiatrists) staff. Twenty-four training sessions were scheduled from November 2012 to April 2013, offering a total of 72 delegate places to nurses working at the trust.

One of the key project objectives is to promote learning in multiprofessional teams and highlight the importance of teamworking and communication in the clinical arena. The project also aims to engage all levels of clinical staff in the promotion of learning from serious incidents via simulation training.

Alex Obamwonyi, team manager at Tower Hamlets Inpatient Ward, said: “Providing simulation-based training for serious incidents gives nurses the opportunity to learn from other peoples’ mistakes, meaning that the same sort of incidents will not occur again. Nurses also have the opportunity to practise newly learnt skills or skills that have not been practised for a while in a safe and controlled environment.”

Another trust, North Bristol, is a great example as to how a medical-focused project could be adopted by other professions. This pilot investigates the use of video-recorded consultations as a training tool for specialty trainees in secondary care, starting with specialties in which chronic disease management is prominent. Currently, the pilot focuses solely on medical trainees but the programme shows potential for training nurses who see patients in clinics. With this finding, I, along with the BTBC team, am very keen to see North Bristol’s model rolled out not just in medical teams around the country, but also across other health professions who are involved in consultations (Box 3).

Box 3. Case study two: East Kent hospitals university foundation trust

The pilot at East Kent Hospitals University Foundation Trust has revised its working model for the delivery of emergency care, urgent care and long-term conditions care at William Harvey Hospital, to enhance trainee support and improve patient care. The pilot has created hot “emergency” and cold “ward-based” multiprofessional weekend teams.

There has been a huge amount of cross-professional support for the project and the weekend “cold” team has found that after promptly reviewing its ill patients, staff have more time for learning and assessment during their shift.

Susan Kennedy, project manager and education adviser at the trust, said: “Trainee doctors experience a block of hot team work – an intense, learning-rich experience – and also a longer spell on the cold team, during which specialist activities like clinics, ambulatory care and procedural experience can be undertaken. At weekends, the cold team is multiprofessional with a registrar, foundation doctor, a Band 6 nurse and additional phlebotomy support provided by a healthcare assistant.”

Liz Bonham and Sue Herridge, who are both Band 6 nurses, and Paula Achong, who is a healthcare assistant at William Harvey Hospital, have worked as key members of the cold weekend team. Ms Bonham said: “The nurses on the wards appreciate that the enhanced team are able to help with cannulas, venepuncture and facilitating discharge. Very junior doctors appreciate having a Band 6 nurse on board to help them, and they are eager for reassurance and advice. We definitely feel that the provision of a skilled nurse on the team helps to promote safe and effective care.”

The team at East Kent Hospitals University Foundation Trust believes that this new way of working will improve handovers and supervision at weekends and, in turn, improve patient care and safety, especially at weekends.

A mental health trust in Teeside is looking at ways to improve supervision and support for trainees in the first few weeks of their job. It has redesigned how trainees work across its services (both inpatient and in the community) and put in place simple but effective ways to signpost new members of staff to the rest of the multidisciplinary team.

As with the pilot in North Bristol, this is for medical trainees but has highlighted how training and trainee job descriptions could be redesigned for nurses so they get the best possible learning experience and feedback in their first days on the job.

Dissemination

A source of frustration is that even when we have proven examples of changes that will benefit patients, we have failed to translate those into system-wide action that will improve care for everyone. This brings me back to one of the crucial aspects of BTBC - dissemination.

There is already a great deal of commitment within BTBC to ensure trusts across the country adopt the successful projects. I can talk about 16 specific pilots here but there are many other hospitals involved in this work that are keen to see the progress we are making and help spread the ideas that work. At HEE, we want to make multiprofessional teamworking the very core of NHS education and training programmes. A coordinated team-based approach must become the norm; HEE’s BTBC programme provides an ideal opportunity to help embed this as standard practice across the NHS. We have a wide range of professionals who, together, provide a combination of skills that must be used together and based around patients rather than professions.

HEE exists for this one reason alone - to help ensure the delivery of the highest quality healthcare to the population by developing people for healthcare; part of that development is embedding multiprofessional teams as the expected norm.

Key points

  • Teams made up of professionals from different disciplines provide better overall care
  • The Better Training Better Care programme delivers the recommendations outlined in two reports: Time for Training and Foundation for Excellence
  • BTBC has provided £1m to 16 NHS trusts for pilot projects that meet the recommendations of those two reports
  • When change has improved care, it is crucial that it is disseminated throughout the NHS
  • If a coordinated team approach is to become the norm, multiprofessional teamworking must be placed at the core of NHS training
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