NIHR CLAHRC Community e-newsletter - Workforce

Published Date: 26 Jan 2018

NIHR CLAHRC Community e-newsletter - Workforce

Issue 67



CLAHRC East Midlands: Clinical academic network launches in East Midlands for non-medical staff

NIHR CLAHRC East Midlands has helped to establish a new network in the region aimed at furthering the emerging field of clinical academics from non-medical backgrounds.
 
The East Midlands Clinical-Academic Practitioner Network aims to bring together non-medical, clinical academics to share experiences, understand the benefits and pitfalls – and is the first of its kind in the region.
 
Members will also be encouraged to explore innovative ways to influence the National Strategic Agenda of this emerging career pathway.
 
The network has been established by NIHR CLAHRC East Midlands alongside the Institute of Nursing and Midwifery Care Excellence at Nottingham University Hospitals NHS Trust.
 
The initiative was launched on Wednesday, November 1, at a special event at the University of Nottingham Innovation Park.
 
Co-founder Dr Louise Bramley, Clinical Academic Lead Nurse at Nottingham Hospitals NHS Trust, said: “Are you a nurse, midwife, allied health professional or a clinical scientist? Do you work in a role that combines clinical practice and research leadership? Would you like to connect with other non-medical, clinical-academics within the East Midlands? Then join us and help us further this emerging field.”
 
Fellow founder Emma Rowley, Capacity Development Lead at NIHR CLAHRC East Midlands, added: “We are launching this practitioner network for staff working in a clinical-academic career. This is the first network of its kind in the East Midlands, which will be practitioner led and developed from the outset. It is a unique opportunity to meet others who are combining research, or studying at MRes/PhD, while engaging in concurrent clinical practice.”
 
For more information about the network, email louise.bramley@nottingham.ac.uk or Emma.Rowley@nottingham.ac.uk or call 0115 82 31313.


CLAHRC East of England: Working with engineers to design services and manage risk

With funding from the CLAHRC EoE and other sources, the Engineering Design Centre (EDC) at the University of Cambridge has provided training for over five hundred NHS staff on ‘system safety assessment’ (SSA), a method which helps staff to consider risks proactively, using a comprehensive and systematic approach. The SSA “Toolkit” is free to use and is hosted at: www.ssatoolkit.com

The EDC has also worked extensively with the Royal Academy of Engineering, the Royal College of Physicians and the Academy of Medical Sciences, to develop a ‘systems approach’ to facilitate the design of health and care services. The resulting report, Engineering Better Care, aims to promote new thinking and is driving a growing number of initiatives with NHS staff to improve care.

The report can be downloaded here.

 
CLAHRC Greater Manchester: Addressing Long-Term Workforce Challenges in General Practice in Greater Manchester

With increasing demands on primary care and pressing workforce shortages both regionally and nationally, there are a number of key challenges to be addressed if general practices are to continue to deliver the highest quality care. As such, we are working in collaboration with the Greater Manchester Health and Social Care Partnership (GMHSCP) and the 10 Greater Manchester (GM) CCGs to evaluate the long-term challenges faced by the general practice workforce across the region, in line with the GMHSCP’s GM-wide Workforce Strategy.

As part of the ‘GM Primary Care Workforce Study’, the project will assess the current landscape of the general practice workforce in GM, identify factors affecting the recruitment and retention of GPs, the introduction of new ‘non-medical’ healthcare roles, and share learning about the findings of the study, to support future workforce planning.

We have already conducted a rapid review of the existing workforce literature to gain a greater understanding of the potential impacts of introducing new non-medical roles within primary care. Over the next year we will assess the composition of the general practice workforce across the region, engage with key stakeholders with expertise in the recruitment/retention of GPs or the introduction of new roles, both locally (e.g. GM CCGs and GP Federations, Health Education England North West) and nationally (e.g. the Royal College of General Practitioners), as well as analyse a GM-focused extract of the national GP Work Life Survey. We will then feedback our findings through three facilitated workshops throughout 2018. Further information is available here


CLAHRC Greater Manchester: Salford Primary Care Workforce Study: Contribution to a Safer Salford through Evaluation of New Non-Medical Roles in General Practice

General practice in England is under increasing pressure with shortages of GPs and nurses to manage a population that is living longer with greater health needs. National policy is driving a push to stabilise general practice by increasing the range and numbers of non-medical health professionals to work alongside GPs in general practice teams.

NHS Salford CCG’s ‘Primary Care (General Practice) Workforce Strategy’ aims to support the creation of multi-disciplinary general practice teams including new types of health professional across the city. As part of this strategy, the CCG has appointed CLAHRC GM to carry out a process evaluation of the implementation of three new non-medical health professional roles within its primary care workforce:  Advanced Practitioners, Physician Associates, and Clinical Pharmacists.

 Commencing in April 2017 and due for completion this March, the project is seeking to identify the challenges and opportunities encountered by the Salford early adopter sites when establishing these new roles. Participants include frontline health care trainees and practitioners, host practice staff and commissioning/provider/training leads. Working closely with Salford CCG, the CLAHRC GM project team has conducted in-depth interviews and focus groups with around 30 individuals, supplemented with analysis of relevant documents, to understand the challenges involved in embedding these new roles into Primary Care. By conducting the evaluation in this way, it is hoped that valuable insights and learning can be shared with key staff, healthcare partners and stakeholders to inform future service development.

Please see the project page for further information which also includes a rapid scoping review of the background literature on new-non-medical roles in international primary care: the Salford Primary Care Workforce Strategy: Contribution to a Safer Salford – Rapid Literature Review, produced in May last year.



CLAHRC North Thames: Improving anxiety and depression in chronic obstructive pulmonary disease 

Chronic obstructive pulmonary disease (COPD) is an irreversible, disabling lung condition that affects people both physically and emotionally.  Over a third of people living with COPD suffer from anxiety and/or depression. An exercise programme (pulmonary rehabilitation or PR) can improve the physical and emotional health of people with COPD but the majority of patients do not attend, or fail to complete, PR programmes. A multi-centre, four year, NIHR HTA study, supported by CLAHRC North Thames sees physiotherapists, nurses and occupational therapists develop skills in Cognitive Behavioural approaches to tackle the issue.

TANDEM (Tailored intervention for ANxiety and DEpression Management in COPD) is investigating whether one to one sessions (based on Cognitive Behavioural approaches) with a trained respiratory healthcare professional, and delivered before attending  PR, helps improve the emotional and physical health of people with moderate to very severe COPD and anxiety/or depression.

We are currently recruiting more respiratory health care professionals to train to deliver the intervention and you can read about this opportunity here.

Contact: r.sohanpal@qmul.ac.uk


CLAHRC North Thames: Helping involvement of patients and carers in treatment decisions during psychiatric hospital treatment

Carer involvement in psychiatric treatment is recommended in mental health policies. Yet, patient and carers often report being excluded from treatment decisions, particularly in hospital settings. A CLAHRC North Thames study has developed an intervention to help clinicians to implement patient and carer involvement in hospital. This was informed by a systematic literature reviewfocus groups with patients, carers and clinicians and contact with PPI groups.

A training package in communication and facilitation skills is a central element of the intervention. The team, led by Dr Domenico Giacco, has delivered this to a 71 mental health clinicians (nursing staff and doctors). Based on positive early results they are developing an online training module. This module could be used across the NHS to upskill the workforce and increase their confidence in exploring and validating experiences of the patients and their carers. This can help to ensure all views are considered, disagreements are dealt with effectively and shared care plans are achieved.

Contact Dr Giacco at d.giacco@qmul.ac.uk.


CLAHRC North West Coast: Partner Priority Programme evaluation workshops

Partners have been sending members of their workforce to the CLAHRC NWC Partner Priority Programme evaluation workshops, where they have gained new skills in bespoke Collaborative Learning Groups. The groups have access to academic specialists to assist with research methods, developing implementation plans and learning about transformation in organisations.

Service Users and Public Advisers attend the series of workshops in conjunction with the Partners to develop and feed input into their plans and evaluation ideas. The overall aim is to share knowledge and experience in order to identify which of the new healthcare models being developed by Partners are most effective in reducing health inequalities, improving population health and wellbeing and reducing emergency admissions. More information here.

Partners including NHS Trusts, Local Authorities and Clinical Commissioning Groups are also supporting their staff to undertake a research internship with CLAHRC NWC, developing research ideas that are important to their patients, clients and communities whilst developing valuable research skills. Read how June Holmes, a Chemotherapy Nurse and working on an initiative for Clatterbridge Hospital, is developing her skills with CLAHRC NWC to evaluate a cancer pathway.


CLAHRC North West London: CLAHRC NWL Champions Collaboration and Networking to Help Address Gaps in Workforce Development


Improving the quality of healthcare involves collaboration between many different stakeholders. Collaborative learning theory suggests that teaching different professional groups alongside each other may enable them to develop skills in how to collaborate effectively, but there is little literature on how this works in practice
 
CLAHRC NWL has developed innovative pathways for workforce development. Here's a case study example of how this could benefit an individual. 
 
 Wendy Carnegie joined the CLAHRC NWL team following extensive experience as a perioperative nurse in both the NHS and Private sector, during which time she worked clinically in the area of plastic, craniofacial and burns surgery. Wendy was seeking the next phase of her career and researching opportunities for development. However, traditionally, where development came from experience rather than an academic background, options for opportunities could be quite limited.
 
To contribute to addressing this gap, CLAHRC NWL developed and reviewed a collaborative fellowship in Northwest London, designed to build capacity to improve healthcare, which enabled patients and professionals to learn together.
 
In the meantime, within Wendy’s journeys  seeking future development, she gained a mentor from the clinical education group, met the director of nursing and discussed the options of deciding between management or nursing pathway. As the inpatient Theatre Matron, Wendy had the opportunity to join the 'Productive Operating Theatre' programme, developed by the NHS Institute of Innovation and Improvement. Carol Dale, a CLAHRC NWL Improvement Fellow, was involved in the 'Productive Ward' programme. Wendy's introduction to Carol via these productive programs led to a patient experience secondment and later an introduction to Rowan Myron, CLAHRC NWL Collaborative Learning Partnerships lead at the time and tutor at UWL. Wendy was invited to apply for the MSc in Improvement Science.
 
The MSc in Improvement Science is a work based learning course, delivered by CLAHRC NWL, providing opportunity to work on an improvement project in the workplace. Students study improvement science methodology and theory, directly putting into practice what they learn into making a change in the workplace.
 
To read more about Wendy’s journey of workforce development and how CLAHRC NWL are contributing to addressing the gap, visit the CLAHRC NWL Blog.


CLAHRC Oxford: Care home training

The Enhanced Care Homes Outcomes (ECHO) project integrated established care home support services with a new mental health ‘in reach’ service, aiming to enhance the quality of care and outcomes for people with dementia in Oxfordshire’s care homes.

As part of the ECHO programme, the diversity of skills, training or knowledge that staff required in their roles (AKA ‘core competencies’) had grown. This led to a review of the existing ‘competency framework’ and core competencies of care home staff, and how they were recorded and tracked.

It became apparent that the methods currently used to assess staff’s competence – that had worked successfully with the original team of nurses – needed to be revised and adapted for the new model of care that integrated both physical and mental approaches to assessment and treatment.

A new competency ‘matrix’ was developed, in partnership with care home staff, taking a more objective and accurate approach to measuring competence across physical and mental health domains of skills and knowledge. The matrix incorporated several key themes related to frail older people.

The new matrix has also increased clarity around performance expectations and established a clearer link between individual and organisational performance.

The competency training matrix has since been rolled out to all care home staff across our host trust, Oxford Health NHS Foundation Trust. Read more here


CLAHRC Oxford: Improving dental health in care homes 

Based on anecdotal learning from the CLAHRC’s ECHO study and work supported by Health Education England Thames Valley (HEETV) about the need to improve dental care, it became apparent that dental needs and neglect in Oxfordshire’s care homes needed to be assessed.

At the start of the Enhanced Care Home Outcomes (ECHO) study an audit was carried out of its 104 care homes (approx. 4,000 residents) to collate baseline data on dementia diagnosis, nutrition, end of life care and medication use. A further audit was planned for the end of the project, in January 2016, as part its evaluation.

This audit is, to our knowledge, the largest audit in this subject area and highlights a number of care needs for a vulnerable population. The results found that only 10% of care home residents in Oxfordshire had a fully completed dental care plan.

The results of the audit were fed back to each care home enabling them to examine their practices, and has also provided Oxford Health Dental Team with valuable information regarding the dental health of care home residents living in Oxfordshire’s care homes and to develop an action plan to address this.

Involving the Oxford Health NHS FT Dental team in the designing of the data collection tools also helped to further embed a culture of research in an NHS setting. Read more here


CLAHRC Oxford: Upskilling the NHS workforce for new interventions

Rolling out new, clinically proven interventions in the real-world NHS is a complex process.

One of the major hurdles with this process is training people to be able to deliver the new intervention, and to do so in a way which ensures that patients receive the same benefits seen in the clinical trial of the intervention. How best to train the workforce in these new interventions?

One answer to this is to offer training in a location agnostic and easily accessible manner: online. Providing effective training that reaches the clinicians that need it, wherever they are, and preferably at low cost.

CLAHRC Oxford has two such projects currently underway,  evaluating online training platforms for new interventions – proven in clinical trials – for low back pain and rheumatoid arthritis of the hand and write, the Back Skills Training (iBeST) and the 'Strengthening and Stretching for Rheumatoid Arthritis of the Hand' (SARAH) programme, respectively.

The implementation and uptake of both projects are being evaluated, as well as their ability to deliver both the training and the promised benefits to patients. Read more about iSARAH here Read more about iBeSt here


PenCLAHRC: Care Under Pressure: Supporting interventions to improve doctors’ mental health

The NHS needs healthy, motivated doctors to provide high quality care for patients, however doctors are more likely to suffer from mental ill-health than other working adults. The Care Under Pressure study uses a realist review with the aim to understand when and why doctors develop mental ill-health, and which preventative strategies are effective and in what circumstances.

Find out more on the project page.


PenCLAHRC: Helping healthcare professionals make sense of evidence

Healthcare professionals who are able to use research to inform their decisions can provide the best possible care to their patients. Workshops developed and delivered by PenCLAHRC are helping to achieve this by giving health care providers the tools by which they can interpret and make sense of research evidence. Find out more on the Making Sense of Evidence webpage.


PenCLAHRC: Healthy Workplaces:  Improving the health and wellbeing of NHS ward staff

To create a healthy workplace for staff we can intervene to enhance those characteristics of a workplace system that encourage and support the emergence of healthy adaptive behaviour patterns.

The Healthy Workplaces research team worked closely with the European Centre for Environment and Human Health and the Royal Cornwall Hospitals  NHS Trust to develop and explore the effects of a whole-system intervention framework on the health and wellbeing of NHS ward staff.

Read more here.


PenCLAHRC: The Care Home Implementation and Knowledge Mobilisation Project (CHIK-P)

Health and care professionals have identified a need to improve the quality and appropriateness of patient care for the elderly living in care homes in the South West. CHIK-P aims to develop our understanding of how to implement best practice and share knowledge with the residential care workforce, in order to improve the overall health and social care of residents. Find out more on the project page.


CLAHRC Wessex: safe staffing in acute care hospitals

Researchers in the NIHR CLAHRC Wessex have developed a significant portfolio of workforce research focussing safe staffing in acute care hospitals. Their work includes projects funded by the NIHR HS&DR programme exploring the association between nurse staffing levels, missed vital signs observations and mortality (https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/1311417/#/), and the costs and consequences of using the NICE endorsed ‘Safer Nursing Care Tool’ to determine ward establishments (https://www.journalslibrary.nihr.ac.uk/programmes/hsdr/1419421/#/). 

Members of the team have worked with NHS Improvement and NICE reviewing evidence and providing advice on safe staffing resources in acute care, the community and emergency departments. As part of this work they produced a series of Evidence Briefs which were published by the CLAHRC they include:

Other work within the CLAHRC, supported by a PhD studentship, has focussed on the effects of 12-hour nursing shifts on the quality of care and the nursing workforce 

For more see Evidence Briefs in our publications section of the CLAHRC Wessex website.


CLAHRC Wessex: Managing night-time vital signs observations: the conflicting care work of supporting sleep and preventing deterioration.

The team at CLAHRC Wessex has also been working on studying safety and night time observations. It culminated in the presentation of a poster at the RCN International Nursing Research conference, Oxford, UK 2017 and publication in theJournal of Clinical Nursing


CLAHRC Wessex: Supporting the delivery of better care to patients living with frailty

The Data Science and Health Analytics team has been working for Health Education England to help provide better care for frailty. The team aimed to identify the healthcare staff delivering frailty care and to identify the educational resources and training initiatives used by staff to deliver quality care. The evaluation also identified gaps in the training currently pro- vided and made recommendations to improve the provision of frailty education and training for healthcare staff. It looked at initiatives in acute, community and primary care settings. Here’s our initial report


CLAHRC West: Evidence and evaluation workshops for STP staff

Local Sustainability and Transformation Partnership (STP) programme and project managers benefitted from workshops on evidence and evaluation in October and November. The CLAHRC West training team, in partnership with the West of England Academic Health Science Network, ran the two workshops to give a rapid, practical and inspiring introduction to evidence and evaluation. 
 
Find out more about the STP staff training


CLAHRC West: Evaluating a real-time feedback app to improve staff engagement

Evidence shows that NHS organisations deliver better quality care when staff engagement is high, staff are strongly committed to their work and are involved in decision-making.
 
The Staff Participation Engagement and Communication application (SPEaC-app), also known as Happy App by staff from University Hospitals Bristol NHS Foundation Trust, collects real-time, work-related mood feedback from staff. CLAHRC West was research and evaluation partner on the project to develop and roll out the app across the trust.
 
The evaluation has shown that there have been real improvements in engagement locally between managers and their teams and it has inspired improvements in service delivery. Other NHS organisations are interested in introducing the SPEaC-app and evaluating its effects on staff engagement, and it has been praised by the Care Quality Commission and won an HSJ Award.
 
Find out more about the SPEaC-app project


CLAHRC West Midlands: Making the Most of Leadership Development Training

Developing leadership in NHS healthcare organisations is recognised as important for improving services and patient care, encouraging innovation, and building workforce resilience. To achieve this, leadership development training is a common approach, yet how readily does leadership training translate back into the workplace? Research by CLAHRC WM has been exploring the optimal conditions for training transfer in healthcare leadership to occur. Based in qualitative empirical data from a case study of an in-house hospital leadership development programme, we highlight four critical areas.

First, having the space and pace to practice leadership is important. Workplace and service pressures, lack of protected training time, and ‘time-out’ for reflection can hinder use of training in the workplace. Trainees need adequate time and space to put their training into practice.
Second, there must be realistic workplace opportunities to practice newly acquired leadership skills. While practical exercises on training days may help cement learning in the classroom, to become embedded in practice requires achievable day-to-day opportunities being present at trainees’ places of work.

Third, given that NHS staff work in a pressured environment and time is critical, leadership trainees tend to be selective in their learning. If training concepts are easy to use, related to trainees’ actual work experiences and with clearly visible benefits, then trainees are more motivated to retain and use their training. Perceived relevance is vital.

Finally, leadership training should be widely supported. It’s all too easy for employees to return from a training course with enthusiasm but encounter resistance back at work. For training to be sustainable over time, management and peer support, accountability and openness alongside a shared language and strategic goals across are important. Under such conditions, the benefits of leadership training are also likely to become diffuse and have wider organisational-level impact.

Gary Kerridge (Research Fellow, WBS)


CLAHRC Yorkshire & Humber: Beyond knowledge: a new approach to behaviour change for patient safety 

Interventions designed to improve patient safety such as guidelines, checklists and new technologies, all require healthcare staff to do things differently – in other words – to change their behaviour. It is widely, but wrongly, assumed that if people have the knowledge about what to do, change will follow. This is why strategies to implement change usually focus on increasing knowledge through emails, posters, meetings and training. However, if knowledge were the key to behaviour change, few of us would be overweight or inactive.

The NIHR CLAHRC YH Evidence Based Transformation with the NHS theme have been working with the AHSN Improvement Academy in Yorkshire and Humber to support improvement projects by helping staff across the region to implement change more effectively by using theories of behaviour change to underpin their work.  We developed the Achieve Behaviour Change approach which involves working with teams of health professionals to identify barriers to change and then developing a tailored intervention to specifically address these barriers. To support roll-out we worked with the AHSN to develop a workshop to spread these ideas across the region. Over eight hundred people have now attended one of these ABC Workshops and a toolkit is freely available via the Improvement Academy website to support their change projects. http://www.improvementacademy.org/tools-and-resources/abc-for-patient-safety-toolkit.html

A good example of the ABC approach changing practice was a project to increase the use of pH testing, over x-rays, to determine correct nasogastric (NG) tube placement. X-ray use for this purpose fell from 55% to 24% across four hospital Trusts, saving an estimated £1M across the region in one year alone. The ABC approach has also been used in the region for increasing cancer referrals in general practice, implementing the safer surgery checklist and reducing Acute Kidney Injuries. In the UK, the approach underpins the patient safety work within the Y&H Patient Safety Translational Research Centre YH (UK) more information can be found on the Yorkshire Quality and Safety Research (YQSR) website. 
Internationally, this work is being implemented as part of a New South Wales Translational Cancer Research Network project in Australia.
 
To find out more contact R.Simms-Ellis@leeds.ac.uk


CLAHRC Yorkshire & Humber: Digitally enhanced workforce Transformation

It is estimated that care for the last year of life in England costs £1.3billion and delivery of an effective and efficient high quality community-based palliative care service continues to be a challenge in the UK. Where available, the existing model of 1:1 nursing by senior specialist palliative nurses is difficult to sustain in the long term. 

The Enhanced Community Palliative Support Service (EnComPaSS) a NIHR CLAHRC Yorkshire and Humber project is a model of care, whereby community-based nurses are trained and delegated to deliver palliative care plans under online supervision by specialist palliative care nurses. The innovative technology, developed by our Canadian industry collaborator Sensory Technologies, provides online access to up-to-date clinical records to support effective team interaction and decision-making; it enables the community-based staff to document observations and care delivery in the chart while in the community, and provides them with immediate access to clinical support from the specialist palliative care clinicians. Instead of being able to care for just one person at a time, the technology enables the delegating nurse to manage a number of lower band nurses who act as their eyes, ears and hands delivering their care plans at the bedside. This leverages the scarce specialist care resources and facilitates expanded care capability through smart workforce deployment. Please contact s.mawson@sheffield.ac.uk for more information about the EnComPaSS project.