In 2006 the NHS Institute commissioned three consortia to develop a short course in service improvement and to pilot it on pre-registration healthcare professional students. The consortia were made up of a university that provides pre-registration education for healthcare professionals with the healthcare providers in their locality where their students undertake clinical placements and work experience. The students involved covered a full multi-professional provision of health professionals; nurses, midwives, doctors, physiotherapists, occupational therapists, dieticians, radiographers, paramedics, social workers, etc. The initiative was externally validated.

The initial three consortia (now known as Phase 1 Partners) were kept separate and asked to develop and pilot their short courses. The criteria for the short courses was:

  • They must be offered within programs of initial training for clinical staff of all professions
  • They must provide a minimum of a one day (or equivalent) session to introduce the core knowledge and skills
  • There must be practical application and facilitated reflection

We found that the all the Phase 1 Partners used the same fundamental principles.  They all started from the position that service improvement has to be user focused.  Patient / client / service user involvement was incorporated either through the involvement of actual users or by way of recordings (both visual and audio) of users’ experiences.  This was the foundation of all three pilot courses.  

The theory sections of the short courses also contained amazing similarities; they insisted that students needed a systems focus (Berwick 1996), to understand process mapping (NHS Institute, 2007) and to be able to apply a Plan Do Study Act (PDSA) Cycle (Scholtes et al 2003).  Most used the model for improvement developed by Langley et al (1996) (cited in NHS Institute, 2007).

A Model for Improvement

 

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Langley et al (1996) (cited in NHS Institute, 2007)

One of the differences between the pilots developed by our Phase 1 Partners was when it was delivered to the students.  One Partner chose final year students as they qualified in their preceptor stage and inserted the short course into their already programmed preceptor curriculum.  Another Partner chose students who were just starting their final year of training and also inserted the pilot into a mandatory part of the course.  The final Partner chose students at the start of their penultimate year of training.  They were unable at this point to insert it into an already existing section of their courses so it was offered as a certificated, voluntary extra course and had remarkably good up-take, nearly two-hundred students from three different professions attended. 

The way the theory was delivered varied from a whole day’s study, to sessions within a taught course, to two hour sessions a week apart.  All the students were then given a more in-depth practical experience of developing an improvement project within a clinical workplace placement. 

The evaluation of the pilots was exceptionally good.  The students were amazed that it is not already mandatory and most felt they could apply the knowledge and experience they had gained within their chosen professions.  Some even asked to return to their placements to continue to do improvement work on a voluntary basis! The staff in the hospitals that were supporting the students on their placements became very enthusiastic to continue the initiative, particularly after they saw the success of the students’ proposals.  At this point in the project the academic staff, from the Universities were passionate champions of improvement.  They did not need to have the topic ‘sold’ to them and were clearly hoping the pilot would allow them to bring their faculties on board and to get service improvement embedded within their health professional programs – this has proved successful. 

The NHS Institute and the Phase 1 Partners agreed on issues that they consider to be  essential to the introduction of service improvement into the pre-registration education of healthcare professionals for better, safer healthcare. These are;

  • public and patient involvement: listening and understanding service user experiences and needs
  • personal and organizational development: recognizing and working with differences in culture and people
  • process and systems thinking: understanding the effects of different practices and procedures
  • initiating, delivering and sustaining improvement: generating change ideas then knowing how to plan for and measure the effects of improvement
  • students not only have to have the theory but they are expected to use the tools of improvement within a practical healthcare setting

It was obvious to us at the NHS Institute that we needed to investigate whether the piloted short courses could be replicated or whether they were institutionally specific.  It was also necessary to know whether these courses could be adapted to fit the requirements of other universities without the key messages and ideals being diluted.
 

 
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