Improving Global Health through Leadership Development Annual Report

Transcription

1 Improving Global Health through Leadership Development Annual Report Tess Talbot, Amanda Sewell, Andrew Boyd, Fleur Kitsell August 2014 Improving Global Health through Leadership Development Annual Report Page 1

2 Contents Page No. 1. Executive Summary 3 2. Overview of Programme 4 Background Financial Support Recruitment Programme Structure Management and Support 3. Partner Organisations 7 4. Key Achievements and Changes 7 THET Health Partnership Scheme Grant Programme Expansion Induction Fellows Handbook Mentor Training Major Incident Plan Communications 5. Narrative Reporting on Fellows Projects 9 Samlout, Cambodia Cape Town, South Africa George, South Africa Kisumu, Kenya 6. Learning and Evaluation 19 Dissemination Benefits to NHS Staff Alumni Update Development of Overseas Partners 7. Expenditure The Future 25 Value for Money Comparison of Domestic and International Leadership Approaches Funding Peer Group Learning THET Independent Evaluation 9. Conclusion Appendices: 1. IGH Fellow Demographics Fellows Handbook (attached) 3. Major Incident Plan (attached) Improving Global Health through Leadership Development Annual Report Page 2

3 1. Executive Summary Improving Global Health through Leadership Development (IGH) is a programme run by the NHS Thames Valley and Wessex Leadership Academy (TVWLA) which gives NHS volunteers a unique opportunity to develop their own leadership abilities by contributing to the improvement of sustainable healthcare in a resource-poor setting outside of the UK. Once recruited the volunteers are known as IGH Fellows. Using quality improvement (QI) methods, IGH Fellows work in partnership with local health teams towards delivering the eight Millennium Development Goals for health. Currently the programme has active partners in Cambodia (Samlout), South Africa (Cape Town and George) and Kenya (Kisumu). This report is an annual update on the programme and details IGH s key developments and achievements from April 2013 to March 2014; below is a brief summary: During this year 27 IGH Fellows have delivered 88 months of work. The award of the THET Health Partnership Scheme (HPS) grant for long-term volunteering for 24 months, beginning in April 2013, meant that IGH could increase the number of partners with whom it works and, for the first time, recruit volunteers nationally from the NHS, in addition to the Thames Valley and Wessex areas. The IGH team has appointed a Programme Manager and three Senior IGH Fellows, who each lead on a separate aspect of the programme. In addition, three members of the Steering Committee volunteered to act as Partner Leads for Cambodia, South Africa and Kenya. All overseas placements now last six months and IGH Fellows are paid a monthly stipend of 1,000 to cover living expenses. The IGH Induction Programme has been revised to better prepare Fellows for their placement abroad, with an added emphasis on leadership behaviours, QI methods, project planning and public health. A Continuing Professional Development (CPD) day for IGH Mentors was piloted and due to its success will be held annually. A detailed Major Incident Plan has been written and approved; this will guide the response of the IGH team in the event of an untoward incident that may threaten those involved in the programme. An updated IGH website was launched, with a blog and social media area. The IGH programme formed a partnership with Kisumu in Kenya and the first two Fellows went to work there in March The IGH programme was cited as a case study of good practice in the All-Party Parliamentary Group on Global Health report Improving Health at Home and Abroad in July The IGH programme recognises that leadership behaviours cannot just be taught in the classroom, but that skills and behaviours are developed on the job, and that this process is consolidated through critical reflection, and self-assessment. The IGH Fellowship takes participants away from their normal working environment and immerses them in a healthcare system in a different country. This experience provides them with a unique opportunity to take responsibility for a QI healthcare project and, through this, develop their leadership skills and behaviours. It is an intense period of personal and professional development, something which is difficult to achieve in the same way while continuing in their NHS job. Improving Global Health through Leadership Development Annual Report Page 3

4 2. Overview of Programme Background The IGH programme is an innovative leadership development programme run by the TVWLA. The scheme fulfils the Department of Health s challenge to create global partnerships and support health development abroad in order to deliver on its Health is Global outcomes framework. 1 The IGH programme has three equal goals: To support the delivery of sustainable improvement in health and healthcare in resourcepoor settings. To provide an unparalleled personal and leadership development experience for NHS volunteers. To create a cadre of skilled clinical leaders with quality improvement skills who will be able to make a real difference to the NHS, on their return. The IGH programme recruits volunteers from the NHS who each complete a placement with an overseas partner in a resource-poor setting. These volunteers, known as IGH Fellows, are drawn from all staff groups - clinical staff from all professional backgrounds as well as managers. One vehicle for achieving health-related goals worldwide is through increasing the capacity and capability of the healthcare workforce, both by increasing clinical skills and by improving expertise in system development and QI methods. IGH Fellows, working in partnership with local health care teams, undertake a QI project to build sustainable health service improvements in the host country. Through doing this IGH Fellows also develop their own practical leadership skills and behaviours, using the domains of the NHS Healthcare Leadership Model (2013). Prior to this the IGH programme used the earlier NHS Leadership Framework. Overseas placements are for six months and IGH Fellows are awarded a monthly stipend to cover living expenses as well as being funded for one return journey to their placement site. Financial Support The IGH programme has been operational since August 2008, and was initially funded locally by the South Central Strategic Health Authority (SHA). It is currently financed from two sources - the TVWLA and, as of April 2013, the Tropical Health and Education Trust (THET) through a Health Partnership Scheme (HPS) grant. Recruitment The IGH programme recruits IGH Fellows twice a year. Recruitment is through a competitive process (application form and interview). Minimum eligibility criteria are as follows: - employees within the NHS - doctors and dentists must have successfully completed Foundation Year 2 - all others should have experience of working in an Agenda for Change Band 6 role - the support of their line-manager, training programme director or employer (as appropriate) 1 United Kingdom (2011). Health is Global: an outcomes framework for global health London, Department of Health Improving Global Health through Leadership Development Annual Report Page 4

5 Twenty-seven Fellows were recruited to the programme in Since the programme started in August 2008, 99 IGH Fellows have been, or are, on placement, and have delivered 399 months of work. The number of IGH Fellows from April 2013 to March 2014 was 27 with a combined 88 volunteer-months spent working overseas. A more detailed breakdown of IGH Fellow demographics can be seen in Appendix 1. Programme Structure Although the majority of IGH Fellows will only take six months out of UK NHS employment, i.e. the time spent on placement, they are recommended to consider the IGH Fellowship as having an overall time commitment of approximately twelve months. This is because IGH Fellows are requested to carry out a significant amount of preparatory and post-placement activities. Before embarking on their placement, each IGH Fellow is required to undertake a two-day Leadership Development Centre course, attend a two-day IGH Induction Programme, complete three online tasks (the Edward Jenner programme first reflective log, a Project Management learning module and a Myers-Briggs Type Indicator) and meet with their assigned Mentor, to review their leadership self-assessment using the NHS Healthcare Leadership Model. During the meeting with their mentor the IGH Fellow identifies specific individual developmental goals for the placement experience. IGH Fellows are also strongly encouraged to meet with their line manager to discuss the IGH programme and their learning objectives, and reflect on ways to utilise their improved leadership skills and behaviours on their return to the NHS. During their six-month placment with a partner organisation, IGH Fellows contribute to the delivery of sustainable healthcare through a QI project, the focus of which depends on local health priorities and regional and/or national plans, as well as the skills and expertise of the IGH Fellow. The IGH Fellow s role is to support and help build the capacity and capability of the local staff and/or services to deliver effective clinical care; they do not deliver clinical care directly themselves. While on placement IGH Fellows submit a Project Plan, two Monitoring Reports (at the end of the second and fourth months) and an end-of-placement Evaluation Report to the IGH team. IGH Fellows complete a post-placement leadership behaviour self-assessment, which is discussed and compared to their pre-placement self-assessment, when they meet with their Mentor for a final debriefing, ideally within two months of return to the UK. Other postplacement requirements are a Summary Reflective Account, completion of the online Edward Jenner programme and a presentation at one of the regularly held IGH Presentation Evenings (see below). In addition, IGH Fellows are encouraged to meet with their linemanager, and consider submitting an article for publication or a poster of their work at a relevant global health or QI conference. A Certificate of Completion of the IGH Leadership Fellowship is awarded to the IGH Fellow when evidence is received by the IGH Programme Director that all obligatory assignments have been completed to a satisfactory standard. Management and Governance The IGH programme is managed a led by a small group of staff: a Programme Director (Dr Fleur Kitsell), a Programme Manager (Deborah Watts), an Operational Management Group and a Steering Committee. The Operational Group (comprising the Programme Director, Programme Manager, Partner Leads, and the three UK based Fellows) meets every two months; and the Steering Committee (comprising local employers and senior NHS staff ) meeting is held approximately twice a year. All members of the team work on a part-time basis: Improving Global Health through Leadership Development Annual Report Page 5

6 The Programme Director 4 sessions each week The Programme Manager 5 sessions per week Three previous IGH Fellows were appointed to UK based Senior Fellowship posts 2 sessions per week. Each leads on a key area of development within the scheme, working closely with one another and existing members of the Operational Group: o o o Dr Andrew Boyd is the IGH programme Lead for Leadership and Education. He has reviewed the leadership and education model the IGH programme uses, as well as current practice in the recruiting and training of participants in the programme. Amongst other things he has revamped the IGH Fellows induction days, organised the Mentors CPD event and produced an updated IGH Fellows Handbook. Dr Amanda Sewell is the IGH programme Lead for Business Continuity Planning and Communications. Amanda has developed a robust plan for Fellows on placement which will be cascaded in the event of an untoward incident. She has also redesigned the IGH website and is leading IGH s social media presence. Dr Tess Talbot is the IGH programme Lead for Monitoring and Evaluation (M&E). Tess s role includes collating and condensing incoming material to present meaningful data to stakeholders and she has been closely involved with THET, one of IGH s major funders. She has developed tools to monitor and evaluate Fellows project work and experience to provide evidence of the value and impact of the programme. In 2013, three existing members of the IGH Steering Committee with detailed knowledge of their respective countries, agreed to become Partner Leads; their role is to be the main link for the overseas partner, and oversee project work and the experience of the IGH Fellows on placement with that partner: Dr Ian Kemp is the IGH programme lead for the MJP Foundation in Cambodia Dr Juanita Pascual is the IGH programme lead for the Department of Health for the Western Cape, South Africa Dr Mick Nielsen is the IGH programme lead for the County Department of Health in Kisumu, Kenya All IGH Fellows have at least one routine support visit from a member of the IGH team while they are on placement. The Partner Leads normally make a minimum of two routine support visits to their link partner each year. This year there were eight such visits: four to the MJP Foundation in Samlout, Cambodia (February 2013, June 2013, October 2013, Feb 2014) four to the Department of Health of the Western Cape, in Cape Town South Africa, two of which included a visit to the Fellows in George, South Africa (March 2013, July 2013, October 2013, February 2014) In addition members of the IGH team may visit a prospective new partner in order to explore the possibilities for developing an active partnership; these are categorised as either decision-making or scoping visits. This year there was one of each: one decision making visit to George in South Africa (July 2013) one scoping visit to Kisumu in Kenya (November 2013) Each IGH Fellow is allocated a UK-based Mentor. Mentors are volunteers with detailed knowledge of the IGH programme many have been Fellows themselves and wish to stay involved with the programme, and others have expertise in overseas work in healthcare, clinical leadership or QI. All IGH Mentors complete a two-day training programme on Improving Global Health through Leadership Development Annual Report Page 6

7 coaching and mentoring skills. The IGH Fellow/Mentor relationship is difficult to define precisely but the role of the Mentor is to support and direct the Fellow as necessary during their IGH journey. IGH Fellows and Mentors meet at least once before and after the placement and maintain regular contact while the IGH Fellow is away. Most IGH Fellows find the opportunity to reflect on their own progress with, and bounce ideas off, their Mentor, who is removed from the immediate day-to-day highs and lows of placement life, extremely valuable. This personalised support for IGH Fellows is one of the unique features of the IGH programme. 3. Partner Organisations To date the IGH programme has formed eight overseas partnerships. All partners follow the model of Integrated Development as identified by the Global United Nations Millennium Villages initiative. IGH Fellows have completed placements in: Samlout, Cambodia; Tabora, Tanzania; Kisumu, Kenya; Nairobi, Kenya; Cape Town, South Africa; George, South Africa; and Lusaka, Zambia. Currently, there are four active partners: Maddox Jolie Pitt (MJP) Foundation, Samlout, Cambodia (since 2008) Western Cape Government Department of Health, South Africa (since 2012) School of Public Health and Family Medicine, University of Cape Town, South Africa (since 2012) County Department of Health in Kisumu, Kenya and Millennium Cities Kisumu, Kenya (since 2013) The CEO of the MJP Foundation, Stephan Bognar, visited the UK in November 2013 to meet with the IGH team and speak at an IGH Presentation Evening. He also attended an update meeting with members of the IGH Operational Group and THET in London. The IGH programme has been approached by a number of organisations keen to be involved with the programme, recently the Department of Health in the Eastern Cape area of South Africa and the Brighter Futures Foundation in Burma, and it is hoped that the first IGH Fellows will commence placements with both partners in late Although keen to capitalise on exploring potential partner interest, the IGH team is mindful of the fact that any expansion needs to be manageable within the resources the programme has, so that it can continue to give the appropriate level of support required to Fellows and partners and not spread its resources too thinly across too many partnerships. 4. Key Achievements and Changes THET Health Partnership Scheme (HPS) Grant Following the submission of a successful bid, the IGH programme was awarded a grant of 404,000 as part of a long term volunteering programme funded by the THET-administered HPS. The grant runs from April 2013 to March 2015, and includes the cost for 30 IGH Fellows each completing a six month placement i.e. 180 volunteer-months. The first cohort of eight Fellows funded by the THET HPS grant began their placements in September The IGH team are required to provide THET with a quarterly financial report and a detailed narrative report each October and April during the life of the grant in order to continue to receive monthly instalment payments. All quarterly financial and narrative reports have been submitted on the due date. Each narrative report includes: a programme overview Improving Global Health through Leadership Development Annual Report Page 7

8 activities, results and impact of each individual Fellows project successes, challenges and lessons learnt how volunteers/fellows have benefitted from participation in the IGH programme resources developed and outward-facing activities partnership development, local capacity building and sustainability IGH Programme Expansion As a direct result of the grant, the IGH programme has expanded by increasing its core team (as detailed before), the number of Fellows it takes on and how many partners it works with at any one time. Previously IGH Fellows could only be recruited from the Thames Valley and Wessex areas but now anyone who is an employee of the NHS in England can apply. During this year four IGH Fellows (from a total of 27 were recruited from outside the Thames Valley and Wessex areas. IGH Fellows Induction Programme IGH Fellows are required to attend a two-day bespoke residential induction programme, the aim of which is to prepare them for their overseas placement. The induction programme underwent further refinements this year due to feedback from past Fellows as well as to reflect changes to the IGH programme. As well as receiving training in public health basics, educational theory, QI methodology and project management, the induction includes teaching on the Healthcare Leadership Model and a workshop on critical reflective writing. An evening dinner is held on the first night and each IGH Fellow has an individual Myers- Briggs Type Indicator feedback session. The first new look IGH induction was held in December 2013 and feedback was extremely positive. IGH Fellows Handbook IGH Fellows at the December 2013 induction received the first edition of the revamped IGH Fellows Handbook. This is a new document which brings together all educational, developmental, and M&E requirements, before, during and after placement. It includes a revised Project Plan template with notes, and guidance about writing the two-monthly Monitoring Reports (which have replaced the previous monthly reports) and the final Evaluation Report. The handbook is distributed to Fellows, Mentors and other key stakeholders, and is available as an e-document. It will be updated regularly for each IGH Induction Programme, and further resources will be included e.g. links to useful websites, important information including contact details for the IGH team and their partner organisations, a code of conduct and information on risk reduction while abroad. Mentor Training In response to feedback from IGH Mentors at a focus group meeting in November 2013, and incorporating recommendations from a previous independent evaluation of the programme, an IGH Mentor CPD Event was held in February 2014 in Winchester. The event lasted one day and was facilitated by Andrew Boyd and Lorna Wellsteed, an independent coach. Mentors were provided with an update on recent changes to IGH, such as the Fellows Handbook, and participated in a series of small group activities with the aim of strengthening and developing their effectiveness as Mentors within the IGH setting. The event was a success and another is planned for summer The intention is to run this day twice a year and Mentors will normally be asked to attend annually in order to keep up to date with changes to the IGH programme. Improving Global Health through Leadership Development Annual Report Page 8

9 Major Incident Plan As the IGH programme has grown with an increase in partners and number of Fellows, the IGH team decided to formalise its Major Incident Plan. The plan was written after discussion with the Operational Group. It builds on past risk assessments and has a summary flow chart of what IGH team roles are in the event of a major incident. Following a successful desk exercise to check feasibility, the plan was presented to, and agreed with, the Steering Committee. It will be reviewed every six months, and updated as necessary, and a desk exercise will be carried out annually. The plan is stored on the z drive of the computers at Southern House with a separate copy held on an encrypted memory stick off site. The Major Incident Plan is discussed by way of a case scenario at the Fellows induction course along with a list of instructions of what to do and who to contact in the event of a major incident. Communications A new IGH website, linked to the TVWLA site, went live in February The link is The website has been updated and modernised. Items to be added over the forthcoming months include a calendar on which upcoming events e.g. IGH Presentation Evenings, recruitment of Fellows, relevant conferences etc. can be advertised. The website has an area for blogs as it is hoped to start using blog posts from Fellows, for example to describe a typical day on placement, in the near future. The website will also have password protected portal pages which will store current and previous IGH project plans and reports, so that IGH Fellows and the IGH team will be able to access these documents. There will also be a password protected portal page for the Operational and Steering Groups which will include meeting papers and notes, programme updates and site visit reports. The IGH programme now has a twitter 5. Narrative Reporting on Fellows Projects Below is a summary of the projects IGH Fellows have led, in collaboration with their incountry colleagues, from the beginning of April 2013 until the end of March There are 22 projects in total and they are grouped into partner sites. A. Projects with the MJP Foundation in Samlout, Cambodia i. Postnatal Care To improve postnatal care (PNC), thereby reducing maternal and neonatal mortality and morbidity. This work stream started in late The aim is to establish routine PNC as the norm rather than the exception. Project activities include a pre-intervention audit of the service provided and attendance, a survey of post-partum women, Traditional Birth Attendants (TBAs) and local midwives, and PNC education sessions at TBA meetings. The procurement of national PNC guidelines has proved challenging but WHO resources have been circulated amongst health staff and a PNC checklist, to encourage standardisation of care in the postnatal period, has been written, piloted and distributed. Improving Global Health through Leadership Development Annual Report Page 9

10 ii. Child Nutrition To improve food security and eliminate malnutrition in children under five years of age. Outcomes: 1. Successful running of Baby Friendly Community Initiative (BFCI) programme in eight villages by promoting community ownership. 2. High rates of exclusive breastfeeding in infants less than six months old and correct complimentary feeding in children from six months to two years. 3. Community health workers correctly screening children less than five years of age for acute malnutrition using the mid-upper arm circumference measure. 4. Health staff correctly managing cases of moderate and severe acute malnutrition in children under five. 5. Opportunities for community education maximised and teaching resources available. Nutrition is a long term MJP project which has had IGH Fellow input since BFCI is run by Mothers Support Groups and Bueng Run Health Centre (BRHC) but still relies on MJP health team involvement in all eight villages. The aim is for BFCI to eventually become selfsustaining and owned by the community. Regular screening of children under five years old for malnutrition continues. A nutrition database has been set up and is in use to monitor the growth of local children most at risk of malnutrition. Following official training, four members of health staff are now able to manage cases of severely acutely malnourished children under five without complications using ready to use therapeutic food. The next step will be cascade teaching from these health staff to their colleagues and to the Village Health Support Groups. IGH Fellows have delivered four hours of nutrition teaching to BRHC and Kampong Touk Health Post (KTHP) staff this year in response to their requests for revision on this important topic. iii. Mobiles Uniting Mothers (MUM) Background: In 2012 MJP partnered with a mobile phone company to launch a national programme, Mothers Uniting Mobiles (MUM); a free phone number accessible all over Cambodia providing Interactive Voice Recordings about a number of health topics. The service is aimed at pregnant women and families with children up to five years old. Topics include pregnancy, family planning and health and illness in the under-fives. This year has seen increased collaboration with UNICEF, and national radio, television and billboard campaigns to promote the service. The MUM project is due to be presented in the National Nutrition Working Group meeting in order to increase awareness particularly in the non-governmental organisation (NGO) field. Improving Global Health through Leadership Development Annual Report Page 10

11 iv. Samlout Water, Sanitation and Hygiene Project (S-WASH) To reduce the incidence of hygiene and sanitation related illness in children of Sre Andoung II Primary School (613 children aged between 6 and 15). Outcomes: 1. Sustained improved hygiene and sanitation practices, through behavioural change of primary school children. 2. Availability of well-maintained water, hygiene and sanitation facilities for all children and staff at the school. One fellow worked on this project from September 2013 until February It was then amalgamated into a project known as CHEW (Child Health, Environment and Wellbeing). Progress highlights include the introduction of the tippy tap in the community with the intention of introducing hygienic behaviours at an early age, and a hand hygiene teaching session delivered to Grade 3 children used glo germ to teach about the spread of germs and correct hand washing technique in a child friendly, visual way. Interviews with the school director, five teachers and 20 children also gleaned useful information about attitudes towards hygiene and sanitation. v. Indoor Smoke Pollution Reduction Enterprise (INSPIRE) To reduce mortality and morbidity attributable to indoor air pollution. Outcomes: 1. Decreased source of indoor smoke. 2. Improved ventilation and decreased exposure to indoor smoke. One IGH Fellow led INSPIRE, a new health project, from October 2013 until February 2014, during which time the project was thoroughly delineated. A survey of 100 people brought to light community attitudes towards, and behaviour around, indoor air pollution. Research was conducted e.g. into locally available alternatives to using wood and charcoal as fuels. There were also a number of discussions with stakeholders including the village chief, other NGOs and the MJP Microenterprise Team. A health staff teaching session on respiratory illness and indoor air pollution was given and a promotional video was made. The project has now entered its second phase. From February 2014 the child health portion of INSPIRE has been incorporated into the CHEW project. One Fellow continues to work on the other aspects of INSPIRE. Improving Global Health through Leadership Development Annual Report Page 11

12 vi. Child Health, Environment and Wellbeing (CHEW) As of February 2014 this has become an umbrella project combining S-WASH, the child health aspect of INSPIRE and Child Nutrition. Details of CHEW targets and progress will be included in the 2015 annual report. vii. Youth Empowerment and Special Support (YESS) To improve the wellbeing of vulnerable children and youth (VCY) through societal inclusion, empowerment and meeting basic mental and physical health needs. Outcomes: 1. Increased confidence and competence of healthcare staff in recognising VCY s medical and holistic needs and offering local interventions accordingly. 2. Children and youth directly affected by landmines and road traffic accidents accessing appropriate medical care and follow-up services. 3. VCYs psychologically, emotionally and spiritually supported. 4. VCYs leading physically active and healthy lives through sports and active play. 5. Individual village Action Groups active and supporting VCYs. The YESS project was conceived in late 2012, and has undergone a series of revisions since that time. In its current form it is at the implementation stage, and has the backing of important stakeholders such as the community-led Action Groups. Members of staff at BRHC and KTHP have had a number of teaching sessions on disability, and a promotional day is planned for the wider community to increase awareness about disability and decrease stigma. viii. Improving Cataracts, Astigmatism, and Refractive Errors (ICare) To improve eye care through the recognition and appropriate management of common eye conditions and utilising local services. Improving Global Health through Leadership Development Annual Report Page 12

13 An eye screening program was piloted in Sre Andoung Lower Secondary School; approximately 120 pupils were screened for refractive errors. The pupils also took part in interactive games designed to teach them about looking after their eyes. To strengthen the provision of eye care services in the health care facilities at BRHC and KTHP through health staff capacity building, teaching sessions on the management of common eye problems and how to screen for visual acuity problems took place. The Fellow, who worked on this project from September 2013 until January 2014, collaborated with a local organisation specialising in eye care and managed to establish a relationship which will benefit the community of Samlout in the future. B) Projects with the Department of Health in the Western Cape, in Cape Town, South Africa i. Defaulter Tracing and the Cervical Smear Program To improve the defaulter rate for patients referred to Groote Schuur Hospital from the cervical screening programme for first colposcopy. IGH Fellows worked on this project from November 2012 and handed it over to the local team in August Reasons for the poor defaulter rate were investigated through studying the method of defaulter tracing at secondary care level, auditing nine primary healthcare facilities, patient and nurse questionnaires and compiling a detailed systems analysis. Service improvement recommendations, including a program of systematic nurse re-education across the Western Cape, a flowchart for client tracing and an audit tool to assess number, quality and delivery of results and patient reminders were implemented and the defaulter rate had improved from 52% to 31% by the time IGH Fellow involvement came to an end. Improving Global Health through Leadership Development Annual Report Page 13

14 ii. Learning Development in the Stabilisation of the New-born Clinical Setting To improve the quality of healthcare delivered to new-born babies at Groote Schuur Hospital through enhanced education of medical personnel. Outcome: Development of an educational intervention based on an understanding of how paediatric trainees learn in this environment. Output: Learning Needs Assessment of current Interns and Medical Officers on the University of Cape Town clinical rotation to ascertain how they learn within the stabilisation of the newborn clinical setting (semi-structured in-depth interview). This qualitative information gathering phase of the project was completed in June A strategic plan was created and the project was handed over to the local team to develop and pilot an educational intervention. iii. Use of SBAR as a Structured Communication Tool in the Neonatology Department Goals: 1. To reduce morbidity and mortality in the neonatology department at Groote Schuur Hospital through improved communication, using the tool SBAR (Situation, Background, Assessment and Recommendation). 2. A decrease in unnecessary delays in clinical care due to ineffective communication through increased use of SBAR techniques. Outcomes: 1. Increased use of the structured communication tool, SBAR in the department. 2. Staff seeing benefit of using SBAR and willing to continue to use it when IGH Fellow no longer present in department. One IGH Fellow worked on this project from September 2013 until December 2013, when it was handed over to the local partner. In total, 146 neonatal and obstetric staff members were trained to use SBAR over a total of 26 sessions. In a questionnaire completed by 21 nurses, 17 doctors and 10 midwives, 75% of doctors and nurses in the neonatal department and 90% of midwives reported using SBAR daily or every other day. Nearly 80% of 21 nurses and 71% of 17 senior doctors in a staff questionnaire agreed SBAR had helped with doctors attending more promptly. Over 90% of midwives agreed that SBAR had helped with ease of communication and quality of patient care. Ninety per cent of 21 nurses, 100% of 17 doctors and 100% of 10 midwives agreed SBAR should be taught to incoming staff. The same nurses and doctors were asked how confident they were that SBAR would improve patient safety and that they would implement it in the future; the mean responses were 8.4/10 and 8.3/10 respectively, where 10 was extremely confident. Improving Global Health through Leadership Development Annual Report Page 14

15 iv. Rational Medicine Use To reduce irrational medicine use in the Western Cape Province over a period of one year, thereby reducing unnecessary expenditure in this field. Outcomes: 1. Improved accuracy of documentation on prescriptions. 2. Improved understanding by prescribers (doctors and specialist nurses) and pharmacists of the problems caused by irrational medicine use. This project started in September An audit of 350 patients into the practises of prescribers within the province at the seven tertiary hospitals was conducted and showed that between 20-30% of medications prescribed were being initiated without strong medical requirement. A Rational Medicine Use audit tool and supporting manual were created, and a document outlining the findings of the project and recommendations for the policy framework on behalf of the Health Impact Assessment offices was submitted. Unfortunately a significant delay, beyond the Fellow s control, meant that education sessions she had planned to conduct during her placement did not happen but the policy framework she created included pre-prepared teaching materials to be used in the future. The project was handed over to the Rational Medicine Use Committee (a sub-committee of the Provincial Pharmacy and Therapeutics Committee set up by National Government for the Western Cape region) after four months. News of the project had also reached other facilities in the Western Cape Province and more hospitals and clinics expressed an interest in becoming involved. v. Implementation of a Standardised Empowering Teaching Programme, D- LECA, for New Diabetic Patients To improve the management of type 2 diabetes and its complications in primary care clinics the Western Cape Metro Health District through the Diabetes Lifestyle, Education, Collaboration, Action (D-LECA) programme. Outcomes: 1. Enhanced patient engagement in the management of their diabetes. 2. Improved patient knowledge of diabetic targets, lifestyle measures and how to prevent complications of diabetes. 3. Improved clinical management of type II diabetes and its complications in community health clinics. 4. Improvement in healthcare staff attitudes and knowledge about type 2 diabetes. 5. D-LECA programme self-propagating and, ultimately, self-sustaining in ten community health clinics in Metro District. Three IGH Fellows have worked on this project, which started in September So far the D-LECA programme for newly diagnosed type 2 diabetics has been implemented in three community health clinics, two of which have completed one course of the programme (four months in total with one session every month). Feedback from patients and staff has been extremely positive, and some individuals clinical targets have improved even at this early stage. Improving Global Health through Leadership Development Annual Report Page 15

16 vi. Improving Patient Experience Improved patient-centred care leading to better overall medical care and therefore enhanced health outcomes at The New Somerset Hospital. This project ran from September 2013 to February 2014, when it was handed over to the local partner. It focussed on obtaining narratives of patient and clinician experience of the health care provided in The New Somerset Hospital which is a regional hospital in Cape Town. The Fellow carried out a qualitative research project in collaboration with the Head of Primary Care at University of Cape Town to determine the efficacy of using patient centred experience information to influence healthcare management decisions. The project is currently being written up as a research paper. vii. Maternal, Infant and Child Wellness in the First 1000 Days of Life To improve maternal, infant and child wellness in the Western Cape through the creation and use of a Department of Health Indicator Dashboard Tool to identify the key indicators, gaps in the policies, services and health outcomes. This project started in February Further details are to be included in the IGH Annual Report. viii. An Integrated Maternal and Child Audit Tool To improve maternal and child health in the Western Cape Province by creating a robust audit process to drive quality improvement of the above health programmes. Outcomes: 1. Increased quality of maternal and child health care provided by primary health care facilities in the province, based on gaps in provision of service identified from a maternal and child health audit. Improving Global Health through Leadership Development Annual Report Page 16

17 2. Improved communication and collaboration internally between Health Impact Assessment and Facility Based Programmes, and externally of these directorates with primary health care workers and managers. This project started in March 2014 so further information will be in next year s report. C) Projects with the Department of Health in the Western Cape, in George, South Africa i. Women s Health Provision To improve women s healthcare in Eden District of the Western Cape by targeting service provision, as part of the National Health Insurance pilot scheme. Outcomes: 1. Better access to, and awareness of, primary level services such as family planning, obstetric care, breast and cervical screening. 2. Improved range of women s health services provided at primary level. 3. Locally-agreed audit tool to assess women s health provision at individual primary care clinics in use in Eden District. One IGH Fellow worked on the review and research phase of this project for four months from September Of the seven key women s health areas defined in a situational analysis, an audit tool was created for four: contraception, cervical smear, antenatal care and postnatal care and a further tool was created to assess the overall ability for the primary health clinic to deliver a comprehensive service. In December the audit tool was presented to the Director of Health Impact Assessment for the Western Cape Department of Health, who plans to further develop the tool over a two year period for use in all primary health clinics in the Western Cape, and for it then to be trialled in Cape Town clinics instead of Eden. In March 2014 another IGH Fellow started working on the next stage of the project (An Integrated Maternal and Child Audit Tool for the Western Cape see above). The longer term aim is for the tool to be used in all seven districts of the Western Cape. ii. Decongesting Rural Emergency Centres To improve the effectiveness and efficiency of health care delivery and enhance the patient experience at George Hospital Emergency Centre (EC). Outcomes: 1. Improved waiting environment for patients attending the EC. 2. Improved communication in the EC at handover. 3. Timely and streamlined patient flow from the EC to other clinical areas. Improving Global Health through Leadership Development Annual Report Page 17

18 This project was led by one IGH Fellow from September 2013 until December 2013, and another has taken on the project from February The first phase of the project involved a needs assessment to identify obstructions to timely delivery of care in the EC, and the design and implementation of solutions to speed up the processing of laboratory specimens. iii. Improving Theatre Efficiency To improve theatre efficiency in George Hospital, Eden District. Outcomes: 1. Improved list utilisation. 2. Improved communication between healthcare professionals. 3. Improved patient experience. 4. Reduced number of non-clinical cancellations. One IGH Fellow started work on this project in February 2014 so further details on progress will be reported next year. iv. Assistive Device Provision To improve the quality of the seating services provision across the Eden District. Outcomes: 1. Increased cohesion in basic seating provision across the Eden District (focus on repair services and billing for assistive devices). 2. Improved patient experience accessing basic seating services across the Eden District. 3. Better patient experience at the Intermediate Seating Boutique. 4. Supported transition from secondary care provision of intermediate seating services to the district level. This project commenced in February Progress details will be included in next year s IGH Annual Report. D) Projects with the County Department of Health in Kisumu, Kenya i. An Ambulance Service for Kisumu County To improve pre-hospital emergency services through strategic assessment and cost analysis of the ambulance options available. This project was commenced in March 2014 and the final project plan was incomplete at the time of writing. Details will be in the 2015 IGH Annual Report. Improving Global Health through Leadership Development Annual Report Page 18

19 ii. Community Health Team/Strategy in Kisumu County To improve the services provided by Community Health Workers. This project also started in March Further details will be included in next year s annual report. 6. Learning and Evaluation Dissemination IGH Presentation Evenings took place in April 2013, August 2013, November 2013 and February These are a forum where recently returned IGH Fellows present their experiences during their overseas placement. They present a brief overview of a project they led on, including a description of the QI tools used, identify the leadership skills and behaviours they have developed whilst on placement and how they have used, or propose to use, these additional skills and behaviours now they are back in the UK. The audience includes interested parties such as individuals who want to find out more about the IGH programme, IGH Fellows about to start their placements, returned IGH Fellows, Mentors, members of the Steering Committee and other IGH stakeholders. As mentioned, many returned IGH Fellows are extremely keen to stay involved with the programme by acting as Mentors to new Fellows; this helps to reinforce and draw on the QI, leadership and project management skills they developed whilst on placement themselves. In order to share information about returned IGH Fellows achievements and career progression to inspire newly returned and prospective Fellows, every IGH Presentation Evening now includes a talk from a IGH Fellow, who returned not less than two years ago, to illustrate the impact the Fellowship has had on that individual s career and how they have utilised their experience and enhanced skills to enrich their NHS work. The IGH team also prepares and shares its reports e.g. the IGH Annual Report and the THET Six-Monthly Narrative Report. In addition, the IGH team has had two papers about the programme published in peer-reviewed journals as discussed in previous IGH Annual Reports. As stated previously, IGH Fellows are encouraged to write up their projects and experiences for publication, and to present work at global health, QI or leadership conferences, and there is usually funding available for travel and accommodation expenses to enable this. This year four returned IGH Fellows had a storyboard poster accepted for display at the 25 th Annual Improving Global Health through Leadership Development Annual Report Page 19

20 National Forum of the Institute for Healthcare Improvement (IHI). Details of IGH Fellows and their posters are below under Alumni Update. IGH Fellows are also encouraged to share their experiences and skills learned by presenting in their NHS workplace. This has often resulted in their colleagues applying to the programme! The IGH Programme Director is a member of two national groups - the NHS Staff Volunteering Group and the NHS International Health Group; the purpose of participation in these groups is to be able to influence NHS and the Department of Health for England policy and practice in this area, as well as learn from others who run other overseas health projects. Benefits to NHS Staff The IGH team is exploring ways to capture evidence of transferable skills learned or developed as a result of participation in the scheme which Fellows then use on their return to the NHS. Currently each IGH Fellow has a post-placement interview with his/her Mentor and redoes the NHS Healthcare Leadership Model self-assessment, which gives some information on how the placement experience has influenced him/her immediately but, as yet, the programme team has not systematically gathered evidence of the longer-term impact or any colleague perspectives. Some additional measures being considered are the introduction of an informal post-placement interview between six and 12 months after returning from the placement abroad, and collecting multi-source feedback from the incountry team the IGH Fellow worked with whilst on placement and his/her line manager/employer/training programme director after resuming their NHS post. Nationally the NHS Volunteering Group is developing a tool-kit for this purpose which the IGH team is keen to pilot. Although individual leadership development can be difficult to quantify, the IGH programme has much qualitative evidence of benefit from Fellows reflections on their own personal progress. Here are a few quotes from Fellows reports and Summary Reflective Accounts in : Looking at different project proposals and designing internal and external stakeholder matrices has highlighted to me that in order to make progress within project management and service improvement it is essential to have an understanding of my own role and relationship to the rest of the service. I hope that this has made me more strategic in approaching and analysing issues. I found the Fellowship challenging; it has revealed much needed insights into my leadership style, forced me to confront areas of weakness and allowed me to see greater successes in the achievement of my project outcomes through listening to feedback and modifying and developing my approach. Moving forward I have a greater confidence (and) realise that I need to put myself forward more to take on leadership roles and practice those skills that I have learned. Improving Global Health through Leadership Development Annual Report Page 20

21 practical management at an operational level is something I had never had the opportunity to experience before. As such is was fairly daunting but my confidence in it grew over my time (on placement). Developing a project logic plan in the early stages was a valuable tool is assessing what tasks needed to be achieved and within what time-frame. It also allowed me to consider how to achieve each task I found that by creating a project plan I was able to define the scope of the project...(and) set myself clear objectives. (It was) a slow process but taught me the importance of perseverance in a project as the small changes are still hugely important over a long time especially in chronic disease. I held numerous structured meetings with every level of healthcare delivery in the clinics (and) acknowledged what they felt the issues would be with a new programme and modified it accordingly. This work allowed me to use the physical and human resources in the clinics effectively and allowed implementation with minimal interference to systems already in place. (I now have a ) better understanding of how to improve service provision in my locality and interact better with Clinical Commissioning Groups to balance the needs of my practice population with national budgets and objectives. I visited numerous different clinics and discussed issues around diabetic education with many different health professionals. This allowed project design to be tailored to the structure of the systems in place while taking into account the cultural sensitivities of the patients and nurses. Alumni Update As mentioned, IGH Presentation Evenings now include a keynote speech from an invited guest. During IGH has been delighted to welcome back three returned Fellows who have used their experience with IGH to help them achieve positions of leadership within the NHS. They share their leadership journeys here: Dr Juliette Kemp IGH Fellow in Battambang, Cambodia in 2008 and IGH Mentor (I am now) A newly appointed Anesthetic Consultant for Hampshire Hospitals Foundation Trust. I applied for the IGH programme (as a registrar) with a desire to work in the developing world, but specifically with an organisation which appeared likely to achieve long Improving Global Health through Leadership Development Annual Report Page 21