Welcome to the workshop
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- Tobias Edwards
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1 Faculty John Colvin Consultant Anaesthetist and Senior Medical Advisor Scottish Government Health Workforce Daniel MacDonald Workforce Advisor/Programme Director, Scottish Government Health Workforce Emily Broadis Scottish Clinical Leadership Fellow, Scottish Government Health Workforce Andrew Pearson Scottish Clinical Leadership Fellow, Scottish Government Health Workforce/RCoA Neil Ritchie Chief Resident Medicine, QEUH Emily Ward Scottish Clinical Leadership Fellow, Scottish Government Health Workforce/RCPE Lesley Curry Scottish Clinical Leadership Fellow, Scottish Government Health Workforce/NES
2 Welcome to the workshop
3 Outline for this afternoon Overview of PCAT & experience from Acute Medicine, Queen Elizabeth University Hospital Round Table Discussion (40 minutes) Panel Session (25 minutes) Short summary piece from tables Q&A session Round up and Rotapedia Please use the post it notes to write down examples of good practice or difficulties you are facing with regard to working patterns and the environment of trainees
4 Overview of PCAT Why change rotas? What is PCAT? GMC Promoting Excellence Standards Feedback from departments and workshops
5 Why change rotas? Rotas are designed with the available numbers of doctors in training to provide service within the contractual limits of the EWTR and the ND Rotas are designed to empower doctors in training to become Good Doctors
6 Define Good Doctors? Good Doctors make the care of their patients their first concern, they are competent, keep their knowledge and skills up to date, establish and maintain good relationships with patients and colleagues, are honest and trustworthy, and act with integrity and within the law GMC Professionalism in Action
7 Define Good Doctors? Rotas Good Doctors make the care of their patients their first Rotas with Patient at the centre of design concern, they are competent, keep their knowledge and Quality of training: Symbiosis between training and service skills up to date, establish and maintain good relationships Team Cohesiveness and Compassion with patients and colleagues, are honest and trustworthy, Rota Monitoring Process and act with integrity and within the law Workload intensity allows timely breaks GMC Professionalism in Action
8 What is PCAT? Quality Improvement Framework Working environment of Doctors in Training To foster a synergistic relationship between Safe Patient-Centred Care High Quality Training Doctor Health and Well-Being
9 Framework and Themes Patient Safety and Centred Health and Wellbeing Training and Education Post night recovery Timely release of rota Flexibility of annual leave Healthy shift patterns Percentage OOH Re-establishing teams Health and Wellbeing Adequacy of medical staff Adequacy of nursing & AHP staff Workload intensity Preparedness for changes in workload intensity Continuity of care: Turnover of medical staff Safe management of transition phases: induction and handover Trainees actively involved in rota design Formal teaching time is protected Accessibility of study leave Time for non-clinical tasks provided on rota Adequacy of clinical supervision Adequacy of educational supervision Acting up Support Mentorship Structure Formal teaching and planning for unique learning opportunities within the rota
10 The PCAT Process Assessment Trainee Survey Rota Factual Data Analysis & Discussion Data Analysis Data presented back to Trainees, Consultants & Managers Active discussion on how to improve Quality Improvement Quality Improvement Outcomes Identified Quality Improvement Work Commences Agreement of time scales & evaluation process
11 The PCAT Process Assessment Trainee Survey Rota Factual Data Analysis & Discussion Data Analysis Data presented back to Trainees, Consultants & Managers Active discussion on how to improve Quality Improvement Quality Improvement Outcomes Identified Quality Improvement Work Commences Agreement of time scales & evaluation process Active Trainee Engagement throughout entire process
12 PCAT is an Improvement Tool using Structured Conversation The PCAT process gathers data and presents this back to the Unit It brings all relevant parties around a table to discuss the evidence : it provides the space This structured conversation is crucial to enable identification of outcomes and improvements
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14 Formal teaching protected (bleep free) Educational supervision satisfactory FY 2 Yes Agree/Strongly Agree (80%) Neutral (15%%) Disagree/Strongly Disagree (5%) Registrar No Agree/Strongly Agree (75%) Neutral (10%) Disagree/Strongly Disagree (15%) Kept up to date with educational opportunities Attendance at internal teaching sessions Formal teaching quality VG or Excellent Agree/Strongly Agree (90%) Agree/Strongly Agree (85%) All/More than half (70%) Around half (20%) Less than half (10%) Agree/Str Agree (60%) Neutral (40%) More than half (30%) Around half (10%) Less than half (50%) None (10%) Excellent/VG (75%) Neutral (25%) Rota allows easy access to Study leave Neutral (20%) Disagree (60%) Strongly Disagree (20%) Agree (50%) Neutral (22%) Disagree (28%) Audit/research opportunities -Yes and Have -Yes and Have not -No but would have like to -No and do not wish to 30% 25% 40% 5% 80% 0 15% 5% Fictional example of a section of the analysis, presented back to the department
15 Health and Wellbeing Patient Safety and Centred Training and Education Active management of rotas Administration support Filling gaps in advance: pre-empting rota gaps and dedicating funding towards alternative posts to fill them Diverse workforce Focus on workload relevance with respect to training benefit Allied health professionals working at top of skill set Out of hours working Induction Teamwork overnight to address tiredness Rotas which integrate juniors and seniors to ensure support Department handbooks accessible on shared drives Virtual induction programme running all year round Buddy system for new starts Examples of QI work streams from feedback and workshops
16 GMC: Promoting Excellence STANDARDS REQUIREMENTS PCAT DOMAIN S1.1 The learning environment is safe for patients and supportive for learners and educators. The culture is caring, compassionate and provides a good standard of care and experience for patients, carers and families. S1.2 The learning environment and organisational culture value and support education and training so that learners are able to demonstrate what is expected in Good medical practice and to achieve the learning outcomes required by their curriculum. R1.1 Organisations must demonstrate a culture that allows learners and educators to raise concerns about patient safety, and the standard of care or of education and training, openly and safely without fear of adverse consequences. R1.2 Organisations must investigate and take appropriate action locally to make sure concerns are properly dealt with. Concerns affecting the safety of patients or learners must be addressed immediately and effectively. R1.3 Organisations must demonstrate a culture that investigates and learns from mistakes and reflects on incidents and near misses. Learning will be facilitated through effective reporting mechanisms, feedback and local clinical governance activities. 1.3a Workload intensity Day 1.3b Workload intensity Night 1.4 Preparedness for changes in workload intensity 1.6 Safe management of transition phases: handover and change over 2.4a Adequacy of clinical supervision 2.5 Acting up Support 2.6 Mentorship Structure 1.4 Preparedness for changes in workload intensity 1.6 Safe management of transition phases: handover and change over 2.2a Formal teaching time is protected 2.3 Time for non-clinical tasks is provided on rota 2.6 Mentorship Structure Department work streams can be mapped to the GMC Standards, useful for communication to external bodies
17 Contractual Compliance At what cost? Welcome from the PCAT Team
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19 Assess the ability of rotas to provide an environment that fosters professional behaviour amongst doctors in training Support trainees to act as rota guardians Aims of PCAT Benchmark rotas across Scotland to highlight good and bad practices Provide a framework for supporting improvement and disseminating good practices in rota design
20 Don t find fault, find a remedy: Anybody can complain. Henry Ford
21 The PCAT Process Assessment Trainee Survey Rota Factual Data Analysis & Discussion Data Analysis Data presented back to Trainees, Consultants & Managers Active discussion on how to improve Quality Improvement Quality Improvement Outcomes Identified Quality Improvement Work Commences Agreement of time scales & evaluation process
22 Seek first to understand, then to be understood. Stephen Covey
23 Framework and Themes Patient Safety and Centred Health and Wellbeing Training and Education Post night recovery Timely release of rota Flexibility of annual leave Healthy shift patterns Percentage OOH Re-establishing teams Health and Wellbeing Adequacy of medical staff Adequacy of nursing & AHP staff Workload intensity Preparedness for changes in workload intensity Continuity of care: Turnover of medical staff Safe management of transition phases: induction and handover Trainees actively involved in rota design Formal teaching time is protected Accessibility of study leave Time for non-clinical tasks provided on rota Adequacy of clinical supervision Adequacy of educational supervision Acting up Support Mentorship Structure Formal teaching and planning for unique learning opportunities within the rota
24 One good conversation can shift the direction of change forever. Linda Lambert
25 Why is PCAT relevant? Recruitment and Retention EWTR and ND does not guarantee high quality Practices vary widely Areas with poor recruitment and retention quote rota issues as a major factor GMC Visit to Scotland Deanery in 2017 Promoting Excellence: Standards for Medical Education and Training Workforce 2020 Vision and Realistic Medicine Scottish Government
26 PCAT Support Package PCAT Champions: Key personnel who deliver initial PCAT training Rotapedia* Intelligent Rota Design Guide Rota Guardian Network: Lead trainees are encouraged to share ideas Best Practice Library: Educational and Support Resources *Website currently under construction
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