National Leadership and Innovation Centre for Nursing and Midwifery, ONMSD, HSE Clinical Leadership Competency eportfolio Implementation Report
Clinical Leadership Competency eportfolio Implementation Report 2017 About this Report: This report includes details of the implementation of the Clinical Leadership Competency e Portfolio (CLCeP) from August 2015 to March 2017. The CLCeP is an e learning resource and e portfolio which is available on www.hseland.ie and is accessible to every nurse and midwife in Ireland. This report was prepared by the National Leadership and Innovation Centre for Nursing and Midwifery, Office of the Nursing and Midwifery Service Director, HSE. Suggested Citation: National Leadership and Innovation Centre for Nursing and Midwifery (2017) Clinical Leadership Competency eportfolio Implementation Report 2015 to 2017. Dublin: Health Service Executive. Health Service Executive ISBN 978-1-78602-058-1 2
Contents Introduction... 5 Phase 1: Awareness Campaign (Aug 2015 to May 2016)... 5 Impact of Awareness Sessions... 6 Evaluations from Information Sessions... 7 Participants Feedback... 7 Recommendations... 7 Phase 2: Supporting staff to actively engage with the CLCeP... 8 Implementation Science... 8 Using the PARIHS Framework to guide implementation of CLCeP... 8 Evidence... 8 Context... 8 Culture... 9 Leadership... 9 Evaluation... 10 Facilitation... 10 3
Strategies used for Implementation of the CLCeP... 10 1. Promoting ongoing awareness of the CLCeP... 10 2. Collaboration with the Nursing and Midwifery Board of Ireland... 11 3. Higher Education Institutes (HEI s)... 11 4. National Clinical Leadership Competency Programme for Staff Nurses and Staff Midwives... 11 5. Future Nurse Leaders Self Awareness Competency Project... 11 6. Clinical Leadership Competency Workshops... 12 7. Bespoke Clinical Leadership Competency Programme... 12 Impact of Implementation to date... 13 Conclusion and Future Direction... 14 Acknowledgements... 15 Appendix 1... 16 Appendix 2... 18 References... 19 This report was compiled by Marie Kilduff, CLCeP National Lead on behalf of the National Leadership and Innovation Centre for Nursing and Midwifery. 4
Introduction The Clinical Leadership Competency eportfolio The key priority of the National Leadership and Innovation Centre for Nursing and Midwifery (NLIC) Office of the Nursing and Midwifery Services Director, HSE, is leadership and innovation development. To this end, in 2013, the NLIC developed the on-line resources, the Clinical Leadership Competency eportfolio (CLCeP), a high quality; evidence based clinical leadership e- learning resource and e portfolio, incorporating 7 competencies. Development was supported by contributions from nurses and midwives from all sectors and grades, national and international experts in leadership and online learning resource professionals. It was launched and became live on HSELanD (HSE online learning portal) in May 2015. Implementation began in August 2015. Initially the main aim was to inform staff about the resource and therefore phase 1 of implementation, an awareness campaign, took place from August 2015 to May 2017. Phase 2 of the implementation began in June 2016 which aimed to support staff to actively engage with the CLCeP. To execute this plan effectively, implementation science research was used together with the recommendations from staff who attended the information sessions during phase 1. Phase 1: Awareness Campaign (Aug 2015 to May 2016) This phase had a dual purpose a) to raise awareness of the need for nurses and midwives to develop effective leadership competencies and b) to raise awareness of the availability, design, content and value of the CLCeP. Engagement strategies included inviting nurses and midwives to attend one of a number of CLCeP information sessions offered nationally (Appendix 1), in which a comprehensive overview of the resource was presented. From August 2015 to the end of phase 1 in May 2016, 593 staff had attended these information sessions. The number of staff who attended per grade is presented in Figure 1 and the profile of staff who attended per discipline is presented in Figure 2. Figure 1: Overview of attendance, per grade at information sessions (n = 593) 5
Figure 2: Profile of staff per discipline, at Information Sessions ( N=593) per discipline Impact of Awareness Sessions At the end of phase one, in June 2016, 2,205 staff had engaged with the CLCeP (Figure 3). Figure 3: Number of staff per grade, engaged in the CLCeP June 2016 6
Evaluations from Information Sessions The feedback from staff who attended the CLCeP sessions demonstrated that the short introductory sessions enabled participants to engage with the CLCeP (Figure 4) and understand the benefits of doing so (Figure 5). Figure 4 Figure 5 Participants Feedback Very informative, well presented, motivates you to engage with the CLCeP Great resource, excellent presentation, I will definitely use the CLCeP I wish I had the CLCeP when I first qualified, it would have been invaluable for my personal and professional development Very valuable resource, timely, will help to develop clinical leadership knowledge and skills. Great resource for interview skills and reflection Recommendations The recommendations from staff attending the sessions led to the following changes to the CLCeP in June 2016: Approval was sought and given from NMBI to increase the Continuing Education Units (CEUs) for the on line presentations from 1.5 to 3 CEUs per competency (21 CEUs in total) 7
A folder was added to the resource called my files where evidence of CPD relating to all personal and professional development can be recorded and saved e.g. clinical skill competencies A number of adjustments were made to the CLCeP site on HSELanD, to facilitate easy access by all staff and organisations. Phase 2: Supporting staff to actively engage with the CLCeP While initially the focus of implementation was to raise awareness, in June 2016, phase 2 of implementation began. The main aim of this phase was to support staff to actively engage with the CLCeP and to apply the knowledge to practice. In order to do this effectively, significant time was invested in exploring the literature on implementation science to identify an appropriate implementation framework for the CLCeP. Implementation Science Implementation science is the theoretical approach to understanding, reflecting on, planning and evaluating implementation (Babbie 2013, Rycroft-Malone 2014). Nilsen (2015) describes it as the scientific study of techniques that can support the systematic uptake of evidence based research into routine practice to improve outcomes and quality. Having reviewed the literature on implementation science, the Promoting Action on Research Implementation Health Services framework (PARIHS) was chosen to contextualise and frame the CLCeP. The PARIHS framework presents successful research implementation as being reliant on the relationship between high levels of evidence, context and facilitation. Using the PARIHS Framework to guide implementation of CLCeP Evidence The PARIHS framework proposes that implementation of any new practice should be based on knowledge derived from a variety of sources, has been subjected to testing and has been found to be credible (Rycroft-Malone, 2004). On reviewing the evolution of the CLCeP, it is evident that a multi-faceted approach was used to develop and test it which resulted in a high quality elearning resource with eportfolio. The evaluations from the information sessions demonstrated that participants felt that it offered a practical, flexible and user-friendly format for building clinical leadership competency. The recommendations from these evaluations informed phase 2 of the implementation process. Context In the PARIHS framework, the term context is used to refer to the environment or setting in which new evidence or change is to be implemented into practice. Within the framework, the contextual 8
factors that promote the successful implementation of evidence into practice fall into 3 broad themes of culture, leadership and evaluation. Culture From a national perspective, nurses and midwives from all grades have been considerably challenged in the past decade to continue to deliver high quality, safe care in a culture of significantly reduced staffing levels, limited financial resources and little opportunity for professional development. The findings from the Health Service Employee Survey (2014) demonstrated the need to reconnect with leadership, enhance communications, exhibit staff value and maximise staff potential. The recently published Framework for improving quality in our Health Services (2016) clearly demonstrates the need for effective leadership and leadership development strategies. The CLCeP is an ideal tool to support nurses and midwives to enhance their clinical leadership competencies so that they can reshape the culture to one where staff development and quality of care can flourish. In line with the Nurses and Midwives Act (2011), each nurse and midwife must maintain their professional competency on an ongoing basis (Government of Ireland 2011, Part II 87 (1) yet to be enacted). This change to the regulation of the Nursing and Midwifery profession has resulted in a culture where staff are conscious that in the future an NMBI competency assurance process will be implemented. Therefore, it is an opportune time for the NLIC to promote the CLCeP and for managers to encourage staff to use the CLCeP to support and maintain their professional competency and demonstrate continuing professional development. Leadership Leaders have a key role to play in transforming the culture to create contexts that are more conducive to the integration of evidence into practice (Rycroft-Malone, 2004). During phase 1, considerable time was invested in building relationships with senior nursing and midwifery leaders and managers across the services. Building good working relationships within services has been critical to the success of this phase. The success of these collaborations is measured by the number of leaders and manager requesting that their organisations be used as pilot sites for phase 2. Effective engagement with these leaders is vital as they are ideally positioned to influence and support phase 2 and ultimately embed the CLCeP into their services. In October 2016, a CLCeP Think Tank Day was held with nursing and midwifery leaders to explore the future direction of the CLCeP. It was evident that the CLCeP is recognised as a valuable resource with the potential to support nurses and midwives to engage with clinical leadership and Continuing Professional Development. A number of strategies to support implementation were explored. These include the introduction of the CLCeP to undergraduate and postgraduate nursing and midwifery programme participants and continued implementation in the services. 9
Evaluation Measurement generates evidence in which to base practice and is part of the feedback process which demonstrates if changes to practice are effective and efficient (Rycroft-Malone 2004). A critical role for the NLIC is to develop a culture of evaluation around the CLCeP Therefore an integral part of phase 2 will be the development and use of appropriate methods of evaluation for all initiatives. Facilitation In the context of the PARIHS framework, facilitation refers to the process of enabling the implementation of evidence into practice. Facilitators are those with the appropriate roles, skills and knowledge to support individuals, teams and organisations to apply evidence to practice (Rycroft-Malone, 2004). In phase 2, the successful implementation of the CLCeP is dependent on the support of nurse and midwife educators and facilitators nationally. These key stakeholders will be included in the planning and delivery of all implementation initiatives to ensure sustainability of this valuable resource going forward. It was evident from the feedback from the awareness sessions and collaboration with nurse and midwife leaders that staff require support to actively engage in leadership competency development. Taking this feedback and all aspects of the PARIHS framework into consideration, a multifaceted approach is now applied to implementation. Strategies used for Implementation of the CLCeP 1. Promoting ongoing awareness of the CLCeP While the long term provision of single site awareness sessions was deemed unsustainable due to the very significant time commitment, the NLIC continues to raise awareness of the CLCeP activities which include: CLCeP flyers are consistently disseminated at Nursing and Midwifery conferences, forums and events nationally Articles are published in the World of Irish Nursing and national and regional HSE newsletters Other promotion activity include; CLCeP presentations at national conferences e.g. RCSI Leadership conference, RCSI eportfolio Masterclass, Mental Health Conference. Presentations are also delivered to specialist nursing and midwifery groups e.g. The Irish Nursing and Midwifery Practice Development Association, Primary Care Diabetes Nurse Network, Irish Cancer Society Nurses In 2016, the NLIC commissioned a short video which provides a comprehensive overview of the CLCeP. The video is now shown at all NLIC events and programmes. The link to the video was circulated to all key stakeholders and is available on the NLIC website 10
To ensure sustainability and to keep pace with new information, the online resources are reviewed and updated bi annually. 2. Collaboration with the Nursing and Midwifery Board of Ireland There is ongoing collaboration between the Nursing and Midwifery Board of Ireland (NMBI) and NLIC to explore how the CLCeP can support the pending competency assurance process. 3. Higher Education Institutes (HEI s) Throughout 2016 and 2017, CLCeP presentations were delivered to both undergraduate and postgraduate nursing and midwifery students. The HEI s have access to the CLCeP which can be used to underpin leadership master classes or as a blended learning component for their leadership modules. The feedback from students suggest they recognised the value of the CLCeP, both as a formal and informal learning opportunity and as a support to record evidence of their personal, academic and professional development. 4. National Clinical Leadership Competency Programme for Staff Nurses and Staff Midwives A 2.5 day Clinical Leadership Competency programme is currently being designed for staff nurses, staff midwives, CNM 1 & CNM 2 s (and equivalent grades). The content of the programme will include all 7 competencies. Prior to commencing the programme, participants will be required to register on HSELanD and view the on-line CLCeP user guide and/or navigation video. They will also be required to complete the Assess stage of the Self-Awareness competency. A pilot programme will be delivered to staff nurses and staff midwives from one acute hospital group in May 2017. Following evaluation, the programme will be available for national rollout. 5. Future Nurse Leaders Self Awareness Competency Project Self Awareness 1 is one of the 7 competencies in the CLCeP. As part of the Future Leaders Programme (FLP) 2 in 2016, a project group, in which 6 FNL nurse leaders and 12 staff (n= 18) from six different Health Care organisations, engaged with the self awareness competency. The outcomes were evaluated using a pre/post questionnaire. The findings (Figure 6) demonstrate that all participants showed growth and improvement in all the behavioural indicators for this competency. The findings were presented at the Future Nurse Leaders Forum day in the RCSI in Sept 2016. 1 A common observation made by many who contributed data for the evaluation of the National Clinical Leadership Development Project Pilot (2011) was that self-awareness underpinned all other competencies. It was recommended that consideration be given as to whether self-awareness should be the starting point in the Clinical Leader Development Pathway for participants 2 The NLIC have commissioned the Institute of Leadership to deliver the Future Leaders Programme to senior nurses and midwives. 11
Figure 6: Self Awareness Pre/Post Questionnaire Following on from the RSCI project, the NLIC has received a number of requests from Directors of Nursing and Midwifery to discuss how they can support their staff to engage with the CLCeP and in particular the self-awareness competency. In response, the NLIC have designed a self-awareness workshop which will be piloted with staff from an acute hospital in Q3 2017. Prior to attending the workshop staff are requested to complete self awareness competency assessment. A pre/post questionnaire will be use to evaluate the impact of this initiative. This workshop will be available to facilitators and educators to support blended learning in their organisations. 6. Clinical Leadership Competency Workshops Workshops have been developed on clinical leadership and for each of the 7 clinical leadership competencies. These workshops have been designed to meet the needs of staff so that they can be implemented independently, in combination, or as blended learning. Each workshop had been independently approved for CEUs by NMBI. 7. Bespoke Clinical Leadership Competency Programme The NLIC designed a bespoke 8 day Clinical Leadership Development programme for Clinical and Social Care Managers from Intellectual Disability Services. This programme was co designed with participants in order to meet their leadership and Person in Charge role. All participants agreed to engage in each of the 8 workshops as part of their programme. As a requirement of the programme, all participants are completing the on-line selfawareness competency over the course of the programme. They also complete the assess stage of each competency prior to attending the relevant workshop. On completion of the 12
programme, participants will re assess themselves on all 7 competencies and submit their pre/post scores so that the data can be evaluated to identify what changes may have occurred in each competency. Figure 7: Overview of Bespoke Clinical Leadership Competency Programme for Staff from Intellectual Disability Services Date 22 nd Nov 2016 23 rd Nov 2016 6 th Dec 2016 10 th Jan 2017 7 th Feb 2017 7 th Mar 2017 28 th Mar 2017 25 th April 2017 Am Clinical Leadership Workshop Self Awareness Workshop Q & S Workshop Communication Workshop Decision Making Workshop Advocacy Workshop Empower ment Workshop Team Work Work shop Pm Needs Led Needs Led Needs Led Needs Led Needs Led Needs Led Needs Led Needs Led In relation to phase 2 of implementation process, it is imperative that facilitators are key stakeholders in planned initiatives, for spread and sustainability. It is envisaged that following initial support, these facilitators will deliver these workshops to embed the CLCeP into the future. Discussions are ongoing in this regard. Impact of Implementation to date A summary of the initiatives used for implementation of the CLCeP are presented in Appendix 2. To date, it is evident from the increasing numbers of nurses and staff who have engaged with the CLCeP from June 2016 (n = 2, 205) to March 2017 (n = 5, 572) that the initiatives being used to actively encourage staff to engage in the CLCeP are achieving success. It is important to acknowledge the numbers of non nursing and midwifery staff who engaged with the CLCeP (n= 1675) as this demonstrates the potential for the CLCeP to be used by other health care professionals, as a multidisciplinary elearning resource and eportfolio. 13
Figure 8: Number of nurses and midwives actively engaged in competency development using the CLCeP (Total = 5, 572) March 2017 Conclusion and Future Direction In conclusion, the PARIHS framework is being used to contextualise and frame the CLCeP. Having reflected on the preceding account, it is proposed that phase 2 of implementation will continue to focus the following key areas: 1. Continue to raise awareness using marketing materials such as using the CLCeP video at NLIC events 2. Continue to present at relevant nursing and midwifery conferences and other events 3. Deliver the CLCeP workshops and use the data obtained from evaluations to measure the impact of engaging with the CLCeP over a 6 month period 4. Complete the pilot 2.5 day Clinical Leadership Competency Programme for nurses and midwives and following evaluation, implement recommendations and roll out this programme nationally 5. Evaluate the pilot Clinical Leadership Programme for Nursing and Social Care Managers from ID Services and use the relevant data to evaluate the leadership competency workshop component 6. Continue to deliver presentations on both undergraduate and post graduate programmes in the Higher Education Institutes 14
7. Continue to liaise with key stakeholders, including those in education and practice development, to encourage and support them to use the CLCeP to underpin other relevant programmes/courses in a blended learning approach. Acknowledgements The NLIC would like to acknowledge all those who were involved in the development and publication of the National Clinical Leadership Competency Framework (NCLCF) (HSE 2010) and the subsequent pilot by HSE South (2011). The NLIC would also like thank the national and international experts who contributed to and supported the development of the CLCeP. The NLIC would like to express sincere gratitude to Directors and staff of Nursing and Midwifery Planning and Development Units and Centres for Nursing and Midwifery Education, Directors Nursing and Midwifery, Clinical and Service Managers, frontline staff, undergraduate and postgraduate students for all their support. This support is critical for the implementation and uptake of the CLCeP. We would also like to acknowledge the manager and design team of HSELanD for their support and guidance. 15
Appendix 1 Phase 1: Information Sessions Delivered Nationally Total No of Attendees: 596 DATE SITE 1. 06/08/2015 Dublin North East Community 2. 11/08/2015 Irish Cancer Society 3. 20/08/2015 NMPDU Cork/Kerry 4. 25/08/2015 Dublin North East Community, Ballymun Community Area 5. 28/08/2015 Clonskeagh/Dalkey OPS 6. 03/09/2015 CNM 2, Supportive peer network for CNM s 7. 09/09/2015 Dublin North City, Mental Health Services 8. 29/09/2015 Mercy University Hospital/SIVUH 9. 30/09/2015 Peamount Health Care 10. 01/10/2015 8/10/2015 Mater Misericordiae University Hosptial 11. 09/10/2015 James Connolly Memorial Hospital 12. 14/10/2015 CNME Galway 13. 14/10/2015 Midlands Regional hospital, Mullingar 14. 15/10/2015 St James's hospital 15. 16/10/2015 Wexford General Hospital, 16. 20/10/2015 Merlin Park 16
17. 21/10/2015 Midlands Regional hospital, Portlaois 18. 27/10/2015 NMPDU Ardee 19. 29/10/2015 NMPDU Dublin Mid Leinster, Stewart's Hospital, HSE Boardroom 20. 08/10/2015 Mayo, CNME 21. 18/11/2015 Derg Centre, Nenagh 22. 19/11/2015 Sligo - CNME 23. 20/11/2015 Letterkenny CNME 24. 25/11/2015 St Brendan's, Lough Rea 25. 25/11/2015 Tallaght Hospital 26. 30/11/2015 CNME, UL Hospital, Dooradoyle 27. 01/12/2015 Daughters of Charity 28. 09/12/2015 Portiuncula 29. 19/01/2016 NMBI Meeting 2 30. 20/01/2016 Daughters of Charity, Navan Rd 31. 21/01/2016 Daughters of Charity, Glenmaroon, St Joseph's, Clonsilla 32. 05/01/2016 Stewart's Hospital Palmerstown 33. 24/02/2016 Dublin North City Older Person's Services, St Mary's Hosptial, Pheonix Park 34. 18/5/2016 Daughters of Charity Services Roscrea, Limerick & Dublin (Venue: Portlaoise) 17
Appendix 2 CLCeP Implementation Aug 2015 to Mar 2017 Action Dates Status CLCeP Information Sessions Aug 2015 to May 2016 Complete to 593 nurses & midwives nationally Distribution of CLCeP August 2015 to Present Ongoing marketing material Presentations on CLCeP at August 2015 to Present Ongoing forums, conferences etc Articles Published in World of 2016 Complete Irish Nursing & ONMSD Newsletter CLCeP Video developed by digital marketing company July 2016 Complete Updating of CLCeP Online 2016 &2017 O Ongoing Resources Collaboration with NMBI Meetings in 2016 &2017 OnO Ongoing going Future Nurse Leader Self Jan to Sept 2016 Complete Awareness Project CLCeP Think Tank Day Oct 2016 Complete CLCeP presentations to undergraduate and postgraduate nursing and midwifery students CLCeP Workshops developed and delivered Clinical Leadership Competency Programme developed and tested for Staff Nurses and Staff Midwives Self Awareness Competency Workshop Pilot 2016 & 2017 Ongoing Nov 2016 to May 2017 (Pilot site: St Michael s House & Daughters of Charity) Mar 2017 to Oct 2017 (Pilot site: Saolta Group) Sept 2017 (Pilot site: Naas General Hospital) Ongoing Ongoing Ongoing 18
References Babbie, E. (2013) Social Research Counts. Wadsworth: Cengage Learning. Health Service Executive (2015) Have Your Say: The Health Service Executive Survey 2014 Report of Findings. Dublin. Available online from: http;//www.hse.ie/employeesurvey/ Health Service Executive (2016) The Framework for Improving Quality in our Health Service. HSE, Dublin. Nilsen, P. (2015) 'Making sense of implementation theories, models and frameworks', Implementation Science, 10(53). Rycroft-Malone, J. (2004) 'The PARIHS framework - A Framework for Guiding the Implementation of Evidence-based Practice', Journal of Nursing Care Quality, 19(4), pp. 297-304. 19
ISBN 978-1-78602-058-1