Clinical Skills and Simulation Strategy August 2010
Contents 2 Forward... 3 Definitions... 4 Introduction... 4 Regional context... 5 Aim... 6 Action Plan... 6 Quality Standards... 7 Regional investment to improve clinical skills provision... 8 Five-year plan...10 Appendix 1...13 Apendix 2... 15 Yorkshire and the Humber Clinical Skills and Simulation Strategy
Forward Healthcare continues to advance at an extraordinary pace. New surgical procedures allowing patients to return home on the day of major surgery are now common place. Procedures only undertaken by junior doctors when I was a house officer are now undertaken by a large range of practitioners. Looking forward, more health care will be delivered in the community with the challenges that brings. Central to these advances is clinical skills and simulation training. Healthcare professionals need to be confident in their own skills. We need to ensure that these skills are undertaken safely and meet a high quality standard. New clinical skills equipment ensures practitioners become competent before undertaking procedures on patients. This will, not only include the practical procedure but other vital parts of care such as infection control, good preparation, good communication with patients and appropriate documentation. High risk industries have long identified, however, that individual tasks are not all that need to be considered for safe practice. Indeed seventy to eighty percent of errors occur due to non-technical skills and human factors, such as teamwork, communication and situational awareness. Healthcare is now learning these lessons from other industries and is using simulation to help address these issues. (Ref The Government Response to the Health Select Committee Report Patient Safety 2009) This document outlines a comprehensive strategy to ensure that quality assured clinical skills and simulation training is provided to all healthcare staff in the Yorkshire and Humber Region. It documents a step by step plan to meet the considerable challenges set out. Once achieved it will ensure training is available for the staff of our region to meet the challenges of 21st Century healthcare and thus bring huge benefits to the patients they care for. Dr Alasdair Strachan Chair, Yorkshire and the Humber Clinical Skills Executive 3 August 2010
Definitions Clinical skills has been defined for this region as any action performed by staff involved in direct care of patients which impacts on clinical outcomes in a measurable way and includes: Cognitive or 'thinking' skills such as clinical reasoning and decision making Non technical skills such as team working and communication Introduction Technical skills such as clinical examination and invasive procedures Simulation can be defined as: a person, device or set of conditions that tries to present problems authentically. The student or trainee is required to respond to the problems as he or she would, under natural circumstances. 4 Every day more than a million people are treated safely and successfully in the NHS. However, the advances in technology and knowledge in recent decades have created an immensely complex healthcare system. The volume and complexity of skills and knowledge of current technical equipment and procedures is evolving at such a pace that it is no longer safe to teach practitioners a skill and assume the knowledge will last for their lifetime. It therefore is reasonable to suggest that essential factors in supporting patient safety within the NHS are education & training, equipment & resources. Education & training: The availability and quality of training programmes for staff can directly affect their ability to perform their job or to respond to difficult or emergency circumstances. The effectiveness of training as a method of safety improvement is influenced by content, delivery style, understanding and assessment of skill acquisition, monitoring and updates. Equipment and resources: Equipment factors include whether the equipment is fit for purpose, whether staff know how to use the equipment, where it is stored and how often it is maintained. Resource factors include the capacity to deliver the care required, budget allocation, staffing allocation and skill mix. In 2008/09, 6,080 claims of clinical negligence and 3,743 claims of non-clinical negligence against NHS bodies were received by the NHS Litigation Authority (NHSLA). This was an increase on 2007/08 figures up from 5,470 claims of clinical negligence and 3,380 claims of non-clinical negligence. 769 million was paid in connection with clinical negligence claims during 2008/09, up from 633 million in 2007/08. (Ref. NHSLA 2009) We need to use modern education techniques if we are to fulfill our ambition to widen participation in learning and to enhance the learning environment for both those in training and those undertaking Continuing Professional Development. We will therefore review the appropriate use of e-learning and other modern education techniques, such as high-fidelity simulation suites, to develop a strategy for the appropriate use of e-learning, simulation, clinical skills facilities and other innovative approaches to healthcare education. (Ref: A High Quality Workforce NHS Next Stage Review, Department of Health, 2008) In 2008 Yorkshire and the Humber Strategic Health Authority (Y&H SHA) commissioned a review into clinical skills and simulation education in the region (Clinical Skills & Simulation in Yorkshire and the Humber, The current situation 2008 2009). This extensive scoping exercise examined the available resources for all healthcare staff working in the NHS and all undergraduate healthcare and medical students in the Higher Education Institutions. In response to the findings of the review, NHS Yorkshire and the Humber committed to the delivery of this Clinical Skills and Simulation Strategy. Yorkshire and the Humber Clinical Skills and Simulation Strategy
Regional Context The Yorkshire and Humber region has a population of 5.12 million and covers an area of 15, 510 square kilometres. This includes major cities such as Hull, Leeds and Sheffield as well as a number of large towns and rural areas with scattered populations, especially in North Yorkshire. The region has both some of the most thriving and some of the most deprived communities in the country. On a typical day in Yorkshire and the Humber: 144,000 patients will visit their GP or community nurse or receive support from mental health services 5,000 people will go to Accident and Emergency of these, 800 will be admitted to hospital. The healthcare workforce The regional healthcare demographic identifies approximately 140,000 NHS healthcare staff (including doctors and dentists) currently working within 14 Primary Care Trusts (PCTs), 6 Mental Health and Social Care Trusts, 1 Ambulance Trust and 15 Acute Trusts. There are 800 GP practices, 750 dental practices & approximately 1700 Care Homes. NHS Yorkshire and the Humber currently commissions health professional education from 9 universities within the region, supporting the training of approx. 20,000 healthcare students at any given time. Meeting the training demands of all the above in relation to clinical skills acquisition & continuing professional development is a substantial requirement. The Chief Medical Officer stated that Simulation offers an important route to safer care for patients and needs to be more fully integrated into the health service. Within the airline industry, using simulation to constantly practice skills and rehearse emergency situations is considered a vital part of air safety. Comparisons have been drawn with healthcare. (Ref DH Safer Medical Practice 2008) Training requirements cannot be met within education institutions alone. The learning to be encouraged in any organisation is life-long. To be enabled to do this, access to quality assured training with modern resources is essential. NHS Yorkshire and the Humber felt it pertinent to identify what was available across the region in order to assess what investment would be required to meet the future clinical skills training needs for its workforce. Regional mapping exercise The regional mapping exercise Clinical Skills and Simulation in Yorkshire and the Humber (June 08 April 09) identified that whilst there were many areas of good practice there was clear evidence that there was a lack of consistency in relation to: The standards of clinical skills education across Service & Higher Education Institutions The training standards of trainers of clinical skills The investment in clinical skills resources training facilities, equipment & staff The access to training provision - both geographically & across disciplines. The adoption of a multi-disciplinary approach where relevant The co-ordination of training provision across providers resulting in duplication, under & overuse of facilities. The provision, standards & maintenance of equipment These findings formed the basis of the regional Clinical Skills and Simulation Strategy. 5 August 2010
Aim/Action Plan 6 Aim To provide direction for the Y&H healthcare workforce to perform all clinical skills procedures safely through simulated techniques that allow patients to be cared for safely by fully trained and competent professionals. This will be achieved through investment in the following to ensure a quality standard across the region; Partnership working & promotion of good practice Establish agreed quality assurance standards for trainers & training across the Yorkshire and the Humber region Sustainable quality clinical skills training facilities delivering equitable access to training across disciplines and organisations Monitoring, evaluation and research Action Plan Partnership working Ensure a sustainable infrastructure that supports partnership working and promotion of good practice Identify key stakeholders 1 Establishment of the Yorkshire and the 2 Humber Clinical Skills Executive Board ensuring representation from all sectors (appendix 1: membership, terms of reference). The function of the Clinical Skills Executive Board will be to advise the NHS Y&H on how best to use the resources available as it is evident that high quality simulated learning environments are vital to deliver fast responsive healthcare services closer to the patient. The group membership will represent the entire workforce with direct patient contact to ensure that the patient remains at the heart of all the progress made. Re - establishment of the Yorkshire and 3 the Humber Clinical Skills Network (CSN) (appendix 2: Membership & terms of reference). The re-established CSN will be supported by the Y&H SHA and will exist to advise and make recommendations to the Executive on issues impacting on the clinical skills trainers and facilities at a local level in the NHS, Higher Education Institutions (HEIs) and independent sector, within the wider regional context. The group will be supportive in nature using forum meetings and electronic medium, where best practice, innovation and research will be shared and encouraged. The network will link to the Clinical Skills Executive Board through working groups where contributions to developments in areas such as quality assurance mechanisms, research and financial investment will benefit clinical skills both locally and nationally. Yorkshire and the Humber Clinical Skills and Simulation Strategy
Action Plan/Quality Standards Establishment of Clinical Skills Project Team 4 The development of a regional clinical skills project team will enable the work undertaken by the Clinical Skill Executive Board and the CSN members to be implemented across the region using the promotion of collaborative work across all healthcare organisations and professional groups. The work will begin following a baseline audit of current provision mapped against the existing information, with needs assessments of the locality to determine the issues and will include assisting with quality assurance processes to unify and monitor the standards of training, leading to improved patient safety and quality of care. The team will analyse the available provision and provide evidence of the investment already made throughout the region. This will include identifying inter-professional learning and working with organisations to identify local solutions to staff attendance and release from the clinical areas to attend training sessions. Areas of best practice will be championed by the team and links to the CSN and Clinical Skills Executive Board will inform all those connected with clinical skills of the existing position on an ongoing basis. The team will provide a framework for the sustainability of clinical skills. Effective Communication Strategy 5 Communication with the wider clinical skills network will be effective through the use of; Website This will be established and supported through the NHS Y&H website initially with the formation of a new, independent website, designed, implemented and maintained by the CSN Newsletter This will be evident on the CSN website Annual Conference The conference will be available and supported by the NHS Y&H with workstreams relevant to the CSN and wider clinical skills training providers such as obstetric emergency training and surgical skills training Influence national developments Opportunities to present the strategy to a wider audience beyond the Y&H region will be embraced Clinical Skills Project Team Will promote clinical skills training and best practice solutions alongside the strategy to all organisations and relevant professional groups in the region Quality Standards Research, consult, develop, recommend, & implement quality standards for clinical skills trainers & programmes Sustainable quality clinical skills training facilities that support equitable access to training across disciplines and organisations Commitment to a 3 year investment plan in a hub-spoke model that will ensure access to a minimum standard of quality training provision across the health economy Establishment of stakeholder sub group to 1 undertake consultation and development of standards Monitor progress and support implementation 2 via the regional quality assurance group and Clinical Skills Executive Board Support the development of a Clinical Skills 3 Passport to provide a mechanism for recording and updating training, with a pilot to explore its potential and use as an electronic tool Develop an audit tool to monitor quality 4 processes 7 August 2010
Regional investment to improve clinical skills provision Investment in identified Hubs Leeds, Hull, Sheffield 1 Sheffield Access to hubs for all healthcare community, internal and external to the organisation identified 8 Hull Leeds Invite proposals from Healthcare Partners to support investment in spoke facilities 2 Potential for income generation with external organisations such as HEIs and independent sectors Cross boundary use by healthcare professionals living within the gographical area of the hub Facilities used by all professional groups within the organisation Central Clinical Skills hub Facilities used by external community based healthcare providers Pre and post registered workforce trained within the facilities Yorkshire and the Humber Clinical Skills and Simulation Strategy
Regional investment to improve clinical skills provision Agree investment with criteria that ensures 3 partnership working, capitalisation of multi disciplinary learning opportunities and responsibility re sustainability Investment in a clinical skills project team to 4 work across the region to support return on the investment and facilitate partnership working Monitoring, evaluation and research Demonstrate return on investment & impact on patient care & safety Ongoing monitoring and evaluation to 1 ensure return on investment utilising contract monitoring processes, clinical skills project team, clinical skills executive and clinical skills network. 2 Investment in a 3 year research project to investigate the impact of the clinical skills strategy on patient care and safety. 9 August 2010
Five-year plan PLAN ACTION 5 year programme To provide comparable clinical skills facilities, equipment and staffing across the region To propose systems to improve sustainability of Clinical Skills training Financial investment in provision Investing in areas with little or no provision NHS & HEIs Financial recognition for organisations already delivering quality training through best practice solutions The development of a Clinical Skills Project team (Clinical Skills Project Workers CSPWs) to deliver the strategic plans Ongoing Bids for funding to be decided by the SMT / Education Commissioning Manager / CSN Executive Group 2010 2015 2010 2013 10 Collaboration of all stakeholders including Acute Trusts PCTs Mental Health / Learning Disabilities Social / Care Trusts Medical & Dental Postgraduate Deanery HEIs Non-NHS organisations Ambulance services Montagu Clinical Simulation Centre Ongoing through CSPW role and CSN Clinical skills passport project manager 2010 2013 Audit of resource usage Evaluate financial investment 2009 2010 initially Ongoing Share all educative resources across the region inclusive of the Medical and Dental Deanery Developing a database of resources Equitable provision and access across the region and all professional groups Clinical Skills Project manager role and CSN Executive Group 2010 2013 Implementation by CSPWs Partnership working with existing CS trainers and Post Graduate Centres Collaborate with the Medical and Dental Deaneries Yorkshire and the Humber Clinical Skills and Simulation Strategy
Five-year plan PLAN ACTION 5 year programme Financial investment in provision / resources from SHA SHA, CSN & Exec Group support and involvement in financial investments / bidding processes Medical and Dental Deanery commitment Ongoing Bids for funding to be decided by the SMT / Education Commissioning Manager / CSN Executive Group / CSPW team Medical and Dental Deanery contribution Support for Clinical Skills Educators from an active and innovative Clinical Skills Network and the Montagu Clinical Simulation Centre (MCSC) A needs analysis of each organisation taking into consideration the diversity of the regions geographic and demographic, healthcare needs. The focus in the coming years will be: Primary care, mental health, social care, nursing homes & hospices, though some work will continue in secondary care Ongoing through the CSN / CSPW role With assistance from the MCSC staff and educators 2010 2013 initially Ongoing assisted by CSPW role Ongoing assisted by CSPW role 11 To improve staff attendance at clinical skills training session, by all appropriate staff / professional groups Investment in Clinical Skills passports Ensuring adequate staffing to deliver training Inter-professional learning Management to encourage staff to attend appropriate training, culture change or mandate clinical skills Share and advise Streamline training Clinical Skills Passport Project Manager 2009 2010 Pilot to involve several organisations and professions Support from the Deaneries Ongoing audit through CSPW team Commitment from the Deaneries Ongoing - supported by the CSPW team August 2010
Five-year plan PLAN ACTION 5 year programme Improvement in patient safety with regionally approved quality assurance measures Support the CSN, sharing best practice and quality assurance measures Quarterly meetings Annual conference supported financially by the NHS Y&H Ongoing financial support from the NHS Yorkshire and the Humber Recognition that patient safety is integral to Clinical Skills training Consistency of standards across the region, between organisations & professions Unified approach to quality standards, Links to / collaboration with HEIs and the Deanery as appropriate Ongoing initial monitoring through CSPW team 2010 2013 audit through CSPW team Standardising protocols / assessment tools 2010 2013 through CS project team 12 Quality assuring the training Monitor standards regionally Ongoing Monitor through CS project team and the MCSC Share quality assurance best practice and identify areas of good practice 2010 2013 through the CSPW role CSN / MCSC Investment in research 2010-2015 investment in research project Risk management input regarding the NHSLA and NPSA Research and development linking clinical skills training to improved patient care and patient safety Ongoing Research investment in research project Yorkshire and the Humber Clinical Skills and Simulation Strategy
Appendix 1 Yorkshire and the Humber Clinical Skills Network Executive Group TERMS OF REFERENCE Mission Statement To ensure the provision of consistent quality assured clinical skills training equips all staff involved in clinical care in the Yorkshire and Humber region to provide safe patient care and minimize risk To ensure Yorkshire and the Humber region is at the forefront of clinical skills training in the modern health service Group Purpose The Yorkshire and the Humber Clinical Skills Executive group will exist to consider and advise the SHA on the issues impacting on clinical skills provision and commissioning within the Yorkshire and Humber Region. In particular the group will: Promote and support partnerships and collaboration between all stakeholders in relation to the provision and development of high quality clinical skills training to support healthcare workforce development Consider and make recommendations to the SHA to ensure appropriately resourced clinical skills training is available and accessible across the Yorkshire and the Humber region Consider and make recommendations regarding the appropriateness and effectiveness of clinical skills training to maximise the use of financial resources Consider and develop quality assurance mechanisms to ensure universal core standards for clinical skills training and promote widespread adoption across the region To consider and develop mechanisms of supporting and disseminating best evidence based practice Consider and respond to emerging policy and agendas (local, national and international) Support, develop and resource research and other initiatives to enhance clinical skills training locally and nationally Identify and commission key work streams identified by Terms of Reference to working groups Act in response to concerns, issues and agendas raised by the Yorkshire and Humber Clinical Skills Network Membership Members must be able to represent and make decisions for their stakeholder group. Membership for those not appointed from a group will be for three years. The members will be expected to attend all the meetings and contribute to the work of the committee. The membership should represent the geographical and varying forms of health care provision and training across Yorkshire and the Humber region. Representatives will be expected to send a deputy if they cannot attend. SHA Education Commissioning Manager Chair Secretary of Y& H CSN One Deanery representative to be appointed by the Postgraduate Dean Chair from Y&H CSN network One representative from Y&H CSN network One Primary Care representative from Provider Services One Primary Care representative from Commissioner Services One secondary care representative - Head of Education One secondary care representative - Risk Manager One secondary care representative - Director of PGDME One representative from Dental Education One representative from the York s & Humber Joint Deans forum Non Medical Education One representative from undergraduate medical education One representative from the Yorkshire Ambulance Services One representative from the Mental Health, learning and disability sector (Other stakeholders as and when appropriate) 13 August 2010
Appendix 1 (continued) Non Attendance: In the event of a representative (or deputy) not attending two meetings in a year the Chair will enquire about that member s ongoing representation at the group Quorate: 66 % Meetings: Quarterly Chair: Appointed by SHA for three years taking recommendations from the Executive committee Administration Secretary of Y&H CSN Accountability and Reporting Relationships: The group is a sub group of the SHA Workforce and Education Directorate Review: Chair/Admin/Terms of reference/membership/attendance to be reviewed annually 14 Yorkshire and the Humber Clinical Skills and Simulation Strategy
Appendix 1 Yorkshire and the Humber Clinical Skills Network TERMS OF REFERENCE Mission Statement To ensure the provision of consistent quality assured clinical skills training based on best practice, equips all staff involved in clinical care in the Yorkshire and Humber region to provide safe patient care and minimize risk To ensure Yorkshire and the Humber region is at the forefront of clinical skills training in the modern health service To provide a support network for all those involved in clinical skills teaching in the Yorkshire and Humber region Definition of Clinical Skills Clinical skills are defined as any action performed by all staff involved in direct patient care, which impacts on clinical outcome in a measurable way. These include: Cognitive or thinking skills (such as clinical reasoning and decision making) Non-technical skills (such as teamworking and communication) Technical skills (such as clinical examination and invasive procedures) Group Purpose The Yorkshire and the Humber Clinical Skills Network will exist to consider and advise the Executive Group on the issues impacting on clinical skills provision and commissioning within the Yorkshire and Humber Region and provide a support network for all those involved in the teaching of clinical skills. In particular the group will: Provide a support network for all those involved in clinical skills teaching. Consider and make recommendations to the Executive Group to ensure appropriately resourced clinical skills training is available and accessible across the Yorkshire and the Humber region Consider and make recommendations regarding the appropriateness and effectiveness of clinical skills training to make best use of financial resources Contribute to the development of quality assurance mechanisms to ensure universal core standards for clinical skills training and promote widespread adoption across the region Support, exchange and disseminate best evidence based practice Identify and contribute to initiatives and areas requiring research to enhance clinical skills training locally and nationally Respond to emerging policy and agendas (local, national and international) Act in response to concerns, issues and agendas raised by members of the Yorkshire and Humber Clinical Skills Network Membership: Open to all individuals who are actively involved in teaching Clinical Skills in the Yorkshire and Humber region Quorate: No quorate required, however general consensus, including the views sent in electronically, should be reached. Meetings: Quarterly, one of which will be in the form of an annual conference funded by the Executive Group Chair: Elected by CSN members for a period of three years Deputy Chair: Elected by CSN members for a period of three years Steering Group: The steering group will constitute the Chair, Deputy and three other elected members who will meet bimonthly in the first instance. 50% attendance at meetings is required. Administration: Secretary of Y&H CSN Accountability and Reporting Relationships: Whilst the CSN is a self governing body the network is accountable to the Executive Group for any incurred expenditure provided as a result of prior agreement. The Chair and one other nominated member of the CSN will sit on the Y&H CSN Executive Group and represent the CSN. Review: Steering Group Membership will be reviewed every 3 years or earlier if a position is vacated. Admin/Terms of reference/membership/attendance will be reviewed annually. August 2010 15
CONTACTING THE SHA WORKFORCE AND EDUCATION TEAM Please phone 0113 295 2152 and we will direct you to the appropriate member of staff. Or visit our website at www.yorksandhumber.nhs.uk Designed by integral design and media www.integraldesignmedia.co.uk