Health Sciences and Practice Subject Centre

1. Health Sciences and Practice Subject Centre Mental Health Special Interest Group 22nd April 2009 Judith Ball and Candi Kitt

2. Joining up the dots…Action Research Improving mental health patient safety within pre-registration nurse training. Judith Ball and Candi Kitt

3. Outline of session • Awareness of the NHSI project • Role of Edge Hill University • Curriculum • Patient Safety • Action Learning • Student Projects

4. National Health Service Institute for Innovation and Improvement • The mission of the NHSI is to support the NHS and its workforce in the delivery of world class health care for patients and the public by encouraging innovation and capability at the front line. ( NHSI, 2005) • “…to create an environment that motivates and indeed, inspires them to insist that all care must be as safe as possible.” ( Liam Donaldson, 2006)

5. Pilot site for NHSI • Edge Hill University chosen as a third phase HEI of the national project. • Sept 2007 – March 2008 • Patient Safety focus • Across all branches of pre registration nursing • Diplomat and undergraduate provision.

6. Embedded in Curriculum • The pilot project has now concluded. • The evaluation of the project at Edge Hill recommended that action learning as a teaching and learning strategy be embedded within the curriculum. • Patient Safety is to be the main driver. • Developing qualities for future nurses leadership role, health improvement and patient safety.

7. Introducing Action Learning By introducing action learning at the penultimate module stage of the curriculum the students have been introduced to a new way of thinking and learning. This has not been without difficulties. Student nurses to this point have been taught within a problem based learning pedagogical approach. To now turn towards a new and more critical way of thinking, is clearly more challenging. Footer Info Here

8. Action Research to Action Learning According to McNiff (2002) action research is a concept that refers to a process of people taking action on a problematic situation. They think about what they are doing and decide that they may be able to do it in a different way. They try it out and then reflect upon that action. They will then continue with what they now feel is better practice, however, they will always remain aware that reflection and modification of practice may be up dating as and when the situation arises. Footer Info Here

9. Action Research to Action Learning Therefore, by identifying an issue, in our instance patient safety, reflecting upon it and putting an action plan into place, one can draw parallels with the principles of Action Research (McNiff and Whitehead, 2002) Footer Info Here

10. Why patient safety ? • Improving the safety of patient care is a significant challenge for the NHS. • The challenge is to ensure that patient safety is at the heart of the healthcare agenda. • “..the impact on patients and their families. They are the ones who are harmed and sometimes die as a result of unsafe care. They are the stark reality of patient safety and the human face behind the statistics.” ( Liam Donaldson, 2006)

11. Action Learning Originated in the 1940s by RegRevans for National Coal Board. Roots in management, business and industry (Revans 1982) Used more recently within NHS and is seen as the ‘continuous process of learning and reflection supported by set members, with the intention of getting things done’ McGill & Beatty 1995:21

12. Action Learning • Action learning is a student-centred learning method, which promotes a range of transferable skills and is firmly grounded in the world of work. • These are skills which are usefully transferred into practice as a senior student and as a newly qualified practitioner, problem solving and working collaboratively within a multidisciplinary team.  • Learning with and from others on real problems which will be significant for the future safety of patients is an exciting and worthwhile opportunity. 

13. Action Learning Exactly as it sounds – action and learning! “There is no learning without action and no action without learning” (Revans 1998). So carrying out the solution (the action) is an important part of the learning process.

14. Process of Action Learning Sets (ALS) • Weinstein (1999) points to the very real benefits of action learning as a “way of learning from our actions, and from what happens to us, and around us, by taking the time to question, understand and reflect, to gain insight, and to consider how to act in the future”.

15. Action Learning Based on the principles that people learn from: Experience By doing By working together and collaborating in reflective groups to solve their own issues

16. ALS IS NOT ….. • Problem based learning(PBL) – in PBL the group is given a scenario, ALS problems are real, the student has ownership. • Clinical supervision – ‘ a formal process of professional support and learning which enables individuals to develop knowledge and competence, assume responsibility for practice and enhance client protection and safety’ (NHS Management Executive 1993)

17. How it Works Action learning has a distinct structure The individual brings real problems/ issues to the set. Set – a group of no more than 8 who work together to throw light on issues. Facilitator –to chair, observe and be a catalyst although groups can be self- facilitated.

18. How it looks … 4 set meetings with a final 20 minute summative presentation. All meetings facilitated. 1. Contract setting 2, 3, 4 – development of issues, agree action plan. Set members to work together to share ideas and experience, provide support and motivation, explore problem- solving.

19. Assignment • Analyse of a patient story for improvement opportunities. • Rationale for the chosen area with clear links to the area of patient safety issue. • Identification of service improvement tools and models. • Analysis of the key areas to support and sustain collaborative service improvement. • Reflection on the students personal learning from this project.

20. Patient Journey Background to the patient journey Whom or what have they chosen? Why ? What issues there are with this choice?

21. Rationale for the change Link it to the issues of patient safety in practice with the patient or area. What are the national drivers / NSF / ECC / NICE guidelines /policies and procedures? What are the national and local statistics for the area being looked at. Look at the Dept of Health major documents surrounding chosen area. Do not forget the issues surrounding risk.

22. Improvement Tools Before moving into the improvement models, students are advised to utilise tools to help narrow the issue down and focus their viability before moving into the model of improvement. Circles of Influence SWOT analysis SMART Objectives

23. Circles of Influence What I have no influence over What do I have control over

24. SWOT Analysis Swot Analysis is a powerful technique for identifying strengths and weaknesses, and the opportunities and threats faced with starting a project.

25. SMART This tool narrows down the issue due to the large scale involved. Specific – Be specific in your goals and objectives. Measure – How will you measure your outcomes? What will you be able to measure your change against? Achievable – What can you do within the time you have in this placement? Realistic – You are not changing the world!!! Timescale – Realistic time scale.

26. Models of Improvement Once they have utilised the tools to help identify if the project is viable then they will also be able to identify which improvement model is most For example Lewins or PDSA.

27. Improvement Models Unfreezing Change Refreezing Lewins Model of Change www.mindtools.com ( accessed 7/10/08)

28. PDSA www.scotland.gov/reseoucce/image accessed 7/10/08)

29. Plan the next change cycle and reflect on what has been learnt Plan the change to be tested or implemented Plan Act PDSA Model Study data before and After the change and reflect on what has been learnt Carry out the test Or the change Do Study

30. The analysis of the key areas How could you keep the change going! Issues surrounding sustainability. What resources you needed or may need? What collaboration is needed – who has been involved and who would need to be involved for this to happen. REMEMBER to think about audits. This is the weakest area in the past.

31. Reflective Section • Think about the reflective cycle/model that you will use. • How has using the PDSA model or another model of improvement helped you? • What have been the positives and where have there been issues? • Has using the model improved your service, skills and knowledge?

32. Examples of student work to date. First Cohort • Blister packs • Self harm teaching packs • Policy reviews • Desensitising programmes • Documentation changes • Medication issues Second Cohort • Anticoagulant therapy changes trust level • Blood collection changes hospital wide • Environmental safety checks • Self harm reduction – hospital/trust wide • Prison self harm reduction • Healthy lifestyles – physical health checks

33. Examples of student work to date. Third Cohort • Emergency Equipment lists • Observation & LOA documentation • A&E physical health check • Medication planner /checks • Smoking Visitors policy • Clozaril clinic patient safety leaflets • Harm reduction Prison Service

34. What the students Thought...... Following the first cohort involved with the NHSI project comments and quotations where obtained as part of the evaluation. Here are a few of the comments students made on a number of them Footer Info Here

35. Group Dynamics of the ALS Comments of a positive nature came out “mutual respect” “need each other”, “team work” to a positive conclusion by one member “ pleased with the group dynamics and effort and contribution of all members of the team.” One response gave a balanced response commenting on “issues and problems are more easily remedied by a group as opposed to the individual”. Footer Info Here

36. Sharing Information that “some members of the group are prepared to share information to assist the individual, whilst others don’t like participating in discussing their experiences.” Another individual stated “how beneficial other group members can be with regards to one’s learning and the sharing of information with other people.” Footer Info Here

37. The Down side.... • 2 out of 24 students expressed their dislike from day one of action learning. “ I personally find that it does not suit my learning style so I did not find I learnt anything” was the first comment of the first session. By the third session similar comments where expressed as “ It is not conducive to my style of learning”. “ I find it time consuming and irrelevant to my learning” and in relation to the pre and post evaluation expressed negative feeling towards the session and stated as a reflection of action learning….“ as I don’t like problem based learning and they are similar construction of learning within groups”, Footer Info Here

38. Insight One student wrote a very insightful and reflective comment “ I feel more confident and at ease within the group I feel sometimes I don’t value my own abilities, throughout the action sets I believe I have gained more confidence and an actual realisation that I can become an effective mental health nurse.” Footer Info Here

39. Any questions for ourselves? Judith Ball ballj@edgehill.ac.uk CandiKittkittc@edgehill.ac.uk Thank You for your attention. Footer Info Here

40. Thank you for listening. Questions for discussion: • Are we going in the right direction? • Has anyone else been doing anything similar? • Room for improvement?

41. Contact Us Health Sciences and Practice Subject Centre http://www.health.heacademy.ac.uk info-hsap@kcl.ac.uk Higher Education Academy http://www.heacademy.ac.uk