The Department in Difficulty

Aims and objectives of workshop Share experience of managing depts with training challenges- ‘depts in difficulty’ and discuss an approach that’s been successful for UHL Review a case study and discuss how to approach the issues raised Share the UHL approach- based on experience and lessons learned Explain the underpinning framework that supports the UHL approach

600 Doctors in training 250 medical students 160 Trust Grade doctors

UHL Management structure- Clinical Management Groups (CMG) Each CMG has at least 1 Medical Education Lead with time in their job plan for the role Women’s and Children’s Musculoskeletal and Specialist Surgery Renal, Respiratory and Cardiovascular ITAPS (Critical Care, Theatres, Anaesthesia, Pain and Sleep Emergency and Specialist Medicine CSI (Clinical Supporting & Imaging) CHUGGS (Cancer, Haematology, Urology, Gastroenterology and General Surgery) Clinical Director Deputy Clinical Director Head of Operations Deputy Head of Operations Head of Nursing Deputy Head of Nursing Human Resources Lead Finance Lead Patient Safety Lead Medical Education Lead PPI Lead Research Lead

GMC Standards - Themes Learning environment & culture Educational governance & leadership Supporting learners Supporting educators Developing & implementing curricula and assessments

Assessing education quality in organisations: Information sources National Surveys Quality Visits Annual reviews (ARCPs) Quality surveillance groups Soft intelligence GMC visits

Assessing education quality in organisations: Information sources National Surveys Quality Visits Annual reviews (ARCPs) Quality surveillance groups Soft intelligence GMC visits

Case Study A procedural based specialty with the following staff compliment: FY1s FY2s CMTs HSTs Non training grade/ Trust grade doctors GP trainees Academic Fellows Consultants

Case Study Concerns are raised by several HSTs that their decreasing access to procedures/lists, due to an increasing number of clinics and rota gaps, may impact on ARCP outcomes. Core and Foundation trainees suggest that supervision (in and out of hours) is weak and they are often not able to attend teaching due to service pressures The turnover of non-training grade doctors is high and there are currently a number of gaps on the rota GMC, NTS and the local UHL survey show emerging issues with Supervision and workload.

Case Study Your group task: Using the flip chart, outline your expectation on How this should/could be managed including who to involve, timescales etc? How could/ would improvements be measured? How would you monitor the outcomes?

Measuring/monitoring outcomes Feedback Who to involve Timescales Measuring/monitoring outcomes

The UHL approach ….

Example of Change March 2016 UHL Survey November 2016 UHL Survey

Example of Change March 2016 UHL Survey November 2016 UHL Survey

Example of Change March 2016 UHL Survey November 2016 UHL Survey

Example of Change GMC NTS 3 Year Trend

The UHL approach….the benefits Consistent Scaleable Expected/ anticipated Inclusive Accountability Measurable Pro-active Item Category Action Lead/Trainee Lead Timescale Progress Evidence RAG   1.5 Monitoring of sufficiency of senior ward cover to be ongoing through junior doctors forum and audit WN July 16 Forum to set up. But format not well supported by junior doctors. Will try to join up with teaching session. 5 1.6 Set up Whatsapp group to improve communication with juniors and relaunch junior doctors forum WB Dec 16 Whatsapp group set up, aiming to relaunch forum in Jan 17. 4 1.7 Daily schedule HST point of contact for ward with cross cover and a consultant buddy system to make clear the senior support for junior doctors. ZK/RS/WN Nov 16 This was shelved because the ward planning meeting was intended to replace – will do pending 1.4.

The UHL approach..the underpinning framework UHL Medical Education Strategy Education Quality Improvement Plan Trust Board representation Non-Executive Director for Medical Education ‘Strong educational team’- GMC Regional Review, Oct 2016 CMG Education Leads Quality control mechanisms - Education Quality Dashboard UHL Survey Trainee engagements – LiA, Doctors’ in Training Committee Patient Partners CMG Lead- see poster

Questions?

A consistent recognisable approach improves effectiveness Take home messages A consistent recognisable approach improves effectiveness Mapping to existing Trust approaches ensures that education speaks the same language as other priorities An underpinning support framework is essential Involve the right people Use the right tools- national, regional and local Follow up is essential !!!

Feedback from group discussions Question 1 -Who to involve – trainees, ES, CS, DME, RcT, Service Manager. External input – advice from GM or TPD – try and get some intelligence from others that may have been through this . A discussion with the Junior doctors forum, Local faculty groups may help. Discuss with HR and Medical Staffing at an early stage. Timescales – 7 days for exception reporting. 24 hours if it’s a safety concern report. Reasonable timescales Meet with each group of doctors separately – to engage with trainees and ensure that issues at each level are recognised. One example – took 2 years to sort out. Concerns that these things cannot be resolved quickly and drag on.

Feedback from group discussions Question 2- Monitoring Monitoring trainees on a regular basis – especially after an intervention. Local survey to support GMC/national surveys. Repeat focus group (intermittently) exercise after the change to monitor how trainees feel about changes. Monitoring attendance at teaching. Monitoring procedural log books.

Feedback from group discussions Maybe getting faculty leads to look at different levels of grade and not just specialties as a whole. Needs to be a multi-professional approach to get a view of the environment What spin off effects have the work that you have done on patients? Has it improved? When there are several grades of doctors complaining it is usually a dysfunctional department. It is important to look at the whole picture and not just the Educational issues.