1. Leading End-of-Life Care: An Action Learning Set approach in Nursing Homes Alistair Hewison, Fran Badger & Tina Swani June 2011

2. Outline  Background and context  Rationale for Action Learning Approach  Organisational arrangements  Outcomes  Discussion

3. Background and Context  In excess of 405,000 people over 65yrs live in Care Homes in the UK (Help the Aged 2008)  Proportion of deaths in Care Homes increases with age and almost 40% of people aged 90yrs and over die in a Care Home (NEoLCIN 2010)  Preferred place of care/death. Avoidance of hospital admissions (DH 2008)  Sustained leadership and drive needed locally and nationally (DH 2009)  Educating staff in care homes is one of ten top transformations necessary to improve end-of-life care in the community (HSMC 2009)

4. Background and Context  Leadership and teamwork are crucial in the delivery of effective end-of-life care (Hewison et al 2009; Seymour et al 2009)  Leadership development important in all aspects of health care, nationally and internationally (DH 2008a, 2009; Freshwater et al 2009)  Part of local workforce plan (NHSWM 2007)  Funded by NHSWM as part of its Workforce Development Projects in EoL Care Programme (2009-2010)

5. Rationale  Effective leadership can improve care (Forbes-Thompson et al 2007; Wowchuk et al 2007)  Issues with focus and costs of conventional courses  Application of knowledge  Limitations of competency based approaches

6. Approach Action Learning Set: A continuous process of learning and reflection, supported by colleagues, with an intention of getting things done (McGill and Beaty 2001, p11)

7. Rationale  Evidence for effectiveness in health care (Hardacre and Keep 2003; Graham and Partlow 2004; Lamont et al 2010)  Useful in developing partnership approaches (Glasby and Peck 2005)  Practice focussed

8. Action Learning Sets  22 managers invited- 10 attended 5 managers, 4 deputy managers, 1 senior nurse.  Focussed on EoL leadership issues Discussed and selected by participants  Challenge and sharing Questions, clarification  Goal centred Goals/targets agreed at the end of each meeting  Peer support Facilitated jointly

9. Action Learning Sets  Focus on real problems in End of Life care - Action oriented  Ground rules/Structure  Meet on equal terms  Sharing knowledge and experience  GROW model used as a framework (Whitmore 2002)

10. Outcomes  Improved support for night staff  Greater involvement of residents and families in discussions about advance care planning  Introduction of a ‘memory book’ to enable residents to record thoughts and messages  Wide range of training attended  More discussion of EoL care

11. The Managers ‘productive way to develop and discuss ideas and suggestions of how to approach the different issues that were raised’ ‘Very helpful with updating knowledge and research on end of life care’ ‘The support from the action learning team and the discussion we had…has enabled us to understand the end-of-life care pathway and solve a few issues we were facing’

12. Discussion  Limited attendance despite ‘backfill’ and travel costs  Useful approach with practical benefits  Sustainability issues  Importance of facilitation  Initiated dialogue in the homes  Considerable potential

13. Conclusions  The organisation of End of Life Care remains a challenge  The Action Learning Set approach was effective in this context  Communication skills in the ALS useful in EoL Care leadership  ALS approach useful addition to development activities for managers

14. Thank You

15. References Department of Health (2009) Inspiring Leaders: Leadership for Quality. (Guidance for NHS talent and leadership plans). London: Department of Health. Department of Health (2008) End-of-life Care Strategy Promoting High Quality Care for all Adults at the End-of-life 9840. DH, London. Department of Health (2008a) High Quality Care for All: NHS Next Stage Review Final Report. DH, London. Forbes-Thompson S, Leiker T & Bleich MR (2007) High-performing and low- performing nursing homes: a view from complexity science. Health Care Management Review 32, 341-351. Glasby J and Peck E (2005) Partnership Working between Health and Social Care: The impact of Care Trusts. Health Services Management Centre, University of Birmingham Graham I.W. and Partlow C. (2004) Introducing and developing nurse leadership though a learning set approach. Nurse Education Today 24, 459-465. Hardacre J.E. and Keep J. (2003) From intent to impact: developing clinical leaders for service improvement. Learning in Health & Social Care 2 (3), 169-176. Health Services Management Centre (2009) Evidence for Transforming Community Services: Services for End-of-life Care. HSMC/DH, Birmingham.

16. References Hewison A, Badger F & Swani T (2011) Leading end of life care: An action learning approach. International Journal of Palliative Nursing 17 (3), 135-141. Hewison A, Badger F, Clifford C and Thomas K. (2009) Delivering ‘Gold Standards’ in end-of-life care in care homes: a question of teamwork. Journal of Clinical Nursing 18, 1756-1765. Lamont S, Brunero S & Russell R (2010) An exploratory evaluation of an action learning set within a mental health service. Nurse Education in Practice 10, 298-302. McGill I and Beaty E (2001) Action Learning: a practitioner’s guide. Kogan Page, London NEOLCIN (National End-of-life Care Intelligence Network) 2010 Deaths in older adults in England. NEOLCIN www.endoflifecare- intelligence.org.ul/resources/publications.aspx Accessed 20.10.2010www.endoflifecare- intelligence.org.ul/resources/publications.aspx NHS West Midlands (2007) Investing for the Workforce: Investing for leadership 2007- 2012. NHSWM, Birmingham. Seymour J, Frogatt K and Kumar A. (2009) End-of-life in care homes: Mapping and understanding innovative solutions. Lancaster University/Nottingham University. Nottingham.

17. References Whitmore T C (2002) Coaching for performance. GROWing people, performance and review. 3 rd edn. Nicholas Brealey, London. Wowchuk S.M., McClement S. and Bond J. Jr. (2007) The challenge of providing palliative care nursing in the nursing home part II: internal factors. International Journal of Palliative Care 13: 345-50