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Developing Doctors to

Deliver (3D)

Annual Report 2015-2016

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Table of Contents Page 1 Contents 2 Forward 3 Background and Evolution 4 Summary table of Participants 6 Programme Outcomes 2015-16 10 Review of the Year 11 Appendix 1: Evaluation Data 13 Appendix 2: Posters

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Foreword

I am pleased to welcome you to the 2015-16 report of the Wales Deanery’s Developing Doctors to Deliver (3D) Programme. This marks the fourth year of a

programme that continues to strengthen in content and popularity. Oversubscription is an annual reality that we would dearly like to address in

future years. The integration of general practice with a range of hospital, dental, public health specialists continues to be a major aspect of strong

networking within the programme and beyond.

The results have been very positive in terms of feedback and content. We see this joint working across the primary secondary care interface as being a small

but important contribution towards integrated care within Health Boards in Wales. The 2015-16 programme continues to deliver clear evidence of shared

understanding and barrier elimination.

As usual the emphasis of the project material is on collaboration and quality improvement. It is encouraging to see these themes continuing to develop.

As in previous years, I would again like to take this opportunity to thank Drs Stephen Hailey and Martin Sullivan for their contributions and leadership in

delivering the programme and to wish them and the next cohort of delegates another successful year. Recruitment for the 2016-17 has been completed with

the programme significantly oversubscribed, the programme will begin in autumn 2016. Finally, a word of thanks to the RSU office team, Jo Small and

Celia Lloyd, who make the delivery of the programme possible.

Professor Malcolm Lewis OBE LLM FRCGP FAcadMedEd

Director of General Practice Postgraduate Education, Wales Deanery

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Background & Evolution The Developing Doctors to Deliver Programme (3D) is provided by the Revalidation Support Unit (RSU) of the Wales Deanery. It is designed to address the educational requirements of doctors in all parts of the NHS in Wales who wish to extend their abilities in engaging with and influencing the service improvement agenda in NHS Wales. The NHS in Wales has been set the target of creating world class healthcare services. The strategy detailed in Setting the Direction presents a framework which is intended to act as the vehicle through which the health and social care system will make the shift towards locally-designed community-focused care. This framework is founded on ten principles including "Strong clinical leadership at locality level, supporting local engagement and understanding". Setting the Direction poses the question “How will clinical leadership and engagement from Primary and Secondary Care be assured?” The 3D programme seeks to provide some of the tools needed to address this question. The first year of the 3D Programme in 2011-2012 addressed the educational needs of GPs. This programme was very positively evaluated by the participants. However it did not cross the interface into secondary care. Therefore in order to become more closely aligned to the strategic direction of the NHS in Wales, in 2012-2013 the 3D programme broadened its access to all doctors across NHS Wales. The main aim of the programme is to strengthen the skills of participants, as well as providing new insights into the interface issues that often cause health service improvements to falter. It was anticipated that there would be clear educational gains for clinicians in primary and secondary care to learn about service improvement together.

In 2015-2016 the 3D Programme was once again offered to all doctors working Wales from across the spectrum of the NHS. This resulted in a large number of expressions of interest. Subsequently we recruited forty two participants into the programme. This report outlines the progress of the 3D over the last twelve months.

Intended Educational Outcomes:

Increased capacity to engage in the improvement of the NHS in Wales

Enhanced ability to work within and to lead teams

Recognise and manage the barriers preventing improvement in patient care

Develop opportunities which can lead to improvements in the quality of care

Apply aspects of organisational theory to work place and project

Gain insights into the local NHS organisational development, to improve the delivery of care

Become part of a network of clinicians with a broadened understanding of the NHS, with experience of trying to effect change at a local or national level.

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Table 1

Name Health Board Project Total

Ibtisam Abbas Cardiff and Vale UHB Physical Health Monitoring Clinics for Patients with Mental Disorders and on Psychotropic Medication

Sonya Adhiyaman Betsi Cadwaladr UHB Care synchronising for patients with chronic diseases Raja Adnan Ahmed

Cardiff and Vale UHB /Aneurin Bevan UHB Falls reduction strategy on elderly dementia assessment wards

Chandra Basavaraj Cardiff and Vale UHB Falls reduction strategy on elderly dementia assessment wards

Sara Bodey Betsi Cadwaladr UHB Renegotiation of the North Wales LMC constitution and T of R to ensure that it remains a truly representative and relevant organisation

Tania Bugelli Betsi Cadwaladr UHB Liaison Refresher Day

Alagar Chandra-mohan Betsi Cadwaladr UHB Trans Nasal Laryngopharyngeal Oesophagostomy

Purnima Dalal Betsi Cadwaladr UHB Shared Leadership: a thought

Fran Ferner Cardiff and Vale UHB Community model/shared care of Respiratory Diseases ( Asthma/COPD)

Mark Forster Cardiff and Vale UHB Developing a remote follow up mechanism for orthopaedic outpatients

Alison Godwin Betsi Cadwaladr UHB Optimising management of Actinic Keratosis in Primary Care - "AK OK"

Owain Greville Cardiff and Vale UHB The Implantation of breast feeding in the Rhondda area

Sabine Grundle Cardiff and Vale UHB Develop and implement a pathway for the management of emergency neurosurgical patients

Claudia Hardy Betsi Cadwaladr UHB Implementation of outpatient hysteroscopy clinic at Clan Clwyd Hospital

Juliana Hughes Abertawe Bro Morgannwg UHB Reducing patient cancellations in elective surgery

Avkash Jain Cardiff and Vale UHB Integrating Pharmacists into primary care, better for patients, better for clinicians

Archana Jauhari Betsi Cadwaladr UHB Consultant psychiatrist

Khan Khan Cardiff and Vale UHB Initiating Insulin Therapy in General Practice for Improving Communications between Community Mental Health Teams, General Practice and their clients

Susan Kidd Betsi Cadwaladr UHB Integrated Community Pain Management Service

Keir Lewis Hywel Dda UHB Establishing Bevan Fellows in the Welsh NHS

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Nicola Lewis Cwm Taf UHB Implementation of the new NICE guidelines for early diagnosis of cancer using a co-ordinated approach across both Primary and Secondary care

Jennifer Liddell Betsi Cadwaladr UHB Increasing the awareness of North Wales as a possible destination for GP Training or working as a GP

Sandeep Mathews Betsi Cadwaladr UHB Improving quality of reports to Mental Health Review Tribunals

Vazira Moosajee

Cardiff and Vale UHB and Abertawe Bro Morgannwg UHB Establishing an interventional palliative pain service in South Wales

Karen Pardy Cardiff and Vale UHB Improving primary - secondary communications links between General Practice and Paediatrics

Rebecca Payne Aneurin Bevan UHB Recruiting Today's GPs for Tomorrow's Future

Elba Peter Abertawe Bro Morgannwg UHB Shared care between Psychogeriatric and Geriatric medicine

Lionel Peter Abertawe Bro Morgannwg UHB Effective triage and liaison provision of care from psychogeriatric teams

Sioned Richards Hywel Dda UHB Improving care of frail and elderly in the Amman Gwendraeth area

Gemma Rogers Cwm Taf UHB Medication re-order reminder service

Elizabeth Shaheir Betsi Cadwaladr UHB Evaluation of falls prevention project in Flintshire

Steve Short Cardiff and Vale UHB Community Director for Gastrointestinal Disorders

Darren Smith Hywel Dda UHB To Develop a funding model to support inter practice shared work at GP cluster level

Nina Williams Abertawe Bro Morgannwg UHB Swansea Early Years Strategy - Reducing the Gap

Elizabeth Williams Betsi Cadwaladr UHB Development of local coordinated Services for MND in North Wales

Amy Williamson Betsi Cadwaladr UHB Facilitating GP direct access to CT scans in Betsi Cadwaladr UHB

Lee Wisby Betsi Cadwaladr UHB Child & Adolescent health

Jacqueline Woolley Abertawe Bro Morgannwg UHB

Improvement of the sleep services in Princess of Wales Hospital and Neath Port Talbot Hospital

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Programme Outcomes 2015-16 There are 4 key themes that are emerging as core aspects of the 3D programme:

1. The breadth of appeal of the programme

2. The collaboration between clinicians from primary & secondary care

3. The educational value that participants derive

4. The impact of project work and its benefit to the wider NHS

1. Broad appeal The programme is designed to be flexible in order to attract the broadest range of doctors as possible. There are six one-day modules which are held in South Wales each year and three per year in North Wales. The programme for North Wales is delivered over 2 years. The programme runs from September through to May. The structure is designed to appeal to two groups:

a cohort of doctors drawn from across the NHS in Wales that wish to undertake the whole programme of modules and develop a service improvement project. This can be done over either 1 or 2 years;

individual doctors that 'drop in' to the speaker led session of a module which take place in the afternoon, allowing them to focus a specific area of learning for their own CPD requirements.

The advertising of the 2015-16 programme in June 2015 lead to over 150 enquiries. In order to select the most appropriate individuals, potential participants were asked to outline how their project would benefit patients using the NHS in Wales. Those applicants which had projects that appeared to have the best chance of having a positive impact on patient care were invited to attend. The final attendance being the core group was 24 participants in South Wales modules and an average of 18 doctors attending the North Wales modules. There was a very broad range of specialties represented from the secondary care sector along with GPs.

2. Engagement & Collaboration

Providing an educational programme which aims to get to the heart of the engagement and collaboration agenda is vital for the future progress of clinical leadership and management across the NHS in Wales. The programme endeavours to strengthen the skills of participants as well as providing new insights into the interface issues that often cause health service improvements to falter. We have found the interaction of clinicians from different backgrounds to be one of the most rewarding aspects of the programme helping to breed a greater understanding, tolerance and ultimately effectiveness amongst and between our primary and secondary participants – sentiments which are reflected in the comments below:

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The programme itself continues to engage with the Health Boards in Wales through dissemination of this annual report and our interim report which is provided half way through the programme.

3. Educational Structure & Value Three educational themes underpin the programme:

Project skills – the skills and methods needed to plan and deliver the service development project;

Organisational Understanding – an appreciation of the context of the NHS in Wales within which doctors operate and the various interfaces that influence change;

"Very interesting to hear project ideas. Great opportunity for primary and secondary care to interact." "Really helped to talk through projects with other GP's and get the perspective of doctors in secondary care. Great to have a mix of specialities in each group." "An excellent session from my point of view - very useful discussions with some primary care colleagues with top tips on how I can make progress with my project ideas and delivery." "Helpful to have insight from both secondary and primary care. It was also useful to develop contacts and ideas." "Support and understanding that colleagues share same frustrations and ways to address these." "Discussing my project with GP colleagues helped me find other ways of tackling the few difficulties in timely progress of my project." "Networking+++. Insight into how secondary care work and how they view us in primary care." "Networking opportunities, a chance to reflect on my project away from the crazy world of general practice!" "Overall - course is excellent and ideal for senior registrars coming up to consultancy/established GPs and consultants. The target group was therefore spot on and nice to have a mix of hospital/primary care to provide a rare interface. A great opportunity. Thank you"

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Personal Development/Self Awareness – encourage participants to reflect on how their personality and behaviours affect others and how others affect them.

The programme is comprised of 6 one day modules and each module consists of a morning ‘project clinic’ session followed by an afternoon ‘educational’ session. The module afternoon sessions were: Module1: “I’m a doctor – Why don’t these people understand me?”

An insight for doctors into how the culture of an organisation can be used to influence it

Module 2: Project skills for doctors: How to identify obstacles and find ways to overcome them

Module 3: Negotiating skills for doctors: Ways of creating a win-win

Module 4: Practical business skills for doctors: How to get the most from meetings Understand the principles of writing an effective business case

Module 5: Leadership skills for doctors: Develop leadership Skills which respond to the situation

Module 6: Presentation skills for doctors: Persuading people that you are right……!

We measure the educational value of each module by gathering information through our online evaluation surveys and the results are detailed in Appendix 1.

There was an overall good response rate to the survey, with 84% of respondents finding the project clinic session Excellent or Very Good. 94% of respondents felt confident that their learning objectives were met during the afternoon sessions. There were also a significant amount of additional unintended learning outcomes reported.

Personal

Development

Organisational

Understanding

Project

Skills

72%

22%5%

1%0%

Overall confidence that learning objectives were met ( %)

5 Excellent 4 Very Good 3 Good

2 Fair 1 Poor

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More specific and detailed commentary about some of the modules can be found in the boxes below:

4. Project Impact A key component of the 3D Programme is the 3D Project. Doctors that wish to attend the whole programme identify a project which has the potential to enhance delivery of care in the Welsh health community. The project gives the participant the opportunity to apply their newly learned theory and test it in a real setting. An overview of the projects undertaken by the participants can be found in Table 1 and a selection of posters detailing those projects that have been completed can be found in Appendix 2. The programme provides support for the projects via the Theory into Practice or 'TIA Session'. The morning session of each module is given over to a small group discussion of each project. This is followed by a short session in which the participants reflect on their learning from the theoretical

"Great insight on how to formulate a plan and put it into action."

"Helped me think laterally about the project."

"Getting suggestions from others many of whom have a considerable amount of experience is very helpful."

"I find I learn something useful each time I talk with colleagues."

"This was a real light bulb moment for me - it helped with my feelings of frustration at the slow pace of things in the LHB."

"Learned a lot from listening and discussing other participant's projects in TIA session." "Not just useful for 3D project but transferable across other areas of work."

"The skill set and understanding will be useful in the future."

"I'm about to start a big project, which I'm anxious about, but now will hopefully have a better chance of succeeding."

"Given me increased confidence to look at other projects."

"An understanding of what is most likely to work. Learning from what others have done."

"Gave me tremendous insight into how to approach management more respectfully and constructively for both parties. Invaluable!"

"This session gave me many ideas about how to deal with a variety of different organisations within my current roles and how to progress potential areas of conflict."

"Networking and support of colleagues keen to find out how the project was going. Good questions asked in TIA."

"Project discussion useful - peers think of things I had not considered."

"I have never really understood what is meant by being a leader. I know have a much better idea and I know which style would suit me best most of the time."

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taught session from the previous module. In this way the group can further embed their learning within their everyday work roles and project delivery. This part of the modules has consistently been evaluated as very useful by participants.

Review of the year Opening the 3D programme to all doctors in Wales over the last 4 years has been a highly successful development. The numbers of doctors attending has increased in both North and South Wales. The evaluation and feedback has been very positive with evidence of broadened educational impact. The aim for the programme next year is to build on this success and develop in a number of ways. Taking into account the feedback on individual models and analysing areas which doctors feel need to be covered in more detail, the programme is going to refine the delivery of a number of modules to more closely align the content and focus to the needs expressed by the participants. The development of what was the Project Clinic into the TIA Session has continued to provide the opportunity to discuss an individual's projects with a wide range of other clinicians. In addition the process of reflecting on learning from the previous module is aimed at strengthening the utility of the theoretical session. The inclusion of all doctors in the NHS in Wales has increased the reach and impact of the programme and it has been widely perceived that there is a latent effect to the value of the learning. The increase in numbers attending either as part of the main programme cohort or as 'drop' in attendees has been significant. There are greater numbers of secondary care doctors now included within the MARS database (which was used to market the programme by email) and this raises the potential of more applicants. The programme will continue to promote itself within the GP and consultant community, with attendees highlighting the achievements, benefits and flexibility of the programme. The current round of advertising and application has just commenced and we have already seen continued interest from all areas of the NHS in Wales. Selecting those which will go on to take part is always difficult but will be based on their ability to demonstrate the added value of their participation through the potential impact of their project on the quality of care received by patients. A number of modules have been adapted in to interactive learning modules, focussing on Engaging & Influencing Skills, developed from 4 of the topics covered in the programme, these include Presentation Skills, Organisational Cultures, Running Better Meetings and Writing Effective Business Cases. Modular content is already available online through our introduction of the file sharing system (Dropbox) and participants find this very useful.

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APPENDIX 1: When considering how useful 3D is going to be to their future role, here are some of the comments received:

“The skill set and understanding I have received will be useful in the future” “Now able to recognise behaviours and is reassuring to know it is not personal.”

“My proposed project will require communicating with various players from different organisational backgrounds - this (and subsequent ) sessions have helped me plan future interaction with different organisations” “Any meeting I set the agenda for will now be in the format suggested.” “I now have a clearer plan about how to take my project forward and how to evaluate it” “More planning was useful tip” “I'm about to start a big project, which I'm anxious about but now will hopefully have a better chance of succeeding.”

“Overall found the course excellent - the 6 modules complement each other well and will be very useful going into consultant interviews and consultant practice. Thanks!!”

“Relevant to current team dynamics!”

“Given me increased confidence to look at other projects”

QUANTITATIVE FEEDBACK ON THE SESSION:

HOW WELL DID WE DO?

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10

20

30

40

50

60

70

80

5 Excellent 4 Very Good 3 Good 2 Fair 1 Poor

3D South Feedback(On a scale of 1 - 5 with 1=not at all useful, 5=very useful)

How useful did you find theProject Clinic/TIA session overall?

How useful was this session inrelation to your current role?

How useful was the session inrelation to a future role?

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Additional Comments

I gained insight why colleagues respond differently to proposed changes, and how I might be able to address concerns that allows further discussion and progression.

I enjoyed the sessions and format. It has stayed in my head and it was useful to be given materials to look at for more detail

Helpful to have insight from both secondary and primary care. It was also useful to develop contacts and ideas

Understanding organisational cultures was a real eye opener - makes sense to try and view yourself from the other party's perspective - and how to use knowledge of organisational cultures to one's advantage

Interesting to see the progression of projects during the nine months. Listening to others, I realised how much I have learnt and can take forward.

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5

10

15

20

25

5 Excellent 4 Very Good 3 Good 2 Fair 1 Poor

3D North Feedback(On a scale of 1 - 5 with 1=not at all useful, 5=very useful)

How useful did you find the TIA clinicsession overall? (1=not at all useful,5=very useful)

How useful was this session in relationto your current role?

How useful was the session in relationto a future role?

0

10

20

30

40

50

60

70

80

90

100

Influencing andNegotiational

skills

PracticalBuisness Skills

OrganisationalCultures

PresentationSkills

ProjectManagement

Skills

SituationalLeadership Skills

Attendees confidence that the workshops met the set objectives (%)

5 Excellent

4 Very Good

3 Good

2 Fair

1 Poor

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Appendix 2: Posters

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19

20

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