Action learning sets

The role of action learning sets and self-reflection in your

development

Jamie Ripman

#ccgdev

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What is an Action Learning Set?

• History

• Structure

• Objectives and philosophy

• My personal experience

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• The story of the London ALS for CCG Secondary Care

• What might you create in your area?

• What tools and techniques might individuals use for self-reflection if you can’t get to an ALS?

#ccgdev

The Action Learning Sets for CCG Secondary Care Doctors in London

Overview

• Sponsored by NHS England in London • All Secondary Care Doctors on London

CCG Governing Bodies were invited • A few statistics! • Group champion – Sir Cyril Chantler • Group facilitator – Jamie Ripman

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Our first meeting. Getting underway. Important for success of group?

Agenda

• Welcome and introductions • What is an ALS? • What else is required of us? • Assurance from sponsors vs participant led learning – expect

some tension! • Complete initial evaluation • Our compact – how are we going to work together? • Understanding the context – STEEPLE • If this is our context, what do we want this ALS to achieve? • Group objectives • Personal objectives • Start Action Learning • Set dates for future meetings

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Starting point – initial evaluations

To what extent do you have an awareness of what your peers are doing across London CCGs?

Not at all 4 (2)*

To a little extent 2 (2)

To some extent 0

To a moderate extent 0

To a large extent 0

* Evaluations from members who didn’t attend final session are shown in brackets

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To what extent do you have a full appreciation and understanding of your role as a CCG Governing Body member?

Not at all 0

To a little extent 1

To some extent 4 (1)

To a moderate extent 0 (3)

To a large extent 1

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How do you rate your current knowledge and skills specific to your role?

Poor 0

Below average 0

Average 4 (2)

Above average 2 (2)

Excellent 0

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To what extent do you contribute to innovation at CCG level?

Not at all 1


To some extent 2 (2)

To a moderate extent 2 (2)

To a large extent 0

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Our compact. As part of this group we agreed to: Respect confidentiality. Anything taken out of the

group is agreed first. Share air time. No dominant voices Feel able and confident to give / receive positive

challenge Allow all questions – no stupid questions Be committed to this for the long term – after the four

allotted sessions Apply respectful behavioural rules Learn from everyone Keep revisiting our learning

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Group objectives

• Gain further clarity of role of CCG

• Create clarity of CCG roles

• Develop ability to get greater influence of commissioning intentions

• Create / develop an informal network

• Maximise the value of our network – create a collective force; maximise our influence

• Better understand what are the ‘givens’ / non-negotiables

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Individual objectives – included: • Develop clarity around 2ndry Care role

• Improve ability to influence governing body strategy

• Develop a network of CCG 2ndry care Drs

• Create learning which can be shared in my CCG

• Clarify the role of CCG in commissioning

• Role of competitive tendering

• Quality issues v finance

• Responsibility / clarity of role of CCG vs NHS England vs CSU (feels lacking power)

• Influence / power of CCG 2ndry care doctor to drive local commissioning intentions

• How to work with a CCG in debt

• Better understand influence of NHSE on General Practice and Social Care

• Understand my responsibilities to NHSE

• Specific knowledge in how to influence commissioning decisions

• How to get more effective information about trends and outcomes

• Sharing & exploring common CCG issues

• Cut and paste good service redesigns/pathways

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Some of the topics we explored. How do I:

• Work with my Governing Body to achieve high standards at the CSU so they do what we want them to do? How do I articulate my concerns?

• Help my Governing Body to influence the Local Authority to spend money most effectively on health and social care (Better Care Fund)

• Have sensible input into our procurement processes from start to finish?

• Influence commissioning decisions with integrity? (Value Based Commissioning)

• Ensure I am being used for my full potential in this role?

• Get clarity of my responsibility for the governance of my CCG?

• Interact effectively with outside bodies (NHS England, CQC, Monitor)?

• Ensure we run an effective competitive tendering process for a large service provision?

• Create some collective power and start the revolution?

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Four sessions later – final evaluations To what extent do you have an awareness of what your peers are doing across London CCGs?

Not at all To a moderate extent Not at all To a moderate extent Not at all To a large extent Not at all To a large extent To a little extent To a moderate extent To a little extent To a large extent No data* To a moderate extent * Did not attend first session

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To what extent has the Action Learning Set helped to enhance your appreciation and understanding of your role?

Not at all 0


To some extent 1


To a large extent 3

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To what extent have your knowledge and skills (related to your role) improved or increased as a result of attending the actions learning sets?

Not at all 0


To some extent 0


To a large extent 2

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To what extent do you contribute to innovation at CCG level?

Not at all To a little extent

To a little extent To a moderate extent

To some extent To a moderate extent

To some extent To a moderate extent

To a moderate extent To a large extent

To a moderate extent To a moderate extent

No data* To some extent

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To what extent do you feel your personal learning objectives have been achieved?

Not at all 0


To some extent 0


To a large extent 3

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How would you rate the programme overall?

Not at all 0


To some extent 0


To a large extent 6

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What have you found the most useful about the Action Learning Sets? • Opportunity to have others views & to have “assisted”

reflection

• Finding out about the differing roles secondary care doctor takes

• Cyril Chantler. Great perspectives which stimulate group.

• Network with London CCG 2nd Care Doctors and building confidence in role!!

• Discussion & learning from colleagues, learning from Sir Cyril Chantler

• Learning from others /getting ideas from Cyril & Jamie

• Understanding the differing needs & contributions CCGs have for 2° Care Drs. Cyril’s wisdom & perspective

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What have you found the least useful about the Action Learning Sets? • Other secondary care doctors ‘in my day’ anecdotes & chat.

• Can’t think of anything

• Sometimes too much emphasis on process.

• Nothing in particular!

• Need a more regular frequency (I know this is expected end date) with ongoing funding.

• I think whatever was covered was useful. I think the ALS should continue. Maybe once every 4 months. This will form part of our continuing education. Would like to thank Jamie & Cyril and all my colleagues on the group. I feel better having attended.

• Occasional issues became too prolonged convoluted

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What next steps would you like to see and take, as an individual and group? • Continue facilitated Group work to develop Action Learning

• Independently apply what I’ve learned. As a group keep in touch 2-3 times per year – ideally with continued facilitation.

• Continue contact & discussion with colleagues, talk to Sir Cyril Chantler

• Would be helpful to maintain a network to share experiences & developments

• To influence NHSE with a feedback session in next 6 months

• Be more involved in changing pathways & contribute to improving patient care – meeting again.

• Learning to engage with local authorities & join up communication paths 2° Care →Primary→Community→Local Authority

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Any other comments? • I am now better able to be an ambassador for clinical

commissioning.

• At the end of 1 year, my main outcome has been to understand better what I’ve learned & how to apply it to influence change in the service.

• On balance these sessions have been most useful & informative & very worthwhile. Group should be reviewed. These meetings will enable me to be much more effective on my CCG.

• Link in with other 2nd Care Dr networks across England.

• Useful

• Has helped to open horizons and ways to address common problems

• Structure very useful

• The group as a whole feel it’s important to continue to have these meetings as a development tool. It would be great if NHSE would fund further development please. Much better than personal coaching. Interaction between like-minded clinicians.

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And one participant added the following:

Outcomes from ALS:

1) Able to have a London wide perspective of the health economy

2) The local CCG has been able to use me to develop Value Based Commissioning for N.C London CQUINS.

3) The understanding of CPD in finances, procurement, tendering.

4) I would have given up the CCG role, without this ALS!!

5) The changes occurring in NW London and NC London over the last year and on-going 2014/15

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Your thoughts, questions and reactions?

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What might you create in your area? What might you need?

• Sponsor?

• Champion?

• Facilitation?

• Compact?

• Skills and behaviours?

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What tools and techniques might individuals use for self-reflection if you can’t

get to an ALS?

#ccgdev

GROW – John Whitmore, Coaching for

Performance

G

W

O

R

GOAL –

exploring and

setting clear

goals

REALITY –

checking and

raising

awareness of

the situation

right now

OPTIONS – finding

alternative

strategies, solutions,

answers

WILL (and

WHAT, WHEN,

by WHOM –

testing your

commitment to

your goal,

making

concrete,

realistic plans to

reach it

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OUTCOME?

CONTRIBUTION?

ATTRIBUTES?

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#ccgdev

#ccgdev

Heron’s six styles of

intervention Supportive

Catalytic

Confronting Informative

Cathartic

Prescriptive

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Healthcare

Action learning sets