Lib Jones, Head of Nursing Workforce, Doncaster & Bassetlaw Hospitals NHS Foundation Trust

Synopsis of Implementation of Calderdale Framework : Facilitator Critical Reflection

Please use this to summaries your experience of implementing the Calderdale Framework. This will probably be the based on the project you identified at the beginning of your facilitator training.

We understand that due to sometimes unforeseen circumstances that progress may not have been as timely as you`d planned so please write up to the stage you have got and at this point describe the reason for being at the stage you are.

This is to enable us to understand if there are any emerging themes to lack of progression that we could develop potential solutions to within the facilitator training.

The Learning Outcomes set out the criteria that needs to be met, so please ensure there is evidence of these within the synopsis.

Learning Outcomes: 1. Knowledge & Understanding: On successful completion of this course you will be able to...  Critically analyse and evaluate different theories and approaches to quality and service improvement in health and social care 2. Subject-Specific Skills: On successful completion of this course you will be able to...  Synthesise and apply the 7 stages of the Calderdale Framework in relation to a designated area of practice  Evaluate strategies to assess the impact of the implementation of the Calderdale Framework on service delivery

3. Personal Transferable Skills: On successful completion of this course you will be able to… ©Rachael Smith&Jayne Duffy .All rights reserved. Not to be reproduced or copied in whole or part without permission of copyright holder.  Reflect on & critically evaluate personal and organizational practice in relation to service improvement and workforce development  Apply advanced decision making skills in the workplace  Work collaboratively with professionals, service users, carers, community groups, statutory bodies & the third sector, as appropriate Enhance written, verbal &information technology communication skills.

Anyone who has written a project report or who is intending to submit their work for publication can use this as evidence and does not need to complete a synopsis.

Ward nurse bleep Bassetlaw Hospital

STAGE WORKED WELL DO DIFFERENTLY PLAN/REFERENCES 1.AWARENESS RAISING Good support from senior Did not share the framework with Use project in Newsletter / article managers following Awareness the whole working group which in Staff Buzz to share progress on Raising with 24/7 steering group, minimised time out so we could Calderdale Framework tool ©Rachael Smith&Jayne Duffy .All rights reserved. Not to be reproduced or copied in whole or part without permission of copyright holder. working group and 1-1 move onto the task of reviewing across Trust. communication. the workforce requirements of the role Include in first highlight report to One of the ward managers and This may have been a missed share local and Trust wide Band 6 from another ward opportunity to share the learning with Calderdale identified need for change and Calderdale Framework and use Framework stakeholders. championed the project. Ward Nurse Bleep BDGH Project As a consequence, reasons for as an example of the process, I learnt from this and introduced change at department and Care supporting knowledge of the framework at final workshop, Group level were readily identified participants who will be involved sharing how the Calderdale to share and build on at first in the Bassetlaw 24/7 Framework was used to change meeting of stakeholders. Programme. roles and responsibilities to widen I was invited to facilitate the Trust knowledge, in preparation project and chose to use the for further projects, particularly Calderdale Framework tool to More focused engagement with 24/7 BDGH. review the workforce. HoN and matron by facilitator I identified that this was a small and champion (on stakeholder Used this example when project within the BDGH 24/7 grid they are high influence/high undertaking further Awareness project. As Nurse Expert for 24/7 interest) by group meeting (or if Raising Trust wide. Facilitators project, I was able to identify unable to attend 1-1 meetings) to workshops and during further national and Trust wide drivers so discuss reasons for the project, service quality aligned with Trust Strategy drivers and get their views as a improvement/workforce reviews communication. group of their understanding of Pre meet with facilitator and project outcome, which could then champions determined objectives be aligned with that of ward of project, stakeholders and managers and Deputy Director of engagement, project plan, Nursing and Quality and Deputy meeting organisation etc. COO Facilitator prepared for meeting so it ran well e.g. arrived early, refreshments, equipment, planned session, planned feedback

Each ward and department was

©Rachael Smith&Jayne Duffy .All rights reserved. Not to be reproduced or copied in whole or part without permission of copyright holder. represented and stakeholders had opportunity to feedback if not physically able to attend meeting

The awareness raising ‘Snowballing Exercise’ was used which supported all staff groups to agree the scope and concerns.

KPI’s were identified and measured:  Staff satisfaction (bleep holder, CSMT, support for ward staff)  Delays in patient flow  Accuracy of nurse staffing data at op’s meeting  Ward staffing levels (UNIFY) planned v actual

2.SERVICE ANALYSIS Led by front line staff, including Despite engagement by Personal learning was keep eyes ward managers and CSMT champion and line manager, and ears to ground for feedback representatives, reviewed on CSMT thought hidden agenda and take every opportunity by self flipchart service analysis of and were disruptive during the and influential players (in this BDGH Unit Bleep and how it Service analysis. Following the case DCOO and DDNMQ) to linked with CSMT so that they meeting one particularly sent engage and secure ownership. could work closer together to negative message to rest of team. understand roles required to Only came on board when Personal learning needs, to improve patient experience (flow fortuitous opportunity to re- support own practice and also to and care). This enabled me, as enforce drivers to CSMT support other Calderdale facilitator, to facilitate. representatives, with line facilitators: managers present (Deputy  Further develop Project Named facilitator enabled full Director of Nursing and Quality management skill

©Rachael Smith&Jayne Duffy .All rights reserved. Not to be reproduced or copied in whole or part without permission of copyright holder. review and documentation of the and Deputy COO ) to endorse. (secured place on Prince current service functions and Site manager who was most 2 course), tasks, (who, when,where,what vocal went on to become Acting  coaching (secured place and when). These were listed by Matron and became very on in-house course), the group. supportive of project.  LEAN methodology (to The group looked at the process Next time, further work to engage review on line resources) from a patient point of view and all stakeholders up front so  Continue developing QI by process mapping the patient engaged early on in service tool knowledge (attending pathway and where each task analysis and task analysis – one various Leadership pulled pt’s through the pathways, can never over communicate! Academy training) this helped review where there was duplication, lack of continuity By working in pairs, one facilitator and who tasks should sit with and may have addressed this by it re-iterated prioritisation of taking individual aside during the certain tasks so when we used meeting rather than waiting for the Impact Grid people had the natural break already got ideas. We looked at what could be changed to improve, who responsible, timescales and follow up actions

Within the group, there was good understanding of how the service could be changed from national (literature search and site visits) and local (DRI) best practice review.

BDGH patient flow performance, clinical incidents and informal and formal patient complaints reviewed to articulate where service provision for patients could be improved.

©Rachael Smith&Jayne Duffy .All rights reserved. Not to be reproduced or copied in whole or part without permission of copyright holder. The impact grid was very helpful to identify impact and complexity to implement. Highlighted who best to lead on each change, inter relationships and timescales

3.TASK ANALYSIS Preparation carried out as per The Decision Table approach was This project is a micro project but Calderdale Framework used but a more structured will feed into a meso project recommendation. approach to Task analysis by (Quality by Design - a clinical Role definition of care group facilitator by using the actual microsystems approach (Eugene responsibility and CSMT from Decision Table would be required C et al 2007) Further review of DCOO and DNMQ obtained to to focus the group if a bigger roles will be required when determine any plans to alter role project otherwise risk of missing Hospital at Night Team set up (by following task analysis were in detail. April 2016) – out of scope of this keeping with Trust strategy. project e.g. HCSW and ACP roles Good engagement of may undertake clinical skills at stakeholders to review tasks. present carried out by CSMT. Tasks carried out by site Curious how this links and managers (band 7) and tasks learning gained when build on carried out by Unit Bleep Holder role development (Band 5-7) reviewed using the principles of Decision Table As the Band 5’s are developing into the role, part of the Task analysis included review of how mitigate risk when staff in learning role As a small number of tasks, were able to use the same session to identify who should best carry out which task. Good communication to stakeholders to gain agreement of role changes.

©Rachael Smith&Jayne Duffy .All rights reserved. Not to be reproduced or copied in whole or part without permission of copyright holder. 4.COMPETENCY GENERATION Good engagement of On reflection, this section was not Personal learning required to stakeholders to review confirmed clearly during the develop competencies using competence requirement, project initially. This was retrieved LCAT format e.g. support from involved using junior staff to test by: Deputy Director of Education and competencies / Standard  Confirm at second education leads trained as Operating Procedure. This follow up meeting that facilitators enabled a decision to be made all Competencies have regarding how much knowledge been written and Need mechanism to feedback is required to carry out each task learning from this project Trust inserted into the Bleep competently. wide – in this case it defaults to Were able to include experts e.g. Holder folder to support HoN and Matron CSMT. NHSP and E roster team in inexperienced staff. developing the competencies /  Confirm at second As part of 24/7, the role of the site SOP if not already existing. This follow up meeting that manager will again change, also supported supporting check list to confirm moving towards 2 roles - a systems and development of competence has been triage/co-ordinator role and an training requirements e.g. access completed for all advance practice role. The role to Trust on call rotas. member of staff on each has not taken on new ward competencies as a result of the SOP was developed by individual Bleep holder Project but has been care groups and reviewed to freed up to support this further ensure all in line, meeting both development. Will be interesting care group and hospital/Trust to identify learning of how the 2 wide needs projects inter link and if would do differently to inform 2020 Programme 5.SUPPORTING SYSTEMS Identified and actions agreed for Informal audits have shown staff Ensure links with 2020 who and when to meet undertaking the roles are happier Infrastructure work stream to implementation date. with the scope of the role and ensure maximise use of new Sisters followed this through support received. Ward staff Trust wide systems e.g. new effectively, evidenced by staff have articulated that they feel PAS, bed management system, competently fulfilling role e.g. more supported. use of iPad on wards, access to e roster and NHSP bookings for all bleep holders, At second follow up meeting, proforma availability for safe confirmed that agreed support

©Rachael Smith&Jayne Duffy .All rights reserved. Not to be reproduced or copied in whole or part without permission of copyright holder. staffing, supervision/buddy mechanisms in bleep holder system for junior staff, updating of folder are present e.g. policies, folder to include on call rota’s, procedures, rota’s, safe staffing policies and guidance sheet Trust wide there has been a push from executive level to make care groups accountable for staffing and this has been re-iterated at op’s group through the Senior Manager on Call – this support has re-enforced the role changes and communication between Unit Bleep Holder and CSMT 6.TRAINING Agreed at the meeting training Prior to systems and processes I am confident that the required and who would provide being altered, should have set up organisation has mechanisms and monitor to ensure all staff a formal process to ensure and resources in place to secure have appropriate training to fulfil happens e.g. through Training formal and informal training if the role competently. Action Plan and at local level required for future projects Ability to undertake role implementation mechanisms e.g. measured by senior staff by appraisal, use of check list buddy staff on shift and This was retrieved at a follow up individuals ward sister monitoring meeting and it was identified that feedback. existing mechanisms had been Expectation of role SOP in Unit used. Bleep Holder folder Reporting of senior ward staff supporting staff across the unit 7.SUSTAINING KPI’s agreed and collated. KPI’s If this was a bigger stand-alone Formal monitoring has taken demonstrate: project, I would formalise and place through the Operational Aligning of planned v actual build in follow up reviews using Group, chaired by COO, as part staffing across the unit KPI’s so able to identify clear of the Emergency Pathway Improved staff satisfaction (bleep benefits and continues to meet agenda. holder, CSMT, ward staff, matron) service needs Review operational practice Anecdotal feedback that patient through op’s meeting (COO, flow is managed better as CSMT DCOO and Clinical Site

©Rachael Smith&Jayne Duffy .All rights reserved. Not to be reproduced or copied in whole or part without permission of copyright holder. not bogged down with staffing Management Team (CSMT) and ward clinical issues that more matron to review need for 1 bleep appropriately addressed by bleep across hospital. holder Ensure correct stakeholders at Follow up meetings have ensured 24/7 project group to be part of that the roles have been planned further development e.g. Vision of appropriately to meet service 1 bleep across hospital over needs, correct competencies and winter as further development to training in place. Excellent the project communication to stakeholders to Outstanding (high impact/hard to ensure all agree and engages in do) is further Trust wide work change. towards weekend and night cover Induction process, preceptorship by senior staff to ensure safe and and appraisal is used to confirm effective delivery of care out of competencies for new starters/ hours. Being re-iterated during developed staff. review of e roster rule with each ward manager / matron/ HoN/ accountant with e roster manager, DDNMQ and myself Continue to monitor roles of Ward bleep holder and CSMT with 24/7 progress to support alignment

I have been invited to CSMT meeting in October where we will discuss how to sustain this project, continue awareness raising and update on progress of 24/7 BDGH Project

This project can be used as an example to demonstrate utilisation of Calderdale Framework within the organisation. This was a small project as part of a larger work stream, identified, following an opportune conversation.

The Calderdale Framework is now being used to support the Bassetlaw 24/7 programme.

The learning from this project has informed the development of a proposal to Executive Team of how to use the Calderdale Framework Trust wide, including governance structure for projects, support mechanisms for new facilitators and how to sustain the Calderdale Framework across the Trust. This has included the request for further cohort of foundation and facilitator training this financial year.