clinical skills and simulation strategy · yorkshire and the humber clinical skills and simulation...

Clinical Skills and Simulation Strategy

August 2010

Forward ................................................................................... 3

Definitions ............................................................................... 4

Introduction ............................................................................. 4

Regional context ..................................................................... 5

Aim .......................................................................................... 6

Action Plan .............................................................................. 6

Quality Standards .................................................................... 7

Regional investment to improve clinical skills provision .......... 8

Five-year plan ........................................................................10

Appendix 1 ............................................................................13

Apendix 2 .............................................................................. 15

2

Contents

Yorkshire and the Humber Clinical Skills and Simulation Strategy

Healthcare continues to advance at an extraordinary pace. New surgical procedures allowing patients to return home on the day of major surgery are now common place. Procedures only undertaken by junior doctors when I was a house officer are now undertaken by a large range of practitioners. Looking forward, more health care will be delivered in the community with the challenges that brings.

Central to these advances is clinical skills and simulation training. Healthcare professionals need to be confident in their own skills. We need to ensure that these skills are undertaken safely and meet a high quality standard. New clinical skills equipment ensures practitioners become competent before undertaking procedures on patients. This will, not only include the practical procedure but other vital parts of care such as infection control, good preparation, good communication with patients and appropriate documentation.

High risk industries have long identified, however, that individual tasks are not all that need to be considered for safe practice. Indeed seventy to eighty percent of errors occur due to non-technical skills and human factors, such as teamwork, communication and situational awareness. Healthcare is now learning these lessons from other industries and is using simulation to help address these issues.

(Ref The Government Response to the Health Select Committee Report “Patient Safety” 2009)

This document outlines a comprehensive strategy to ensure that quality assured clinical skills and simulation training is provided to all healthcare staff in the Yorkshire and Humber Region. It documents a step by step plan to meet the considerable challenges set out. Once achieved it will ensure training is available for the staff of our region to meet the challenges of 21st Century healthcare and thus bring huge benefits to the patients they care for.

Dr Alasdair StrachanChair, Yorkshire and the Humber Clinical Skills Executive

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Forward

August 2010


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Clinical skills has been defined for this region as any action performed by staff involved in direct care of patients which impacts on clinical outcomes in a measurable way and includes:● Cognitive or 'thinking' skills such as

clinical reasoning and decision making ● Non technical skills such as team

working and communication

● Technical skills such as clinical examination and invasive procedures

Simulation can be defined as: a person, device or set of conditions that tries to present problems authentically. The student or trainee is required to respond to the problems as he or she would, under natural circumstances.

Definitions

Introduction

Every day more than a million people are treated safely and successfully in the NHS. However, the advances in technology and knowledge in recent decades have created an immensely complex healthcare system. The volume and complexity of skills and knowledge of current technical equipment and procedures is evolving at such a pace that it is no longer safe to teach practitioners a skill and assume the knowledge will last for their lifetime. It therefore is reasonable to suggest that essential factors in supporting patient safety within the NHS are education & training, equipment & resources.

Education & training: The availability and quality of training programmes for staff can directly affect their ability to perform their job or to respond to difficult or emergency circumstances. The effectiveness of training as a method of safety improvement is influenced by content, delivery style, understanding and assessment of skill acquisition, monitoring and updates.

Equipment and resources: Equipment factors include whether the equipment is fit for purpose, whether staff know how to use the equipment, where it is stored and how often it is maintained. Resource factors include the capacity to deliver the care required, budget allocation, staffing allocation and skill mix.

In 2008/09, 6,080 claims of clinical negligence and 3,743 claims of non-clinical negligence against NHS bodies were received by the NHS Litigation Authority (NHSLA). This was an increase

on 2007/08 figures – up from 5,470 claims of clinical negligence and 3,380 claims of non-clinical negligence. £769 million was paid in connection with clinical negligence claims during 2008/09, up from £633 million in 2007/08. (Ref. NHSLA 2009)

“We need to use modern education techniques if we are to fulfill our ambition to widen participation in learning and to enhance the learning environment for both those in training and those undertaking Continuing Professional Development. We will therefore review the appropriate use of e-learning and other modern education techniques, such as high-fidelity simulation suites, to develop a strategy for the appropriate use of e-learning, simulation, clinical skills facilities and other innovative approaches to healthcare education”. (Ref: A High Quality Workforce NHS Next Stage Review, Department of Health, 2008)

In 2008 Yorkshire and the Humber Strategic Health Authority (Y&H SHA) commissioned a review into clinical skills and simulation education in the region (Clinical Skills & Simulation in Yorkshire and the Humber, The current situation 2008 – 2009). This extensive scoping exercise examined the available resources for all healthcare staff working in the NHS and all undergraduate healthcare and medical students in the Higher Education Institutions.

In response to the findings of the review, NHS Yorkshire and the Humber committed to the delivery of this Clinical Skills and Simulation Strategy.

August 2010

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Regional Context

The Yorkshire and Humber region has a population of 5.12 million and covers an area of 15, 510 square kilometres. This includes major cities such as Hull, Leeds and Sheffield as well as a number of large towns and rural areas with scattered populations, especially in North Yorkshire. The region has both some of the most thriving and some of the most deprived communities in the country.

On a typical day in Yorkshire and the Humber:● 144,000 patients will visit their GP or

community nurse or receive support from mental health services

● 5,000 people will go to Accident and Emergency – of these, 800 will be admitted to hospital.

The healthcare workforce The regional healthcare demographic identifies approximately 140,000 NHS healthcare staff (including doctors and dentists) currently working within 14 Primary Care Trusts (PCTs), 6 Mental Health and Social Care Trusts, 1 Ambulance Trust and 15 Acute Trusts.

There are 800 GP practices, 750 dental practices & approximately 1700 Care Homes.

NHS Yorkshire and the Humber currently commissions health professional education from 9 universities within the region, supporting the training of approx. 20,000 healthcare students at any given time.

Meeting the training demands of all the above in relation to clinical skills acquisition & continuing professional development is a substantial requirement.

The Chief Medical Officer stated that ‘Simulation offers an important route to safer care for patients and needs to be more fully integrated into the health service.’ Within the airline industry, using simulation to constantly practice skills and rehearse emergency situations is considered a vital part of air safety. Comparisons have been drawn with healthcare. (Ref DH Safer Medical Practice 2008)

Training requirements cannot be met within education institutions alone. The learning to be encouraged in any organisation is life-long. To be enabled to do this, access to quality assured training with modern resources is essential.

NHS Yorkshire and the Humber felt it pertinent to identify what was available across the region in order to assess what investment would be required to meet the future clinical skills training needs for its workforce.

Regional mapping exerciseThe regional mapping exercise Clinical Skills and Simulation in Yorkshire and the Humber (June 08 – April 09) identified that whilst there were many areas of good practice there was clear evidence that there was a lack of consistency in relation to: ● The standards of clinical skills

education across Service & Higher Education Institutions

● The training standards of trainers of clinical skills

● The investment in clinical skills resources – training facilities, equipment & staff

● The access to training provision - both geographically & across disciplines.

● The adoption of a multi-disciplinary approach where relevant

● The co-ordination of training provision across providers resulting in duplication, under & overuse of facilities.

● The provision, standards & maintenance of equipment

These findings formed the basis of the regional Clinical Skills and Simulation Strategy.


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Aim/Action Plan

AimTo provide direction for the Y&H healthcare workforce to perform all clinical skills procedures safely through simulated techniques that allow patients to be cared for safely by fully trained and competent professionals.

This will be achieved through investment in the following to ensure a quality standard across the region;● Partnership working & promotion

of good practice● Establish agreed quality assurance

standards for trainers & training across the Yorkshire and the Humber region

● Sustainable quality clinical skills training facilities delivering equitable access to training – across disciplines and organisations

● Monitoring, evaluation and research

Action PlanPartnership working● Ensure a sustainable infrastructure

that supports partnership working and promotion of good practice

1 Identify key stakeholders

2 Establishment of the Yorkshire and the Humber Clinical Skills Executive Board

ensuring representation from all sectors (appendix 1: membership, terms of reference).

The function of the Clinical Skills Executive Board will be to advise the NHS Y&H on how best to use the resources available as it is evident that high quality simulated learning environments are vital to deliver fast responsive healthcare services closer to the patient. The group membership will represent the entire workforce with direct patient contact to ensure that the patient remains at the heart of all the progress made.

3 Re - establishment of the Yorkshire and the Humber Clinical Skills Network (CSN)

(appendix 2: Membership & terms of reference).

The re-established CSN will be supported by the Y&H SHA and will exist to advise and make recommendations to the Executive on issues impacting on the clinical skills trainers and facilities at a local level in the NHS, Higher Education Institutions (HEIs) and independent sector, within the wider regional context. The group will be supportive in nature using forum meetings and electronic medium, where best practice, innovation and research will be shared and encouraged. The network will link to the Clinical Skills Executive Board through working groups where contributions to developments in areas such as quality assurance mechanisms, research and financial investment will benefit clinical skills both locally and nationally.

August 2010

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Action Plan/Quality Standards

4 Establishment of Clinical Skills Project Team

The development of a regional clinical skills project team will enable the work undertaken by the Clinical Skill Executive Board and the CSN members to be implemented across the region using the promotion of collaborative work across all healthcare organisations and professional groups. The work will begin following a baseline audit of current provision mapped against the existing information, with needs assessments of the locality to determine the issues and will include assisting with quality assurance processes to unify and monitor the standards of training, leading to improved patient safety and quality of care. The team will analyse the available provision and provide evidence of the investment already made throughout the region. This will include identifying inter-professional learning and working with organisations to identify local solutions to staff attendance and release from the clinical areas to attend training sessions. Areas of best practice will be championed by the team and links to the CSN and Clinical Skills Executive Board will inform all those connected with clinical skills of the existing position on an ongoing basis. The team will provide a framework for the sustainability of clinical skills.

5 Effective Communication Strategy

Communication with the wider clinical skills network will be effective through the use of;

● Website ♦ This will be established and supported

through the NHS Y&H website initially with the formation of a new, independent website, designed, implemented and maintained by the CSN

● Newsletter ♦ This will be evident on the CSN website

● Annual Conference ♦ The conference will be available and

supported by the NHS Y&H with work-streams relevant to the CSN and wider clinical skills training providers such as obstetric emergency training and surgical skills training

● Influence national developments ♦ Opportunities to present the strategy

to a wider audience beyond the Y&H region will be embraced

● Clinical Skills Project Team ♦ Will promote clinical skills training and

best practice solutions alongside the strategy to all organisations and relevant professional groups in the region

Quality StandardsResearch, consult, develop, recommend, & implement quality standards for clinical skills trainers & programmes

● Sustainable quality clinical skills training facilities that support equitable access to training – across disciplines and organisations

● Commitment to a 3 year investment plan in a ‘hub-spoke’ model that will ensure access to a minimum standard of quality training provision across the health economy

1 Establishment of stakeholder sub group to undertake consultation and development of

standards

2 Monitor progress and support implementation via the regional quality assurance group and

Clinical Skills Executive Board

3 Support the development of a ‘Clinical Skills Passport’ to provide a mechanism for recording

and updating training, with a pilot to explore its potential and use as an electronic tool

4 Develop an audit tool to monitor quality processes


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Sheffield

LeedsHull

Access to hubs for all healthcare community,

internal and external to the organisation identified

Central Clinical

Skills hub

Facilities used by all professional groups within

the organisationFacilities used by external community

based healthcare providers

Pre and post registered workforce

trained within the facilities

Cross boundary use by healthcare

professionals living within the gographical area

of the hub

Potential for income generation

with external organisations

such as HEIs and independent

sectors

Regional investment to improve clinical skills provision

1 Investment in identified Hubs – Leeds, Hull, Sheffield

2 Invite proposals from Healthcare Partners to support investment in ‘spoke facilities’

August 2010

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Regional investment to improve clinical skills provision

3 Agree investment with criteria that ensures partnership working, capitalisation of

multi disciplinary learning opportunities and responsibility re sustainability

4 Investment in a clinical skills project team to work across the region to support return on

the investment and facilitate partnership working

Monitoring, evaluation and research● Demonstrate return on investment &

impact on patient care & safety

1 Ongoing monitoring and evaluation to ensure return on investment utilising contract

monitoring processes, clinical skills project team, clinical skills executive and clinical skills network.

2 Investment in a 3 year research project to investigate the impact of the clinical skills

strategy on patient care and safety.


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Five-year plan

PLAN ACTION 5 year programme

To provide comparable

clinical skills facilities,

equipment and staffing

across the region

To propose systems to

improve sustainability of

Clinical Skills training

● Financial investment in provision

Investing in areas with little or no provision

– NHS & HEIs ● Financial recognition for organisations

already delivering quality training through

best practice solutions

Ongoing – Bids for funding to be

decided by the SMT / Education

Commissioning Manager / CSN

Executive Group

2010 – 2015

The development of a Clinical Skills Project

team (Clinical Skills Project Workers –

CSPWs) to deliver the strategic plans

2010 – 2013

Collaboration of all stakeholders including● Acute Trusts● PCTs● Mental Health / Learning Disabilities● Social / Care Trusts● Medical & Dental Postgraduate

Deanery● HEIs● Non-NHS organisations● Ambulance services● Montagu Clinical Simulation Centre

Ongoing – through CSPW role and

CSN

Clinical skills passport project manager

2010 – 2013

Audit of resource usage

Evaluate financial investment 2009 – 2010 initially

Ongoing

Clinical Skills Project manager role and

CSN Executive Group

Share all educative resources across the

region inclusive of the Medical and Dental

Deanery

2010 – 2013

Implementation by CSPWs

Partnership working with existing CS

trainers and Post Graduate Centres

Collaborate with the Medical

and Dental Deaneries

Developing a database of resources

Equitable provision and access across the

region and all professional groups

August 2010

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Five-year plan


Financial investment in provision / resources

from SHA ● SHA, CSN & Exec Group support and

involvement in financial investments /

bidding processes● Medical and Dental Deanery commitment

Ongoing

Bids for funding to be decided by

the SMT / Education Commissioning

Manager / CSN Executive Group /

CSPW team

Medical and Dental Deanery

contribution

Support for Clinical Skills Educators from an

active and innovative Clinical Skills Network

and the Montagu Clinical Simulation Centre

(MCSC)

Ongoing through the CSN / CSPW role

With assistance from the MCSC staff

and educators

A needs analysis of each organisation

taking into consideration the diversity of

the regions’ geographic and demographic,

healthcare needs. The focus in the coming

years will be:● Primary care, mental health, social care,

nursing homes & hospices, though some

work will continue in secondary care

2010 – 2013 – initially

Ongoing assisted by CSPW role

Ongoing assisted by CSPW role

To improve staff attendance at

clinical skills training session,

by all appropriate staff /

professional groups

Investment in Clinical Skills passports Clinical Skills Passport Project

Manager 2009 – 2010

Pilot to involve several organisations

and professions

Support from the Deaneries

Ensuring adequate staffing to deliver

training

Ongoing – audit through CSPW team

Commitment from the Deaneries

Inter-professional learning

Management to encourage staff to

attend appropriate training, culture

change or mandate clinical skills● Share and advise● Streamline training

Ongoing - supported by the CSPW

team


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Five-year plan


Improvement in patient

safety with regionally

approved quality assurance

measures

Recognition that patient

safety is integral to Clinical

Skills training

Consistency of standards

across the region,

between organisations &

professions

Support the CSN, sharing best practice

and quality assurance measures● Quarterly meetings● Annual conference supported financially

by the NHS Y&H

Ongoing – financial support from the

NHS Yorkshire and the Humber

Unified approach to quality standards, Ongoing – initial monitoring through

CSPW team

Links to / collaboration with HEIs and the

Deanery as appropriate

2010 – 2013 audit through CSPW

team

Standardising protocols / assessment tools 2010 – 2013

through CS project team

Quality assuring the training

Ongoing

Monitor through CS project team and

the MCSCMonitor standards regionally

Share quality assurance best practice and

identify areas of good practice

2010 – 2013 – through the CSPW role

CSN / MCSC

Investment in research 2010 -2015 – investment in research

project

Risk management input regarding the

NHSLA and NPSA Ongoing

Research – investment in research

project Research and development linking clinical

skills training to improved patient care

and patient safety

August 2010

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Appendix 1

Yorkshire and the Humber Clinical Skills

Network

Executive Group

TERMS OF REFERENCE

Mission Statement● To ensure the provision of consistent

quality assured clinical skills training equips all staff involved in clinical care in the Yorkshire and Humber region to provide safe patient care and minimize risk

● To ensure Yorkshire and the Humber region is at the forefront of clinical skills training in the modern health service

Group PurposeThe Yorkshire and the Humber Clinical Skills Executive group will exist to consider and advise the SHA on the issues impacting on clinical skills provision and commissioning within the Yorkshire and Humber Region. In particular the group will:● Promote and support partnerships and

collaboration between all stakeholders in relation to the provision and development of high quality clinical skills training to support healthcare workforce development

● Consider and make recommendations to the SHA to ensure appropriately resourced clinical skills training is available and accessible across the Yorkshire and the Humber region

● Consider and make recommendations regarding the appropriateness and effectiveness of clinical skills training to maximise the use of financial resources

● Consider and develop quality assurance mechanisms to ensure universal core standards for clinical skills training and promote widespread adoption across the region

● To consider and develop mechanisms of supporting and disseminating best evidence based practice

● Consider and respond to emerging policy and agendas (local, national and international)

● Support, develop and resource research and other initiatives to enhance clinical

skills training locally and nationally● Identify and commission key work

streams identified by Terms of Reference to working groups

● Act in response to concerns, issues and agendas raised by the Yorkshire and Humber Clinical Skills Network

MembershipMembers must be able to represent and make decisions for their stakeholder group. Membership for those not appointed from a group will be for three years. The members will be expected to attend all the meetings and contribute to the work of the committee. The membership should represent the geographical and varying forms of health care provision and training across Yorkshire and the Humber region. Representatives will be expected to send a deputy if they cannot attend.SHA Education Commissioning ManagerChairSecretary of Y& H CSNOne Deanery representative – to be appointed by the Postgraduate DeanChair from Y&H CSN networkOne representative from Y&H CSN network One Primary Care representative from Provider ServicesOne Primary Care representative from Commissioner Services One secondary care representative - Head of EducationOne secondary care representative - Risk ManagerOne secondary care representative - Director of PGDMEOne representative from Dental EducationOne representative from the York’s & Humber Joint Deans forum Non Medical EducationOne representative from undergraduate medical educationOne representative from the Yorkshire Ambulance ServicesOne representative from the Mental Health, learning and disability sector(Other stakeholders as and when appropriate)


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Appendix 1 (continued)

Non Attendance: In the event of a representative (or deputy) not attending two meetings in a year the Chair will enquire about that member’s ongoing representation at the groupQuorate: 66 %Meetings: QuarterlyChair: Appointed by SHA for three years taking recommendations from the Executive committeeAdministration – Secretary of Y&H CSNAccountability and Reporting Relationships: The group is a sub group of the SHA Workforce and Education DirectorateReview: Chair/Admin/Terms of reference/membership/attendance to be reviewed annually

August 2010

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Yorkshire and the Humber Clinical Skills Network TERMS OF REFERENCE

Mission Statement● To ensure the provision of consistent quality

assured clinical skills training based on best practice, equips all staff involved in clinical care in the Yorkshire and Humber region to provide safe patient care and minimize risk

● To ensure Yorkshire and the Humber region is at the forefront of clinical skills training in the modern health service

● To provide a support network for all those involved in clinical skills teaching in the Yorkshire and Humber region

Definition of Clinical SkillsClinical skills are defined as any action performed by all staff involved in direct patient care, which impacts on clinical outcome in a measurable way. These include:● Cognitive or “thinking” skills (such as

clinical reasoning and decision making)● Non-technical skills (such as team-

working and communication)● Technical skills (such as clinical examination

and invasive procedures)

Group PurposeThe Yorkshire and the Humber Clinical Skills Network will exist to consider and advise the Executive Group on the issues impacting on clinical skills provision and commissioning within the Yorkshire and Humber Region and provide a support network for all those involved in the teaching of clinical skills. In particular the group will:● Provide a support network for all those

involved in clinical skills teaching.● Consider and make recommendations

to the Executive Group to ensure appropriately resourced clinical skills training is available and accessible across the Yorkshire and the Humber region

● Consider and make recommendations regarding the appropriateness and effectiveness of clinical skills training to

make best use of financial resources ● Contribute to the development of quality

assurance mechanisms to ensure universal core standards for clinical skills training and promote widespread adoption across the region

● Support, exchange and disseminate best evidence based practice

● Identify and contribute to initiatives and areas requiring research to enhance clinical skills training locally and nationally

● Respond to emerging policy and agendas (local, national and international)

● Act in response to concerns, issues and agendas raised by members of the Yorkshire and Humber Clinical Skills Network

Membership: Open to all individuals who are actively involved in teaching Clinical Skills in the Yorkshire and Humber regionQuorate: No quorate required, however general consensus, including the views sent in electronically, should be reached. Meetings: Quarterly, one of which will be in the form of an annual conference funded by the Executive GroupChair: Elected by CSN members for a period of three yearsDeputy Chair: Elected by CSN members for a period of three years Steering Group: The steering group will constitute the Chair, Deputy and three other elected members who will meet bimonthly in the first instance. 50% attendance at meetings is required.Administration: Secretary of Y&H CSNAccountability and Reporting Relationships:Whilst the CSN is a self governing body the network is accountable to the Executive Group for any incurred expenditure provided as a result of prior agreement.The Chair and one other nominated member of the CSN will sit on the Y&H CSN Executive Group and represent the CSN.Review: Steering Group Membership will be reviewed every 3 years or earlier if a position is vacated.Admin/Terms of reference/membership/attendance will be reviewed annually.

Appendix 1

CONTACTING THE SHA WORKFORCE AND EDUCATION TEAM

Please phone 0113 295 2152 and we will direct you to the appropriate

member of staff.

Or visit our website at www.yorksandhumber.nhs.uk

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