Developing Doctors to Deliver (3D)

Annual Report

2016-2017

Table of Contents Page 2 Contents 3 Forward 4 Introduction 5 Educational Framework 7 Programme Outcomes 2016-17 8 Education Structure and Value 9 Project Impact 12 Appendix 1: Theory into Action 13 Appendix 2: Project Proforma Details for South Attendees 15 Appendix 3: Project Proforma Details for North Attendees 17 Appendix 4: How well did we do – The Statistics 20 Appendix 5: The poster submissions 30 Appendix 6: Frequently asked questions 31 Appendix 7: Our New Flyer

Foreword

I am pleased to welcome you to the 2016-17 report of the Wales Deanery’s Developing Doctors to Deliver (3D) Programme. This marks the fifth 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, and 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 2016-17 programme continued 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 2017-18 is underway with the

programme significantly oversubscribed, the programme will begin in autumn 2017.

Finally, a word of thanks to the RSU office team, Steffan Biggs 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

Introduction The Developing Doctors to Deliver Programme (3D) is provided by the Revalidation Support Unit 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 Programme is now in its fifth year. The recent "Independent Review of Continuing Professional Development Activity Provided by the Wales Deanery" made a number of recommendations. This included an enlargement of project-based quality improvement centred CPD. In addition, it recommended the development of collaborative delivery of CPD activities to multidisciplinary teams. One of the main strands of the 3D Programme is to facilitate participants to engage in a project which is based upon health care improvement. The 3D is the only educational programme in Wales which draws participants from doctors and dentists working within all aspects of health care in Wales. Therefore, the 3D programme is already addressing the Reviews' suggestions. What is the 3D trying to achieve? The 3D aims to influence clinicians who do not see themselves as leaders in the traditional sense. Many clinicians want to make systems of care work effectively in their individual area of practice. This maybe in response to changing clinical demand, diminishing resources or new developments in service provision. Time, confidence and the skills to instigate and sustain improvements are often the limiting factors in achieving success. The 3D programme is aimed at increasing the skills and confidence of those clinicians, who make up the majority of the clinical workforce, that wish to implement and influence change within their clinical area.

Our 2016 to 2017 Cohort from the South

Educational Framework.

The programme is based around three educational themes.

Personal Development/Self-Awareness – a key aspect of the programme is to encourage participants to reflect on how their personality and behaviours affect others and how others affect them. This knowledge can then be applied constructively to future challenges.

Project skills – the skills and methods needed to plan and deliver the service development project are fundamental to the programme.

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

Personal Development

Project SkillsOrganisational Understanding

The 2016-2017 3D Programme was advertised to all doctors in Wales. In the first round, one hundred and twenty-six applications were received from clinicians within South Wales. Forty-three applicants were asked to forward their project proposal for Round Two of the recruitment process. Of these, twenty five clinicians were invited to attend the South Wales Programme. In North Wales there were thirteen applicants, all of whom were invited to attend. There is a broad range of doctors from different specialities represented in the 2016-2017 cohort 3D Project All participants are required to design and implement a 3D Project to enhance delivery of care in the Welsh Health Community. The choice of project comes from the participant. This ensures that there is a high degree of ownership of the project and contributes to sustaining enthusiasm over the 12 months. The project gives the participant the opportunity to apply, test and evaluate their newly learned theory in the clinical setting. (See Appendices 1 and 2) The participants are asked to submit short updates to their project during the morning session of each module. This is an opportunity for each participant to discuss their project in small groups focusing on what progress has been made towards their goals. It also provides a forum for discussion of any barriers or difficulties encountered. The small groups then draw on their own clinical backgrounds and experiences to generate possible solutions. The morning session also provides an opportunity for a small group to reflect on the content of the previous module. This is known as the "Theory into Action or TIA". The aim is to consolidate learning. The group discussion is learner-led, therefore the discussion may focus on how specific topics and how they can be utilised in influencing their project or in some aspect of their practice. (An example of the TIA session proforma can be found in Appendix 1)

The 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 workplace 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.

Programme Outcomes 2016-17 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;

The advertising of the 2016-17 programme in June 2016 led to over-subscription. 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 from the core group was 25 participants in South-Wales modules and 18 doctors attending the North Wales modules. There was a very broad range of specialties represented from Primary and Secondary Care.

2. Engagement and 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 is designed 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 care participants. Some sentiments and comments are reflected below:

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

3. Educational Structure & Value The programme is run through 6 different modules building on the skills of doctors: 4. Project Impact

Useful to review the progress made and very reassuring that others have also made amazing progress. The main benefit of this session is to view the problems from the view of others. The offers of help and suggestions from colleagues of other specialities has been invaluable.

I enjoy many aspects of these modules, very relevant to our work, lots of practical tips. Meeting both Primary and Secondary Care doctors has improved networking, which is going to continue.

I would recommend the whole course to colleagues. Helping doctors to find their way through the maze of the NHS to make useful changes. The main benefit has been the interaction between participants and learning from others in other specialities

Opportunity to discuss my project and network with other clinicians, especially refreshing to be able to spend time with GPs and hear about the difficulties that they face at first hand.

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: 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……!

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 appendices 2&3 and a selection of posters detailing those projects that have been completed can be found in appendix 5. The programme provides support for the projects via the Theory into Action or ‘TIA’ Session. The morning session of each module consists of small group discussion of each project. This is followed by a short session in which the participants reflect on their learning from the theoretical taught session from the previous module. In this way the group can further embed their learning within their everyday roles and project delivery. This part of the modules has consistently been fed-back as very useful by participants. The educational value of each module is reviewed by the gathering of 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’. 91% 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, these are detailed below.

49.25%

34.33%

11.94%

1.49% 2.99%

How positive was the TIA session

5 Excellent

4 Very Good

3 Good

2 Fair

1 Poor

More specific and detailed comments received about what else the respondents gained from the Modules can be found here:

Module1: Organisational Cultures

Not sure that it helps me communicate better (Have you met our managers?) but it certainly helps me understand why I get frustrated!

The session was interesting and interactive. The study material provided is excellent I have already read the pocket book on PowerPoint presentations. The ideas included in this book are helping me improve my presentation skills.

Module 2: Project Management

Materials to go away and think about. Discussion of my project, and further opportunity to network especially with GPs.

This session simplified the various techniques which was useful and easy to understand

An excellent session, I was able to breakdown the project into manageable sections and focus on what was needed to enable to progress with the project

Module 3: Negotiating and Influencing Skills

It made me realise that a colleague processes information in a different way and is quiet in meetings because they want to think things through before discussing rather than because they have nothing to say

What can I say? ( ‘name of facilitator’) I could listen to him all day

Module 4: Practical business skills

I gained reassurance that my longstanding frustrations with the way in which NHS meetings are organised and run is well founded and a vision of better ways to do things

This session has changed how my meetings are completed in both my practice and in my cluster.

Module 5: Presentation Skills

Would highly recommend, it has given me tools to understand barriers in bringing about change and to overcome those ( Hopefully)

Module 6: Situational Leadership:

Realising the styles of communication one uses automatically and mostly appropriately influence others, realising that one is constantly being interpreted

Understanding how leadership styles need to adapt depending on the situation

Conclusion Opening the 3D programme to all doctors in Wales over the last 5 years has been a highly successful development. The 2016-2017 3D Programme has continued to attract a high number of applications. There has been significant interest from across the medical community within NHS Wales and there is an even division of participants from both primary and secondary care. The number 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 including encouraging dentists to take part in the programme. 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 current round of advertising and application has commenced following the recommendations for further development this year we have made the programme available to dentists in addition to our current cohort of doctors from both Primary and Secondary Care. We have already seen continued interest from all of these areas within the NHS in Wales. A number of modules have been adapted into interactive learning modules, focussing on Engaging & Influencing Skills, developed from 4 of the topics covered in the programme. These include Presentation Skills, Organisational Cultures, Improving Meetings and Writing Effective Business Cases. The 3D Programme has identified that there are generic learning needs across all areas of clinical practice. These specific learning needs can be delivered via a carefully designed educational input. The opportunity for professionals from across the range of disciplines within clinical care to learn together is limited within NHS Wales. It can be said that the 3D programme provides a unique learning environment. Finally the 3D programme addresses the recommendations made by the "Independent Review of Continuing Professional Development Activity Provided by the Wales Deanery", as noted earlier.

Appendix 1:

3D Theory into Action TIA Session

Each 3D module will present you with new ideas and ways of approaching your chosen project.

The morning session of the following module is an opportunity to update the group on how your

project is progressing. It is also a time to reflect on what you learned from last module and how you may have applied this learning to further your project.

Project update: Provide a brief overview and update of the progress of your project. Then focus on an area that is

currently impeding your progress, use the group to explore solutions and resolve upon an agreed course of action. (Remember that there may be those in your group who may not know the details of your project.)

Reflection on learning from previous module: look back at the previous module teaching session. Please

reflect on those areas of learning which you:

have utilised in moving your project forward or in some aspect of your work:

feel may be useful in the future either in delivering your project or in your work

Please bring this document with you to the module to act as the basis for your discussion in the morning session

Appendix 2

Project Proforma for 3D Doctors attending the South Programme

Doctors Name Role/Speciality Project Proforma Title

Eleri Murphy ST5 CAMHS Setting up a sleep management clinic

Emma Mason Consultant in Acute Medicine Development of an Ambulatory Care Service for Medical Assessment Units (MAU) at the Royal Gwent Hospital

Farah Mushtaq Substantive Consultant Write up a business case for the essential equipment for our Paediatric High Dependency Unit

James Grose GP- Speciality Doctor Impact of living with cancer

James Lewis Substantive Consultant Development of a virtual fracture clinic

Kiran Kumar Dantu

ST5 Old Age Psychiatry

Assessment and Management of Elderly patients and younger patients with memory problems – A general Adult Clinicians Perspective. I am doing a survey to identify training and management needs in this area and am organising a workshop to improve cognitive assessment skills of General Adult Psychiatry staff. I will then repeat survey to measure progress

Nicholas Mason Consultant in Intensive care medicine Improving the quality of mechanical ventilation in the critically ill: a multimodal approach.

Patricia Hanna General Practitioner So, you want to set up a community skin cancer clinic?

Pranav Kumar Speciality Registrar Diabetes and Endocrinology

Insulin self-administration in hospital in-patients(part of ‘think glucose’ project)

Rachel Frost Substantive Consultant Working with GPs and allergies

Richard Swain GP Principal Introducing nurse led chronic disease management in Primary Care

Sian Clement GP Partner

Streamlining repeat prescribing to improve safety and reduce workload.

Description: I am looking at our repeat prescribing processes to ensure that medication on repeat prescriptions is prescribed safely and that inefficiencies in the system are resolved reducing the workload meaning that less decisions are being made when GPs are tired which could compromise safety.

Sugandha Kumar

Consultant Orthopaedic Trauma Review of Emergency Hotline for GPs in Mental Health Services for Older people and development of a single point of contact for MHSOP

Vasileios Sarafis

A&E Specialty Doctor “Do you really need to spend your time waiting in the A&E waiting room?''

Vikki Logan Lecturer in Medical Education Simulation in Obstetric Emergencies for medical student

Yusuf Rangoonwala

ST 5 General Adult Psychiatry

Reconfiguration of the community rehabilitation services within Adult Mental Health services in Cardiff and Vale Health Board. The project involves local consultations with two teams and combining them to evolve into a more robust community service. The combination was completed in February 2017.

Appendix 3

Project Proforma for 3D Doctors attending the North Programme

Doctors Name Role/Speciality Project Proforma Title

Algar Chandra-Mohan

Hospital Doctor - Consultant for Day care services

Trans Nasal Laryngo Pharyngo Oesophagostomy

Alison Godwin Speciality Doctor Dermatology

Optimisation of management of Actinic Keratosis in Primary Care - "AK OK"

Anita Naik ST5 in CAMHS,

Improving service for young people who have co-occurring difficulties of alcohol and drug misuse and ADHD (Attention Deficit and Hyperactivity Disorder).

Claudia Hardy Hospital Doctor - Clinical Research, Obstetrics and Gynaecology

Implementation of outpatient hysteroscopy clinic at Glan Clwyd Hospital

Elizabeth L Williams

Associate Specialist Palliative Medicine

Improving Coordination of care of MND patients in North Wales

James McGuigan General Practitioner - Cluster Lead Fostering closer working of GP practices in South Flintshire

Jamie Bingham General Practitioner Developing a primary care weight management program

Jana Schmidt General Practitioner OOH Service Facilitating the introduction of treatment escalation plans for Anglesey care home patients - and looking beyond

Jennifer Liddell General Practitioner Partner

'Developing training opportunities in our practice in North Wales to help improve recruitment'

Karen Sankey

General Practitioner - Wrexham and Cluster lead for North West Wrexham

Project is the development of a primary care centre for the cluster i.e. A building which will act as a central hub to house shared services and resources for the 6 surgeries within the cluster in an attempt to divert some of the workload thereby reducing pressure and demands on the surgeries

Purnima Dalal Senior Clinical Fellow Improving Ultrasound Scan training opportunities at Glan Clwyd Hospital

Qamar Jabeen ST6 CAMHS

Development of SPEED – The CAMHS specialist eating disorder service for BCUHB, it was setup on trial basis to offer a robust, centralized assessment and management of care to eating disorder clients, their families, offered from a range of professionals including medical, dietetic, psychological and family therapists.

The aim is to skill staff to use the Maudsley model of care. To identify, treat and possible reduce the number of transitions from CAMHS to adult services

Sandeep Mathews

Consultant in Forensic Psychiatrist Improving quality of reports to Mental Health Review Tribunals

Sara Bodey GP Partner and Vice Chair of North Wales LMC

Bringing the North Wales LMC constitution up to date and ensuring the committee is truly representative

Sonya Adhiyaman

General Practitioner

Care planning – chronic disease reviews streamlined to improve access.

Susan Kidd General Practitioner Integrated Community Pain Management Service in Primary Care

Tania Bugelli Consultant Psychiatrist in Liaison Psychological Medicine Training Series

A series of clinical topics in mental health conditions for general hospital staff

APPENDIX 4

When considering how useful 3D is going to be to their future role, here are some of the

comments received:

QUANTITATIVE FEEDBACK ON THE SESSION:

HOW WELL DID WE DO?

Learned the importance of keeping things nice and easy and preventing waste of many, time and resources

Extremely valuable to understand some of the terminology around quality improvement and the importance of being clear as to the aims in order to ensure that you measure gains in the right things

I have learnt negotiating skills that suite my needs which I am hoping to inculcate in my project as well as day to day work

Although I probably won’t do very high-flying presentations, it has provided food for through for the small ones I do, like tutorials, inductions and teaching sessions.

0%

10%

20%

30%

40%

50%

60%

70%

5 Excellent 4 Very Good 3 Good 2 Fair 1 Poor

3D Feedback( On a scale of 1-5 ( 1 Poor- 5 Excellent)

by %

Theory into Action Clinic (TIA)

How useful was this session inrelation to your current role?

How useful was the session inrelation to a future role?

On a scale of 1-5, how confident are

you that the objectives set for the Module were met? (1=not at all confident, 5=very Confident)

Organisational Cultures - An

insightful view of the culture clash that

sometimes exists between different

sectors of the Health Service

53%

38%

9%

0% 0%

Attendees confidence that the workshops as a whole met the objectives

5 Very Confident

4 Confident

3 Good

2 Poor

1 Not Confident at all

Additional comments from our attendees:

The facilitator has a rare gift of being able to bridge the division between hard working clinicians and the mysterious world of NHS management.

3D course is something I have looked forward to for quite some time. It is excellent. I feel it has helped me with different skills I newer concentrated on improving in the past.

It is essential to get such insights even if you are not doing it yourself (business case), the chairing a meeting session had lots of transferable insights and will help in any meeting even if you are not chairing it.

Highly valuable. Yes, I would recommend this to my colleagues. Influencing skills are very important in day to day working life. Using the skills instilled in this course makes life a lot easier and ability to work in a team or achieve targets a lot better

Highly recommended course, Appreciation of individual differences in approach and communication style means we can want the same think but achieve it in different ways

48% 48%

4%0% 0%

Organisational Cultures

5 Very Confident

4 Confident

3 Good

2 Poor

Practical approach to Project Management: Gaining experience of different management tools

Negotiating skills for doctors: Ways of creating a win-win situation within the workplace

Practical business skills for doctors: How to get the most from meetings. The principles of writing an effective business case.

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

49%

42%

9%

0% 0%

Negotiating Skills

5 Very Confident

4 Confident

3 Good

2 Poor

28%

62%

8%3%

0%

Project Management5 Very Confident

4 Confident

3 Good

2 Poor

1 Not Confident atall

75%

20%

5%0% 0%

Practical Business Skills

5 Very Confident

4 Confident

3 Good

2 Poor

1 Not Confident atall

52%

33%

15%

0% 0%

Presentation Skills

5 Very Confident

4 Confident

3 Good

2 Poor

1 Not Confident atall

Appendix 5

Poster Submissions

Appendix 6

Frequently Asked Questions: for 3D Developing Doctors to Deliver

How many CPD points is each session worth?

Each day is awarded 6 points equivalent to 6 hours of CPD activity

Do I need to complete all sessions to gain the CPD points?

No, although certificates are not provided until the end of the programme

What happens if I cannot attend all of the sessions?

We would like all attendees to attend all sessions if possible, however individuals have attended alternative

sessions provided in other regions if applicable (North to attend South and vice versa)

Can I claim travel expenses to attend sessions?

Yes you can a form is available to download and calculates the mileage automatically for you. This will then

have to be printed off and signed before being sent to the RSU. You must claim expenses within 3 months of

session.

Do I have to complete a project to complete the course?

We do expect you to apply for the programme with a project in mind, however if there is room on the course

we may allow individuals to attend the afternoon session which covers various topics by external speakers

(please contact us before hand before attending)

Does my project need to cover all Wales?

No there are no restrictions on the project, it just needs to have some positive impact/improvement on the

NHS in Wales

Do I need to have completed my project before creating my poster?

No, we request that you produce a poster for the last session of the course, this gives you a chance to

amalgamate your process and status of the your project – details will be given as the course progresses

Can I complete the project within the sessions?

The project is not time bound to the 9 months, as many projects have continued to evolve well after the

programme has finished. However there are project clinics that are aimed to help you overcome issues that

you may be facing with your project.

How much of my personal time will my project take?

It is expected that you carry out the project within your own/work time and that as it progresses your peers

and project leads will help you overcome any issues that you may be facing at the project clinic sessions (the

morning session of every module)

Appendix 7

For Further information

https://rsu.walesdeanery.org/cpd-appraiser-training/developing-doctors-deliver-3d

Or email Celia at: lloydc@cardiff.ac.uk