Commissioning Support for London Stroke continuous professional development project Final report
Contents 1 Executive summary 4 2 Context of the continuous professional development project 8 3 Project objectives 10 4 Stroke-specific education framework 11 5 Project phases 12 5.1 Information gathering 12 5.2 Collation of training opportunities 12 5.3 Analysis and final recommendations 13 6 Summary of the questionnaire 14 6.1 Competencies 15 7 Summary of stroke workshop 16 8 Analysis 17 8.1 Data capture (skills) 17 8.2 Data capture (training) 17 8.3 Data analysis 18 9 Continuous professional development delivery style 20 10 Existing training summary 22 11 Identification of priority themes 23 12 Recommendations 26 13 Conclusion 28 List of appendices 29 Acknowledgments 30 Stroke continuous development project: Final report 3
1 Executive summary The stroke continuous professional development project was set up to explore the opinions of stroke clinicians across London regarding continuous professional development requirements. It included physiotherapists, occupational therapists, speech therapists, dieticians and stroke nurses. The provision of education to this workforce is an essential aspect of workforce development. Initially the project was designed to map the skills and knowledge required to work within the stroke pathway to identify gaps. Since the original project brief, however, stroke knowledge and skills have been mapped by clinicians working in the field of stroke in various forms. The objectives of the project were: To build on previous knowledge and skill mapping work undertaken in stroke, in particular stroke-specific education framework, to align stroke continuous professional development opportunities and recommendations for project. To identify and collate training opportunities currently available across London. To produce an analysis of educational gaps for stroke as identified by stroke clinicians, in relation to the stroke-specific education framework with clear recommendations for priorities for continuous professional development. To recommend possible areas for further stroke continuous professional development for AHP s and nurses across the patient pathway. The project was divided into three key phases: information gathering collation of training opportunities analysis and final recommendations. Information gathering This phase of the project involved a questionnaire and an engagement workshop. The aim of the questionnaire was to gain information on education and training and was targeted at team leaders. There were 120 responses from stroke clinicians and the main information utilised was regarding those skills identified for further development and training that had been accessed within the last year. This was used as a starting point for data analysis. The questionnaire also found that there are multiple, non-standardised competencies in use across London. This highlights the need for a pan London coordinated approach to utilising competencies because without standardisation, there can be no consistency of clinical standards between stroke 4 Commissioning Support for London
networks and individual trusts. Agreed competencies are also necessary for carrying out a pan London training needs analysis to identify training gaps in a systematic way. The questionnaire sought information on preferred methods of continuous professional development delivery. The top five methods of continuous professional development delivery identified were: external courses clinical sharing IST study days/mentoring online resources. A stroke continuous professional development workshop was held to engage clinicians, gather their views on current continuous professional development, and generate future continuous professional development delivery ideas from priorities identified on the day. The discussions were wide-ranging and generated a large amount of varied ideas. Collation of training opportunities As well as collecting information regarding skills which required development, a list of education and training programs in and around London that addressed stroke skills, ranging from one day to two years, was collated with the name of the training provider and the target audience. Analysis and final recommendations Following the identification and analysis of skills to be developed and training programs available, a number of continuous professional development priority themes were identified. These priorities were identified by the project s clinicians through: analysis of the questionnaire and event data, and information obtained from stroke training database cross referencing with the National Stroke Strategy quality markers and the Skills for Health competencies mapped within these evidence from the Royal College of Physicians clinical guidelines and Scottish Intercollegiate Guidelines Network (SIGN) recommendations clinical opinion from continuous professional development project team and other experts in the field. Stroke continuous development project: Final report 5
Out of the 10 priority themes listed, seven were identified as having stroke-specific opportunities within them (in bold). These opportunities are detailed in full in this report. Communication, information, advice and support Upper limb rehabilitation and management Goal planning and discharge planning Continence Vocational rehabilitation Splinting Counselling and cognitive behavioural therapy End of life care Audit/data collection/it Leadership. Alongside the development opportunities within the priority themes, strategic and high level recommendations have been created. Strategic/overarching recommendations There needs to be an agreed stroke competency framework used by all professionals working in stroke based on the skills and knowledge required at all stages of the patient pathway. A pan London comprehensive training needs analysis needs to be carried out based on the agreed competency framework. High level recommendations New stroke staff should be trained up within the first six months via an induction programme, which covers basic competencies and includes information on priority areas. To encourage stroke clinicians across London to share documentation and best practice. To identify a multidisciplinary role of a stroke facilitator within a team. The primary aim would be to facilitate knowledge teams through training and education. To increase clinicians knowledge of how to access training opportunities relevant to their personal objectives and required competencies. 6 Commissioning Support for London
2 Context of the continuous professional development project This report describes the process that the stroke continuous professional development project has followed while investigating what the priorities should be for the development of continuous professional development in stroke care across London. The project has investigated the opinions of stroke clinicians across London but was limited by the questionnaire responses and attendance at the engagement workshop. Recommendations have been developed based on the available information, which detail priority areas for continuous professional development; specific work that would allow continuous professional development to be accessed easier; and methods that can improve the benefits to patients and clinicians. The project approach has been a time-limited information gathering exercise with a market research style to find out the views and opinions of trusted stroke professionals on the best ways to increase continuous professional development. As such, this report cannot be seen as a definitive representation of priorities as opinions can vary. Purpose of the report This report has been produced to present the priority areas for continuous professional development for stroke professionals across London and recommend how each priority could be addressed. The report also discusses the processes used by the team to inform the final recommendations and includes an overview of the information gathered during the project. Background to the project The background to the continuous professional development project is introduced clearly in the continuous professional development project initiation document (see Appendix 1: e-information pack) and states: The stroke project has been set up in order to deliver large scale change in care delivery and improvement for patients. A key aspect which has been identified as needing improvement in order to deliver this agenda for both projects is the provision of a skilled workforce. The provision of education to this workforce is an essential aspect of workforce development. The core assumption central to the project is that improving the knowledge and skills of those working in stroke will have a direct impact on patient care, improve patient outcomes and will further develop stroke as a specialism. The continuous professional development project is an integral part of Commissioning Support for London s stroke improvement agenda to improve stroke services in the capital. One outcome of the Commissioning Support for London stroke project has been the recognition that an increase in staffing is fundamental to improving stroke services. As a result, funding has Stroke continuous development project: Final report 7
been identified for an additional 509 nurses and 87 therapists across the capital. Once these posts have been filled the additional capacity should enable more time to be released for continuous professional development activities, meaning the traditional issue of a lack of time should become less of a barrier to professional development. Now the focus can shift from system capacity issues to capability issues around the workforce, and an emphasis should be placed on continuous professional development as one way to improve capability. London s clinical director of stroke, Dr Tony Rudd, would ideally like to see dedicated time allocated for stroke-specific continuous professional development of one day per month for all professionals working in stroke. Initially the project was designed to map the skills and knowledge required to work in the stroke pathway to identify training and education needed by the workforce and help identify gaps. Since the original project brief, however, stroke knowledge and skills have been mapped by clinicians working in the field of stroke in various forms. One such knowledge and skills framework now in existence is the stroke-specific education framework (see section 4). The continuous professional development project has utilised this broad framework to structure data capture and analysis. Scope of the project The scope of the stroke continuous professional development project was to look at the continuous professional development requirements for professionals working along the entire stroke pathway, from first contact through to the community setting. The project included physiotherapists, occupational therapists, speech therapists, dieticians and stroke nurses, and therefore is only representative of these professions. The project was not designed to extend to pre-hospital care, long-term social care, or medical staff working with stroke patients. Stakeholders The report is targeted at sector leads and managers of stroke therapy and nursing teams in London and across pathway. It is also designed to help the People and Organisational Development team at NHS London to channel funds into appropriate workforce development during the next financial year in stroke. 8 Commissioning Support for London
3 Project objectives The original aims and objectives of the stroke continuous professional development project were shared with those of the major trauma continuous professional development project and were: to map the knowledge and skills required by the workforce to identify training opportunities currently available to produce an analysis of educational gaps for major trauma and stroke with clear recommendations for priority continuous professional development. During the process it became apparent that these aims should be amended for the stroke element of the project, in response to feedback from clinicians and stakeholders about work that has already been undertaken in stroke. This work has included stroke specific competency frameworks such as the Stroke Modernisation Initiative qualified and unqualified staff competencies in 2005 and the pan London draft band 1-4 stroke rehabilitation core competencies for healthcare staff working in stroke (see Appendix 1: e-information pack). The knowledge and skills mapped across the pathway have also been linked with the relevant National Occupational Standards as developed by Skills for Health, the learning and skills council for the healthcare sector. This work was undertaken in partnership with Southbank University and the North East London Cardiac and Stroke Network and can be accessed via the demonstrator site (see Appendix 1: e-information pack). The most recent mapping of stroke knowledge and skills was used as the basis for the Department of Health s stroke-specific education framework, which was produced in response to the UK Stroke Forum s call for a coordinated approach to workforce development. It became clear that the objectives of the stroke project needed to be amended in light of this comprehensive work that has already been undertaken. The revised project objectives are as follows: To build on previous knowledge and skill mapping work undertaken in stroke, in particular the stroke-specific education framework, to align stroke continuous professional development opportunities and recommendations for project. To identify and collate training opportunities currently available across London. To produce an analysis of educational gaps for stroke as identified by stroke clinicians, in relation to the stroke-specific education framework with clear recommendations for prioritising continuous professional development. To recommend possible areas for further stroke continuous professional development for AHP s and nurses across the patient pathway. Stroke continuous development project: Final report 9
4 Stroke-specific education framework The stroke-specific education framework was commissioned by the Department of Health in response to the UK Stroke Forum s recognition of the need for a coordinated approach to workforce development through education and training. The framework uses the stroke pathway as defined in the National Stroke Strategy, dividing it into four key areas prevention, first contact, treatment and rehabilitation and long-term support and review. The framework can be viewed on the Department of Health s website. The aim of the stroke-specific education framework is to create UK recognised, quality assured and transferable standards for stroke training. It also outlines stroke specific knowledge and skills that are required when working in the stroke pathway. The stroke-specific education framework is further divided into 16 sections, mirroring the first 16 quality markers of the National Stroke Strategy. Each of the 16 sections focuses on the knowledge and skill required by professionals to deliver that element of patient care. The full document can be viewed on the Department of Health s website. The final version of the framework will have its own website and will remain a living document, updated as necessary to reflect changes and improvements in evidence related to stroke. Stroke-specific education framework has been adopted as the basis for the stroke continuous professional development project as the framework has already comprehensively mapped the skills and knowledge required by professionals, which should underpin the delivery of good stroke care as detailed in the National Stroke Strategy. 10 Commissioning Support for London
5 Project phases The project was divided into three key phases: information gathering collation of training opportunities analysis and final recommendations. 5.1 Information gathering A questionnaire was designed by the team and sent via the stroke networks to senior clinicians working in stroke across London. The aim of the questionnaire was to identify what training had been undertaken and to identify clinician s opinions regarding training and education. It consisted of 19 questions focusing on continuous professional development and was aimed at team leaders who were asked to complete on behalf of their teams. The questionnaire was opened on 11 January 2010 and closed on 1 February 2010. There were a total of 146 responses and of those 120 were completed by professionals working in stroke (see section 6). A stroke engagement workshop was held on 8 February 2010 and was attended by 83 stroke professionals. The aim of the event was to find out what clinicians felt were priorities for the development of continuous professional development across London and to generate ideas of how theses priorities could be tackled. The day consisted of lectures and workshops (see section 7). 5.2 Collation of training opportunities The project aimed to collate the current training programmes and courses, which are running within Greater London. The rationale behind this was to: help professionals with accessing courses in the future identify if there are any significant gaps in training and education opportunities within stroke in relation to the skills, which professionals need to deliver quality care (see section 8). Stroke continuous development project: Final report 11
5.3 Analysis and final recommendations Analysis has been undertaken from the information gathered to: Identify which stroke-specific skills clinicians felt need further development. Identify the training courses relevant to stroke that have been accessed in London. Identify the preferred continuous professional development methods of delivery for different professionals and look for innovative ideas. Understand what other enabling factors might contribute to the development of continuous professional development. 12 Commissioning Support for London
6 Summary of the questionnaire Analysis of the questionnaire identified key questions that provide an insight into continuous professional development issues and priorities. These are: The names of external courses undertaken by members of the team over a 12 month period, their titles and any accreditation. The skills people considered to be key priorities for development in the next year. The preferred method of knowledge and skill development. Any specific continuous professional development delivery methods and enabling factors that would enable acquisition of knowledge and skills more effectively. The questionnaire was targeted at team leaders and was completed by 120 stroke clinicians. Figure 1: Breakdown of questionnaire respondents Profession Number Nurses 13 Physiotherapists 56 Occupational therapists 26 Speech and language therapists 12 Other 13 As can be seen from the breakdown of respondents, there was a noticeable lack of nurses who completed the questionnaire. As there are currently 677 nurses working in stroke in London versus 203 therapists, it was hoped that a larger proportion of nurses would have completed the questionnaire to accurately reflect the views of all targeted professionals. Possible reasons why nurses may not have answered the questionnaire: The route of dissemination via the stroke networks may not have filtered into the nursing arena. The questionnaire may have been more relevant to AHP s than nurses and therefore nurses did not fully complete it. Nurses may not have had the time to complete the questionnaire due to work pressures. Stroke continuous development project: Final report 13
6.1 Competencies Around 60% of respondents answered yes when asked whether or not there were defined competencies for their roles. They were then asked whether these competencies were internally generated or provided by an external source. Most of the competencies in use were internal ones with only a handful of professionals using external, standardised stroke competencies, thus demonstrating the lack of consistency in the use of competencies throughout London. The responses were also varied on the integration of such competencies into practice, ranging from mandatory for all staff within a team to limited or no use at all. These views were also echoed at the engagement workshop. This feedback highlights the need for a pan-london coordinated approach to utilising competencies as without standardisation, there can be no consistency of clinical standards between networks and individual trusts. Agreed competencies are also necessary to use as a basis for carrying out a detailed pan London training needs analysis to identify training gaps in relation to the competence levels required for a particular post. This project has not carried out a detailed training needs analysis as at present there is still a lack of agreement on the use of competencies in London, and was outside the scope of this short project. 14 Commissioning Support for London
7 Summary of stroke workshop The stroke engagement workshop was intended to engage clinicians, gather views on current continuous professional development and generate future continuous professional development delivery ideas from identified priorities. The day was well attended with 83 clinicians. The day consisted of a mixture of lectures and interactive workshops. The workshops were very open and the following questions formed the basis of the two main workshops: Workshop 1: Describe the perfect continuous professional development program. Workshop 2: Detail how the priorities could become a reality. The discussions were wide-ranging and generated a large amount of varied output. To utilise the broad information captured, comments from the workshops were categorised by the continuous professional development team. From the workshops a number of skills requiring development were identified, which were added to the data captured from the questionnaire. Figure 2: Breakdown of attendees Profession Number Nurses 12 Stroke coordinators and project leads 12 Clinical specialists (mixed) 4 Physiotherapists 22 Occupational therapists 15 Speech and language therapists 8 Dieticians 2 Other 8 Stroke continuous development project: Final report 15
8 Analysis 8.1 Data capture (skills) Responses to the questionnaire were grouped within the four stages of the patient pathway as defined by the stroke-specific education framework. These are: prevention first contact treatment and rehabilitation long-term support and review. General skills were also identified and these have been classified within a separate group. As the data was entered, emerging common themes (see Appendix 3) were identified and the responses were grouped under these themes. Skills that were applicable to more than one part of the pathway were included within all relevant areas. Skills highlighted at the event were also grouped using the same method and themes, and then merged with data from the questionnaire. 8.2 Data capture (training) A similar process was followed for education and training information. The education and training programs undertaken by clinicians over the previous 12 months were collated and grouped into the four stages of the stroke-specific education framework and further classified under the same emerging common themes. Charts were created that compared the skills highlighted by professionals with the number of training programs clinicians had accessed to address a skill. 16 Commissioning Support for London
8.3 Data analysis It was clear from some of the graphs and the skills identified that they were reflective of the respondents opinions and may not necessarily reflect service priorities. In addition, it is important to highlight that the questionnaire was not a formal skill mapping process and hence did not capture all the skills required by staff in different settings to treat stroke patients. As a result, the data cannot be taken to be definitive. The training database information was therefore included to add weight to the questionnaire data (see Appendix 3). Prevention skills Few skills were highlighted within this area, with patchy training for AHP s and nurses. It is possible that AHP s and nurses do not consider primary and secondary prevention to be their direct role; rather it is the prerogative of medical professionals. Goal planning and discharge planning skills Although these skills have been identified there are already a number of training programs available to address them. Potential reasons why clinicians continue to highlight their desire for further development in this area could be: Clinicians are unaware of the range and content of training programs available. That existing programmes may be theory-focused and the issues around discharge planning need a more practical problem solving approach. These issues may be very specific to a certain setting and are dependent on local resources. Communication, information, advice and support skills Communication was highlighted both in terms of management of patient communication disorders and communication between the multidisciplinary team, patients and carers. There is, however a good amount of specific training around the management of dysphasia. Communication between members of the team is an integral part of clinical practice and clinicians have repeatedly highlighted this as a skill requiring ongoing development, although local training is thought to be available. Continence skills The skills to assess, intervene and treat continence were highlighted as a priority in the questionnaire although not many people highlighted it as an important skill for development in the next 12 months. The Royal College of Physicians however, provides evidence that incontinence should be assessed, investigated, treated and documented by stroke professionals. Stroke continuous development project: Final report 17
Splinting skills These have been listed here as a priority although a number of programs have been identified to address this skill. A multitude of non-accredited providers exist to train clinicians in this area. Upper limb rehabilitation skills These were highlighted as a priority for skill development. This is an area where evidence does not readily translate to practice and as a result the treatment approaches have remained largely unchanged. There aren t clearly identifiable training programs that link evidence and theory to practice. Vocational rehabilitation skills Relatively fewer clinicians highlighted the need to develop these skills, although there was a fair representation of respondent professionals in the questionnaire. In the Commissioning Support for London discussions, vocational rehabilitation was identified as one of the areas that required development in the provision of longer term care and follow-up of the stroke patient. Cognitive behavioural therapy (CBT) and counselling skills A large number of clinicians identified skills to be developed in this area of practice. However, programs exist ranging from a few days to a Masters level to address this skill gap, but this does not seem to have been accessed by respondents. It is unclear what the barriers to accessing these programs might be. One hypothesis is that there is funding and time issues, but equally the nature and the length of the training program could be a deterrent to professionals that might prefer a short course. End of life care skills Skills around end of life care were not highlighted as a priority at all, although some training was identified in the training database search. It is not entirely clear why there is no mention of any skill development in this area, but the absence of this only highlights the importance of the knowledge and skill required in the multidisciplinary team in this part of the pathway. It is important to highlight that end of life care is a quality marker in the provision of stroke care across the pathway. General skills The responses to the questionnaire identified generic skills as needing prioritisation and this was emphasised during the workshop. These overarching generic skills are equally important as they are encompassed in Quality Markers 17 19 of the National Stroke Strategy and are essential if good patient care is to be provided. The analysis suggests that leadership, data collection, auditing, supervision, mentoring and conflict resolution skills are seen as priorities for development. 18 Commissioning Support for London
9 Continuous professional development delivery style The questionnaire also sought information on preferred methods of continuous professional development delivery along with other enabling factors which might contribute to skill development. The respondents were given a list of fifteen closed options to select from and were also asked an open question about their preferred methods in the following question. The qualitative results were then categorized under the fifteen headings provided in the previous question to align the data. The top five combined continuous professional development methods of delivery were: external courses clinical sharing IST study days/mentoring online resources. Figure 3: Preferred continuous professional development methods highlighted within the questionnaire 80 70 60 Question 15 Question 11 Combined total 50 40 30 20 10 0 Other PG study Training DVD Study days SIGs Research work Project work Online resources Mentoring Journal review Information exchange IST Group discussion/reflection External courses Clinical sharing Continuing professional development methods Stroke continuous development project: Final report 19
The top methods of continuous professional development delivery are mostly face-to face styles of learning. This reflects traditional methods of learning that most professionals are used to. It is important to note, however, that these methods usually involve time away from the work environment. It may be important to develop alternative methods that challenge existing ways of learning as well as developing current techniques, as the main barrier to learning cited was time. It is also important to mention that a number of professionals, both in the questionnaire and at the event, brought up the issue of governance of learning. It was felt that whilst it is important to facilitate continuous professional development using these and other methods, thought must also be given to how learning may be demonstrated or governed and knowledge must therefore affect the quality of clinical practice. 20 Commissioning Support for London
10 Existing training summary As well as collecting information regarding skills which required development, a list of education and training programs in and around London that addressed stroke skills, ranging from one day to two years, was collated with the name of the training provider and the target audience. These training programs were also grouped in the fours stages of the stroke pathway and the emerging common themes. The data was then merged with that from the questionnaire and the first workshop. This provided a more robust process of assessment of training available to potentially address the skills that require development. Charts were then created that compared the skills with the training from the questionnaire, and that collated by the project clinicians. It was hoped that any gaps present may provide us with priorities for continuous professional development. Alongside the information taken from the questionnaire, the continuous professional development team also searched professional databases and other sources to find any other training courses within the London region. The list of resources utilised to compile the training and education database can be seen in Appendix 4. It is recognised that this process has not been exhaustive and is open to interpretation as to what skills may be addressed within specific courses in the absence of full course contents and objectives. It does, however, provide us with a useful snapshot of the training that is available at this point in time for stroke professionals to help us identify potential gaps in training. Stroke continuous development project: Final report 21
11 Identification of priority themes Following the identification and analysis of skills to be developed and training programs available, a number of continuous professional development priority themes have been identified. These priorities have been identified by the project clinicians through: Analysis of the questionnaire and event data, and information obtained from stroke training database. Cross referencing with the National Stroke Strategy quality markers and the Skills for Health competencies mapped within these (demonstrator site work within e-information pack) Evidence from the Royal College of Physicians clinical guidelines and Scottish Intercollegiate Guidelines Network (SIGN) recommendations. Clinical opinion from continuous professional development project team and other experts in the field. These are described in more detail in section 8.3 and are represented in figure 4. They are displayed in each relevant stage of the pathway along with the quality markers as defined in the National Stroke Strategy and stroke-specific education framework (see Appendix 5). 22 Commissioning Support for London
Figure 4: List of priority themes following data analysis Prevention First contact Treatment & referral Long term support & review Communication, information, advice and support QM2 QM3 Upper limb rehabilitation and management QM8 QM9 QM10 QM14 Good planning and discharge planning QM3 AM4 QM9 QM10 QM12 QM13 QM14 QM15 Continence QM8 QM9 QM10 Vocational rehabilitation QM10 QM15 QM16 Splinting QM9 QM10 Counselling and cognitive behaviour therapy QM10 End of life care QM11 Audit, data collection, information technology QM17 QM20 Leadership QM18 QM19 Stroke continuous development project: Final report 23
From these ten broad priority themes, seven have been further identified as having stroke-specific continuous professional development opportunities within them. They are represented within the dotted line in figure 4 and target areas are detailed in figure 5. Figure 5: Target areas within priority themes for development First contact Treatment and rehabilitation Long term support and review Upper limb rehabilitation and management Improve translation of evidence and theory into practice across the pathway. In particular, use of constraint induced movement therapy, robotics, bilateral arm training, motor re-learning approaches, function electrical stimulation, imagery. Improve multidisciplinary team involvement in the management of upper limb problems across the pathway. Goal planning and discharge planning Increase inter-agency involvement in carrying forward patient goals between setting. Encourage use of standardised tools to set goals that can be used across the whole pathway. Encourage user and carer involvement in short and long term goal setting. Continence Improve links of evidence with practice. Improve understanding amongst multidisciplinary teams about their roles and responsibilities in continence management throughout the pathway. Vocational rehabilitation Improve voluntary involvement and links with community stroke services and stroke professionals at the right time. Improve understanding amongst stroke professionals about the issues that encompass vocational rehabilitation in terms of integration of the stroke patient back in society. Ensure a review of the patient s long term ability to re-integrate into society is undertaken Splinting Ensure that splinting training providers are standardised and accredited. Improve understanding of role and responsibilities in multidisciplinary teams in splinting and splint management. Improve links of evidence in splinting in stroke and its translation in practice. Counselling and cognitive behaviour therapy Improve understanding amongst the multidisciplinary team in managing psychosocial issues following stroke throughout a patient s journey. Improve knowledge of how and whom to refer counselling and cognitive behaviour therapy. End of life care Improve knowledge and skill amongst stroke professionals in managing patients and supporting carers and families dealing with end of life care issues. Encourage a coordinated multidisciplinary team approach in dealing with end of life care in stroke. 24 Commissioning Support for London
12 Recommendations Alongside the development opportunities in the priority themes, strategic and high level recommendations have been created. The strategic recommendations over arch the entire stroke pathway and are fundamental to the ongoing development of relevant and appropriate continuous professional development across London. The high level recommendations should have relevance for all professional groups working within stroke and provide some local, network and pan London based continuous professional development solutions Strategic recommendations There needs to be a standardised stroke competency framework used by all professionals working in stroke based on the skills and knowledge required at all stages of the patient pathway. A pan London comprehensive training needs analysis needs to be carried out based on the agreed competency framework. Method: Centrally run project to agree competencies. Training needs analysis completed by team base on competencies. High level recommendations New stroke staff should be trained up within the first six months via an induction programme which covers basic competencies and includes information on priority areas. Method: Induction programmes developed centrally Stroke passport developed and used Pan-London by individuals to document induction and ongoing training Responsibility: Pan London. Stroke continuous development project: Final report 25
To encourage stroke clinicians across London to share documentation and best practice Method: Creation of stroke-specific on-line tool extranet where documentation can be up/ downloaded by stroke professionals along with a discussion forum. Responsibility: Pan London. To identify a multidisciplinary role within a team of a stroke education facilitator. The primary aim would be to facilitate knowledge within a team, through training and education. Method: Identify lead clinician within a team that will facilitate education and training through knowledge of how and where to access training opportunities and provision of in-house training sessions once team training needs have been identified. Responsibility Local or networks. To increase clinicians knowledge of how to access training opportunities relevant to their personal objectives and required competencies. Method: Potentially utilise Stroke Association London directory/stroke-specific education framework format and add a web-link within each quality marker to training opportunities available Responsibility: Pan London. 26 Commissioning Support for London
13 Conclusion Services and organisations are made up of people that are its greatest strength if they are skilled and understand the values of the organisation as a whole. The National Stroke Strategy concluded that it will be unable to fulfil its objectives unless the size of workforce increases, and individuals further develop their skills. With the projected increase in stroke workforce capacity, an associated increase in the capability of professionals is also essential in making an impact on patient care and service delivery. Training should address the skills and competencies required by the workforce to deliver the service and should also reflect service priorities. It is recommended that a standardised training needs assessment is undertaken on a regular basis by service and clinical leads. This will be achievable once the same set of standardised competencies is in use across stroke networks and sectors. Training of the workforce is necessary to develop skills, but, equally important is the translation of this training into practice. Hence governance structures should be in place to facilitate this. It is important to develop and foster a culture of sharing best practice across the pathway to contribute to learning and development. We need a workforce that considers innovative ways to deliver service, is self-disciplined with continued learning and development, and shares best practice to move the agenda of a world-class stroke service forward. Stroke continuous development project: Final report 27
List of appendices Appendix 1: e-information pack Appendix 2: Archive of proposals Appendix 3: Raw data and graphs Appendix 4: Course database Appendix 5: Project diagrams Appendix 6: Questionnaire These appendices are available online at www.healthcareforlondon.nhs.uk/stroke 28 Commissioning Support for London
Acknowledgments Authors Aparna Belapurkar Alison Garrett Andrew Jackson Contributors Sam Catermole Suparna Das Lorna Donahue Ros Hilton Annette Keen Professor Mary Lovegrove Katie Marsh Mary Pointer Andrea Rapolthy Marcia Reid Anthony Rudd Hilary Walker Professor Caroline Watkins at the University of Central Lancashire (author of the strokespecific education framework) The Stroke Association The People and Organisational Development team at NHS London All the clinicians who either attended the stroke continuous professional development event or completed the questionnaire. Stroke continuous development project: Final report 29
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May 2010 www.csl.nhs.uk Commissioning Support for London Portland House Stag Place London SW1E 5RS Tel: 020 8433 6800 Email: info@csl.nhs.uk