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Staff support in continuing professional development

in the first of two articles, Karen staniland and colleagues describe a project at three trusts to make the best use of learning opportunities
Summary
This article reports on a training needs analysis (TNA) project, undertaken with three different hospital trusts in England, that uses a work-based and action-learning approach. It relates to the format of the projects and the identification of training needs for healthcare practitioners. A second article will report on the implementation of TNA in one trust after completion of the project. The work is important for nurse managers and leaders responsible for continuing professional development budgets. The project was targeted at the delivery of trust priorities and offered potential for a different way of working designed to meet new and emerging NHS organisational requirements. In addition, given its multidisciplinary nature, it offered the facility to work with multidisciplinary clinical colleagues to explore different learning and development opportunities and issues. Keywords Continuing professional development, training needs Government policy requires all public services to provide a good return on investment, and in the nHS this now involves the annual return of a Quality Account. Quality Accounts are reports to the public from organisations that provide nHS services about the quality of services provided. Senior managers should declare that they are aware of the quality of the nHS services they provide, and understand where the organisation needs to improve the services it delivers (Department of Health (DH) 2009). this report is particularly relevant in the context of continuing professional development (cpD) and lifelong learning in health care, both of which lead to improvements in services and for service users. Further, cpD and lifelong learning are linked to clinical governance and quality (coward 2010). previous administrations have attempted to embed lifelong learning in the health service through various policies such as Working together: Securing a Quality Workforce for the nHS (DH 1998), which identified the need for health services to become learning organisations to support
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the processes and systems required to make improvements to the nHS. two years later, A Health Service of all the talents (DH 2000a) proposed a comprehensive review of information needs to support nHS education training and workforce planning, while An organisation with a memory (DH 2000b) made the case for the development of knowledge management systems to capture and disseminate the learning and tacit knowledge generated through work. A framework for lifelong learning in the nHS (DH 2001) introduced the idea of individual learning accounts and the nHS university to promote the initiative. However, these did not come to fruition and this type of learning became the responsibility of health service organisations rather than government.

Improving learning opportunities

in 2007, the University of Salford was contacted by a trust for help in making best use of learning opportunities and ensuring equitable and transparent mechanisms to support trust staff at all levels to engage in cpD. Since this project was completed the university has undertaken two further projects with different trusts. these aims had to correspond with the trusts business objectives and priorities. problems highlighted by the trusts included: Senior nurses, managers and practice educators were not making the best use of learning opportunities for their staff, resulting in duplication of attendance at conferences and learning events. Difficulty due to budget restrictions in allocating staff to attend events. A lack of progression and organisation in staff education in specialist fields of practice. the need for the development of trust cpD leaders was recognised in the operating Framework for the
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Box 1 Work-based and action learning Work-based learning Work-based learning is a mechanism for integrating university-level learning with experience in the workplace. Its work-linked features enable learning to take place at, through and be centred on the working environment. The knowledge process is supported through blending learning from experience through enquiry, thinking and reflection, and relating this experience to existing generic knowledge through learning materials and facilitation. Using an organisations objectives and real, work-based projects as the focus for academic enquiry enables this method of learning to benefit employees and employers (Seagraves et al 1996). Action learning Action learning is a continuous process of learning and reflection, carried out with the support of colleagues, with the intention of getting things done (McGill and Brockbank 2004). People learn with and from each other by working on real problems and reflecting on their own and each others experiences. Action learning sets Participants had the opportunity to explore the concept of training needs analysis planning in small sub-groups at regular intervals throughout the project in action learning sets. The purpose of these sets was for participants to discuss anything to do with their project that was going well, or that might be causing them difficulty or concern. The groups worked confidentially and were supported by a school of nursing and midwifery external action learning facilitator. NHS knowledge and skills framework The project was closely linked to the NHS knowledge and skills framework (DH 2004) to enable participants to develop a single, consistent, comprehensive and explicit framework on which to base and review the development needs of all staff. It is particularly relevant to practice educators working with individual members of staff, so that they can plan their education and development needs around individual and service needs and priorities. needs in professional multidisciplinary practice and organisational settings. to enable the project participants to use a framework to develop a staff training needs analysis for their own clinical area. to improve the return on investment in cpD. the team comprised mary Douglas, head of learning and development at Salford royal nHS Foundation trust, and lillian neville, strategic lead for lifelong learning, and Karen Staniland, senior lecturer and flexible learning co-ordinator, both from the school of nursing at the University of Salford. the intended learning outcomes of the project were that by the end of it participants would be able to: critically analyse the role of training needs analysis, using the concepts and issues extracted from the literature. critically appraise the application of training needs analysis in health care. Demonstrate a systematic understanding and critical awareness of current problems and/or new insights into current professional practice. carry out a systematic and structured piece of training needs planning for healthcare staff. critically evaluate current problem-solving frameworks used in a dynamic healthcare context. critically review the systems that enable the support and empowerment of healthcare professionals. Demonstrate the ability to prepare a professional plan for a training needs analysis in a multidisciplinary team/multi-agency context.

nHS england (DH 2008). in 2009, the strategic health authority identified support and development of leaders of learning as critical to ensure trusts have competently trained employees (marrow 2010). the expertise of the project team in work-based learning has shown us that this creative way of learning encourages participants to focus on real-life work issues related to their education and training in their workplace, developing individuals and their organisations (Seagraves et al 1996). Action learning supports this approach because it is a specific process for work-based professional development (revans 1980) and is one of the learning strategies required to enable learning leaders to develop leadership competencies (marrow 2010). it was decided, therefore, to use this approach to meet the three trusts cpD needs, and after discussions with the trusts learning development units the project team identified and agreed the following overall aims for the projects: to develop project participants critical and evaluative skills to identify staff development 34 April 2011 | Volume 18 | Number 1

Action learning sets

Following discussion with senior managers, participants for the action learning sets were identified by senior nurse educators in the learning development units at the three trusts. Trust one this set involved ten multidisciplinary participants, including nursing staff in educational/ development posts from surgery, medicine, critical care, emergency medicine, midwifery and neonatology directorates, and non-nurse education leads from postgraduate medicine, radiology and palliative care. Trust two this set involved nine nurse participants from medicine, renal, rehabilitation, surgery, maternity, gynaecology and child health directorates, and a trust practice education lead for mentorship activities. Trust three this involved eight multidisciplinary participants. including a clinical education manager,
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an academic education facilitator, a clinical education facilitator and education leads from radiotherapy, physiotherapy, occupational therapy, diagnostic radiography and pathology/biomedical science. the project began with two half-day orientation sessions, which included presentations from the various directorates involved, each one titled Where we are now?, and information about the project. the project team then ran concurrent work-based action learning sets for each of the three trusts to enable them to identify problems and initiate improvements. each trust held one orientation day, five action learning sets and one presentation day. A more detailed description of work-based learning and action learning, and how these were applied to this project, is given in Boxes 1 and 2. Box 2 Action learning set Dates for the action learning sets were agreed in advance to ensure all participants could establish protected study leave and a tripartite agreement was used to formalise this. There were seven participants in each set. Each set generated its own ground rules, a summary of these being: Social discussion to take place before the set started. All discussions within the set would be confidential. Commitment to attend all sets. Each participant would have the same amount of time, unless more time was deemed necessary by the set or the facilitator. Active listening to take place. One person to talk at a time. Mobile phones off. Ground rules can be changed at any time. An agenda was always agreed in advance by the facilitator to ensure that requests from the set regarding guest speakers or specific issues would be taken into account, and time was allocated accordingly. An initial whats on top round was used to enable each participant to talk about anything that was on their mind, which may or may not have led into what that participant brought to the set (McGill and Beaty 2001). The round-table discussion then began. This was the heart of the action learning process. Each participant used the allocated time to review actions set previously and discuss what had been achieved in relation to those actions, asking themelves: What did I do or not do, and why or why not? What went well, and why? What didnt go well and why not? Did I do something differently? If so, what, and if not, what could I have done? What have I learned? Was there any unexpected learning? What do I need from the set today? What new actions have evolved to take forward? All members of the set then provided support, information, suggestions, and a facilitator summarised the set activity.

Initial findings
one of the first discussions was about the need to review the current position of cpD in the trusts to establish some baseline information. the results of this suggested a wide variation of knowledge among participants with the same jobs. large numbers of draft documentation were found to be circulating in the trusts and there was a lack of formal guidelines on study leave, cpD budgets, strategies and protocols. this was particularly true for nursing staff study leave and budgets for other healthcare professionals were more clearly defined. Another area of concern was that records of staff cpD activities and progress were poor, partly because the trusts software was not designed for this kind of record keeping. this meant some employees kept records of their cpD on their personal computers to which others had no access. one participant was able to produce a useful method of calculating the cost of cpD for various Agenda for change bands information that had not been available to staff but was easily obtainable from the trust finance office. other concerns raised were that arrangements for sharing cpD activities between healthcare professionals were generally poor, and the use of adverse incidents for staff education purposes were somewhat ad hoc. these initial findings helped participants to identify specific issues that required clarification before progress could be made. the issues were specific to each trust but included the following questions: there appear to be no formal guidelines for study leave allocation for trust staff. Are there any at trust or local level that the panel are aware of? We would be interested in your comments and
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the trusts position on the Joint Statement for continuing and professional Development for Health and Social care practitioners (rcn 2007), in particular to comment on the recommendation for the six days per year protected cpD time granted to support health and social care practitioners. What is the actual budget for staff cpD? How is it allocated and how is it time-protected? Have any training monies been redirected from the medical training budget to other professional groups in relation to taking on new roles? How does the trust differentiate between mandatory training and cpD activities? How does the trust achieve a balance between the increasing demands on time and resources to meet the extensive list of mandatory training, while ensuring the cpD needs of staff? How is the adverse incident reporting system used to identify training needs? (For instance, out of 96 complaints in one year, 39 were related to communication issues.) We have a mandatory training policy, but do we have a cpD policy?
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Box 3 Staff-designed training needs analysis questionnaire framework Staff profile Generic information, including information about grade, job role, length of time in post, and academic qualifications gained or ongoing and those desired or required for career development. Specific mandatory updating and advanced certification determined. Roles and responsibilities This question aimed to establish what staff believed were the key knowledge and skills required to undertake their role effectively, any skills they felt unable to perform effectively and any skills performed that were not appropriate for their role. This was linked to their NHS knowledge and skills framework (KSF) post outline. In addition, a value was placed on the importance of developmental activities required by each individual. Mandatory training Update and completion dates were included. Continuing professional development The number of protected time CPD days allocated was identified, with bespoke examples for individual departments offered as a tick-box option. Any refused requests for CPD events were determined, with a rationale for refusal. CPD activities undertaken in own time was calculated. Suggestions were requested for best time to deliver CPD activity, and opinion sought on whether grade was important when being granted CPD protected time. Finally, a satisfaction rating scale was offered for all CPD activity events. Job or role-specific education/training This section considered essential and desirable criteria in respect of each job or role to examine competence and capability, giving a detailed analysis of practice development. Specific areas of interest This was considered to be an important aspect of the questionnaire, requesting staff to consider their ongoing appraisal and needs for moving through the KSF requirements and developing specialist skills in relation to role and career development. Professional publications and conference presentations It was thought this was often an aspect of staff development that was not acknowledged and cascaded down to peers. clarified by senior management staff it was felt to be a restraining force on the action learning set members roles. it also emphasised the power of the action learning set members if they presented a united front to managers. Senior managers gave an assurance that more guidance would be made available to staff following this action learning set. the next step was for participants to develop a training needs analysis questionnaire for their respective areas. it was important that this questionnaire came from the group members and was relevant for their clinical area. A number of core issues that were identified were then supplemented with specialist requirements for each area.

Training needs analysis

A training needs analysis (tnA) is a formal process of identifying a training gap and its related training need. it involves an assessment of the training requirements of any target group in terms of number of trainees, their educational and professional backgrounds, their present level of competence and the desired behaviour or skill level acquired at the completion of any instigated training. the training needs identified can then direct managers in identifying relevant programmes or courses required for staff within that area. By systematically gathering information about the skills, talents and capabilities of the organisations, gaps in the existing skills, knowledge, attitudes and capabilities of their employees were exposed. the participants were then able compare these gaps with the organisational demands identified in the trusts business plans and determine the implications for training and education requirements. this would then ensure the right quality and quantity of resources needed and provide opportunities for staff to achieve their personal and career goals, support the development of a trust staff retention strategy and increase employee engagement (robson 2009). Although tnAs can be undertaken at a number of levels, the purpose of this project was to encourage the participants to review their own departments so that new projects and opportunities, new ways of working, reorganising, restructuring and role changes could be considered. individual employee information could also be considered as part of the trusts annual performance review, which would then be used by senior management to identify all employees training needs and commission the relevant courses appropriately. the participants developed questionnaires based on a general structure but individualised them where appropriate. the questionnaires were then
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currently the trust computer systems for recording cpD and the electronic staff record are not compatible. When will the electronic record system be used for recording all cpD activities? Will this be a visible document for all staff? the relevant senior trust management panels were then invited to an action learning set for further discussion. Although these meetings were informative and necessary, the participants then had to work on their training needs analysis within certain restrictions. Although senior management staff identified that there were no guidelines for some of the above issues, an explanation of this gave the action learning set members an opportunity to identify some of the difficulties they experienced in trying to get information to guide their understanding for example, how the cpD budget worked and how staff were allocated study days. Until this had been 36 April 2011 | Volume 18 | Number 1

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piloted and due care was given to confidentiality since the information was potentially sensitive. All questionnaire respondents were invited to complete the tnA using their job description and their trusts five-year plan as a guide. the generic framework of the questionnaire is described in Box 3. At the conclusion of each trust project, participants gave short presentations on their directorate or unit tnA to relevant colleagues, including senior nurses and general managers from their trusts and local higher education colleagues. the presentations identified ways in which tnAs support and contribute to service improvement and link up with trusts priorities. these events enabled participants to disseminate their work and discuss how their work with practice development and education teams could contribute to improving patients experience, as well as highlight some of the constraints in fulfilling their roles that became a management organisational issue. A major concern in all three projects was the inappropriate computer systems for the recording of cpD activities and the lack of overall co-ordination between the complaints system and an identification of training needs to address complaints. At one trust, staff were keeping duplicate records on individual computers because the trust system was so unreliable and frequently lost data. this was time-consuming and resulted in lost time for other activities. While progress was slow, senior management promised to meet frequently with the action learning set members beyond the end of the project so that similar problems could be addressed. effective team working in and across trusts, and an increased awareness of the existence and function of educational teams by senior and corporate managers. tnA plans are more comprehensive, pro-active and are clearly related to service need. participants have also identified that the learning involved did not finish with the end of the project. rather, this is an ongoing process where they frequently find themselves putting ideas explored during the project into their practice. to truly identify the learning taking place, it is recommended to re-evaluate any project at six or 12 months when staff have had the opportunity to embed their learning into current and future practice. We believe that, overall, the projects were genuinely worthwhile. As with any similar undertaking, some difficulties were encountered during the project period in keeping all participants engaged and motivated. At first, it was difficult for some to see where the project was going and what they were achieving. However, on completion, and particularly after completion, the benefits are increasingly apparent. lessons learned can contribute to review of the process and planning of the action learning approach. We strongly recommend these action learning projects as a positive investment in terms of time and effort and that they could be replicated across other organisations where similar needs are identified. this work is particularly important for nurse managers and leaders responsible for cpD budgets. the project was targeted directly at the delivery of trust priorities and offered potential for different ways of working to meet current and emerging organisational requirements. in addition, given its multidisciplinary nature, the project offered participants an opportunity to work with other clinical colleagues and to explore different learning and development opportunities and issues.

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Karen Staniland is senior lecturer Lyn Rosen is lecturer Jill Wild is director of lifelong learning All at the school of nursing and midwifery, University of Salford

Conclusion
From evaluations collected from action learning set members, it has been identified that these projects have led to longer-term benefits, resulting in more

References
Coward R (2010) educational governance in the nHS: a literature review. International Journal of Health Care Quality Assurance. 23, 8, 708-717. Department of Health (1998) Working Together: Securing a Quality Workforce for the NHS. DH, london. Department of Health (2000a) A Health Service of all the Talents: Developing the NHS Workforce Consultation Document on the Review of Workforce Planning. DH, london. Department of Health (2000b) An Organisation with a Memory Report of an Expert Group Learning from Adverse Events in the NHS. DH, london. Department of Health (2001) Working Together, Learning Together: A Framework for Lifelong Learning for the NHS. DH, london. Department of Health (2004) The NHS Knowledge and Skills Framework and the Development Review Process. DH, london. Department of Health (2008) The NHS in England: The Operating Framework for 2009/10. DH, london. Department of Health (2009) Quality Accounts. http://webarchive.nationalarchives. gov.uk/+/www.dh.gov.uk/en/Healthcare/ Highqualitycareforall/Qualityaccounts/index. htm (last accessed February 28 2011.) McGill I, Beaty L (2001) Action Learning; a Guide for Professional, Management and Educational Development. Kogan page, london. McGill I, Brockbank A (2004) The Action Learning Handbook. routledge palmer, london. Marrow C (2010) Leaders of Learning Competencies: A Review of the Literature. nHS north West, Salford. Revans R (1980) Action Learning: New Techniques for Management. Blond and Briggs, london. Robson F (2009) Learning Needs Analysis. chartered institute of personnel Development, london. Royal College of Nursing (2007) A Joint Statement on Continuing Professional Development for Health and Social Care Practitioners. rcn, london. Seagraves L, Osbourne N, Neal P et al (1996) learning in Smaller companies (liSc) Final report. University of Stirling: educational policy and Development. in moore l, Bridger J (2008) Report: A Realistic, Longitudinal Evaluation of Work-Based Learning of Qualified Nurses. www.heacademy.ac.uk/assets/ york/documents/ourwork/evidencenet/ webformatevaluationproj.pdf (last accessed: march 1 2011.)

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