Clinical Leadership Pilot Evaluation Report

Clinical Leadership Pilot Evaluation Report

Nursing & Midwifery Planning & Development UnitHSE West (Limerick, Clare & North Tipperary)

Acknowledgements

• I would like to acknowledge the clinical leaders who undertook the pilot

projectfortheirmotivationanddedicationtobetterpatient/clientcare.

• Sincerethanksandappreciationtothelinemanagers,mentors,Directorsof

NursingandMidwifery,generalmanagersandmulti-disciplinarycolleagues

within the services for their support to programme participants and the

project.

• The Clinical Leadership Steering Committee members chaired by Pat

Harvey(formerCEOoftheNorthWesternHealthBoard)fortheirongoing

commitment to developing clinical nurse/midwife managers in improving

safequalitycarewithintheHSEWest(Limerick,ClareandNorthTipperary).

• The National Council for the Professional Development of Nursing and

Midwifery for part funding the pilot project and the subsequent National

ClinicalLeadershipProject.

• The Royal College of Nursing UK and Geraldine Cunningham, Head of the

RCNInstitutefortheirsupportandguidance.

• MichelleFrawley(ClericalOfficer-NMPDU)forherhardworkanddiligence

throughouttheproject.

• DrSarahMacCurtainandDrJulietMacMahon,CollegeofBusiness,University

ofLimerickfortheircollaborationonindependentlyevaluatingtheoutcomes

oftheprogramme.

• FrancisRogers-AssistantNationalDirectorHumanResourcesHSEWestfor

hisguidanceandcommitmenttotheproject.

• Finally, Many thanks to Nora Irwin-Area Director-Nursing and Midwifery

PlanningandDevelopmentHSEWest,GillianConway-ActingDirector-Nursing

andMidwiferyPlanningandDevelopmentUnitandmyNMPDUcolleaguesfor

theirongoingsupport.

CoraLunn

Project Manager-National Clinical Leadership Project

NursingandMidwiferyPlanningandDevelopmentUnit

HSEWest,31/33CatherineStreet,Limerick

Authors:CoraLunn,MSc,ProjectManager-NationalClinicalLeadershipProject,NursingandMidwiferyPlanningandDevelopmentUnitDrSarahMacCurtain,LecturerinOrganisationalBehaviour,UniversityofLimerickDrJulietMacMahon,LecturerinHumanResourceManagementandIndustrialRelations,UniversityofLimerick

contents

FOREWORD 2

INTRODUCTION 3

PROJECTCONTEXT 3

PROGRAMMESTRUCTURE 4

EVALUATIONMETHODOLOGY 8

PROJECTOUTCOMES 9

OverallPostProgrammeFeedback 9

EarlyProgrammeFeedback 10

OverallProgrammeEffectiveness 10

SteeringCommitteeFocusGroup 12

LineManagersFocusGroup 12

OUTCOMESATTRIBUTEDTOPARTICPANTSBEINGONTHEPROGRAMME 13

Changestoleadershipcapability 13

Changestopatient/clientcare 15

Changestothewaycareisorganisedanddelivered 16

Changestotheclinicalenvironment 17

Changestostaffdevelopmentandsupport 18

Changesincommunication–patientandteam 19

Changesinpolicydevelopment 19

Organisationlevelbenefitfromtheprogramme 21

Satisfactionwithprogrammecontent 22

PILOTEVALUATIONRECOMMENDATIONS 26

CONCLUSION 28

REFERENCES 29

APPENDICES 30

Appendix1-ClinicalLeadershipSteeringCommittee 30

Appendix2-PreProgrammeQuestionnaireforclinicalleaders 31

Appendix3-MidProgrammequestionnaireforclinicalleaders 35

Appendix4-PostProgrammeQuestionnaireforclinicalleaders 37

Appendix5-RCNClinicalLeadershipProgramme-WorkshopEvaluationForm 41

Appendix6-ActionLearningLogTemplate 42

Appendix7-ServiceImprovementProjectundertakenintheHSEWest 43

LISTOFTABLES

Table1ParticpantDetails 4

Table2Source:Finalparticipantevaluationform 11

Table3Satisfactionwithprogrammecontent 22

foreword1The implementation of the RCN framework for the pilot ClinicalLeadership Programme in the Mid West has been a significantachievement for both the clinical leaders and Cora Lunn theProgrammeFacilitator,theyarealltobecongratulated.

The Clinical Leadership Programme has provided an ability to work with clinicians in the

developmentofskillsandknowledgethatenablesNursesandMidwivestobeempoweredandto

contributetoimprovementsinpatientorclientoutcomes.Thisevaluationreportdemonstrates

thatthemajorityofparticipantshavebeenverypositiveabouttheirinvolvementandtheirself

development.Commentsfromnurseandmidwifemanagersindicatethatinanumberofcases

demonstrablechangehasbeenobservedinthosewhohaveparticipated.

The model of action learning conducted over the course of the programme supported the

embeddingofnewbehavioursinboththeacuteandprimary,communityandcontinuingcare

(PCCC)servicesandhasensuredthatbothindividualandorganisationalchangeismaintained

intothefuture.

Priortothedevelopmentofthispilotprojecttherewerelimitedprogrammeswithdirectpatient

orclientinterventions;fornurseandmidwifemanagerswhowishedtodevelopleadershipskills

intheclinicalenvironment.Theevaluationofthispilotprojectrecommendsthatnationalclinical

leadershipstrategiestosupportfrontlinestaffshouldbefurtherdeveloped,particularlyasthe

contextofIrishnursingandmidwiferyischangingandnewwaysofworkingareessential,inthis

currenteraofhealthcaretransformation.

Thedeliveryofthepilotprojectwouldnothavebeenpossiblewithoutthefinancialsupportfrom

theNationalCouncilfortheProfessionalDevelopmentofNursingandMidwifery,theguidanceand

supportoftheSteeringCommittee,localDirectorsofNursingandMidwiferyandtheevaluation

expertiseoftheKemmyBusinessSchool,UniversityofLimerick,thankyou.

Finally, sincere thanks are offered to Cora for her commitment to the development and the

progressingofclinicalleadershipdeliveryintheMidWestRegionandNationally.

GillianConway

Acting Director

NursingandMidwiferyPlanningandDevelopmentUnit

HSEWest,31/33CatherineStreet,Limerick

page 02 Clinical Leadership Pilot Evaluation Report November 2008

introduction 2

November 2008 Clinical Leadership Pilot Evaluation Report page 03

NursesandmidwivesintheRepublicofIreland,likethoseinmanyothercountries,work inahealthcaresystemthathasundergonedramaticchangeinthepastfiveyears.

TherecenttransformationoftheIrishhealthcaresystemrepresentsthebiggestreformprogramme

thecountryhasseenin30years. Ithasbroughtabouttherestructuringofservices,agreater

emphasisonthedevelopmentofprimarycare,thedownsizingofpersonnelandareductionin

spending.Thesedevelopmentshavechangedthecontextofclinical leadership innursingand

midwifery(Baumannetal2001,Clifford1998,Havens2001),precipitatingthelaunchofvarious

clinicalleadershipdevelopmentstrategiesfornursesandmidwives.Thesestrategiesareneeded

tosupport the requiredtransition tonewandexpandedwaysofdeliveringpatientandclient

care.Meanwhile,theNationalCommissiononNursingHoursReport(unpublished2009)which

willreportshortly,willhaveanticipatedcallsforchangesinleadershipdevelopmenttosupport

increasedcapacitywithintheprofession(Bakeretal2004).

ProjectContext

Thecurrentneedtodevelopspecificclinicalleadershipdevelopmentstrategiesforallnursingand

midwiferygrades,hasbeenhighlightedinthispilotprojectevaluationstudy.Theprojectutilised

theRoyalCollegeofNursing’s(RCN)ClinicalLeadershipProgrammeasframeworkforexploring

clinicalleadershipdevelopment.TheaimoftheprojectwastoevaluatetheimpactoftheRCN

ClinicalLeadershipProgramme(CLP)onenhancingleadershipdevelopment,initsparticipants

andinimprovingpatient/clientcarewithinanIrishcontext.

TheRCNClinicalLeadershipProgrammeisatwelvemonthexperientialbasedprogrammethat

aims to develop transformational leadership behaviours in its participants. It concentrates on

selfdevelopmentoftheparticipants,closelylinkedwithpatient/clientinvolvementandquality

improvement.

TwentytwoClinicalNurseandMidwifeManagersenrolledinthepilotprojectoftheRCNClinical

LeadershipProgrammeintheHeathServiceExecutive(HSE)West,(Limerick,ClareandNorth

Tipperary).Twentyoneparticipantscompletedtheprogrammeandonedidnotcompletethe

programmesuccessfullyduetopersonalcircumstances.Participants(Table1)wererecruitedfrom

acuteandprimary,communityandcontinuingcare(PCCC)servicesacrosstheMid-Westregion.

Nineteen out of twenty two participants responded to the pre, mid and post questionnaires.

Fortyfivestakeholdersattendedfocusgroupstoevaluatetheproject.

Clinical Leadership Pilot Evaluation Report November 2008

Grades No.ofParticipants No.ofTeamMembers AreaofResponsibility (Fulltimeandparttime)

CNM/CMM’s3 4 47 LabourandTheatreUnit

72 PaediatricUnit

43 NeonatologyUnit

110 HospiceCare

CNM/CMM’s2 12 26 OrthopaedicWard

37 OrthopaedicWard

24 OrthopaedicTheatre

9 AccidentandEmergency

18 IntellectualDisabilityUnit

19 OlderPersons-residentialcare


3 MentalHealth

2 OutpatientsDepartment

22 CoronaryCareUnit

9 EyeTheatre

23 MedicalWard

CNM/CMM’s1 5 12 Oncology




19.5 OlderPersons-residentialcare

CNS 1 0 MentalHealth-olderpersons

Total 22 611.5TeamMembers

Table1-ParticpantDetails

ProgrammeStructure

TheRCNClinicalLeadershipProgrammewasdevelopedfromawardnurses’leadershipproject

toaninternationallyrecognised,multidisciplinaryclinicalleadershipdevelopmentprogrammein

theUnitedKingdom.Theoriginalresearchfocusedonthelinkbetweenleadershipandpatient/

client outcomes. The theoretical framework (Cunningham and Kitson 2000) supporting the

programmeisfocusedon:

• Learningtoselfmanage

• Developingeffectiverelationships

• Patientfocus

• Networking

• PoliticalAwareness


The programme engages participants in reflective and experiential learning. Its central focus

is to enhance patient/client care. The programme is aimed at Clinical Nurse and Midwife

Managers(CNM’s/CMM’S)astheyarekeyindrivingtransformationincare.Itgivesparticipants

theopportunitytopractisecopingwithchangeinasafeenvironmentandtotryoutdifferent

approachestoclinicalleadershipandmanagement.Theparticipantsaresupportedbyafulltime

ClinicalLeadershipFacilitator (Cora Lunn-NMPDU)throughoutthedurationofthetwelvemonth

programme. The programme is facilitated to encourage participants to consider their clinical

environments and enable participants to develop their teams and care delivery. It empowers

themtocreatepersonalisedactionplans thatcanserveasasteppingstoneto implementing

changesinclinicalpractice.Theprogramme’sinterventionsincluded:

Workshops

Thepurposeofthecoreworkshopswastointroduceparticipantstothekeyinterventionsand

activitiesusedontheprogramme:

• twodayIntroductoryLeadershipWorkshop

• onedayTeamBuildingWorkshop

• twodayPreparationforpatient-focusedactivitiese.g.

Patientstoriesandobservationsofcare

• onedayPoliticalAwarenessandNetworkingWorkshop

• onedayNeedsLead-ArticulatingImpactWorkshop

• onedayNeedsLead-ConflictManagementWorkshop

• onedayNeedsLead-SelfDevelopment-PersonalityTypes-MBTI

• onedayServiceFeedbackandEvaluationDay

Theneeds-ledworkshopsaredevelopedaroundtheparticipantsneeds.

Personaldevelopment

PersonaldevelopmentisanintegralpartoftheCLP,andisseenascrucialindevelopingleaders.

Thereareanumberofopportunities forparticipants todeveloppersonally,byundertakinga

360degreereviewandaclinicalleadersprofile.Eachparticipantisresponsiblefordevelopinga

PersonalDevelopmentPlan(PDP)andidentifyingareasofstrengthandareasfordevelopment.

ClinicalLeadersProfiles

Allparticipantscompletedthisin-depthquestionnaireaboutthemselves,theirteam,patientsin

theirareaandtheirorganisation.ItspurposewastoinformtheirPDPbyhelpingthemthinkabout

theenvironmenttheyworkin,whatknowledgetheyhaveandwhatareastheyneedtodevelop.

Personaldevelopmentactivitiesalsoinclude

Mentoring:Eachparticipantwasencouragedtosourceamentor.Thementorprovidesastrong

leadership rolemodel toworkcloselywith throughout theprogramme;mentorsalsoprovide

goodnetworkingandpoliticalopportunities.

Shadowing:Shadowingprovidesauniqueopportunityforparticipantstodeveloptheirleadership

skillsbyspendingtimeobservingsomeoneelseinactionduringtheirday,learningmoreabout

howtheyworkandthewaytheyworke.g.BedManagers,BusinessManagers,DischargePlanning

Co-ordinatorsandDirectorsofNursing/Midwiferyetc.


Onetoones:Eachparticipanthadone-to-one(1:1)sessionsthroughouttheprogramme,lastingfor

atleastanhourintheirclinicalarea.ThesewerefacilitatedbytheClinicalLeadershipFacilitator.

Thesessionsensuredtheparticipantswereexperiencingtheprogrammetothemaximum,getting

thetimetoparticipateandanopportunityforfurtherchallengeandsupportwhichcontributed

totheirpersonaldevelopment.

ActionLearning

An‘actionapproachtolearning’,enablespersonal,professional,managerialandorganisational

development.Itisbasedonthebeliefthatthemosteffectivelearningtakesplaceinthecontext

in which people are working, learning from experience. Action learning allows questioning,

challenging,supportingandreflectingwithothersonexperiencestogainfurtherinsight,agree

actionsandlearnfromtheactionstaken.Eachparticipantcompletedtwelvefacilitatedaction

learningdayson theprogramme.Therewere fouraction learninggroups running throughout

thecourseoftheprogramme,withtheaimofhavingthemsustainedoncetheprogrammewas

finished.All fourgroupsare self facilitatingandhavebeen sustained in the service since the

programmehasfinished.

PatientCentredActivities

ObservationsofCareandPatientStoriesarethetwopatient-focusedactivitiesundertakenon

theprogramme.Thesegaveparticipantsanopportunityto:

• reallyseewhatishappeningintheirclinicalarea

• reallyhearandlistentowhatpatientsexperience

• celebratethegoodpracticesthatoccur

• developactionplanstoenhancepatient/clientoutcomes

Observationsofcare

Observationsofcareareasimple,qualityimprovementandpersonaldevelopmenttoolthatholds

animportantmessage:‘seeing’and‘observing’arenotthesame.Theapproachtoobservationof

careontheprogrammewascreatedfromtheoriginalpieceofactionresearchbyRoyalCollege

ofNursing(1997).

Thisinvolvestwoobservers:aninsiderandanoutsider.Theclinicalleader(insider)andanoutsider

(anotherclinicalleader)observeandrecordtheinsider’sclinicalareaforthirtyminutes.

Patientstories

Patientstories,alsoknownaspatientnarratives,areaudiotapedinterviewswithpatientsabout

theirexperienceofbeinginhospitalorreceivingcare inothersettings.Patientsarerandomly

selectedandinvitedtotelltheirstoryabouttheirexperienceofreceivingpatientcare.Thestories

areaudiotaped,and‘mindmapped’.

Actionplansaredevelopedfrombothqualityimprovementactivities.

TeamBuilding

The programme helps participants develop creative ways of developing their teams. This

workshopisfacilitatedsothatparticipantsareenabledtoundertaketeambuildingtechniques

with theirclinical teams. Ithelps themtoestablishhowagroupof individualswork together,

howthestrengthsandareasfordevelopmentofindividualscontributetojointworking,andhow

teamscanworkmoreeffectivelytogethertoachievetheirprimarytask.


PoliticalAwarenessandNetworking

Developingcapacityandskillsinpoliticalawarenessiscrucialtodevelopingtheabilitytoinfluence

keystakeholderswithinanorganisation,sothatparticipantscanintroduceresources,structures

andsystemstopromotepatient-focusedcare.Theprogrammeencouragesparticipantstobuild

networks,bothinsideandbeyondtheirorganisation.Networkingstrengthensthecorevalueof

workinginthehealthservice.

OrganisationalSupport

Tomakeapositiveimpactontheorganisation,itwasessentialtohaveappropriatesupportand

communicationabouttheprogrammewithintheorganisation.TheClinicalLeadershipSteering

Committeeplayedamajorroleinthis,bysupportingtheimplementationoftheprogramme.The

committeeinfluencedchangeswithintheorganisationthroughtheprogramme,particularlywith

regardstoqualityimprovementinitiativese.g.patientstories,serviceimprovementprojectsand

observationsofcare.AlistofsteeringcommitteemembersisincludedinAppendix1.

evaluation methodology3


Realisticevaluation(PawsonandTilley1997)providedthetheoreticalunderpinningfortheevaluationoftheproject.

This approach to evaluation is seen as being particularly suited to evaluations of complex

interventions,whereissuesofcontextandprocessaswellasoutcomeareofsignificance(Redfern

et al 2003). Realistic evaluation examines the relationships between context, mechanism and

outcome.Inthisinstance‘mechanism’referstotheinterventions(e.g.actionlearningandpatient

stories)oftheCLP.

Datawascollectedfromthefollowingsources:

• InformationgatheredfromClinicalLeadersApplicationFormsandClinicalLeaderProfiles

• Pre-interviewswithDirectorsofNursing/Midwiferytoidentifyimpactmeasures

• Pre,Mid&PostEvaluationquestionnairesofClinicalLeadersProgress

(Appendix2,3&4)

• WorkshopsEvaluationQuestionnaires(Appendix5)

• TwelveMonthActionLearningLog(Appendix6)

• Threefocusgroupswithparticipants,DirectorsofNursingandMidwiferyandClinical

Leadershipsteeringcommitteemembers

• Eightyeightpatientstoriesandsixtysixobservationsofcareactionplans

• StakeholderMeetings

• PDPObjectives

• Posterpresentationsoftwentyoneserviceimprovementprojects(Appendix7)

DatawasindependentlyanalysedandfindingreportedbyKemmyBusinessSchool,Universityof

Limerick,Ireland.

EightinterviewswereundertakenwithDirectorsofNursingandMidwiferyinservicespriorthe

commencementoftheproject.Theaimoftheseinterviewsweretoidentifythemostcommon

impactmeasuresthatDirectorswanteddevelopedinservicesthroughoutthedurationofthe

programme.Thedatafromtheseinterviewswereanalysedusingthematicanalysis.Thefollowing

fourthemesemergedtobefocusedonduringtheprogramme:

• Qualityimprovement

• Developingparticipantstotakeonresponsibilityandaccountability

• Enablingparticipantstoexertauthority

• Developingserviceprioritiese.g.infectioncontrol,medicationmanagement,team

developmentandactivationprogrammes

project outcomes


Overall-PostProgrammeFeedback

Nineteen out of twenty two participants responded in a very positive manner to the overall

experienceoftheRCNClinicalLeadershipProgramme.Threecommonthemesofbenefitemerged

fromtheevaluationsandfocusgroups:

• theenhancementofleadershipskillsofparticipants

• growthinthepersonaldevelopmentoftheparticipants

• positiveoutcomesinpatientandclientcare

Otherbenefitsincludedthedevelopmentof‘managingthemanager’skills,conflictmanagement,

networkingandchangemanagementskills.Thefollowingquotesarerepresentativeoftheoverall

experienceoftheprogramme:

4

“Thisprogrammewasfantastichavingjust

taken up a new role/position, the course

assistedmeinbecominganeffectiveleader

ofateamandalsogainingtheabilitytobe

moreassertiveandabettercommunicator

withintheteam”.

“It helped me develop and it definitely

helped me deal with team conflict. The

actionlearninghelpedmeexploreongoing

conflictwithpeopleandworkproblems.The

patient stories are a very good feedback

mechanism which we have been adopted

on a continual basis. The networking part

of the course is excellent. Hopefully good

supportsformanyyears”.

“Amostpracticalexperienceencompassing

facets of clinical leadership in a way that

has been both stimulating and calming;

informativeandinfluencing;reassuringand

supportive. That I can influence behaviour

through my own and learned leadership

skillsandtherebyinfluencecareandpolicy

is very empowering. This programme has

beenavaluabletoolformetoachievethis

andtoreflect”.

“The Clinical Leadership Programme has

definitelymademeseethingsmoreclearly

whichforthemostparthasbeengoodand

productive; but there is a part of me that

feelssomewhatfrustratedasIamreflecting

onincidents/thingsalotmoreandstriving

to get results but not always succeeding.

It has definitely made me more aware of

the leadership skills of my line managers

colleaguesaroundmeandindeedmyown.

Reflection has definitely become part of

my working day; and for the most part

is proving positive but there is also the

negativeelementwhichIfinddifficult.But

throughactionlearningandsuchsupportive

clinical leaders and facilitator, it is getting

somewhateasier.Theprogrammehasalso

given me the confidence and courage to

address issues with my line managers if I

feel absolutely necessary, i.e. not just the

positives”.


EarlyProgrammeFeedback

It isusefultocomparefinalfeedbackwithearlyfeedbackfromparticipants. Inthiscaseearly

feedbacktakenatthebeginningofthecoursewaslargelypositivewithallparticipantsdelivering

positivefeedbackcommentssuchas

Howevertherewereindicationsthatsomeparticipantswereexperiencingaleveloffearandanxiety

attheearlystageoftheprogramme,intermsofanticipatedworkloadandtimemanagement.

Theneedtoprovideparticipantswithreassuranceandinitialsupportinmanaginganxieties;in

facilitatingsuchorsimilarprogrammescannotbeunderestimatedparticularlybeingmindfulof

attritionrates.

OverallProgrammeEffectiveness

Theeffectivenessoftheprogrammewasmeasuredinanumberofways.Participantswereasked

tocompletedpre,midandpostquestionnaires.Participantsalsoratedeachmoduleseparately.

Focus groups were undertaken with programme’s stakeholders. Stakeholders included the

programme’sclinicalleadershipsteeringcommittee,theparticipantsandtheparticipants’mentors

andlinemanagers.Overall,allstakeholdersfelttheprogrammehadachieveditsobjectives.The

followingsectionpresentsthefindingsfromtheparticipants’evaluationformsandfocusgroups.

Nineteenrespondentsratedtheoveralleffectivenessoftheprogrammeasbeingveryhigh.See

table2overleaf.

“Iamreallyenjoyingthecourse.IfeelIamon

aself-discoveryjourneywhichissometimes

goodandsometimesnotsogood.Learning

lots from other colleagues on the course.

Wishallnursescoulddoacourselikethis”.

“Enjoying the course and I am finding it

great, it is helping me to grow – in every

sense of the word. Action learning days

havebeensobeneficialI’mlookingforward

toawinteroflearning.”

“I am happy with the programme so far

andfindthefacilitatorverysupportiveand

approachable. I feel the programme has

refocused my attention on how we can

improvethequalityofcareforourservice

users”.

“TheprogrammeisahugesupportforCNM’s.

Thetheoryispracticalandcanbebrought

backtotheworkplace.Thepatient’sstories

andobservationsofcarearepowerfultools

forimprovingpatientcare”.

“Greattohavetheopportunitytoparticipate.

Timetodohomeworkvery limitedthough

due to work and home commitments.

Inclined to worry too much about written

work–causingstress”.

“Iamfindingtheprogrammeveryhelpfulto

meinmydevelopmentasaleader.However

I find I have to complete the work on off

dutytimeduetopressuresonthewardi.e.

nooffice,inadequateI.T.andnoCNM1”.

“At times found it very time consuming

while doing a full time job. Even though I

amlearningfromandenjoyingthecourseI

sometimesfeelabitunderpressure”.

HowwouldyouratetheRCNClinicalLeadershipProgrammeonthescalebelow:

VeryPoor Poor Neutral Good VeryGood

1 19

November 2008 Clinical Leadership Pilot Evaluation Report page11

Table2:Source:finalparticipantevaluationform

Levelsofjobsatisfactionamongparticipantswerealsoaffectedbyparticipationonthecourse.

Fourteenoutofnineteenparticipantsreportedthattheirsatisfactionwiththeircurrentjobhad

improvedoverthecourseoftheprogramme.

Eighteenoutofnineteenparticipants felt thatmoraleandsatisfactionof staff in theirclinical

areahad improvedthroughout thedurationof theprogramme.Thefindings indicate that the

differentexpectationsofallstakeholdergroups(steeringcommittee,participants,mentorsand

linemanagers)werefulfilled.

Nineteenparticipantsfeltthattheprogrammemettheirexpectations,whilesevenparticipants

indicateditsurpassedtheirexpectations.Fouroftherespondentsreferredtotheactionlearning

componentasbeingparticularlyvaluable.Observationsofcare,patientstoriesandtheservice

improvementprojectswerementionedas importantaspectsof theprogramme.Thepractical

andappliednatureoftheprogrammewasalsoseenasahugestrength.Thefollowingquotes

accuratelycapturethenineteenresponses.

“Practical way the course is run/taught

–not liketheusualtextbookmanagement

courses,it’sverydifferentinitsdeliverybut

muchmoreeffective”

“Yesevenmorethanfulfilledthem!! Ihave

grownonapersonallevel,ithasbeenagreat

learningopportunityandIhaveachievedso

much from patient stories/observations of

care/tomanagingteams/settingobjectives/

PDP/ Myers briggs/360 report, I could go

on!! I found action learning invaluable, it

hasbeenverybeneficialtomygrowth.The

supportmechanismwasexcellentandour

group worked well. The different clinical

experiencefromdifferentserviceswasvery

educational it has certainly encouraged

networkingacrosstheservice”.

“Yes, the programme has fulfilled my

expectations; I wanted to improve my

clinical leadershipskills. I feel Iamamore

effective clinical leader. Action learning

dayshavehelpedmetoaddressandresolve

anumberofissues.Theseincludeabetter

workingrelationshipwithCNM1anddealing

withstaffconflict”.

“Absolutely.InitiallyIwasveryapprehensive

about undertaking the course but it is

so practically based it is exactly what I

needed”.

“Yes,unsureatthebeginning,howitwould

help me develop. Through action learning

it helped me realise that the conflict we

wereexperiencinginourarea,wascommon

to most other areas. It helped to explore

solutionstotheaboveinasafeenvironment

through the (Action Learning) group – at

firstgentleprobingandthenmoreindepth

probingwhichhelpedmereflectonmyrole

within theconflictand therebyhelp reach

realsolutions”.


“YES!!! 110% I have learned and shared so

much. It has been a career saver as I was

having doubts and my motivation and

direction were waning and unclear. A

wonderfulprogrammeforCNMs.Certainly

boosts morale and encourages us to

celebrateourachievements”.

“SurvivalGuideforWardManager”(Thomas

2006) Full of hints and tips on how to

survive, It has given me encouragement

andresourcestobuildon–madememore

emotionally aware of myself and my own

behaviour.Mentoringsystemverypositive.

Action learningsetsveryuseful to resolve

problems. Helped me to re-establish the

importance of the patients in service

delivery”.

“The CLP has definitely re-energised me.

Through the Clinical Leader Profile, PDP,

360degreefeedbacketc,theopportunity

tojusttaketimeouttoreflectonmyselfas

a clinical leader has been very beneficial.

TobehonestitisnotsomethingIdidvery

often. To be able to link the programme

to local/nationalpolicies andagendashas

been enlightening e.g. transformation.

THANKYOU”

SteeringCommitteeFocusGroup

Theresponsefromallsteeringcommitteememberswhoattendedtheevaluationfocusgroup

was very positive. There was general agreement that the CLP had met its stated objectives.

Theyreportedthattheycouldidentifyreal,daytodaychangesthattheycouldattributetothe

programme.Thisgrouphighlightedthattheserviceimprovementprojectswereakeydriverof

change.Theyhighlightedimprovementsintermsof:

• networkingbetweenparticipantsandmulti-disciplinaryteam

• improveddecisionmakingandlinkswithothergroupsthroughtheactionlearningsets

• enhancedpoliticalawareness-thegroupnoticedadifferenceinhowparticipantsdealwith

differentstaff,howtheyengagewiththeirownmanagersandimprovementintermsof

‘managingthemanager’

Onapracticallevelthesteeringcommitteefelttheprogrammeenhancedparticipants’personal

development,increasedselfawareness,confidenceandconflictmanagementskills.

LineManagersFocusGroup

Feedbackfromthisgroupwasverypositive.Overallthegroupfeltthattheprogrammehadvery

positiveoutcomesforparticipantsandtheirunits/organisations.Theyfeltthattheprogramme

hadhadacascadeeffectinmanycasesandproducedpositiveoutcomesformorepeoplethan

justtheparticipants.Therewasconsensusthattheprogrammeorsimilarprogrammesshouldbe

developedforClinicalNurse/MidwifeManagersanditcouldformatemplatefordevelopmentof

othernurse/midwifemanagerswithintheHSE.Itwasemphasisedthatsimilarprogrammeswere

longoverdueandthatthatthesecouldprovidedastructurefordevelopmentofCNM/CMM’sin

termsoftheirroleandprogression.

outcomes attributed to particpants being on the pogramme


5The following section outlines changes have been identified andattributedtotheRCNCLPaccordingtoparticipants,linemanagers,mentorsandsteeringcommitteemembers.Thesearedetailed inthefollowingsectionusingdatafromtheevaluationforms,focusgroups, questionnaires, action plans and service improvementprojects.

Changestoleadershipcapability

OneofthekeyobjectivesoftheCLPwastoenhancetheleadershipcapabilityofCNM/CMMs.

Nineteen respondents felt the CLP was instrumental in developing their leadership skills and

capability.Fourteenoutofthenineteenparticipantsspecificallymentionedan increase inself

confidence and awareness as being key to their development as a leader. Other leadership

capabilitiesmentionedwerecommunicationskills,conflictmanagementskills,problemsolving/

decisionmakingskills,abilitytoempowerteamandtheabilitytodevelopavision.Again,these

quotesbelowarerepresentativeofthenineteenresponses.

“I feelmoreconfident inaddressing issues

andusesomeaspectsofactionlearningby

challengingtheteammemberstocomeup

withsolutionstoproblems”.

“Yes,myleadershipcapabilityhaschanged.

I used to worry endlessly at what others

thought of me. . I was self conscious in

myroleasCNMandthatlimitedmeinmy

actions”.

“I often wondered why I didn’t get the

respectthatothersgot.Now,Idon’tworry

inthatsameway.Iamnotselfconscious,I’m

notafraidofbeingaCNM.Iamnotafraidto

saywhatIthink.IsaywhatIfeelandInow

feelthatIamgettingmorerespect”.

“Have been more confident in influencing

how the team works together more

effectively;throughabetterunderstanding

of team dynamics; self awareness and

emotionalintelligence.Openingupdialogue

and discussion about differences. Getting

individual team members more involved.

Promoting a genuine sense of shared

responsibility and accountability which is

benefitingtheserviceofcareprovided”.


Feedback from the participants’ focus group echoed the questionnaire responses with calls

for theCLPorsimilarprogrammestobemademandatory forCNM/CMM’s levelswithinHSE.

Participants felt that the programme had helped their self belief, confidence and they were

‘workingsmarter’.

Keyoutcomesidentifiedbyparticipantswere:

• Increasedconfidenceandabilitytoengagewithmanagers.Forexampleparticipants

indicatedthattheywouldnowcarryoutresearchinadvanceofmeetingmanagersand

presentthemwithevidence/auditresultsetcinordertopresentastrongerargumentand

tofeelconfidentinthemselves.

• Participantswerecomingupwithviableandusefulnewwaysfordeliveringpatientcare.

• Recognisingthevalueofpatientstories-participantsrespondedthattheyhavelearnedto

listenandlookatsituationsfrompatients/clientsperspective.

• Movingoutsideoftraditionalacceptedsystemsandtaking‘risks’inproposingorbeing

activeinlookingatnewwaysofworkingorseeingotherperspectives.

• Improvedabilitytomanagedifficultpeople/issues.Moreconfidentintakingresponsibility

andnotalwayslookingupwardsforsolutions.

• Betterselfawarenessofstrengthsandareasfordevelopment.

• Morereflective.

KeyoutcomesidentifiedbyLinemanagersandmentorswere:

• Anobservableincreaseinselfconfidenceamongparticipantsparticularlyintheirability

tobemanagersandnotpassconflict/issuesautomaticallyuptheline.

• Increasedroleclarity-participantshavealsobecomemoreconfidentinchallenging

managerswheretheyfeelitnecessary.

• Meetingskillsofparticipants,intermsof‘owning’meetingsandpersistingonpoints/issues,

managingconflictandresistance.

• Participantshavelearnedtostandbackandadoptedamoreanalyticalapproachto

situationsinsteadof‘jumpingin’.

• Evidenceofnetworkingcontinuingamongtheprogrammealumniandparticipants

engaginginhigherlevelsofnetworkinginownunits/organisations.

• Casesofacascadingofsustainableactionlearningsetsandrolloutofpatientstoriesto

othernonparticipantswithinclinicalteams.

• Participantshavegainedgreaterinsightinto‘mechanics’ofotherareas/units/disciplines

andhaveincreasedholisticunderstandingofoverallserviceandappreciationof‘bigger

picture’.

• Participantshavebeenreassuredthattheirunits/areasarenotexcessively‘bad’andthey

arenotexperiencingissuesorproblemsuniquetothem.Senseofperspective.

• Onemanagermaintainedthatincreasedconfidencehashadapositiveeffectonbody

languageandprojectedimageofparticipantswhichhasmadethemmoreapproachable

andenabledthemto‘bringstaffwiththem’.

• Greaterevidenceofteambuilding.


Changestopatient/clientcare

The elements of the programme that emerged as the main drivers of change are the action

learningsets,patient stories,observationsofcareand theservice improvementprojects.The

service improvement projects carried out by twenty one participants have led to real and

practicalchangeswithinparticipants’organisations.Thehavebroughtaboutbetterqualitycare

forpatientsandclients.FurtherdetailsontheseprojectscanbefoundinAppendix7.

Themajorityofparticipantsidentifiedchangesinpatientandclientcarethattheyattributeto

theprogramme.Aspreviouslystated,participantsprioritisedthreeaspectsasbeingparticularly

importantinthisarea:

• patientstories(50% of respondents referred to patient stories as specifically bringing

about changes in patient/client care).

• observationsofcare(48% of respondents referred to observations of care as specifically

bringing about changes in patient/client care).

• serviceimprovementprojects(36% of respondents referred to the service improvement

projects as specifically bringing about changes in patient/client care).

“Developing more women centred care,

patients’ stories, and observations of care

enhancingprivacyanddignity forwomen.

Perineal suturing - some midwives have

commencedsuturing”.

“We now have guidelines for family

involvementinthetransitionofcareintothe

unit.Thecarebeingdeliveredismuchmore

personcentredasaresultofobservations

of care and patient stories action plans

beingaddressed.”

“As a result of patient stories we have

increased activation and socialisation

sessionsforthepatients”.

“Yes the patient activation programme

is being drafted for the unit, in line with

HIQAStandard18.2. Ihaveworkedclosely

with those who coordinate activities and

theyhavegiven somuchover thepast 12

months. Most enthusiastic/motivated and

aremakingagreatimpactonthequalityof

life to the residents.Barewalls havebeen

furnishedwithbeautifulpaintingsenhancing

environmentforstaffandpatientsalike”.

“Observationsofcarehighlightedtheneed

to be observant of the small things that

makeadifferencei.e.noise,privacy,dignity

that may sometimes be overlooked in the

businessoftheday”.

“My service improvement project is to

review the admission of orthopaedic

patients to the trauma ward and to local

orthopaedic hospital. The rationale for

undertakingthisistoensurepatientsreceive

theoptimumorthopaediccare.Iwouldnot

have undertaken this project without the

support and guidance I received on the

programme.”

“IfeelIamnowmorefocusedonthequality

ofcarepatientsaregetting,particularly in

communication,inexplainingtothemwhat

to expect from me, what I will be doing

with them and If there are delays in their

treatment,whatthesedelaysareandwhy”.


“Wehavechangedthreeaspectsofourworkthroughpatientstories:

• wevisitallfamiliesonatleastoneoccasionafterthedeathofaclientwherewehave

activeinvolvement”

• patientstoriesidentifiedthatallclientsliketohaveamedicalreviewduringtheirjourney

inourservice.Thisisnowbeingintroduced”.

• patientstorieshavelongbeenadoptedaspartofourcustomerfeedbackprocess/

continuedimprovementonanannualbasis.”

“Supportstaffhaveembracedthekeyworker/careconceptwhichhasgreatlyimprovedand

Increased“relationshipbasedcare”–thisisdirectlyasaresultofmyserviceimprovement

project”.

Allmembersofthesteeringcommitteefocusgroupagreedthattheprogrammehadincreased

patient/clientengagementandprovidedachanceforpatient/clienttogivefeedback.Adopting

apatient/clientcentredapproachwasanimportantcomponentoftheprogrammeandthiswas

achievedaccordingtothegroup.Thegroupfeltthepatientstoriesplayedapivotalroleinthe

achievementofthisobjective.ThepatientstoriesprovidedtheCNM/CMM’swithanopportunity

toreceivepatient/clientfeedbackandledtoimportantchangesincare.Aconcernhighlighted

in theevaluationof theprojectwas the lackofappropriate structures locally to relayquality

improvementactionsacrossbothacuteandPCCCservices.

Changestothewaycareisorganisedanddelivered

The majority of clinical teams had no clear team objectives or performance management

frameworksinplace.Theprogrammeledtochangesinthewaycareisdeliveredaccordingto

sixteenoutofnineteenrespondents.Themajorityofthesechangeswereteambasedchanges.

Forexampleinsomeservicesthefollowingoccurred:

• teamreorganisation

• teamreviewandevaluation

• morefrequentteammeetings

• improvedproblemsolvingwithinteams

• clearerteamroles

• namednursedevelopment

• primarynursingintroduced

• keyworkerconceptdeveloped


“Care delivery is one aspect of our work

thatwouldalwaysbereviewedonaregular

basis”.

“Over the duration of the course we

have reorganised our work teams in my

departmentandfeedbacksofarispositive

fromstaff”.

“Willingnessoftheteamtoactonoutcomes

ofpatientstoriesandobservationsofcare.

Betterapproachtoproblemsolving”.

“We have 1. clearer roles 2. regular team

meetings3.settingteamtargets4.praising

and recognising achievements in better

outcomes”

“Puttingthebabybeforeroutine”.

“Our departmental philosophy is being

reviewed and ideas shared by all the

team to make it more patient centred.

Encouragingteamtotakeapatontheback

forexcellentpatientcare–toacknowledge

theirsuccess”.

Changestotheclinicalenvironment

Participants identified a number of changes in the clinical environment that they perceive as

directlylinkedtotheirparticipationontheprogramme.Themostcommonchangesweretothe

enhancementofthephysicalenvironment,moreprivacy,lessnoise,morepatient/clientcontact

and improvedhandhygiene.Theenhancedawarenessof theclinicalenvironmentwasmainly

attributed to the observations of care element of the programme. The following quotes are

representativeofthefindings:

“In light of current climate, hygiene audit

hasbecomeparamountinmyareaofcare.

Asa resultofCLP I ammoreempowered

to talk toandsupport staff through these

challenging times. Role modelling even

the basic hand washing techniques is so

important.Fromactionlearning,Iammore

aware of risk management, clinical audit,

healthandsafety”.

“Observations of care and patient stories

have highlighted issues that can be

addressed to improve patient care; these

include increased patient supervision,

addressing delays in patient discharge.

Staff adhering to infection control policy.

Thisincludeshandhygieneandusinglinen

trolleys”.

“Privacy and dignity upheld. Noise levels

keptminimal.Morepatientcontact.Fewer

errors”.

“From observations of care, we are

endeavouringtomaketheenvironmentless

clinicalandmorelivedin–morepictureson

thewalls,curtainsinsteadofblinds,personal

itemsforclients”.

“Health and safety: through developed

networks;achievedfunctionalfireescapeto

facilitateevacuationofpatientsontheatre

trolleys if necessary. Persistence +++

required.Teammoreawareofenvironment

fromobservationsofcare”.

“Working on decreasing noise levels and

turningoffunnecessarylights”.


Changestostaffdevelopmentandsupport

Themajorityofparticipantsrespondedthattherewerealreadyimprovementsinstaffdevelopment

andwhichwereattributabletotheprogramme.Themostcommonchangesinstaffdevelopment

identifiedbyparticipants focusedonthetrainingof teammembers.Otherchanges identified

were:

• improvedsupportmechanisms

• improvedcommunication

• morefrequentinteraction

• morerecognitionandempowermentofstaff

Thefollowingisarepresentativesampleofparticipantquotes:

“Havenegotiatedtrainingdaysforstaffand

realise the importanceofprofessionaland

personaldevelopmentforstaff–foundthe

workshoponteambuildingverybeneficial

Keystaffbeingtrainedindifferentarease.g.

infectioncontrol,nurseprescribing.”

“Fulleducationprogrammesetupsupport

and funding approved from line manager

forongoingcourses”.

“In my area of work the CLP has helped

me become more involved with staff

development,especiallytrainingandsupport

in the activation programme. I strongly

advise and encourage staff to nominate

themselvesfornexttrainingsessionssothey

canbecompetentactivationfacilitators”.

“Both CNM 1‘s are now taking more of a

leadership role. More involved in decision

makingandtakingtheleadindepartmental

service provision. They are taking a more

proactivepositionandthegrowingconfident

thattheydisplayiswonderful.Thisinturnis

influencingtheirteamcolleaguesandthey

now experience an authority within the

teamwhichhaspreviouslybeendifficult”.

“Yes, I have realised that when a staff

member is difficult a lot of time can be

focused on them to the detriment of the

otherstaff.Itisimportanttorememberthat

other staffneedenergyand timeput into

theirdevelopment,notjustthedifficultstaff

members”.

“I am encouraging other team members

to become involved in programmes, ie

fundamentalsofcare,infectioncontrol”.

“Have increased the frequency of staff

meetings which gives staff opportunities

to address issues. Have had some team

building sessions with staff to address

issuesontheunit”.

“Given thatpartofprogrammedeveloped

my own capabilities, I am now in a better

position to support my Clinical Nurse

Managers.Allowtimeforlistening.Conduct

clinical nurse managers meeting. Tackle

problems and issues as a team celebrate

whatisworkingwell”.


Changesincommunication–patientandteam

Seventeenoutofnineteenrespondentsfeltthatcommunicationimprovedsinceparticipatingon

theprogrammeparticularlycommunicationwithpatientsandteammembers.Thepatientstories

werehighlightedaskeytounderstandingpatientneeds.

“Improved communication – valuing the

client’sopinions.Enablingmembersofthe

team to develop themselves – in order to

enhancepatientcare......Dailyreportfornew

nursing staff. Use of daily communication

book”.

“Communication within the team has

improved. The patient stories gave the

patients familymemberanopportunityof

expressanyconcerns”.

“Patient stories gave me an opportunity

to listen to patients and understand their

experience inhospital.Giving feedback to

stafffromobservationsofcareandpatient

stories was an opportunity to engage

in effective communication with staff.

Meetingswithmulti-disciplinaryteamshas

developedmycommunicationskills”.

“Toolswereexploredduringtheprogramme

which enhanced communication with the

patientsandteammembers”.

“Greaterlinksdevelopedacrosscommunity

mental health teams. Greater interaction

withmultidisciplinaryteam.Linksdeveloped,

negotiation and political awareness

increasedwithsame”.

“Patientstories.Meetingwithvoluntaryand

statutorygroupsonanannualbasis.Some

documentedforISO.Monthlyreviewofhow

wearefunctioningasateam.MyersBriggs

and 360 degree feedback has helped me

whenworkingwithdifferentteammembers

withdifferentleadershipstyles”.

Changesinpolicydevelopment

Fourteenoutofnineteenrespondedtothissectionofthequestionnaires.However,themajority

ofthechangesidentifiedinpolicydevelopmentfocusedonreviewofpolicyratherthanactual

changes.

“Decontamination: Audit, policy and

guidelinedevelopmentongoing”.

“Reviewcurrentlyongoingofallpolicy’sin

thehospital”.

“Yes–wehavereviewedandupdatedsome

ofourdrugpolicies”.

“Working on trying to get care plans in

place.Havetodevelopapolicyaroundour

activitiesasregardsvolunteersandstudents

onworkexperience”.

“Iammoreinterestedinpolicydevelopment

andwhetherIcancontributetoitornot”.

“Patient stories improvements. Service

improvement project may change the

policiesofhowpeoplewithenduringmental

healthproblemsaccesstheservice”.


Hasbeingontheprogrammeaffectedyourrelationshipwithyourlinemanager?

Thevastmajorityofparticipants reportedan improvement in their relationshipwith their line

manager. Changes include improved communication, conflict management, open discussion,

increasedconfidence,provisionofskillstodebatewithandchallengelinemanagerinaconstructive

manner.Thefollowingquotesarearepresentativesamplefromtheevaluationforms.

“Yes. Action learning has helped me to

reflect on my role in our conflict – how I

contributedtothat–howIhavetoaccept

that I am not responsible for managers

actions – gave me the confidence to get

mymanagermoreinvolvedintheteamand

hopefully has increased overall morale in

somesmallway”.

“Yes. My line manager would have seen

changes in me that I was unaware of.

She feels that I have become much more

confident and more willing to become

involvedinnewchallenges”.

“Yesithasgivenmeframeworksandskills

to debate and challenge in a productive

manner.Veryaware that it is important to

workcloselywithallmanagersRelationship

withlinemanagershasalwaysbeinggood.

HoweverIwillnowquestionmore”.

“The programme has developed my

communicationskills.Thishasenabledme

to be more confident in decisions I make.

I have learned to be proactive and not to

bereactive.Thatistodealwithissuesand

anticipate problems. I feel my manager

appreciates this approach and know I will

seekadviceandsupportwhenIneedit”.

“360o feedbackhasmadememoreaware

of their opinion of me. Yes – I feel more

assertiveandfindIamabletoarticulatemy

concerns/issues in a constructive manner

withideasaroundissuesalreadymade”.

“Linemanagers–havealwayshadagood

relationship as far as I am concerned;

although the 360 degree feedback did

highlight some grey areas. Good to know.

These will be discussed and our mutual

perceptions.Otherrelationshipsarecalmer,

lessfrustrating”.


Organisationlevelbenefitfromtheprogramme

The majority of participants felt the programme brought about organisational level changes.

However,mostof theresponses indicatedthat theorganisationalchangesoccurred indirectly

by improving the individual leadership skills of the participants. The individual benefit of

the programme filtered through organisations, thereby bringing about wider changes and

improvements.

“Hasopeneddialoguewithothercolleagues

within the organisation eg. through

observations of care and patient stories

feedback. Increased patient involved is

alwaysapositivefortheorganisation”.

“Yes, the service improvement project

which I am undertaking will certainly

benefittheorganisation.Itwillhelpexplain

theservicesbettertothepatientsandthus

provideeasieraccesstothepatient. Itwill

alsohopefullycutdownonthenumberof

patientswhodonotattendtheserviceand

allow other patients to benefit from clinic

placesthatarenotgoingtobeavailedof”.

“Definitely patient stories, observation of

careandourprojectallhelpinahugeway

fromanorganisationalpointofview”.

“IbelieveIambetterabletocommunicate

withpeople.Politicalawarenesshashelped

meseetheoverallpicture.IbelieveIama

morepositivepersonandthisshouldbenefit

theorganisation”.

“Yes–therewereotherprojectshappening

within the hospital. The leadership

programmereinforcedanddovetailedwith

theseotherprojects”.

“The organisation has benefited by

improving leadership skills in a high risk

area therefore improving jobsatisfaction -

retentionofstaff”.

“For me – greater awareness of the

importance of political networking,

negotiating skills at senior management

levelwill impactthe largerorganisationas

good”.

“Safer paediatric service. More quality

focused. Highlighted need for paediatric

highdependencyunitatcorporatelevel”.

“Improved leadership skills hashelpedme

tolookatthebiggerpicture”.


SatisfactionwithProgrammeContent

This section concentrates on satisfaction levels with specific content of the programme.

Feedback is taken mainly from participants themselves utilising material from focus groups

whereappropriate.

Thefollowingtableillustratesthelevelofsatisfactionwiththeaspectsoftheprogrammefrom

theevaluationquestionnaires.Eighteenparticipantsrespondedhoweveroneparticipantdidnot

respondtothequestionson360feedback*.

NotSatisfied Neutral Satisfied VerySatisfied

ActionLearningsets 1 17

Personaldevelopmentplans 7 11

*360feedback 7 5

Workshops 5 13

Peersupportedlearning 4 14

Networking 7 11

Observationsofcare 2 16

Patientstories 1 3 14

Table3Satisfactionwithprogrammecontent

ActionLearning

Feedbackfromthefocusgroupsidentifiedactionlearningsetsaspectoftheprogrammeasa

corestrengthasitgavemeaningtotheprogramme.Onekeyaspectidentifiedbyparticipants

wasthediversityofassignedactionlearningsets.Therewasageneralconsensusthatbeingin

groupsnot fromtheirownworkplacegaveastrongsenseof safety toparticipants.They felt

safetodiscussissuesandengageinalevelofdiscussion/reflectionwhichtheywouldnothave

beencomfortabledoingwiththeirownworkgroup.Theyfeltthediversityofcolleaguesfrom

acuteandprimarycareservicesbroughtafreshperspectivestoissuesraised.Theyfeltthatthis

approachtoactionlearningshouldbemaintainedforfutureorsimilarprogrammes.

ThefollowingthreethemesemergedfromtheActionLearningLogasbeingthemostcommon

issuesdiscussedbyclinicalleadersacrossthe12monthperiod:

• Conflictandpeoplemanagementissues

• Teammanagementissues

• Servicedevelopmentissues


“I felt that Ibenefited from the fact that I

wastheonlypersonfrommyworkgroupin

myaction learninggroup. Iwouldbeslow

to participate if there was someone else

frommyareathereeventhoughtherewere

groundrulesputinplace”.

“The action learning study days have

developedmyproblemsolvingskills.Ihave

learned to reflect on my own experiences

and have learned from the experiences of

other members of the group. I benefited

from learning how to prevent conflict and

howtomanageconflict”.

“Action Learning sets and mentorship has

helpedmetotakeonanissueandfindways

myselftoresolvesame”.

360DegreeFeedback

The360-degreetechniqueinvolvesthesystematiccollectionofperformancedataonparticipants,

gathered from a variety of sources (the raters) in a confidential manner. The raters normally

include the participant’s line manager, peers and direct reports. Because each rater offers a

differentperspectiveontheparticipant’sskillsandabilities, the resultingappraisalprovidesa

well-roundedandcomplete(hence‘360-degree’)pictureoftheparticipantandhis/herstrengths

andweaknessesinassessedareas.TheprogrammeutilisedtheLeadershipQualitiesFramework

developedbytheNHS,tosupportthisprocess.The360DegreeFeedbackoccurredtowardsthe

endoftheprogramme.

Twenty one participants completed the process and responded positively to this in the

questionnaire.Key learningpointscitedweretheexperienceofreceivinghonestfeedback,an

awarenessofstrengthsandweaknesses,andtheprocesshighlightingareasfordevelopment.A

numberofparticipantssaidtheyfelttheprocesswasdauntingatfirstbutthat,onreflection,the

processwasverybeneficial.

“Reading in print other people views and

opinions of me as a clinical leader was

daunting and a new experience for me,

moving forward now and developing my

areasforgrowthismychallengeandIlook

forwardtosame”.

“Foundthe360degreeappraisalveryuseful

–ithasgivenmetheconfidencetobelieve

in myself as a leader. It highlighted areas

whereIcoulddevelopfurther”.

“Yes – very useful especially the Action

Planning section of the booklet – key

developmental needs. I am going to have

todoanactionplanofdevelopmentneeds

–bemoreawareoftheseandbeadaptable

tochangeaccordingly”.

“Yes–OnreflectionthecriticismIreceived

has made me stronger – it was hurtful

initially”.

“Yes,Iammoreawareofgettingonething

finished before starting another. Thinking

outsidetheboxandcooperatingmorewith

seniormanagement.Able toadmitwhen I

amwrong”.


“Yes it gave me the opportunity to look

at my leadership style through the eyes

of others. The feedback was invaluable in

identifyingareasforselfdevelopment.”

“Yes–allowedformetoreflectonmyown

practiceandimproveonareasidentifiedas

areasofweakness”.

“Ithelpedmereflectonmyownleadership

style and how this was impacting on the

team.ThepositivefeedbackIreceivedfrom

mymanagerandpeerswasappreciated.It

helpedmerealisethatIhavethetendencyto

commenceanewprojectbeforecompleting

thecurrentone.Helpedmetorecogniseto

say no to new work projects when this is

appropriate”.

There were some concerns raised in relation to timing and preparation for the 360 degree

feedback:

“The360oreviewmightbemorebeneficialatthebeginningoftheprogrammetohighlightareas

ofdevelopment”.

The participant focus group was also largely positive on this aspect of the programme.

Participantsfeltthatitwasusefulinbringinghometheimportanceofleadershipskills,increasing

selfawarenessandreflection,andinreassuringpeoplethattheyweredoingmanythingsright.

Itwasrecommendedthatthisprocessshouldbeatthestartoftheprogramme,inbeingableto

identifydevelopmentalneeds.This feedbackwasreflected inthesteeringcommitteeand line

management/mentorfocusgroupwherethetimingwasalsodiscussed.However,itwasnoted

that if the360degree feedbackoccurred tooearly theremaynotbe the requisite trust and

participantsmaynotbereadytoreceivedifficultfeedback.

Workshops

Theevaluationsoftheworkshopswereallverypositive–manyparticipantsremarkingonthe

excellent facilitationskills.Therewasverypositive feedbackonpresentations,especially from

speakersfromoutsidethehealthservice,forexamplebusiness,sportsandpolitics.Theworkshop

onconflictmanagementwasregardedasexcellentandverynecessary.

“MBTI helped me to manage my boss by

recognisingourdifferences”.

“Oneofmyfavouriteworkshopswasteam

building – I do mention some aspect of

thisday so regularly to the team–all the

literatureIgotonthesedaysalwaysavailable

to any team member. I’ve learned how to

managemeandhowtosetobjectives,how

todevelopandsustainteamsandofcourse

thenotionofinterdependence”..

“Getting to know your team, allowing

themtocontributeanddevelop issovery

important. As a leader not to shy from

askingforideas;andbeingsupportive”.


“PatientStorieshaveenabledustoensure

thatthecarewedeliverispatientfocused”.

“Have found the patient stories and

observations of care valuable frameworks

that Ihopetocontinuetousetomeasure

thequalityofcarethatweprovide”.

“Theuseofobservationsofcareandpatient

storiesdemonstratestheneedtoinvolvethe

teamandtotakeintoaccountthepatients

perspectivewhenmakingdecisions”.

“What I found the most difficult was the

patient interviews. I would have benefited

from observing a patient interview before

undertakingsame”.

pilot evaluation recommendations6


Therewasapositiveoverwhelmingresponsetotheprogrammefromallstakeholders.Certainareasforsimilarprogrammedevelopmentemergedbothintheevaluationsandthefocusgroupsthatcouldbeimprovedorbuiltuponforthefuture.

1. AllevaluationdatarecommendedthatsimilarprogrammesbecomemandatoryforCNM/

CMM’s.

2. ThedevelopmentofaseriesofstagedclinicalleadershipstrategiestosupporttheClinical

Nurse/MidwifeManagercareerpathway.

3. EstablishbettermentoringstructureswithintheHealthServiceExecutive,e.g.accessibilityto

personnelthatfocusonlongtermdevelopment.

4. Developmentofa360degreefeedbackmechanismforClinicalNurse/MidwifeManagersand

toreviewthetimingandreportingofthisprocessinprogrammestructures.

5. ExplorethesustainabilityofclinicalleadershipdevelopmentforClinicalNurseandMidwifery

Managerswithinanationalcontext.

6. Developexpertisetofacilitateclinicalleadershipdevelopmentwithinnursingandmidwifery-

howtheRCNclinicalleadershipprogrammewasfacilitatedwasseenofrealbenefit.

7. Developmechanismstodisseminationtheoutcomesfromclinical leadershipdevelopment

–focusonamoreco-ordinatedapproachtosharinginformationonservicedevelopmentand

improvedpractice.

8. Exploreaccreditationprocessesandenableparticipantsflexibilityinachievingaccreditation,

iftheysowish.

Thefollowingquotesfromparticipantsreflectsomeoftheabovepoints:

“Keepupthegoodwork.Istronglybelieve

thatthiscourseshouldbecompletedwithin

twoyearsofanynursebeingpromotedtoa

managementgrade”.

“The Clinical Leadership Programme

shouldbemandatory forallClinicalNurse

Managers, ideally undertaken prior to the

takingupofthepost”.

“IworkasaCNSandstronglybelievethat

inanearlierlifeasCNM2thiscoursewould

havebeeninvaluable.Ifeelthiscourseshould

bemandatoryforallnewlypromotedCNM

2’sandtheyshouldbeintegratedwithmore

experienced people to learn from them.

Alsotheycansharetheirexperiences”.


4“Would like to see a similar programme

developed for staff nurses to enable

them to work more effectively within the

complexities of the health system. If they

were empowered & enabled, they would

have a positive impact on issues within

nursingandhealth”.

“Could this CLP be developed further so

onecouldcontinuetheirleadershipjourney,

atdifferentlevelssothatonecouldbecome

veryproficient”.

“Would there be an opportunity to have

follow up days after completion of the

programme”.

“Iwouldlovetomeetthelargegroupover

the next year to re-visit aspects of the

programmeandhavethevalue/inspiration

fromourexcellentfacilitator”.

“Anexcellent facilitatorand I feel that the

programmeinthefuturewillbesuccessful

ifithastherightfacilitator”.

“The programme worked because of the

greatfacilitationskills”.

“Chooseamentorwhoisreadilyaccessible

and who will still be available when the

programmeiscomplete”.

Anumberof issuesemerged fromthesteeringcommittee focusgroup includingtheneedto

increaseparticipationonsuchprogrammesfrompublichealthandpracticenursing,particularly

withthedevelopmentofprimarycareteams.Thegrouphighlightedtheneedformoreinteraction/

communicationwithstaffunionslocallyandtheneedforculturalchange-“Leaderswillencounter

conflictwhenintroducingchangeandneedtobeabletodealwiththis”.Theyrecommendedthe

inclusionofaworkshopondealingwithunionandpartnershipissuesandthatthiswouldbean

importantadditiontotheprogramme-“enablingCNM’stounderstandwhothestakeholdersare,

identifyingstakeholdersindifferentorganisations,understandingthatstakeholdersmaychange

andfeelingempoweredtodealwiththestakeholders–areimportantpartsofanyprogramme”.

Akeyrecommendationwasthattheoutcomesfromclinicalleadershipdevelopmentshouldbe

collatedinanationalregister/databasetoinfluencethedisseminationofservicedevelopment

andinnovation.Itwasalsosuggestedthatthereshouldbemoreformalandfrequentmechanisms

tocapturepatient/clientvoicesgiventhesuccessofthiscompetentoftheprogramme.

Theissueofsustainabilitywasonethatemergedasanimportantconsiderationinallfocusgroups

andevaluationforms.Theimportanceofsustainingprogrammeactivitiese.g.actionlearningand

lifelonglearningaftersuchprogrammesshouldbeconsidered.

conclusion7


Thefindingsofthispilot,whichutilisedtheRCNclinicalleadershipprogramme as a framework for clinical leadership development,demonstratethattherearebenefitstosupportingandenhancingtheclinical leadershipskillsofclinicalnurse/midwifemanagersintheRepublicofIreland.

Itrecommendsthatnationalclinical leadershipstrategiestosupportfront linestaffshouldbe

developed,particularlyasthecontextofIrishnursingandmidwiferyischangingandnewways

ofworkingareneeded.

FurtherworkinenhancingleadershipcapacityintheRepublicofIrelandisrequiredtodevelopand

sustainaflexiblenursingandmidwiferyworkforce.Itisvitalthatimmediateactionsforenhancing

clinical leadership at all nursing and midwifery grades are identified. These national clinical

leadershipstrategiesshouldbeexperientialandworkbasedtoachievebettersafeoutcomesfor

clientsandpatients.Thislevelofinvestmentisnecessaryinsustainingimprovedperformancein

theIrishHealthService.Itcanmakeorbreakthedeliveryofatransformedhealthservice.


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appendices


Appendix1-ClinicalLeadershipSteeringCommitteeHSEWest(Limerick,ClareandNorthTipperary)

MembershipoftheGroup

1. IndependentChair-PatHarvey(Former CEO -North Western Health Board)

2. MargaretMurphy-PatientRepresentative-IrishPatientAssociation

3. JohnHennessey-A/NetworkManagerAcuteServicesHSEWest

4. BernardGloster–LocalHealthManager-NorthTipperary/EastLimerick

5. NoraIrwin-Director,NursingandMidwiferyPlanningandDevelopmentUnit

6. MaryKenehan-HumanResourceSpecialist.HSEWest

7. MarieO’Haire-PartnershipFacilitatorHSEWest

8. MauraFitzgerald–DeputyDirectorofNursing,MidWesternRegionalHospital,Limerick.

9. GeraldineRyanDelaney-DirectorofNursing,HospitaloftheAssumption,Primary,Community

andContinuingCare

10. MargaretQuigleyDivisionalMidwifeManager,MidWesternRegionalMaternityHospital,

Limerick

11. MaryFogarty–IndustrialRelationsOfficer-IrishNursesOrganisation

12. JeaneMoloney-ProgrammeParticipant-ClinicalNurseManager3-MidWesternRegional

Hospital-LimerickAcuteServices

13. BredaO’Connor-ProgrammeParticipant-ClinicalNurseManager2-DaughtersofCharity,

Lisnagry,Primary,CommunityandContinuingCare

14. MichelleFrawley-ClericalOfficer,NursingandMidwiferyPlanningandDevelopmentUnit,

HSEWest(Limerick,ClareandNorthTipperary

15. CoraLunn-ClinicalLeadershipFacilitator,NursingandMidwiferyPlanningandDevelopment

Unit,HSEWest(Limerick,ClareandNorthTipperary).


Appendix2-PreProgrammeQuestionnaireforclinicalleaders

1. Biographicaldetails

Whatageareyou?

Whatareyourqualifications?

Describeyourclinicalarea (i.e.typeofclinicalarea andtypeofpatients)

Describeyourorganisation

2.Values,patientcareandprofessionaldevelopment

Howisthenursingcarein yourclinicalareaorganised?

Doyouhaveawritten Please elaborate

philosophyofpatientcare?

Dostaffworktoaphilosophy ofpatientcare?

Dostaffunderstandthe philosophyofpatientcare?

Howwouldyoudescribethe qualityofcareinyourclinical area?

Howdoyoumeasurethequalityofcareinyourclinicalarea?

List3waysinwhichthequality ofcarecouldberaised?


3.ClinicalLeadershipexpectations

Howwouldyoudefine

leadership?

Howwouldyoudescribeyour

currentleadershipattributes?

Whatdoyoubelieveareyour

currentstrengthsasaleader

andwhatdoesthismean

inpractice?

Namethreespecificskillsyou

hopetodeveloporbuildon

overthecourseoftheRCN

ClinicalLeadershipProgramme.

Arethereanypatient YES NO involvementinitiatives currentlytakingplacein IfYESpleasedescribeit yourclinicalarea?

Haveyouidentifiedany Pleasedescribe particularproblemsinthe clinicalareainthewaythat careisorganisedordelivered thatmayhaveadetrimental effectonpatientcare?

Doyoubelieveyouhave YES NO goodteamworkinyour clinicalarea? Pleasegiveexamplesofteamwork?

Doyouworkwellwithallthe othernon-clinicalareabased healthcarestaffthatare involvedwithcare? Giveexamples.

Arethereanycurrentresearch initiatives/projectsunderway inyourclinicalarea? Whatprofessionaldevelopment programmesarethereforstaff fromyourclinicalarea?


Canyouexplainwhyyouwould liketodeveloptheleadership skillsidentified?

Howwouldtheleadershipskills identifiedbenefit a)patientcare, b)theclinicalareaand c)theorganisation? Doyoubelieveclinicalareais opentochangeandkeeping pacewithdevelopmentsin clinicalpractice–ifsohow? Arethereanyparticularbarriers tochangethatyoucanidentify?

4.JobSatisfaction

i. Doyoufeelsatisfiedwithyourjob?Pleasetick?


ii. ifnotwhy?

iii. Doyoufeelsatisfiedwithyourabilitytoinfluencetheorganisationofpatientcare?


iv. ifnotwhy?

v.

Dootherstaffinyourclinicalareaofworkfeelsatisfiedwiththeirjob?


vi. ifnotwhy?


5.Follow–upinterview

Willyouagreetocomplete YES NO anotherquestionnaireduring andattheendoftheRCN LeadershipProgramme?

6.Opportunitytocommentgenerally

Wouldyouliketheopportunity tosayanythinginrelationtothe RCNClinicalLeadership Programme?

Thankyouverymuchforyourtime.


Appendix3-MidProgrammequestionnaireforclinicalleaders

1. WhathaveyoulearnedsofarfromtheRCNCLP?

2.Howhastheprogrammecontributedintheareasoflearningyouhaveidentified?

3.Whathasnotbeenbeneficialtoyouwithregardstoyourinvolvementwiththe

RCNCLP?(Pleaseexplain).

4.Howcouldtheseareasbeaddressedforthefutureprogrammes?

5.Pleaserateyoursatisfactionwiththefollowingkeyprogrammeinterventions:

• Personaldevelopmentplans


• 360oFeedbackTool


• ActionLearningSets


• Workshops



• One–to–Ones


• Peersupportedlearning


• Networking


• Observationsofcare


• Patientstories


6.Whathasbeentheimpactintermsof

•PatientCare

•PersonalLeadership development

•ClinicalEnvironment

•Servicedevelopment

•Quality

7.Doyouthinkthecareinyourclinicalareahasorischanginginanyway,asaresult

ofyourparticipationontheRCNCLP?

Ifso,isthataresultofyourparticipationontheRCNCLP?

(Ifyes,how?)

8.Hasyourdevelopmentplanstartedtoaddressthegoalsyouidentifiedatthebeginning

oftheprogramme?

Thankyouverymuchforyourtime


Appendix4-PostProgrammeQuestionnaireforclinicalleaders

1. HowwouldyoudescribeyouroverallexperienceoftheRCNClinicalLeadershipprogramme?

2.HowwouldyouratetheRCNClinicalLeadershipProgrammeonthescalebelow:

VeryPoor Poor Neutral Good VeryGood

3.Hasyourleadershipcapabilitychanged?Pleasedescribe:

AretheleadershipattributesyouidentifiedhighlightedinyourPDP?

4.Wasthe360degreeappraisalusefulinidentifyingareasofsubsequentchange?

a.Howwouldyounowdescribeyourselfasaleader?

b.Didundertakingtheprogrammefulfilyourexpectations?

c. Isthereanyaspectsoftheprogrammethatcouldbeimproved?

d.Aretherechangesdirectlyattributabletoyoubeinginvolvedinthe

RCNClinicalLeadershipprogramme:


i. Patientcare

ii. Changesinorganisingthewaycareisdelivered

iii.Clinicalenvironment

iv.Staffdevelopment

v. Staffsupport

vi.Clinicalgovernance

vii. Quality/Fundamentalsofcare/clinicalgovernance

viii.Communication–patient,teamorwiderteam

ix.Policydevelopment


e.Arethereanychangesinthewaytheteamworkstogetherinyourclinicalenvironment?

Ifso,arethesechangesinanywayconnectedtoyourinvolvementintheRCNClinical

LeadershipProgramme?

f. HaveyouchangedyourpostwhilstbeingontheRCNClinicalLeadershipProgramme?Hasthis

changealteredyourperceptionsoftheappropriatenessoftheprogrammehelpedorhindered?

g.Hasbeingontheprogrammealteredyourcareerfocusordirection?Ifso,how?

h.Howsatisfiedareyouwithyourcurrentjob?Pleaseindicateonthescalebelow:

Verydissatisfied Dissatisfied Neutral Satisfied VerySatisfied

5.Hassatisfactionwithyourcurrentjobchangedoverthecourseoftheprogramme?

Ifso,pleaseexplain.

6.Haveyouobservedanychangeinthejobsatisfactionofstaffinyourclinicalarea?

7. Hasbeingontheprogrammeaffectedyourrelationshipwithyourlinemanager?

• Othermanagersinyourorganisation?Ifso,pleaseexplain.


8.Wehavesofarbeenexploringimpactonyourpersonaldevelopment,thepatient,theteamand

theclinicalenvironment.Doyouthinkthereisanyorganisationlevelbenefit?

9.WouldyouliketoaddanythingyouthinkImayhavemissed?Wouldyouliketheopportunity

tosayanythinginrelationtotheRCNClinicalLeadershipProgramme?

Thankyouverymuchforyourtimeandsupportincompletingthisquestionnaire.


Appendix5-RCNClinicalLeadershipProgramme-Workshop

Name: Organisation: Date:

1. ThethingsIhavelearntfromtoday’sworkshopare:

2.ThemostimportantthingIhavelearntaboutmyselftodayis:

3.Myactionplantotakebacktomyworkplaceis:

4.Theonethingthatstandsoutformetodayis:

5.Theworkshopcouldhavebeenimprovedif:

6.ThethingsIenjoyedmostabouttheworkshop:

7. Thestyleoffacilitationwas:

8.Theimpactonmewas:


Appendix6-ActionLearningLogTemplate

IdentifiedIssue IdentifiedAction Impact


Appendix7-ServiceImprovementProjectundertakenintheHSEWest

(Limerick,ClareandNorthTipperary)

AcuteHospitalNetworkServices

1. IntroductionofcannulationinA/EDepartmentinimprovingcaretoclients-MidWestern

RegionalHospitalNenagh.

2. IntroductionandthedevelopmentofPerinealSuturingbymidwivesforwomen-Regional

MaternityHospital.

3. Thedevelopmentofaneonatalunitinformationbookletforparents-RegionalMaternity

Hospital.

4. Developmentofbedmanagementpolicy/guidelinesfortheacuteTraumaOrthopaedic

ward-MidWesternRegionalHospitalLimerick.

5. Developmentofamorepersoncentredschedulingsystemforpatientsattendinga

haematology/oncologydayunit-OncologyUnit,MidWesternRegionalHospitalLimerick.

6. Thedevelopmentofamultidisciplinaryintegratedcarepathwayforpatientsbeingadmitted

foreyesurgery-MidWesternRegionalHospital,Limerick.

7. Development,implementationandevaluationofaCriticalCarePathwayinaCoronaryCare

Unit-MidWesternRegionalHospital,Limerick.

8. Thedevelopmentofapackageofpatienteducationandinformationinoutpatients

Department-MidWesternRegionalHospitalNenagh.

9. Thedevelopmentofamultidisciplinarypre-operativefastingguidelineforadultand

childrenonanorthopaedicward-MidWesternRegionalOrthopaedicHospital,Croom,

Limerick.

10. Thedevelopmentofamoreeffectivetheatreschedulingsystemtomaximisetheatre

capacityinmeetingtheneedsofpatients-MidWesternRegionalOrthopaedicHospital,

Croom,Limerick

11. Develpmentofapainmanagementserviceinaacuteservices-PaediatricDept,

MidWesternRegionalHospital,Limerick.


Primary,CommunityandContinuingCare

12. Establishmentofasystemwherethemostappropriatehealthprofessionalwouldassess

newclientsattendingmentalhealthservices-ShannonDayHospital,MentalHealthServices-

CoClare.

13. Supportandeducationfortheestablishment/implementationoftwoadditional

intermediatePalliativeCarebedsinanursinghome-MilfordNursingHome,Castletroy,

Limerick.

14. Thedevelopmentofguidelinesforthetransitionofclientsfromhome/acuteserviceto

residentialcare-HospitaloftheAssumption,Thurles,CoTipperary.

15. IntroductionofamodifiedmodelofprimarycarenursinginaRehabilitationUnitforolder

persons-HospitaloftheAssumption,Thurles,CoTipperary.

16. Thedevelopmentofstrategiestoenablethedeliveryofeffectivepatient/clientcarefor

olderpersons-HospitaloftheAssumption,Thurles,CoTipperary.

17. Enhancementofthelivingenvironmentforagroupofolderpersonswithinintellectual

disabilityinimprovingtheirqualityoflife-DaughtersofCharity,Lisnagry,CoLimerick.

18. Explorationoftheserviceimplicationsfortheimplementationofagraduateolderpersons

enduringmentalillnesscareservice-HSEWest,ClareMentalHealthServices.

19. Thedevelopmentofclientinformationresourcese.g.websiteandbrochureforacommunity

residentialfacilityforolderpersons-DeanMaxwellResidentialHome,Roscrea,CoTipperary.

20.DevelopmentandimplementationofanactivationprogrammeinaCommunityResidential

facilityforolderpersons-ReginaHouse,CoClare.

21. DevelopmentandimplementationofanactivationprogrammeinaCommunityResidential

facilityforolderpersons-RaheenHospital,CoClare.

Clinical Leadership Pilot Evaluation Report

Clinical Leadership Pilot Evaluation Report

Documents

Transcript of Clinical Leadership Pilot Evaluation Report