Quality Framework: An Update from Quality team

Simon Smith

Head of Quality

Aims and objectives

• To give an overview of the introduction of the HEE Quality Framework in the TV region

• To outline and advertise the work of the quality team

• To introduce and discuss the next steps in implementation

20/11/2018 QF update 2

Quality Team Structure

320/11/2018 QF update

What has the Quality team ever done for us?

20/11/2018 QF update 4

The existential reasons for QF

• Better training gives better patient care

– Positive association between GMC NTS and CQC grading

– Ditto for staff survey results

– Much published evidence of improvement in patient outcomes and satisfaction with improved education, supervision and training

• N.B. there are caveats

The HEE QF

20/11/2018 QF update 6

A quick reminder

20/11/2018 QF update 7

Assessment of Quality

Organisation Self

AssessmentOrganisational view of

compliance to quality

standards

Learner and

Educator

Feedback

including NETs

Data Analysis

from the HEE

Quality Standard

Metrics

Quality

Framework

Standards

Local Intelligence

Lo

ca

l In

tell

ige

nce

Lo

ca

l Inte

llige

nce

Local Intelligence

Collate and analyse data

and intelligence

Self assessment

Risk assessment

Plan Quality Intervention

Quality Intervention

Monitor and Evaluate

Learning

Environment

Continuous

Improvement

Cycle

.

20/11/2018 QF update

Other ‘new’ elements

• Focus on the learning environment

• Quality standards (do not replace regulatory standards)

• Multi-disciplinary approach

• Some standard metrics (but not exclusive)

• Standard interventions

• Real time

• Less onerous

Progress report from QT

• We will review the promises made, and how we delivered on the, locally and nationally

– Metrics

– Risk based approach

– Interventions (and reducing burden)

The HEE Quality Framework: Metrics (and intelligence)

• GMC trainee and trainer survey• HEFCE National Student Survey • NHS staff survey• CQC reports • Friends and family test • Hospital Episode statistics and • National Education and Training Survey (NETS)

Other possible metrics

• Learner outcome data– Progression rates (ARCP)– Skill acquisition– Supervision metrics (SLEs, supervisor meetings)

• Trainer performance data– Report data– Supervision data

• Process measures– Trainer CPD

• Balancing measures– Exception reports

• Local surveys• LFGs

NETS update

• It is here

• Issues/concerns remain

• Non-mandatory

• Two times per year (November and July)

20/11/2018 QF update 13

Data and its availability

• Tableau update……

20/11/2018 QF update 14

Risk assessment: a reminder

1520/11/2018 QF update

Risk based approach

• So, where are we locally…

• The Risk register:

– Developed and maintained

– 167 items over first year, reduced to c.30 open prior to NTS review, which added c90. Currently at c75.

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20/11/2018 QF update 17

Interventions: Reminder

Interventions: Reminder (2)

Interventions

• Local update

– QC ToR defined

– QC practice iteratively refined, good informal feedback

– Visits, ASR, ATR all halted 2017-2018 (reduction of burden)

– Risk based interventions undertaken

• Most commonly learner/educator meeting

• Occasional desktop review

• First triggered visit planned January 2019

– Quality meetings with Trusts

Available at: https://www.hee.nhs.uk/our-work/quality

Other activities of QT: Updates

• DA

• Raising concerns

• Lay Representatives

Differential attainment

• How did quality get involved?

• Next summer …

Raising concerns protocol

EscalatingConcerns.TV@hee.nhs.uk

Lay Representatives

Discussion: next steps

• Current structure:

QUALITY TEAM REPORTING

MONTHLY

Director for Education and Quality (DEQ) Report

BI-MONTHLY

Quality Surveillance Group (QSG) Report

QUARTERLY

HEE National Quarterly ReportJoint Strategic Oversight Group

(JSOG)Local Assurance Committee

DEQ South Board Report

Also: Continuous reporting to GMC of 12+ risks20/11/2018 QF update 28

Do we need:

• QC structures

• Visits

• Annual reports (Trusts and Schools)

• Autumn reviews (Schools and programmes)

Q Control Structure(s)

• Options:

– Quality Panels

– HoS Autumn review

– Review at ARCP by QT

– Reviews of school/programmes

• Trainee led

– Joint HoS and DMEs meetings

Other concerns

• ‘Single’ ( n<3) placement: how do we identify issues?

• Suspension of training processes in small placements

• Feedback to trainees on effects of raising concerns

– And visibility of this process

• Website and trainee for a

• Engagement of trainees

• Good practice dissemination

In the next year the HEE TV Quality Team plan to:-

1. Streamline and improve the quality assurance processes and communication within Thames Valley and our stakeholders. This will include reassessing the interpretation of the Quality Interventions including the programme of Quality meetings with Stakeholders.

2. Continue to use the Quality Framework, and implement the Intensive Support Framework (ISF) which is designed to enable both categorisations of concerns and provide the support to address them.

3. Support Stakeholders through the launch of the National Education Trainee Survey (NETS) – a multi-professional survey which aims to capture the learner’s experience of clinical placements. Analysis of which will support placement providers to identify good practice and areas for improvement within their own organisations.

4. Continue to collect data from the bi-annual Learning and Development Agreement (LDA) Self Evaluation Document which provides assurance and informs Quality meetings with placement Providers and share the Good Practice document across the Thames Valley.

5. Engage and support placement providers, HEIs, Training Hubs and the HEE TV Workforce Transformation team on increasing the number of clinical placements in line with the demand for increased numbers of trainees especially in Primary Care (20% increase in placement numbers) and in Midwifery - increase of 25% more training places. Also assuring those in educator and supervisory roles are also supported. Existing stakeholder networking forums are a) Learning Environment Leads Network, b) Private, Voluntary and Independent Placement Leads (HEIs) and Training Hub Education Leads Forum and c) Preceptorship Leads and Overseas Nursing Leads Forum.

6. Improve on the results of the 2018 the GMC National Trainee and Trainer Survey position.7. Continue to maintain the Quality Risk Register, and to manage the issues on this register, and use this data

as a metric of Quality Team performance.8. Continue to engage learners in the quality processes, and to increase the profile of the quality team to

learners, including increasing visibility of the quality processes and the effect these have on the learning environment.

9. Build on working relationships with other HEE local office teams to improve the experience of the learners (e.g. Workforce, Commissioning , BI, PGMDE)

10. Ensure structures to support Emerging Concerns policy (reporting and liaison between those involved in safety and quality of health care provision) , and support and advertise Escalating Concerns pathways for leaners.

Any questions?