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									                                                                      Highland NHS Board
                                                                               1 May 2007
                                                                                  Item 8.4


Report by Nigel Hobson, Associate Director of Nursing Jennifer Lobban, Lead
Facilitator Clinical Leadership Programmes NHS Highland
For Heidi May Board Nurse Director

The Board is asked to:

      Note improvements in service quality for patients.
      Note the positive impact on staff motivation.
      Support the continuation of clinical leadership development programme.

1.     Background

(i)     NHS Highland’s Clinical Leadership Development Programmes run in association
        with the Royal College of Nursing enables clinical leaders to develop practical
        strategies to use with their teams to improve patient care. The programmes’
        strengths lie in their practical, person and patient focused perspective. The
        programmes have been rigorously evaluated and quality assured at national and local

(ii)    Research demonstrates the pivotal role of the clinical manager/team leader in
        determining the quality of care. Good leaders produce good care and poor leaders
        produce poor care. The RCN Leadership Programme focused on the clinical
        manager /team leader, the senior nurse, and their leadership qualities.

                   The gap between low and high performing clinical leaders
                                  57% reduction in absenteeism
                                     40% lower drug errors
                                      Source Hay performance
                               45% improvement onGroup 2006
                                    36% lower staff turnover
                                 57% reduction in absenteeism
                                    Source Hay Group 2006

2.     Outcomes & Contribution to the Board’s Corporate Objectives

       The following are some examples of improved clinical outcomes directly attributable to
       the Clinical Leadership Development Programme:

        The introduction of “red meal trays” to identify patients who require assistance with
         their food. (This is now recognised as good practice at a national level as it helps
         prevent elderly frail patients failing to get adequate help to eat their meals) *
        A nurse led clinical pathway for renal patients requiring emergency admission to
         hospital for treatment of suspected peritonitis ( a very serious complication where
         fast treatment is essential) *
        A system to dispose of “clinical sharps” at the patient bedside. (A major
         improvement in staff safety)
        The introduction of diaries for patients and their relatives in adult and neo-natal.
         Evidence suggests this aids long-term recovery and provides psychological support.
                Working with you to make Highland the healthy place to be
         Exchange training for staff from different NHS Highland sites. (An excellent form of
          staff development, and an increased understanding of different specialties/systems
          of work)

* The results of these projects were chosen by the RCN as detailed case studies
included in their national evaluation document

3.     Governance Implications

(i)    Clinical & Patient Focus

       The strength of these programmes is their clinical focus. In other words, they develop
       our clinical leaders in ways which help them to focus their team on clinical quality
       patient safety, and improved clinical processes. Part of the programme involves
       observing care in another clinical environment and conducting interviews with patients,
       both of which help the leaders to gain greater insight of the patient’s perspective.
       Action Learning Sets (ALS) are established for all course attendees. These ALS
       continue after a course has been completed and contribute significantly to the Clinical
       Supervision of Nursing, Midwifery and AHP staff.

(ii) Staff & Financial

      The contribution health care professionals make towards delivering safe, high quality,
      patient focused care in NHS Highland is of the utmost significance.

      Every contact NHS Highland staff have with patients and / or relatives be it in a hospital
      or community setting can make a profound difference to those individuals. As well as the
      patient themselves, it affects the wellbeing of their family and friends, and the reputation
      of NHS Highland stands or falls by what patients/relatives experience whilst the
      percentage of clinical leaders undertaking one or other programme remains small (circa
      19% G Grades/Band 7). The outcomes in terms of improved clinical care, and better-
      motivated teams are quite evident.

      Whilst the resource implications of the 9 month programme is significant in terms of staff
      time, the evidence from both national and local evaluations strongly support the cost
      benefit ratio. NHS Highland has opted to continue the RCN Leadership Programme
      during 2007/08 by renewing our license agreement. We believe this offers excellent
      value for money and enables our clinical leaders and their facilitator to network with
      colleagues nationally.

4. Impact Assessment

The programme itself enables clinical leaders to consider issues of diversity and access.


1.    Programme Aim and Intended Outcomes

1.1   This report is prepared for all stakeholders within NHS Highland. It will identify the
      main outcomes and involvement with the Royal College of Nursing (RCN).

1.2 The overall aim of the NHS Highland Clinical Leadership Development Programmes
    (NHS Highland CLDP) in association with the Royal College of Nursing (RCN) is to
    enable clinical leaders to develop practical strategies to use with their teams to improve
    care received by patients. The programmes’ strengths lie in its practical, needs led,
    person and patient focused perspective. The programme has been rigorously
    evaluated and quality assured.

2.    Background

2.1   NHS Highland’s model of Clinical Leadership is based on the models described in the
      Leadership Qualities Framework of the Critical Leadership Behaviours and the RCN
      Clinical Leadership Development Programmes. The NHS Highland model seeks to
      combine the research that informs these models and to adapt them to meet the needs
      of NHS Highland.
2.2   The NHS Highland CLDP in association with the RCN is based on the understanding
      that although employers can influence the quality of patient care, it is the qualities of
      individual health care professional which have a more direct effect on how patients are
      looked after.

2.3   Current national policy places clinical leadership at the heart of modernising the NHS.
      (Delivering care, enabling health, November 2006). There is now global recognition
      that quality improvement can be achieved by empowering and enabling health care
      professionals, at a local level, to become more effective problem solvers and team
      players (RCN, 2000., Scottish Executive, 2006)

2.4   It is clear from existing research the pivotal role of the clinical manager/team leader in
      determining the quality of care delivered within a clinical area (hospital or community).
      Good leaders produce good care and poor leaders produce poor care. The RCN Ward
      Leadership Project focused on the clinical manager /team leader, the senior nurse, and
      their leadership qualities. The project aimed to promote better practice by identifying
      the skills needed by the clinical manager/team leaders to make them more effective,
      thus demonstrating how those skills could then be transferred to themselves, to their
      patients, their teams and to the organisation.

      The gap between low and high performing clinical leaders

      40% lower drugs errors
      45% improvement on performance
      36% lower staff turnover
      57% reduction in absenteeism

      Source Hay Group 2006 : Nurse Leadership: being nice is not enough

3.    Evaluation

3.1 The NHS Highland programmes were evaluated using a variety of qualitative and
     quantitative methods including 360-degree clinical leadership feedback, action learning
     audit, one to one feedback, appreciative enquiry, action plans from patient narratives
     and observations of care.

3.2   An independent evaluation of NHS Highland managers, Senior Nurses and Allied
      Health Professionals, (Caldwell, 2005) concluded the following: -

              91% of those interviewed were supportive of the programme and wanted its
              83% believed that the programme has successfully targeted the right people
              There is a wider need within NHS Highland for clinical leadership development
              The organisation needs to consider the best vehicle for delivering wider clinical
               leadership development
              63% considered a reduction in the programme duration. This was achieved in
               September 2005 by a reduction of 25% time reduction with no detrimental effects.

Fig. 1 Percentage of NHS Highland Attendees on CLDP

                                                                                 Leadership at the Point of
                                                      Learn to Lead              Care
 Clinical Group                 Total Numbers         4 Month Programme          9 month Programme
 Nurse D+E/ Band 5              1535                  51                         n/a
 Nurse F/Band 6                 667                   35                         67
 Nurse G+H/Band 7               560                   17                         92
 Nurse I/Band 8                 25                    2                          0
 Pharmacy                       50                    0                          0
 AHP                            353                   12                         12
 Doctor + Others                                      3                          2
 Total Numbers                  3190                  120                        173

 Dates of Programmes                                  August 2004 - April 2007   September 2001- June 2007

4.     Some examples of improved clinical outcomes undertaken by staff attending the CLD
       programme include:-

               Food, fluid, and nutrition. Introduction of red food trays to identify which patients
                require assistance with nutrition

               Nurse led and developed pathway for renal patients’ emergency access to
                commence treatment for peritonitis without delay

               Immediate sharps disposal beside patient

               Introduction of diaries for ITU and Neo-natal ITU patients and relatives

               Exchange training for staff from different NHS Highland sites

               Positive Partner Scheme/ The Orchard – A collaborative venture with social
                work colleagues

            New Ante Natal Care Pathway on trial at present

            Older adults falls at home (25% of older adult admissions). Core plan
             introduced to get patient back into the community and not unnecessarily
             admitted to hospital

            Information pamphlets translated into other languages including Polish and

            Use of bed rails audited following clinical governance issues. Bed sensor alarm
             systems now being trialled and policy under development

            Eating assessment team developed at New Craigs to encourage more healthy

            Increased awareness of stress, and how staff can access appropriate

            Obesity pathway to assist staff to manage patients in the community (now being

            Quality System introduced in Caithness General Hospital following a cleanliness

       More information on improved quality to patients’ services is available via the Intranet
       on NHS Highland CLDP reports.

5.    Setting Direction

5.1   The National Workforce Plan outlines the need for staff with such leadership
      capabilities to equip them to work strategically and interdependently with diverse
      partners in an ever changing political landscape.

5.2   The modernisation and reform of health services will not happen without effective
      clinical leadership. ( Delivering care, enabling health, 2006)

5.3   Clinical leadership can be developed across the whole service, with the appropriate
      investment, support and targeted activity.

5.4   Clinical leadership and management, whilst different in complexion are both necessary
      and related, and that development in both will be required to support the modernisation
      and reform of the services. (Delivering care, enabling health, 2006)

6.    Contribution to Heat Targets

6.1   The evidence presented in this paper demonstrates that the clinical leadership
      development programmes significantly contributes to the work of NHS Highland
      including many aspects of the Heat Targets. Furthermore, it is entirely congruent and
      supportive of the NHS Highland Clinical Strategy and other local and national initiatives.
      E.g. Delivering Care, Enabling Health, Charge Nurse Review, Visible, Accessible and
      Integrated Care, Developing Community Hospitals.

Nigel Hobson, Associate Director of Nursing
Jennifer M Lobban, Lead Facilitator CLDP NHS Highland

20 April 2007


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