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Partnership Quality Assurance Framework for Healthcare Education in England

Streamlining the Quality Assurance of Healthcare Education in England

Interactive event for students and service users held in Sheffield - 13 January and London - 9 February 2005: A report of proceedings

Executive summary

This report provides an overview of the rationale, background development and subsequent outcomes from the second dedicated event for students and users of healthcare services. Both events form part of the stakeholder consultation on the development of a shared and streamlined Quality Assurance Framework for Healthcare Education (DH 2003). The report on the first event held in December 2003 is posted on the Department of Health website.

As a result of feedback from the event held in London in December 2003, a decision was made to stage this event on separate days at two separate venues, firstly in the North (Sheffield) and then in London.

The event involved 158 delegates, drawn from users of healthcare services (12 delegates attending the Sheffield venue and 20 in London) and students from a range of healthcare education programmes (34 delegates attending the Sheffield venue and 92 in London). One representative from the Nursing and Midwifery Council and one from the Health Professions Council attended the London venue.

The event programme was developed in consultation with a delegate from the previous event held in December 2003 with emphasis given to group activity rather than presentations. A key element of both events was the inclusion of feedback from the December 2003 event and subsequent response to this in the development of the Partnership Quality Assurance Framework for Healthcare Education in England (the PQAF). This feedback was achieved through a dedicated presentation, given jointly by a previous student delegate and a member of the Skills for Health Quality Assurance Team, and supported by the inclusion of a handout in the delegate pack.

The group activities explored the following issues.

  • The significance of quality assuring healthcare education.
  • How the student and service user contribution to the PQAF can be strengthened.
  • Reflections on the presentation – ‘Emerging arrangements for the involvement of students and service users in the PQAF’ – and recommendations for the future.

Discussion and views arising from the activities were collected on 'tablemats' and postcards (completed by delegates) with the latter used to give feedback concerning key issues. These key messages were:

  • practice should be a key feature of quality assurance
  • the importance of securing appropriate involvement of everyone in quality assurance arrangements and
  • the need to ensure that the range and focus of the PQAF addresses overtly and robustly the issue of 'fitness for purpose'.

Overall, evaluation of the event (136 forms completed) was positive. Accompanying evaluative comments highlighted:

  • the value of meeting others at such an event
  • the opportunity to learn about new quality assurance arrangements and
  • that the event served to highlight the significance and value attributed to the views of students and service users within the development of the PQAF.

A number of recommendations emerged from the event, identified below.

  • Direct, rather than indirect, student and service user involvement.
  • Provision of targeted, specific and jargon free information.
  • Ensure students and service users are informed about the PQAF and their role and routes are influenced within this.
  • Continue dialogue with delegates from the 2003 and 2005 events and the wider student/service user community.
  • Develop facilitative approaches to support direct student and service user involvement.
  • Review the PQAF to ensure robust and direct involvement of students and service users in decision processes.
  • Develop a shared database and communication networks to engage service users both nationally and locally.

These recommendations, together with detailed analysis from the event activities, will go forward to national working groups and partnership forums involved in the development of the streamlined PQAF in order to inform their deliberations and further development of the PQAF.

Reference

Department of Health (2003) ‘Streamlining Quality Assurance in Healthcare Education: Purpose and Action’ (31091) available from:

Department of Health Publications
PO Box 777
London
SE1 6XH

1 Introduction and background to the interactive event

This report offers an overview of the rationale, background, developmental process and subsequent evaluations arising from an interactive event held on 13 January and 9 February 2005 in Sheffield and London respectively. Additionally, the report provides:

  • feedback to all delegates attending the event, with a copy of the report sent to each delegate
  • general information regarding the event to interested parties through publication of the report at www.skillsforhealth.org.uk and www.qaa.ac.uk
  • a progress report to key stakeholders involved in the development of the Partnership Quality Assurance Framework for Healthcare education in England (the PQAF), and
  • the basis for a synopsis for inclusion in the Quality Assurance News for Healthcare Education (Spring 2005 edition).

The event was held as part of the Skills for Health1 stakeholder consultation regarding the development of a Streamlined Quality Assurance Framework for Healthcare Education (DH 2003).

2 Rationale

The rationale for the event was the need to continue to engage both students undertaking healthcare education and users of healthcare services in the development of the PQAF, in recognition that both groups were key stakeholders. The decision to involve these particular stakeholders through dedicated events rather than representation on working groups and other forums associated with the development of the PQAF was purposeful, in order to avoid 'token' representation. Similarly, the timing of the event was planned to allow sufficient development of the PQAF to have taken place though the auspices of the established National Working Groups, in response to suggestions arising from the first bespoke event held for students and service users in December 2003.

Responses from this interactive event will be incorporated in the continuing development of the PQAF, particularly the elements of Approval and Ongoing quality monitoring and enhancement (OQME) before final refinement and subsequent implementation.

In adopting this stance, the potential challenges and issues of defining the user or consumer of healthcare education were acknowledged as outlined below.

3 Defining the user or consumer of healthcare education

In the context of professional healthcare education, the identification of the service user or consumer is potentially problematic, in that many groups may be viewed as warranting this title. These include:

  • the student body undertaking an approved programme
  • the user of health care services who has an investment in the appropriateness of the programmes provided and the associated learning gain and
  • the Strategic Health Authority Workforce Directorates who purchase and monitor the contracted education provision.

For the purpose of the bespoke interactive event, only the student and healthcare user were considered, as arrangements are already in place to engage the Strategic Health Authorities/Workforce Development Confederations.

4 Reasons for involving the healthcare education service user or consumer

A number of reasons were agreed as to why a bespoke interactive event was appropriate. These included:

  • to fulfil public accountability for the nature and quality of health professional education
  • to facilitate public confidence in the emergent arrangements and
  • to ensure consumers' identified needs and 'lived experience' appropriately inform developments.

5 Challenges and issues

The following issues were particularly significant in informing planning for the event.

  • Ensuring that consumers selected for involvement would be truly regarded as representative.
  • Facilitating consumers' involvement in a way that was perceived as equitable and relevant.
  • Facilitating 'feedback' mechanisms from consumer representatives to a wider consumer body.
  • The need to be transparent in the definitions and categorisation of healthcare education service users and principles adopted.
  • The need to build purposefully upon prior involvement (December 2003 event) of students and service users.

6 Differentiating between types of healthcare service user/consumer involvement

The rationale given above for health service user involvement potentially facilitated the identification of the types of involvement that could be considered as desirable. Health service user involvement may be classified in the following way.

  • Patient involvement, the primary focus of which can be seen as influencing the quality of health service delivery, such involvement being either as individual recipients of care or as a representative of a user group.

    Recently such involvement has been supported by Patient Advocacy/Advisory Liaison Services (PALS).

    Patient involvement, within more recent years, has also occurred in the context of health professional education, in terms of engagement in curriculum development and delivery through session teaching, such initiatives influenced by emerging policy (ENB 1996). The emphasis here is to provide insights into the patient’s experience and care needs, usually from the perspective of a recent/former patient rather than someone currently receiving care.
  • Public citizenship (Giddens 1998 and 2000) also seeks active involvement but primarily in decision-making forums and groups, thereby influencing strategic policies and innovations relating to health and social care services.
  • Public involvement, however, is a different and broader perspective, in that the focus is generic, seeking to secure appropriate quality of public services, primarily through stakeholder consultation processes. This classification would appear to be particularly relevant to the service users' involvement in the streamlining of health care education and can therefore serve to inform the scope of their involvement together with the approach to be adopted.

7 Principles of approach

  • Use, as far as possible, existing networks and forums.
  • Ensure communication seeks both to provide information about developments pertaining to the streamlining of quality assurance of healthcare education and determines students' and service users' perspectives as a basis for influencing future agendas and development.
  • Ensure students and service users have a voice in determining the nature and structure of any consultation event.
  • Ensure that the established collaborative and partnership based approach to the development of the PQAF is evident.
  • Delegates should have their travel costs reimbursed.

8 Developing an agreed event programme

In order for the event to be relevant and meaningful, it was important to ensure that the event was planned and developed in partnership. Accordingly, the final programme was initially structured against feedback and suggestions arising from the previous December 2003 event. This resulted in the event being offered at two venues, one in the South and the other in the North of England.

Further development involved discussion with a student who had been a delegate at the December 2003 event in order to ensure:

  • mid morning commencement, to allow ease of travel for delegates from across England
  • the balance of time during the day gave emphasis to group work and activity rather than formal presentations (with a ratio of 1:3 in favour of group work)
  • delegate working groups planned to allow a mixture of each delegate group (i.e. healthcare students and users of healthcare services) and
  • the event was planned to allow for:
    • delegates' current perspectives regarding quality generally to that of quality in the context of health and healthcare education
    • a presentation of the emerging PQAF
    • a review of suggestions and feedback arising from the December 2003 event and identification of the ways in which the PQAF incorporated these suggestions (Appendix 1)
    • discussion of the respective roles and influence of delegates within future quality assurance arrangements.

Other factors influencing the development of the event programme were the following.

  • It was helpful to contextualise the discussion and consultation event within wider healthcare policy, particularly that relating to achieving a quality service which was patient centred, with this serving as a basis for any presentations during the event
  • It was important to 'capture' delegates’ discussions in an open and participative manner. To this end, it was agreed that 'tablemats' be used, with delegates recording their views and discussions on these for subsequent collection. A limited opportunity would also be given to display a sample of the completed tablemats during refreshment interludes.
  • Some time should be allowed at the end of the event for comments and questions from the floor.
  • Group work and activities should be supported by facilitators drawn from delegates.

The event was staged in cooperation with the Quality Assurance Agency for Higher Education (QAA) acting under contract to Skills for Health.

9 Identifying and inviting delegates

In recognition of the principle of using existing networks as mentioned above, the following approach was agreed for the identification and invitation of delegates.

9.1 Delegates at previous December 2003 event

All delegates attending the previous event were invited to attend the 2005 event, recognising that some of the student delegates may no longer be students, having completed their programme of study in the intervening period. In the final event, eight delegates (three at the Sheffield venue and five at the London venue) identified themselves as having previously attended.

9.2 Healthcare students

All higher education institutions offering healthcare programmes and the Council of Deans and Heads (an organisation already involved as a stakeholder in the development of the PQAF) were informed of the 2005 event by post and email. Specifically, higher education institutions were requested to select delegates from a range of healthcare programmes. In the final event, while students from nursing and midwifery programmes were in the majority, representation from a variety of professions was achieved, including speech and language therapy, physiotherapy, podiatry and occupational therapy.

Appendix 2 detail sthe pattern of invitation, response and attendance.

9.3 Users of healthcare services

All Strategic Health Authority Workforce Directorates/Workforce Development Confederations were contacted. They were asked to issue an invitation to service users to attend the event, via their patient information and advisory network/officers together with their quality assurance staff leads. Additionally, service user contacts known to Skills for Health received information and invitations to the event. This was supplemented by a mailing to other relevant user focused organisations, for example the National Patient Safety Agency. Decisions regarding circulation patterns were taken in recognition that the issue being explored in the event was not only a complex one but could be viewed as indirect rather than having immediate and direct influence upon the care a patient/client receives. Thus, it was considered helpful to engage users of the service who had some experience of discussing policy issues. Additionally, both the Health Professions Council and Nursing and Midwifery Council were invited to nominate their lay council members as delegates.

Appendix 2 details the pattern of invitation, response and attendance.

9.4 Generic distributions

Other distribution strategies were used. These included notification at a range of forums and meetings, including a National Practice Learning Forum, and inclusion within the Quality Assurance News for Healthcare Education (printed and distributed by QAA).

9.5 Information to delegates

Prior to attendance, delegates were provided with the following by post:

  • a letter of invitation and explanation regarding the event and route by which they as individuals had been nominated as a delegate
  • provisional programme
  • briefing papers outlining the purpose and development to date of the PQAF and
  • arrangements for the reimbursement of travel costs.

9.6 On arrival, delegates received a pack containing:

  • a welcome letter
  • a confirmed programme
  • a copy of all presentation slides
  • a mat and leaflet which summarised the PQAF
  • paper and pen
  • a summary of suggestions/feedback from the December 2003 event and how these had been incorporated into the PQAF thus far (Appendix 1)
  • a briefing paper outlining development to date in respect of the PQAF
  • Quality Assurance News for Healthcare Education newsletter No 4 (October 2004) and, for the London venue, No 5 (January 2005)
  • a booklet – The future of Skills for Health, Health Service Journal Supplement (22 July 2004), which outlined the role and purpose of Skills for Health
  • an evaluation form and
  • an expense claim form.

10 Overall evaluation

10.1 Positive evaluation points

The event overall evaluated positively with 136 evaluation forms being returned (36 in Sheffield and 100 in London). The pattern of evaluation is given in Appendix 3.

The majority of comments included in the evaluation forms were positive in nature as summarised below.

  • A thought provoking and interesting day.
  • Good to meet others and network.
  • Now realise many of us have shared concerns.
  • Good to have an input and know our voice is heard and counted.
  • Learnt a lot.
  • Good that it was so interactive.
  • Good. Can we have follow-on events?

10.2 Negative evaluation points

  • Need to have questions at the end of the session not during (Sheffield).*
  • Need more information before the event (Sheffield).*
  • Give more time to presentations and questions.
  • A request for the provision of certificates of attendance (Sheffield).*

10.3 Modifications made in response to Sheffield event evaluations

In response to the evaluations points marked *, three modifications were made to the subsequent staging of the event in London, these being:

  • the provision of more information prior to the day itself
  • a certificate of attendance and
  • restriction of questions to the end of each presentation rather than permitting questions at any point in the proceedings.

11 Key messages

In addition to the collection of feedback from specific activities via tablemat notation, delegates were invited to complete cards and 'post' these during the day as a means of giving feedback regarding key messages. Seventy-seven cards (27 in Sheffield and 50 in London) were received in total and collated through key word analysis. Emerging themes and sub themes are as follows.

Theme 1: Practice should be a key feature of quality assurance

Sub themes

  • Ensuring adequate mentor preparation and support.
  • Addressing inadequate mentorship capacity.
  • Ensuring adequate and relevant tutorial support in practice.
  • The identification and dissemination of good practice pertaining to practice-based learning and support.
  • Ensuring appropriate exposure to practice settings and not relying upon the use of 'theoretical or insight packages' within the curriculum alone or as a replacement.
  • Developing strategies to address any potential theory practice gap.
  • Clinical currency of the curriculum content and experience of teaching staff.

Theme 2: Securing appropriate involvement of everyone in quality assurance arrangements

Sub themes

  • Direct participation rather than merely indirect involvement.
  • Mandatory inclusion of the PQAF processes within all curriculums to ensure students are aware of these and their own role/spheres of influence within the PQAF.
  • A need for more forums and interactive events both nationally and more locally.
  • Active involvement of students' unions and a range of patient /carer organisations.
  • Production of specific, jargon free material adopting a range of mediums.
  • Direct involvement of service users in decision-making including Major Review.
  • Adequate preparation and training for involvement.
  • Development of protocols for involvement including practical issues such as payment of service users for their involvement.
  • A need to engage independent service users rather than those simply employed by groups or agencies.

Theme 3: Range and focus of the PQAF needs development and clarification

Sub themes

  • The need to ensure the PQAF addresses robustly fitness for purpose and thereby results in the enhancement of patient care and the provision of graduates who are clinically competent and who can meet both current and future service needs.
  • Practice is encompassed fully.
  • Needs to be applicable to continuing education as well as initial registration provision.
  • The need to publish both outcomes of and evaluation of PQAF processes.
  • Clarification of the relationship of the PQAF to other policies including the higher education Research Assessment Exercise and Healthcare Commission activity in practice settings.

12 Analysis of activities

For each of the three group activities within the event programme, an analysis of the comments on the tablemats provided for individual/group feedback has been undertaken through key words. Emerging themes are identified below.

Activity one/tablemat: The significance of quality assuring healthcare education

This first activity was, in part, an 'ice breaker' activity, designed to facilitate delegates’ initial consideration of the concept of 'quality' as a basis for more detailed and specific exploration of quality within the context of healthcare education. Delegates were requested to provide their personal reflections upon the significance of quality assuring healthcare education.

The following top ranking themes emerged from the analysis of 145 submitted mats (46 in Sheffield and 99 in London). Detailed analysis is given in Appendix 4.

Reflection Number of tablemats
Ensure consistency of standards and comparability across provision83
Ensures registered staff are fit for purpose and competent83
Maintains the quality of mentoring in practice settings34 submitted
Results in good patient focused care, communication and advocacy31
Arbitrates on and disseminates good practice30

Activity two/tablemat: I believe that the student and service user contribution to the PQAF can be strengthened by:

The focus of this activity was to record on the tablemat provided details of how delegates felt that student and service user contribution to the PQAF can be strengthened.

The following top ranking themes emerged from the analysis of 142 submitted mats (46 in Sheffield and 96 in London). Detailed analysis is given in Appendix 4.

Reflections Number of submitted tablemats
More regular forums for students and service users 63
Increased information and publicity 61
Strengthen quality assurance regarding higher education institution and practice links, placement support and potential theory practice gap 37
More direct participation for each element and process of the PQAF including Major Review teams 35
Inclusion of the PQAF in the curriculum including explicit identification of students’ responsibilities as well as routes of involvement 24
Dedicated time and resources to support involvement, especially for service users 24
Formal linkage of the PQAF to patient information, advice and advocacy services and processes, service user organisations and students' unions 24
Make quality assurance outcomes public including the outcomes from these events with targeted information to service user organisations 24

Activity three/tablemat: Reflections upon the presentation

This activity invited delegates to reflect upon the presentation, 'Emerging arrangements for the involvement of students and service users in the PQAF' (given jointly by a member of the Skills for Health Quality Assurance Team and a student who had attended the previous December 2003 event), and to make recommendations for the future.

The following top ranking themes emerged from the analysis of 115 tablemats (35 in Sheffield and 80 in London). Detailed analysis is given in Appendix 4.

Reflections Number of submitted tablemats
Provision of a follow up national event and local focus groups to disseminate further information and develop the PQAF 40
Specific focused and jargon free leaflets and guides etc for students and service users 40
Active direct (rather than indirect) participation and involvement in the PQAF processes 34
Include PQAF in student induction programmes and at regular periods thereafter 23
Preparation and training for involvement 21

Conclusion

In conclusion, the interactive event for students and service users did achieve the aims identified with this initiative. Effective engagement of delegates was evident.

The detailed analysis of the activities undertaken during the day (Appendix 4) will be reported to partnership forums involved in developing the new streamlined PQAF, as a basis for informing their deliberations and further development of the PQAF.

A number of recommendations and action points emerged from the event. These are identified below.

Recommendation 1: Direct rather than indirect student and service user involvement

Action points

  • Consider the involvement of student and service user representatives in the new PQAF stakeholder forums established in March 2005.
  • Include student and service user representation in the review of the Major Review element of the PQAF following completion of the current cycle of Major Review activity (2006-07).
  • Consider the inclusion of a lay/service user as a member of the Major Review team in any future cycle of Major Review activity (2007 onwards).

Recommendation 2: Provision of targeted, specific and jargon free information

Action points

  • Consider periodic publication of a dedicated student and service user quality assurance newsletter.
  • Develop bespoke 'toolkits' and leaflets for students and service users (Recommendation 5 below refers).

Recommendation 3: Ensure students and service users are informed about the PQAF and their role and routes of influence within this

Action points

  • Require education providers to include details of the PQAF and student role within it in course induction arrangements, course handbooks and at appropriate transition points.
  • Utilise NHS Patient Information networks in order to disseminate information about the PQAF.

Recommendation 4: Continue dialogue with delegates from the 2003 and 2005 student and service user events and the wider student /service user community

Action points

  • Post prototype activity to be informed, by student and service user focus groups drawn from delegates at events held in 2003 and 2005.
  • Plan for a bespoke national/bi-regional event in 2006 to disseminate the outcomes from the prototype activity and subsequent development.

Recommendation 5: Develop facilitative approaches to support direct student and service user involvement

Action points

  • Develop bespoke training programme/package to support student and service user involvement.
  • Devise and agree protocols regarding the practicalities of student and service user involvement e.g. payment schedules.

Recommendation 6: Review PQAF to ensure robust and direct involvement of students and service users in decision processes

Action points

  • Address within the review of the Major Review element of PQAF (2007).
  • Review against the outcomes from the Prototype evaluations.
  • Identify emerging good practice concerning direct student and service user involvement from the Prototype evaluations and Major Review trend analysis as a basis for inclusion within revised arrangements.

Recommendation 7: Develop a shared database and communication networks to engage service users both nationally and locally

Action points

  • Follow up contact points identified during the 2005 event.
  • Consider as a project within the PQAF work programme.
  • Review PQAF procedures as to the way in which these formally link to existing NHS patient information and advice services and networks.

Appendices >>>

References

Department of Health (2003) 'Streamlining Quality Assurance in Healthcare Education: Purpose and Action' (31091) available from:

Department of Health Publications
PO Box 777
London
SE1 6XH

English National Board for Nursing, Midwifery and Health Visiting (1996); Learning from Each Other; London, ENB

Giddens A (1998); The Third Way; Cambridge, Polity

Giddens A (2000); The Third way and its Critics; Cambridge, Polity

Consultation event held 16 December 2003 in London: A report of proceedings; www.dh.gov.uk

1The Quality Assurance Team and its work programme, the PQAF, transferred from the Department of Health to Skills for Health in October 2004.

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