Interprofessional Teams:

more than just education

Professor Mary J LovegroveHead, Department of Allied Health Professions,

London South Bank UniversityAnd

Professor Niki EllisDirector, Centre for Military and Veterans’ Health

University of Queensland

Goal of the Cardiac Catheter Practitioner Project:

To reduce cardiac catheter laboratory down time by extending the roles of cardiac physiologists, cardiac radiographers and cardiac  nurses in order to reduce patient waiting time.

Traditional Catheter Laboratory

Professional expertise provided by:– Cardiac Radiographer– Cardiac Physiologist– Cardiac Nurse – Cardiologist

Pressures on a Cardiac Cath Lab

• All Staff– Hours– Recruitment and retention– Pay– Career Progression– Expansion to services– Lack of trainees in the system

• Cardiologist Availability– Private/NHS– Radiation Protection restriction

• Lab– Lack of Capacity– Inefficient use

Multi-Skilled Cardiac Catheter Laboratory Practitioner Project

________________________________Proposal to educate and train the existing

non-medical clinical cardiac staff to extend their role to cover a portion of each

other’s jobs =

increased flexibility

Organizational Flow Chart

Board Members

• AHP Lead ‐ North East London Strategic Health Authority• AHP Lead ‐ North West  London Strategic Health Authority• Principal Cardiac Physiologist ‐ Royal Brompton & Harefield NHS Trust• Challenge Fund Manager ‐ North West London Strategic Health Authority• Head of Department – Allied Health Professions, LSBU• Chair, Consultant Cardiologist ‐ St Mary’s Hospital• Senior Nurse ‐ Royal Brompton & Harefield NHS Trust• Officer – Society & College of Radiographers• Clinical Support, CHD Department of Health• Project Lead

Project objectives:

• To define new job role• To develop competencies• To design and validate a curriculum• To deliver training• To implement and evaluate the new way of 

working in Cardiac Catheter Laboratory• To generate recommendations and material for 

national  roll‐out

Evolution not Revolution?

• Agreed scope of new role• Day case angiography excluding:• Paediatrics• CHD (coronary heart disease)• Electrophysiology• Emergency work

• Working in a supervised environment where additional expertise is always available

Development of Agreed Competencies

• Pilot leaders workshops• Profession specific workshops• Additional competencies

identified for each professionalgroup

First Cohort of Students16 radiography/nursing/cardiac physiology students enrolled on the first Elective Angiography Course.

9 hospital sites involved: Royal Brompton & Harefield NHS Trust, St. Mary’s NHS Trust, Guy’s & St. Thomas’ NHS Foundation Trust, Royal Free Hospital NHS Trust,  The Wellington Hospital, Whipps Cross University Hospital NHS Trust, UCLH The Heart Hospital, King George Hospital, Southampton General Hospital

Student Prerequisites• Qualified health care professional in

one of the three disciplines (radiography, nursing, cardiac physiology) either employed in a cardiac cath lab for 25 hours/week or to be guaranteed full time practice learning in a cardiac cath lab

• Two years experience in a cardiac cath lab• Intermediate/Immediate Life Support Certificate• Support from service manager and access to appropriate work environment during training

Clinical & Academic Team

• Clinical– Practice Learning Coordinator– Practice Facilitator– Site Coordinators

• Academic– Course Director– Module Coordinators– Project Administrator

Course Structure• Academic Awards:

– Post graduate Certificate (M-level)– Graduate Certificate (H-Level)

• Programme:– Effective Delivery – compulsory– Diagnostic Imaging– Cardiac Physiology– Patient Management

AP(E)L from ‘own’ discipline.Each module delivered by block releaseClinical Supernumerary practice

Clinical Skills Development

Clinical Supernumerary Practice

- The 2006 cohort had to undertake4 months per clinical module.

(i.e. 8 months)

- The current 2007 cohort have to undertake a minimum of two months per clinical module.

(i.e. 4 months)

First Cohort Outcomes

• Private Sector removed 2 students• A radiology services manager removed one student

• One student left UK• 1 student failed• 11 students successfully passed, all working in extended role, 3 have achieved significant promotion

Evaluation

• Reduction in down time, increase in patient throughput?• Cost effectiveness?• Quality – incidence & management of adverse events?• Impact on patients, trainees, other CCL workers?• Were learning outcomes achieved?• Did course design satisfy students, clinical educators/supervisors,

lecturers?• What is the likely demand for this learning programme in its current format?• How could this programme best be extended to assist CCLs to meet

workforce shortages?

Results so far…+ Scope for multi-skilled CCL practitioner defined+ Development of a set of clinical competencies

(based on existing local sets of each discipline in each hospital)

+ 3rd cohort being recruited too+ Skills acquisition much less time than expected+ Well received nationally

Cohort 1: Student Feedback

• All Students believed they had a distinct advantage over clinicians who had not received multi-skilled training

• 81% specifically indicated they noticed a decrease in the downtime/increase in throughput within their lab

• 81% noted an increase in job satisfaction

• 64% noted high-quality clinical support from their Trust, whereas only 1 student noted significant problems

• 64% mentioned that communication with the University could be improved

Students’ views

+ Quality of patient care improved

+ Greater awareness of procedure

+ Improved workflow

+ Greatest challenge was Cardiac Physiology

• Unanimously, students took issue with the Non-Clinical Unit, finding it ambiguous or irrelevant

• Many students commented on uncertain future of the role in the NHS, and expressed frustration at getting their skills recognized and properly recompensed.

Manager/Supervisor Feedback• 100% found it difficult to staff their labs for a full eight

hours a day because of the need for people to take breaks

• Several commented that three students assigned to each site is best for skills development

• Most expressed the difficulty of recruiting cardiac physiologists

• All experienced an increase in understanding of the roles of other disciplines in the lab

• More than half commented on improvement of morale: “We actually sit down and talk to each other about what we are doing and how we are training our staff, something we didn’t do before.”

(-Lead Interventional Physiologist)

Manager/Supervisor Feedback Continued…

• All but one supervisor reported reduction in downtime/increase in throughput:

“We’ve saved 18 hours and that will certainly grow… when you compute that into managerial terms in the lab, its quite a lot of money.”

(-Radiography Clinical Lead)

• 86% mentioned that communication with the University should be improved

• Most expressed that the end product far exceeded their expectations.

• Most specifically mentioned they plan to put another nurse on the course.

Educator Feedback

• All educators insisted cross-fertilization between professions was necessary for maximizing potential of course

• Unanimously, there is a challenge of finding cardiac physiologists to help with course implementation.

• All educators found that supernumerary support and structure for students varied in practice between Trusts

• The departments were good at releasing students for academic days, but not for gaining clinical skills

• Educators found students to be highly enthusiastic

Educator Feedback Continued…• Most Educators found that students struggled to live

up to M-level expectations.

• Many E-learning tools were used to assist the students learning experience; the trouble was in familiarizing the students with the format & how to navigate their way through the programme.

• It is envisaged that we will run an extra module on PTCA (“percutaneous transluminal coronary angioplasty”)

• Course Directors with Cath Lab experience, Peripatetic Practice Facilitators, and Manager & Mentor Meetings are all referred to as “critical for a successful course” and“quite valuable.”

What we have learnedfrom such a project

• Definition of overall goal in terms of benefits of the new way of working

• Recognition that the definition of the new role needed industrial relations strategy and skills

• Establishment of effective structures for ongoing academic and industry partnership– Board level (senior management)– Course design and delivery level  (lecturers and clinical educators)

– Implementation and evaluation of new way of working  (researchers and service managers)

• High level of involvement of clinical colleagues in course design and development of competencies

Lessons Learned – what worked

+ Academic and clinical partnership essential – structures were effective+ Having workplace change skills as well as education and research skills+ Course designed around clinical competencies taken from the field+ Patient input valuable, particularly in relation to evaluation design+ Practice Facilitators – liaison between academic and health service

delivery+ Accepting a conservative scope, achieving success, then pushing for

greater role extension

Lessons Learned – what we have done differently second time

- Consulted higher and earlier with health organisations- Greater structure to standardising clinical supervision

- eg., mentors and management handbooks- Theoretical content (radiography)

- Reduced mismatch of disciplines (nurses were predominate)

- Releasing students- Agreeing supernumerary status with managers

Future developments

Extend the formal scope of the CCLP

Add Angioplasty

Accreditation (Professional recognition)

Evaluate impact of new way of working

Generate recommendations and material for national roll-out

Thank you for listeninglovegrmj@lsbu.ac.uk