Higher Education Institution (HEI) Challenge for patient supported

Transcription

Higher Education Institution (HEI)
Challenge for Patient Supported Quality
Improvement on Health and Social Care
Education and Research: Evaluation
Report
Dr Coral Sirdifield, Rachel Hawley and Prof. A. Niroshan Siriwardena
July 2016
1
Contents
Acknowledgements...................................................................................................................... 4
Executive summary ...................................................................................................................... 5
Background and approach to the evaluation ..................................................................................... 5
Key findings ......................................................................................................................................... 6
1.
Background to the HEI Challenge ........................................................................................ 16
1.1 Aims and objectives of the HEI Challenge................................................................................... 17
1.1.1 Aims...................................................................................................................................... 17
1.1.2 Objectives............................................................................................................................. 18
1.1.3 Expected outputs and outcomes ......................................................................................... 18
1.1.4 Mapping to East Midlands Academic Health Science Network impact dimensions............ 18
2.
Methods for the evaluation ................................................................................................ 19
Figure 1: Evaluation logic model ....................................................................................................... 21
2.1 Short-term outcomes and outputs ............................................................................................. 22
2.2 Medium-term outcomes and outputs ........................................................................................ 23
2.3 Long-term outcomes and outputs .............................................................................................. 25
3.
Findings.............................................................................................................................. 26
3.1 Short-term outcomes and outputs ............................................................................................. 26
3.1.1
1: Map of cognate areas of interest and activity in patient and public involvement,
innovative deployment of technology, inter-professional education and quality improvement
research and education ................................................................................................................ 26
Examples of existing activities: patient and public involvement (PPI) ..................................... 27
Examples of existing activities: innovative deployment of technology (IDT) ........................... 31
Examples of existing activities: inter-professional education (IPE) .......................................... 34
Examples of existing activities: QI research and education ...................................................... 37
Possible Areas for Development and Collaboration ................................................................. 39
3.1.2
2: Creation of new sustainable inter-institutional networks for sharing, developing
and showcasing good practice ...................................................................................................... 41
3.2 Medium-term outcomes and outputs ........................................................................................ 43
3.2.1
1: Measurable improvements in the range of work undertaken in each HEI............... 43
Activities being undertaken by the working groups, their outputs and outcomes .................. 45
Learning - factors that helped and hindered the activities undertaken by the working groups
.................................................................................................................................................. 55
Approaches being used to evaluate the working groups’ activities ......................................... 55
2
Service user, carer, patient and student involvement in these activities, and enablers and
barriers to this involvement...................................................................................................... 56
3.2.2
2: Conference to showcase good practice .................................................................... 57
3.2.3
3: Website to showcase good practice ......................................................................... 60
3.3 Long-term outcomes and outputs .............................................................................................. 61
3.3.1
1: Sustainable cross-institutional working in the future ............................................... 61
3.3.2
2: Development and/or amendment of institutional level policies and 3: Development
of cross-institutional policies and quality indicators for the areas in the Challenge .................... 62
4.
Discussion and Conclusion .................................................................................................. 63
References................................................................................................................................. 66
Appendix 1: Mapping to East Midlands Academic Health Science Network impact dimensions .... 67
List of Tables
Table 1: Expected outcomes and outputs and data sources used to measure progress
Table 4: Case studies of existing work (PPI)
Table 5: Case studies of existing work (IDT)
Table 6: Case studies of existing work (IPE)
Table 7: Case studies of existing work (QI Research and Education)
Table 8: Possible areas for development and collaboration by work stream
List of Figures
Figure 1: Evaluation logic model
Figure 2: Patient and Public Involvement is ACE infographic
Figure 3: Healthcare learner journey (Technology Related Innovation – Implementation Tool: TRI-IT)
Figure 4: Art projects (In Progress)
Figure 5: Logo to represent partnership
Figure 6: Pledge tree
3
Acknowledgements
With thanks to the following for submitting relevant information for, and feedback on this report:
HEI Challenge Steering Group: Jenny Ford and Simon Tansley (De Montfort University), Lorraine
Henshaw (University of Derby), Rhian Last (Education for Health), Elizabeth Anderson (University of
Leicester), Kristen Clements (University of Loughborough), Richard Windle and Heather Wharrad
(University of Nottingham), Carol Phillips and Alison Ewing (University of Northampton), Beverley Peel
and Matthew Griffiths (Nottingham Trent University), Helen Bywater and Helen Best (Sheffield Hallam
University), Patricia Cowell and Judy Clegg (University of Sheffield), Rachel Hawley [project manager],
Susan Bowler [project administrator] and Niro Siriwardena [project lead] (University of Lincoln).
East Midlands Academic Health Science Network: Fiona Kilpatrick (also a member of the Steering
Group), Lucy Sitton-Kent.
Lay assessors: Amanda Brewster and Pauline Mountain.
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Executive summary
Background and approach to the evaluation
The Higher Education Institution (HEI) Challenge was funded by the East Midlands Academic Health
Science Network in 2015. The ultimate goal of the HEI Challenge was for 11 collaborating HEIs in the
region to work together to share, develop, showcase and spread their work around the unifying topic
of healthcare quality improvement (QI).
HEIs providing education and training for health professionals in the East Midlands and South
Yorkshire regions contributed to the Challenge, focussing on four main themes, each of which had an
associated working group:

The involvement of service users, patients and carers in educational design, delivery,
assessment and review (working group leads: Kristen Clements, University of Loughborough
and Rhian Last, Education for Health)

The innovative deployment of technologies in health and social care education for patients
and practitioners (working group leads: Richard Windle and Heather Wharrad, University of
Nottingham)

Inter-professional education that supports quality improvement in healthcare (working group
lead: Elizabeth Anderson, University of Leicester)

Quality improvement in health and social care research and education (working group lead:
Niro Siriwardena, University of Lincoln)
The project had three overarching aims:
1) To provide an exceptional platform to showcase the participating institutions’ excellence
as places to learn, and the region as an outstanding area for work opportunities and
quality of life, and as a destination of choice for education
2) For the HEIs participating in the project to build a sustainable model for working together
to improve the profile of the East Midlands and South Yorkshire regions for innovative
health education and research
3) To stimulate and support the spread of innovation in quality improvement in health and
education
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Specific objectives were to:

Capture and showcase examples of best practice, generating learning about how patientsupported quality improvement could be sustained and further developed;

Build capacity, capability and confidence for patient-supported quality improvement;

Identify opportunities for collaboration and partnership;

Build the reputation of institutions within the region and nationally to attract students and
staff in health and social care
There were a number of expected outputs and outcomes from addressing the above aims and
objectives (see Tables 1-3, below).
We adopted a pragmatic approach to evaluating the work undertaken throughout the HEI Challenge,
drawing on multiple data sources as shown in Tables 1-3 below. The evaluation was underpinned by
a logic model (Figure 1, main report and see Taylor-Powell et al., 2003).
Key findings
Turning first to the expected outputs and outcomes from the HEI Challenge, all of the short and
medium-term outputs and outcomes have been achieved, and the working groups had begun to
consider how they could make the achievements and relationships from the project sustainable as
summarised below.
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Table 1: Short-term expected outcomes and outputs
Expected Outcome or Output
Produce a map of examples of
existing activities and shared
areas of interest in PPI, IDT,
IPE and QI research and
education
across
the
institutions
Data Source(s)
Initial mapping exercise
Meeting records (steering
and working groups)
Case studies of existing work
Findings
A map of cognate areas of interest and existing activities in patient and public involvement,
innovative deployment of technology, inter-professional education, and quality improvement
research and education was produced. (See section 3.1.1 for more on this).
Examples of existing activities being undertaken by institutions prior to the HEI Challenge included the
following:
Providing inter-professional education
through:
 Students of different professions learning
together on specific courses, modules,
projects, and assessment exercises
 Guest lectures
 Conferences
 Inter-professional events
 Online resources, principles and models
 Placements in multi-disciplinary settings
Involving service users and carers in:
 Developing, running and grading student
assessments
 Leading or co-facilitating teaching
 Role-play/practice sessions
 Conference presentations
 Developing online resources
 Creating case studies
Using technology in health and social care education
through:
 Online resources (including Apps)
 Social media
 Use of devices to enable mobile access to
resources
 Video/audio capture of accounts and lectures
 Skype/video-conferencing
 E-portfolios
 Simulated environments
 Rolling folders of resources
 Massive Open Online Courses
Involving service users and carers in education and
research through:
 Being research participants
 Commenting on proposals
 Membership of ethics panels
 Conducting participatory action research
 Being representatives on project steering groups
 Co-production of research
Numerous possible areas for development and collaboration were identified across the Challenge
themes (see Table 8 in the main report).
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Create new sustainable interinstitutional
educational
networks
for
sharing,
developing and showcasing
good practice
Meeting records (steering
and working groups)
Four cross-institutional networks (working groups) were created – one for each theme within the
Challenge as detailed in the background section above.
In addition to this, the groups made links with wider groups and organisations, for example, the
ENQuIRE group included Q fellows linked to the Health Foundation and NHS England, and the PPI group
made links with organisations to whom they gave project awards as part of their activities.
Table 2: Medium-term expected outcomes and outputs
Expected Outcome or
Output
Data Source(s)
Findings
Hold a conference to
showcase good practice
Conference
attendance
and feedback
A conference was organised to showcase good practice, key messages and outcomes resulting from the
work undertaken for the HEI Challenge, and to explore how this work can be built upon in the future.
The conference was held at the Enterprise Centre, Derby on the 14th of June 2016, and was attended by
around 100 delegates including academics, service users and carers. As well as showcasing each of the
working groups’ activities, it included keynote addresses from Professor Rachel Munton (East Midlands
Academic Health Science Network), Professor Kathryn Mitchell (University of Derby), Rachel Hawley
(University of Lincoln), and Simon Denegri (INVOLVE).

A range of posters were also displayed at the conference, and delegates were invited to make a pledge
on a ‘pledge tree’ as a means of ensuring sustainability of activities and learning

A ‘Who will I be when I die’ video produced by students on the Creative Expressive Therapies Programme
at the University of Derby was also shown at the conference. This went on to inform an associated small
art project around service user-student partnerships at Sheffield Hallam University where three pieces
of art, a logo, and an e-poster were co-produced (another unexpected output from the project)
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Create a website to showcase
good practice
Data Source(s)
Creation of website and analytics
Findings
A website was created to showcase good practice and can now be accessed
at www.enqire.org . This includes information on the activities undertaken by
each of the working groups, principles developed by the working groups, and
case studies of activities undertaken by each of the participating institutions
that are relevant to the HEI Challenge. It acts as a ‘live record’ of project
activities
Deliver
measurable
improvements in the range of
work done in each HEI in
relation to the key areas of the
Challenge
Meeting records (steering and working groups)
Mapping of activities using framework documents at
two time points
Measurable improvements were produced in the range of work done in each
HEI in relation to the key areas of the Challenge. These are summarised by
work stream in the boxes below
Notes from institutional visits
9
Patient and Public Involvement (PPI) Work Stream: the PPI working group arranged a conference
to explore what ‘patient supported quality improvement’ means, share learning about what does
and does not work well, share learning around best practice, and explore opportunities for
collaborative working between participants. This was hosted by Loughborough University in
October 2015. This event, was attended by over 50 people from a variety of perspectives (e.g.
staff, learner, public), including representatives from a range of voluntary and service user led
organisations. The event raised awareness and understanding of the contribution that patient and
public involvement makes to quality improvement in education and health and social care
services, and what does and does not work in promoting PPI. There were a number of outputs and
outcomes from this event including:

Creation and dissemination of a report about the event

Creation of a ‘Patient and Public Involvement is A.C.E.’ infographic following the event
(see Figure 2 in the main report)

Production and dissemination of a video of the day

Production of a blog about the event

Networking opportunities, expanding roles and developing new links

Awards of up to £500 were allocated to support small collaborative projects as part of this
event
The PPI working group’s activities also informed the development of Principles for Patient and
Public Involvement. These principles aim to provide a practical framework for institutions that
wish to engage patients and the public in health and social care education and research and are
available at: http://enqire.org/principles-for-practice/patient-and-public-involvement/sharedprinciples. This was an unanticipated and positive output from this working group.
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Inter-Professional Education (IPE) Work Stream: The IPE working group had an ambitious plan to
adapt the internationally acclaimed inter-professional Health Care Team Challenge in which
students from different health-related professions work in clusters to respond to a complex
scenario/case study which is relevant to all professions, focussing on patient-led concerns for
service quality improvement. These ambitions were modified during the course of the challenge
to fit with the available resources.
The group went on to hold two student conferences based on their work. These conferences were
held in June 2016 - at the new Centre for Medicine at the University of Leicester (hosting students
from the University of Leicester, De Montfort University and the University of Northampton) and
at Sheffield Hallam University (hosting students from the University of Sheffield, University of
Derby, and Sheffield Hallam University). Attendees participated in quality improvement
workshops, and shared their work and ideas around quality improvement in healthcare.
There were a number of anticipated and unanticipated outputs and outcomes that arose from the
work that initially went into planning to host a Health Care Team Challenge. These are detailed
fully in section 3.2.1 of the main report.
Hosting these conferences and planning for a Health Care Team Challenge event enabled
participants in this work stream to create re-usable frameworks/models for inter-professional
learning in quality improvement for use by participating HEIs and their partners.
Other key outputs and outcomes from hosting these events included: students being able to share
their work and learning around quality improvement in healthcare, learning to value team
approaches to quality improvement and understand the necessity of this; and universities
collaborating to share the costs and work involved in organising the venues, food, travel expenses
et cetera. It is anticipated that now that this approach has been modelled, it will offer a sustainable
approach that can be repeated in future years.
A collective online learning resource has been created around inter-professional learning on
patient supported quality improvement for learners across health and social care professions. This
is available at http://tinyurl.com/healthcareteamchal.
The IPE group are also working on supporting the formation of local QI IPE groups linked to existing
national and local QI groups and bodies. Finally, a set of shared principles for inter-professional
education
and
quality
improvement
has
been
established.
This
is
available
at
http://enqire.org/principles-for-practice/interprofessional-education/principles
The group plan to share their work at the next All Together Better Health conference series in New
Zealand in 2018.
11
Innovative Deployment of Technology (IDT) Work Stream: this working group mapped the
healthcare learner journey within the education process. They then populated the nodes (or
stations) on this map to show examples of innovative deployment of technology that contributes
to quality improvement at each stage of the journey – sharing examples of best practice from the
participating institutions. The interactive map or tool that the working group produced is available
on the Challenge website at
http://enqire.org/principles-for-practice/innovative-deployment-of-technologies and at
http://www.nottingham.ac.uk/helmopen/tri-it/
The practical and easily accessible tool can be used to help to plan how digital technology can be
used to improve the quality of learning – including lots of suggestions and examples from practice.
In the future, the group hope that it will also be possible to use the tool as an audit tool for
evaluation work.
Quality Improvement in Research and Education (ENQuIRE) Work Stream: The East Midlands
Network for Quality Improvement (QI) in Research and Education working group (ENQuIRE) built
on existing initiatives and networks to showcase quality improvement and implementation
science research and education that are taking place in the East Midlands. They have created a
register of QI activities and courses taking place across the region, which will be co-ordinated by
the Q-network (an NIHR network of experts and fellows in quality improvement/service and care
in healthcare).
This group also produced principles for collaboration in evaluation between Universities and
providers of health and social care which are available from the HEI Challenge website at:
http://enqire.org/principles-for-practice/quality-improvement-in-research-andeducation/principles-for-practice
The group plan to ensure the sustainability of their work by making it part of the national Q
Network in the future.
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Table 3: Long-term expected outcomes and outputs
Data Source(s)
Findings
Produce sustainable cross-HEI
working in the future
Plans for sustainability evidenced
by meeting records, framework
documents or notes from
institutional visits
Framework documents
We did not anticipate that the expected long-
Develop
and/or
amend
institutional level policies
Develop quality indicators and
cross-institutional policies in the
areas of interest
term outputs and outcomes would be achieved
within the lifetime of the HEI Challenge.
However, the working groups are planning how
to make their activities sustainable as detailed
Framework documents
below
Sustainability
Responses on the self-completed framework document show that the working groups are using a
variety of methods to continue their activities. For example, the inter-professional education group
are planning for future cross-university IPE collaborations in teaching and learning activities / events
– including repeating the student conferences, the ENQuIRE group are linking in with the national Q
Network, and the technologies group are planning for how their learner journey tool can be used in
the future.
Unanticipated outputs and outcomes
There were also a number of unanticipated outputs and outcomes from the HEI Challenge (some of
which were included above). For example:

Rhian Last, Education Lead at Education for Health and steering group member and Lucy
Sitton-Kent, EMAHSN, facilitated a workshop on quality improvement and case study design,
to support and build capacity, capability and confidence (consistency) for all steering group
and working group member on 18th March 2016. HEI Development Challenge Group (on 18th
March), hosted by Nottingham University

The IPE working group hope to develop local Q students IP groups and have a method for
designing QI IP cases using service user experiences of health and social care;

The Challenge has raised awareness of Education for Health in HEIs that were not familiar with
the organisation
13

The development of the Principles for Patient and Public Involvement

A ‘Who will I be when I die’ video produced by students on the Creative Expressive Therapies
Programme at the University of Derby, and shown at the HEI Challenge Showcase conference
(see section 3.2.2), and an associated art project around service user-student partnerships at
Sheffield Hallam University

Collaborative workshop at the East Midlands Clinical Audit Network, with Marina Otley, at
Leicester Race Course

Poster presentation at the Health Education East Midlands QIF16 conference, June 2016

The Higher Education Academy commissioned research into recognition for service user and
carer contributions to teaching and learning

Rachel Hawley (Project Manager) co-presented with Cheryl Crocker a the QI network to
explore the synergies between the HEI Challenge and the QI network – a sustainable future,
and also ran sessions at a staff development day, and service user and carer engagement
forum at the University of Northampton
Learning - factors that helped and hindered the work
It was important to reflect on what helped and hindered the activities undertaken by the working
groups. Feedback provided on framework documents suggested that the following things were
helpful:

Previous good working relationships between members of participating institutions had been
enhanced, and new relationships had been forged, which helped the groups to complete their
activities

Participants reported receiving good support from the Project Manager

The IPE group reported that their work was helped by setting regular dedicated meeting times
to focus on their activities
In addition, feedback suggested that the following things hindered the activities undertaken:

Lack of connection between the working groups - one respondent felt that more connection
between the steering groups for the different strands of the Challenge could have been
helpful

Respondents also reported that the activities that they were able to undertake in response to
the Challenge were limited by the resources (time and money) that they had. This was
14
particularly the case for the IPE group, who stated that pump priming would have enabled
them to offer the Health Care Team Challenge and to have designed a professional web-based
teaching resource

It would also have been beneficial to have more resources to support the engagement of
service users and carers in activities being undertaken in response to the Challenge

One respondent also reported being limited by perfunctory support from some colleagues

As yet under-developed learning for sharing learning across disciplines was a challenge

Multiple demands on staff time and energy also posed a challenge
15
1. Background to the HEI Challenge
Funded by the East Midlands Academic Health Science Network, the Higher Education Institution (HEI)
Challenge Award 2014-15 offered an opportunity for institutions, contributing to the education and
training of health professionals in the East Midlands and South Yorkshire, to foster a sustainable
approach to working collaboratively for the benefit of the population and to drive positive experiences
and outcomes for learners and local employers.
The following institutions contributed to this Challenge:

University of Derby

De Montfort University

Education for Health

University of Leicester

University of Lincoln

Loughborough University

University of Northampton

University of Nottingham

Nottingham Trent University

University of Sheffield

The ultimate goal of the HEI Challenge was for collaborating institutions to work together to share,
develop, showcase and spread their work around the unifying topic of healthcare quality
improvement. The Challenge focussed on four main themes:

The involvement of services users, patients and carers in educational design, delivery,
assessment and review

The innovative deployment of technologies in health and social care education for patients
and practitioners

Inter-professional education supporting quality improvement in healthcare; and

Quality improvement in health and social care research and education
Participating institutions aimed to foster new sustainable networks to support novel health education
and delivery focussing on quality improvement to ensure more effective, safe and equitable care,
16
ensuring that the patient voice was at the centre of the initiative and that best use was made of the
opportunities that new technology provides for enhancing education.
1.1 Aims and objectives of the HEI Challenge
1.1.1 Aims
The overall aims of the project were:
1) To provide an exceptional platform to showcase participating institutions excellence as places
to learn, and the region as an outstanding area for work opportunities and quality of life, and
as a destination of choice for education. This was to be achieved by giving participating
institutions across the East Midlands and in Sheffield the opportunity to work together to
share, develop, showcase and spread their work around healthcare quality improvement in
four key areas:
a. The involvement of service users, patients and carers in educational design, delivery
and assessment (Patient and Public Involvement, PPI)
b. Use of novel technologies in health education for patients and practitioners
(Innovative Deployment of Technology, IDT)
c. Inter-Professional Education supporting quality improvement in healthcare (InterProfessional Education, IPE)
d. Quality improvement research and education (East Midlands Network for Quality
Improvement Research and Education, ENQuIRE).
2) To build a sustainable model for HEIs participating in the project to work together to improve
the profile of the East Midlands and South Yorkshire regions for innovative health education
and research
3) To stimulate and support the spread of innovation in quality improvement in health and
education
Underpinning all of this was the recognition that health and social care services are more likely to
deliver better quality care and experience if health and social care professionals receive education and
training that has been designed, delivered and quality assured with the involvement of service users,
carers and the wider public.
17
1.1.2 Objectives
Specific objectives for the HEI Challenge were to:

Capture and showcase examples of best practice, generating learning about how patientsupported quality improvement can be sustained and further developed

Build capacity, capability and confidence for patient-supported quality improvement

Identify opportunities for collaboration and partnership

Build the reputation of institutions within the region and nationally to attract students and
staff in health and social care
1.1.3 Expected outputs and outcomes
A steering group was created consisting of representatives from each of the participating institutions
(see ‘acknowledgements’ for a full list of members) who worked collaboratively to achieve these aims
and objectives.
Full details of the expected outputs and outcomes, and information on how progress towards the
above aims and objectives was measured is provided in Section 2 below.
1.1.4 Mapping to East Midlands Academic Health Science Network impact dimensions
The work undertaken through the HEI Challenge mapped to the following dimensions:

Benefited patient experience or outcome

Influenced or changed commissioning

Led to impacts on public or other audience awareness, attitudes, understanding or behaviour

Change that has benefited the economy, society, culture, public policy or service, health, the
environment or quality of life

Assisted the adoption and spread of innovation or research translation into practice
For more details, please see Appendix 1.
18
2. Methods for the evaluation
We adopted a pragmatic approach to evaluating the work undertaken throughout the Challenge,
drawing on multiple data sources. This was underpinned by the logic model (Taylor-Powell et al., 2003)
shown in Figure 1 and the programme theory linked to this as follows:

A brief summary of the overall aims, objectives and priorities: The HEI Challenge aimed to
map and showcase the work of participating institutions in patient and public involvement
(PPI), innovative deployment of technology (IDT), inter-professional education (IPE) and QI
research and education focussing on quality improvement in health and social care, seeking
to develop further collaborative work in these areas

How participants planned to achieve those aims: The main participants in the Challenge were
individuals from HEIs in the East Midlands and Sheffield (staff and students) who sought to
achieve the aims of the project through a large scale regional collaborative, mediated by four
working groups and coordinated by a team based at the University of Lincoln. Participants
were also able to utilise any existing networks and relationships with external experts that
they had, and were encouraged to develop and expand their networks as part of the Challenge

Anticipated short, medium and long-term outcomes and outputs: There were a number of
anticipated outcomes and outputs from the project as follows:
o
A map of examples of existing activities and shared areas of interest in PPI, IDT, IPE
and QI research and education across the institutions
o
Creation of new sustainable inter-institutional educational networks for sharing,
developing and showcasing good practice
o
A conference to showcase good practice
o
Creation of a website to showcase good practice
o
Measurable improvements in range of work done in each HEI in relation to the key
areas of the Challenge
o
Sustainable cross-HEI working in the future
o
Development and/or amendment of institutional level policies
o
Development of quality indicators and cross-institutional policies in areas of interest
19

Data sources drawn upon to measure outcomes and outputs: A variety of data sources was
used to measure the anticipated outputs and outcomes. Further details of this are provided
below
Return on investment
The project was awarded £250k of funding from the East Midlands Academic Health Science Network.
Measuring the financial impact of work like this is exceptionally challenging and difficult to make
meaningful. Ongoing funding is not being sought for this work as much of the good practice has
already become embedded in the participating organisations (see ‘findings’). Therefore an assessment
of return on investment is not attempted here.
The following sections list the anticipated short, medium, and long-term outcomes and outputs from
the Challenge. Examples of achievements in relation to each of these are listed in the findings section.
20
Figure 1: Evaluation logic model
Project: The HEI challenge for patient
supported quality improvement aims to
develop and showcase the work of
regional universities in PPI, IDT, IPE and
QI research and education focussing on
quality improvement in health and social
care
We wish to know more about the extent
and depth of what HEIs do in each of the
areas above, and to support development
of further work in these areas
Population: HEIs contributing health and
social care education across the East
Midlands region and Sheffield
Priorities (aims):
 Showcase good practice via website
and conference
 HEIs to build (a) sustainable
model(s)/network(s) to support PPI,
IDT, IPE and QI research and education
focussing on quality improvement in
health and social care
 To spread good practice/innovations
Initial mapping (and case
Evidence/
studies for website) –
data:
current activities and areas
to develop
Analytic Initial summary
approach report of mapping
:
Inputs: Funding, activities
Activities:
Participants:
Activities
undertaken by
participants
including taking
part in baseline
mapping and
ongoing data
collection, and
participation in
working groups
HEIs in the
East
Midlands and
Sheffield
Links to existing
and developing
networks
Meeting records
(steering,
working groups)
Anticipated outcomes
and outputs
Experts
Existing
networks
Unanticipated
outcomes and outputs
Improved quality of
activities – as
measured by group
members
Outcomes
Short term:
Medium term:
Long term:
Map of examples of
existing activities and
shared areas of interest in
PPI, IDT, IPE and QI
research and education
across the institutions
Conference to
showcase good
practice
Sustainable cross-HEI
working in the future
AHSN
Students
Increased PPI, IDT,
IPE and QI in research
and education activity
in HEIs
Outputs and outcomes: Demonstrate good
practice in PPI, IDT, IPE and QI research and
education in HEIs
Creation of new
sustainable interinstitutional educational
networks for sharing,
developing and
showcasing good practice
Mapping of activities using
framework document at
two time points
Institutional
visits
Thematic analysis of notes from institutional visits and text from minutes
and framework documents
Website to
showcase good
practice
Measurable
improvements in
range of work
done in each HEI
Conference
feedback; web
analytics
Thematic analysis
of feedback,
present analytics
Development/amendment
of institutional level
policies
Development of quality
indicators and crossinstitutional policies and
in areas of interest
Development of
indicators and policies
by working groups
Present/reference
indicators &/or policies
21
2.1 Short-term outcomes and outputs
S1: Map of shared areas of interest in patient and public involvement, innovative deployment
of technology, inter-professional education and quality improvement research
Initially, participants in the HEI Challenge wished to improve understanding of the extent and
depth of existing work being undertaken by each of the institutions participating in the Challenge
across each of the key project areas (a-d above [p17]). As well as mapping activities, the purpose
was to identify and establish common areas of interest where institutions could share learning
and/or work together to develop and improve existing practice.
To achieve this aim, a mapping exercise was undertaken using an online survey at the beginning
of the project. This was designed to enable respondents to share a snapshot of examples of their
existing activities, and to identify areas in which they would like to undertake further work. Lead
representatives from each participating institution were asked to distribute the survey to a
maximum of ten key people (informants) within their institution.
The institutions were also given further opportunities to showcase their existing work through
providing examples on a self-evaluation framework document and as case studies on a website
(www.enqire.org) created as part of the project. In addition, representatives from the institutions
had the opportunity to add examples of existing practice when reviewing and giving feedback on
the report presented here.
S2: Creation of new sustainable inter-institutional networks for sharing, developing and
showcasing good practice
A steering group was established consisting of key individuals from each of the participating
institutions who were asked to champion and lead the award. Participants aimed to establish
cross-institutional working groups for each of the areas of interest (a-d above [p17]) to enable
leaders and other key participants to further explore areas of innovative practice, collaborate with
each other and identify ways that these could be developed further, sharing their knowledge to
spread improvements. The membership of these groups (academics, health and social care staff,
public and students) was recorded from meeting records.
22
2.2 Medium-term outcomes and outputs
M1: Measurable improvements in the range of work undertaken in each HEI
The HEI Challenge was designed to produce measurable improvements in the range of work
undertaken in each institution in relation to the key areas (a-d [p17]) listed above. The extent and
nature of improvements in the range of activities undertaken in each institution were measured
using several methods. Firstly, the institutional leads were asked to complete a self-evaluation
framework document in October/November 2015, which was repeated again in April 2016. This
aimed to capture participants’ views on the:

Rationale for the HEI Challenge

Details of the activity/activities undertaken by the working groups

Outcomes and outputs from these activities (including unintended outcomes and/or
outputs)

Factors that a) helped and b) hindered the activities undertaken by the working groups

Approaches being used to evaluate the working groups’ activities

Service user, carer, patient and student involvement in these activities, and

Enablers and barriers to this involvement
Secondly, linked qualitative work was undertaken to add clarity and depth to responses to the
self-evaluation framework document. Here, records from steering group and working group
meetings were thematically analysed alongside data from the framework documents.
In addition, the Project Manager undertook a range of institutional visits with participating
institutions, and also undertook relevant network activities and attended relevant conferences
Data from records of these visits were also included in the thematic analysis.
M2: Conference to showcase good practice
Participants in the HEI Challenge aimed to hold a conference to showcase areas where
collaborative working demonstrated innovations in education and healthcare outcomes and
greater public involvement in education and research. Completion of this aim was measured not
only in terms of whether or not the conference was organised, but also though the collation of
feedback from this conference.
23
M3: Website to showcase good practice
Participants in the HEI Challenge aimed to create a website to showcase good practice as well as
to act as a repository. Use of the website will be measured using analytics.
24
2.3 Long-term outcomes and outputs
L1: Sustainable cross-institutional working in the future
Ultimately, it was hoped that participation in the HEI Challenge would lead to the creation of
sustainable cross-institutional working focussed on future quality improvement. Clearly it was not
possible to fully measure this within the timescale of the Challenge itself. However, the selfevaluation framework document was used to elicit information from participants on new links
with groups, organisations or networks which were formed as a result of the Challenge; and
arrangements that had been put in place to ensure the sustainability of the project’s work, and
how the results of the project might inform wider changes/developments such as policies,
partnerships, service user development opportunities, or creating/amending standards for
practice.
L2: Development and/or amendment of institutional level policies
Another potential long-term output from the HEI Challenge was the development and/or
amendment of institutional level policies around the key areas covered in the Challenge.
Therefore, the self-evaluation framework document was also used to obtain information from
participants on any amendments to existing institutional level policies, and the development of
new policies that resulted from the Challenge.
L3: Development of cross-institutional policies and quality indicators for the areas in the
Challenge
A final potential long-term output from the HEI Challenge was the development of crossinstitutional policies and/or quality indicators for the key areas of the Challenge. This was also
measured using the self-evaluation framework document.
We were also mindful of the possibility that this project would have unanticipated outcomes and/or
outputs. Consequently, we gave participants the opportunity to record these on the self-evaluation
framework document and/or website, and sought to elicit further information about these through
the institutional visits.
25
3. Findings
3.1 Short-term outcomes and outputs
3.1.1
1: Map of cognate areas of interest and activity in patient and public involvement,
innovative deployment of technology, inter-professional education and quality improvement
research and education
Participants initially aimed to undertake a mapping exercise to provide a snapshot of some of the
activities already being undertaken by the participating institutions in each of the key areas of the HEI
Challenge prior to its commencement. This exercise also aimed to highlight possible areas for
development through joint working during the HEI Challenge. A total of 44 surveys were returned,
which included responses from all participating institutions, and covered the key themes within the
HEI Challenge.
Further examples of existing work being undertaken by institutions prior to the HEI Challenge, or being
developed in parallel to the HEI Challenge were provided via the self-evaluation framework
documents (n=11 returned in November 2015), minutes of working group meetings, and as case
studies for a website developed as part of the Challenge. Together, these data constituted an output
from the HEI Challenge, as previously, no such repository for sharing institutions’ current activities
existed. Whilst the data do not provide a ‘complete’ picture of existing activities, they provide a useful
foundation for future evaluation.
A summary of the responses is provided below, beginning with existing activities within each of the
work streams, and then detailing areas highlighted as having potential for development.
26
Examples of existing activities: patient and public involvement (PPI)
Many institutions were already involving service users and/or carers in course design including, for
example, participatory design workshops, module planning, development of teaching tools and
materials, developing assessments, and providing formative feedback on programmes. There were
variations between institutions in the range of activities reported.
Examples of existing patient and public involvement work on developing student assessments
included service users and carers developing a range of practical tests to assess social work skills
(University of Leicester), and designing student assessments for mental health nursing students
(University of Nottingham). In the latter case, students conducted a 45 minute assessment of a service
user which was filmed and observed by a mental health practitioner. The service user also gives
feedback on the interaction, and this forms the basis of an assessed reflective essay about what the
student has learnt from the feedback. Further examples are provided through case studies on the HEI
Challenge website (www.enqire.org).
Respondents also listed examples of service users being directly involved in assessments. For
example, at the University of Northampton, University of Leicester, University of Sheffield and
University of Nottingham, service users are assessors for Objective Structured Clinical Examinations
(OSCEs). At the University of Northampton, University of Lincoln and Sheffield Hallam service users
assess student presentations. At Sheffield Hallam, service users are also involved in the assessment of
radiographers in the simulation suite prior to students’ first placement and provide feedback on
student placements through testimonies. At the University of Northampton, service users provide
feedback for students on areas such as communication skills, respect and dignity as part of mock and
real final clinical examinations and on practice placements. Here they are also involved in action
learning as part of the tutor team.
There were numerous examples of service users and/or carers leading/co-facilitating teaching
sessions (e.g. lectures, workshops and staff training events). Often these involved directly sharing
personal experiences. An example of this emerged from the University of Northampton where
speakers shared experiences of a positive home birth. Examples from the University of Leicester
included personal experiences of disability and domestic violence, and an example from the University
of Lincoln was sharing experiences of the impact of the personalisation policy in adult social care. A
participant from the University of Northampton also reported service users teaching practical skills
sessions. Respondents from the University of Nottingham and Sheffield Hallam detailed ‘Talking
27
Heads’ projects that captured narratives around service user experiences. Respondents from the
University of Nottingham discussed ‘meet the patient’ question and answer sessions where service
users/carers tell students about their experience of having a condition, being a patient or accessing
healthcare. They also discussed involvement in delivery of sessions within a nursing care module which
is centred on PPI. Here learning activities are co-facilitated by service users, carers and academic staff,
and all facilitators participate in preparation and debriefing sessions. At the University of Sheffield
carers speak on the dementia modules/programme and are involved in the post-graduate diploma in
nursing leading to nurse registration and the MMedSci Advancing Practice.
Service users and carers had also been involved in specific events, such as the De Montfort Learning
Disability day held in June 2015. Here, local individuals, groups and organisations were invited to share
stories and experiences of nurses and nursing care with nursing students via small group sessions,
displays, workshops and videos. The aim was to influence the future practice of these students and
there was patient and public involvement in developing the agenda for the day. Organisations,
individuals and groups could provide a display (e.g. a poster, audio visual display or art installation);
participate in ‘conversations with’ – where a person with a learning disability and a companion have
a conversation about their experiences of nurses and nursing care, and students can ask pre-prepared
questions at the end; participate in workshops focussed on experiences of nursing and nursing care;
contribute to a cinema screening showing students a series of films followed by facilitated discussion.
Role-play/practice sessions: respondents from the University of Northampton, the University of
Lincoln and Sheffield Hallam University discussed service users and/or carers being involved in roleplays, which in some cases were part of assessment activities. Often, service users were involved in
giving feedback alongside tutors as part of these sessions. Examples were also provided of students
seeing service users in clinics/visiting service users and their families at home to learn about their
experiences (the latter refers to the Shared Family Study project at Nottingham).
Specific modules: De Montfort University for example, reported that Nursing students can take a level
six 30 credit module called “Working in Partnership with Service Users and Carers”.
Conference presentations: service users and carers have assisted, co-facilitated and facilitated
sessions at conferences. For example on the theme of physiotherapy at Sheffield Hallam University.
Online resources (videos, narratives, story boards, and podcasts): Several institutions provided
examples of how service users and/or carers had been involved in developing online resources or
videos. Often these focussed on their experiences, for example, a video developed at the University
of Leicester about being a parent to a disabled child with complex needs. Sheffield Hallam University
28
provided an example of a video co-produced by Darnell Dementia Group about their experiences of
caring for someone with dementia, which is aimed at nurses and Allied Health Professionals. At this
institution, service users and/or carers also contributed to the development of ‘virtual’ individuals
which students encountered time and again throughout their course.
Case studies: Some institutions reported service user and/or carer involvement in the development
of case studies, for example, the Loughborough University gave an example from Human Factors and
Ergonomics.
In many cases, service user/carer involvement was routine practice e.g. at the University of
Northampton, each programme in the School of Health has a representative on the University service
users and carers group, which has been running for ten years, and service user and carer involvement
is audited annually to enable the sharing of good practice and further improvements to this work. At
the University of Nottingham, service users and carers provide feedback on sessions that they
participate in, which then influences future delivery of the subject matter. At De Montfort University,
service user-led reference groups have been developed for curriculum design, delivery and evaluation.
The University of Derby has a well-established Experts by Experience Group who routinely feed into
all aspects of curriculum design, development and recruitment across the College of Health and Social
Care. However, it is acknowledged that there are variations regarding service user and carer
involvement, both within individual institutions and across the region more widely, in teaching and
learning, in research and development, and in how recognition is given for involvement.
Respondents also provide examples of patients and carers being involved in a wide range of research
projects on a variety of topics. This is discussed further under ‘Existing activities: QI Research and
Education’.
Numerous case studies on PPI work were submitted to the project team, and can now be accessed on
the project website (see http://enqire.org/case-studies) as follows:
29
Table 4: Case studies of existing work - Patient and Public Involvement
Institution
Title of Case Study
Evaluation of PPI
University of Derby
The impact of the Experts by Experience Group at the University of
Derby on student mental health nurse practice
Lived Experience Network event (case study in progress)
MSc Nursing development
Education for Health
Focus group
Service user and carer involvement in selecting social work students
and in teaching social work
Loughborough
SHIFT programme
University
Public lectures
Celebrating success
Post + Patient focus group
New research study grant application
Woman(kind)ness, strength and resilience: a celebration of women
worldwide
Co-creation of quality improvements in social care (C-Qisc)
University of
Part of the team – BSc Nursing admissions interviews
Nottingham
Service user co-facilitation
Combining lived experience with the facilitation of enquiry-based
learning (EBL) (in partnership with Making Waves)
Everyone’s story is important: Service user narrative dissertation
Service user participation in the assessment of students’ practice (in
partnership with Making Waves)
University of
Carers Federation
Northampton
Client and carer narrative
Sheffield Hallam
Student recruitment to reflect NHS values
University
Extending PPI in research
Extending care and compassion in the curriculum
30
Examples of existing activities: innovative deployment of technology (IDT)
Respondents provided numerous examples of ways in which technology is used in health and social
care education. These included the use of online resources on platforms such as Blackboard/NILE to
enable staff to easily incorporate web-links, video files and audio files into teaching. These platforms
provide a virtual environment for storing module materials (such as case studies for discussion),
electronic assignment of submission, online tests, marking, and discussion boards/forums. Such
platforms also provide a means for staff to communicate remotely with students. Similarly, social
media was being used as another way to interact with students and enable information sharing when
students are not on site. Online resources also enable ‘flipped’ learning (where instead of the
traditional lecture followed by homework model, students view the lecture at home, and classroom
time is devoted to exercises) and support students to study whenever they want to.
In some institutions, particular devices such as iPads were being used to enable mobile access to
resources e.g. the Medical School at the University of Leicester were issuing iPads to students to
enable staff to provide more frequent feedback to students and improve their learning in areas that
they find difficult, and to support e-assessments where students complete short answer exams using
ExamSoft.
Similarly, respondents from the Universities of Lincoln, Northampton and Nottingham discussed
video/audio capture of service user and carer accounts for teaching. For example, staff at the
University of Northampton were using Panopto to record video tutorials of guest lectures and patient
simulations that can be watched remotely and replayed at any time – enhancing opportunities for
distance learning, and meaning that service users and carers do not have to be available at a specific
time to be able to contribute to a course.
Opportunities for distance learning were also being enhanced through the use of Skype/videoconferencing at Nottingham Trent University, where students use it to showcase their research
findings, and also to contact staff to clarify understanding.
Technology is embedded within the programmes in the College of Health and Social Care at the
University of Derby. Examples of this include the use of Panopto to record lectures, e-submission, and
Skype offered as a tutorial approach. The University of Derby also has a range of on-line Health and
31
Social
Care
programmes
and
modules
(University
of
Derby
On-Line
UDOL)
http://www.derby.ac.uk/online/home-page
E-portfolios were being used at the University of Lincoln for social work and nursing students, and the
University of Nottingham was planning to introduce these. Similarly, the University of Northampton
was making use of PebblePad. These can be used for logbook capture/building professional portfolios,
and were also being used in a ‘speak up for autism’ project at the University of Sheffield. The University
of Derby uses e-portfolios for their Interprofessional Learning programme, radiography and
occupational therapy courses.
Institutions also reported using simulated environments, such as ‘virtual wards’ and developing
rolling folders of resources that can be regularly updated and shared across whole teams to reduce
duplication of work. For example, the University of Leicester has a ‘virtual ward’ for students to
practice diagnostic reasoning skills http://www.le.ac.uk/badger Students at the University of Derby
use virtual learning environments and simulated practice in courses such as nursing and radiography.
Here, students use a full imaging suite.
Respondents from Sheffield Hallam University reported the use of Massive Open Online Courses
(MOOCs), and the use of Apps. The latter were being used to aid patients’ understanding of
treatments and their side-effects, and to help patients to engage and be part of their own care
pathway.
Case studies on IDT work were submitted to the project team, and can now be accessed on the project
website (see http://enqire.org/case-studies) as follows:
32
Table 5: Case Studies of Existing Work - Innovative Deployment of Technology
Institution
Title of Case Study
Use of Skype for interviewing applicants
Teaching in large spaces, web app, classroom response system
Teaching and learning via a virtual, fictional community in Blackboard
Promotion of health and wellbeing – High Street activity
Use of response technologies
Use of SimMan in simulations
Travel and global health (knowledge delivery via electronic methods)
University of Derby
Developing and using virtual reality based simulation of occupational
therapy home visits as part of pre-registration teaching and learning
University of Leicester
One iPad per student in medical study
Use of webinar system for online delivery of lectures
In-class polling for programme evaluation
Loughborough
Supporting Transitions in PE
University
CPD for GPs
Technology used to support research governance/ethics
University of
Carers Federation
Northampton
University of
Use of an electronic portfolio to support practice-learning
Nottingham
Nottingham Trent
Online discussion forums
University
Online, open book tests
Use of an electronic portfolio to support practice-learning
Sheffield Hallam
Enhancing quality of service through effective collaborative practice
University
module
33
Examples of existing activities: inter-professional education (IPE)
Inter-Professional Education was already well established at many of the institutions participating in
the Challenge, with institutions reporting good connections around this, particularly through CAIPE –
the UK Centre for the Advancement of Interprofessional Education.
The participating institutions provided numerous examples of Inter-Professional Education where
students of different professions were learning together, either throughout an entire course, or on
a specific module, project or assessment exercise. This included co-working across universities – for
example between De Montfort University, the University of Leicester and the University of
Northampton, where strategies for ensuring inter-professional learning throughout courses were well
established and encompassed a wide cross-section of professional roles.
Examples of Inter-Professional Education activities included:

Podiatry students from the University of Northampton learning alongside medical students
during dissection sessions at Leicester Medical School

A joint Learning Disability Nursing and Social Work combined degree programme at Sheffield
Hallam University

Courses at the University of Derby that combine undergraduate nursing, radiography and
health and social care students

The University of Derby also offers a PG Certificate in Interprofessional practice education

Inter-professional education modules at Sheffield Hallam University during each year of Allied
Health Professional students’ studies which include input from a range of professionals and
highlight the need to work collaboratively

Specific joint modules/projects at the University of Northampton - ‘Quality Enhancement in
Inter-Professional Work Based Learning’ – a level seven module involving an action-learning
task that requires students to work as an inter-professional group, and ‘Practice Improvement
Project’ – a level six project linking theory and practice around service quality improvement
and research, and the impact of service improvement plans on different professionals and the
dynamics of the healthcare environment

Critical care simulations for small groups of students from a variety of professions at the
University of Leicester to practice rare incidents
34

The Centre for Inter-Professional Education and Learning (CIEL) at the University of
Nottingham combining students from nine professional groups into small groups to discuss
scenarios

An inter-professional learning programme at the University of Nottingham covering basic life
support and professional values

Students at De Montfort University undertaking Inter-Professional Education with medical
students at the University of Leicester, and also participating in simulation with the Fire
Service and Ambulance Service on SPEC 5604 – to enhance communication and development
of clinical skills for postgraduate students

‘Strand one classroom work’ undertaken jointly by the University of Leicester and De Montfort
University where all first year students on professional health and social care courses learn
about their own and other professional roles

‘Achieve more’ – students at the University of Sheffield develop a presentation as an interdisciplinary group

Further examples from the University of Nottingham included the Shared Family Study where
nursing and medical students work with a family in the community to understand their longterm health conditions, joint workshops based on case studies and focussing on
understanding the role of different healthcare professionals and different ways of thinking
about the cases, multi-disciplinary e-learning-supported student discussion groups, and staff
from different professional backgrounds teaching graduate entry medicine students
There were also examples of specific Inter-Professional Education events such as:

Guest lectures at the University of Leicester

School-wide conferences on topics such as domestic violence, homelessness and dementia at
the University of Lincoln

Inter-professional events for midwifery and medical students at the University of Nottingham

An Inter-Professional Education conference at Sheffield Hallam which includes assessed group
work

An annual inter-professional learning event at the University of Derby which brings together
students from varied health and social care backgrounds together with service users
35
There was also some cross-over with IDT here, as institutions and their partners had developed online
resources, principles and models for Inter-Professional Education such as Tiger (Transforming Interprofessional Groups through Educational Resources) http://tiger.library.dmu.ac.uk/.
Finally, institutions such as the University of Northampton reported students undertaking placements
in multidisciplinary settings such as diabetic foot teams and surgical teams.
Case studies on IPE work were submitted to the project team, and can now be accessed on the project
website (see http://enqire.org/case-studies) as follows:
Table 6: Case Studies of Existing Work – Inter-Professional Education
Institution
University of Derby
Title of Case Study
Occupational therapy VLE
Inter-Professional Learning (IPL) conference 2015 (Who do you think
you are?)
QI Chesterfield
IPL strategy
Pilgrim project
University of
Freshers’ week
Nottingham
Sheffield Hallam
Enhancing the patient care pathway (Prostate cancer)
University
Conversations about care of life
Further examples of work relating to this theme can be found on the Centre for the Advancement of
Interprofessional Education (CAIPE) website http://caipe.org.uk/.
36
Examples of existing activities: QI research and education
The initial mapping exercise did not focus directly on existing activities around quality improvement
(QI) research and education. However, it did ask questions around service user and carer involvement
in education and research. Examples of involvement in education have been detailed above. In
relation to involvement in research, examples of various levels of involvement were provided
including being research participants (e.g. in focus groups), commenting on proposals; being members
of ethics panels; conducting participatory action research; as PPI representatives on project steering
groups or groups linked to main research areas at institutions, and co-production of research – with
service users and carers being involved in all stages of the research – project design (including the
design of participant information resources), data collection, writing up and dissemination.
In many cases, service user and carer involvement in research was well established. An example of
this was the Services User and Carer Research Audit Network (SUCRAN) at De Montfort University
http://www.dmu.ac.uk/research/research-faculties-and-institutes/health-and-life-sciences/nursingand-midwifery-research-centre/sucran.aspx.
Respondents completing the Inter-Professional Education section of the survey also provided
examples that were relevant to QI Research and Education, in particular the joint modules/projects at
the University of Northampton - ‘Quality Enhancement in Inter-Professional Work Based Learning’ – a
level seven module involving an action-learning task that requires students to work as an interprofessional group, and ‘Practice Improvement Project’ – a level six project linking theory and practice
around service quality improvement and research, and the impact of service improvement plans on
different professionals and the dynamics of the healthcare environment.
The following is a list of case studies of existing work within this theme that were submitted to the
project team and can now be accessed on the website (http://enqire.org/case-studies):
37
Table 7: Case Studies of Existing Work - Quality Improvement Research and Education
Institution
Title of Case Study
Think Family/Whole Family: Working with families with parental
mental illness (in partnership with NHS Leicestershire Partnership
Trust)
University of Derby
Specialist nurse QI projects and presentation
QI Chesterfield
Research Centre
QI PG cert
Improving the quality and outcomes of pre-hospital care for
emergencies
Improving the primary care management of insomnia
Improving influenza and pneumococcal vaccination rates in primary
care
Loughborough
University
University of
Quality and service improvement
Northampton
Quality improvement (IPL)
Sheffield Hallam
Enhancing the Patient Care Pathway (Prostate Cancer)
University
38
Possible Areas for Development and Collaboration
As well as highlighting a lot of existing good work within each of the HEI Challenge’s work streams, the mapping exercise also highlighted a number of possible
areas that could be further developed through the Challenge, and opportunities for existing good relationships to be renewed and expanded. These are
summarised in Table 8 below.
Table 8: Possible Areas for Development and Collaboration by Work stream
PPI
Making involvement easier e.g. increasing
the training available to service users and
carers, providing opportunities for
engagement outside of office hours.
Training may increase the range of activities
that representatives can do e.g. enabling
them to lead sessions rather than just
having a small part in them
Broadening the range of patient and public
involvement activities (e.g. programme
review and development, assessment,
marking, leading lectures, developing
discussion forums etc.) and subject areas
that service users and carers are involved in
at each institution, and the weight given to
this
Increasing the amount and diversity of
service user and carer involvement
Making PPI systematic and embedded rather
than tokenistic. Ensuring that
representatives are involved in programmes
as early as possible
IDT
IPE
ENQuIRE
Balancing the mix of students for
inter-professional learning so that
there isn’t a bias towards any
particular discipline and to ensure
that staff do not combine groups of
healthcare students that would not
usually work together in the health
service
Focussing on improving dissemination
of work being done on service quality
improvement (e.g. through a student
conference) in order to generate
more inter-professional learning and
collaboration opportunities
Increasing service user and carer
involvement in research so that there
is always some level of involvement,
and increased opportunities for coresearch
Improving access to technologies
More funding to standardise training
Improving understanding of how to
use social media effectively in
educational and health contexts
Developing more relevant case
studies for inter-professional learning
Engaging a wider variety of students in
QI projects and inter-disciplinary work
Involving representatives in the
development of ideas for research
projects
Improving access to computers in
practice environments for use of
PebblePad
Spreading things like embedded weblinks on NILE/Blackboard and lecturecapture to a wider range of subject
areas, and overcoming some of the
challenges associated with this e.g.
the need for consent from presenters
and speed of upload from Panopto
Increasing the diversity of
representatives to ensure appropriate
expertise for different research
studies
39
PPI
IDT
Tracking and sharing the benefits of
involvement, insights and examples of good
practice (in terms of both care and PPI) with
each other and partners e.g. through
forums, blogs research on the impact of
participatory design etc.
.Developing a PPI strategy as an institution
Improving administrative support for
training external partners involved in
curriculum delivery and placement
mentoring in the use of technologies
such as NILE/Blackboard and
PebblePads
Using electronic marking for OSCEs
Developing (online) resources around good
and bad service user experiences to be used
in student learning and to improve care
Developing further MOOCs that
involve service users and carers
Developing ways of overcoming some of the
barriers to PPI e.g. finances
Increasing use of technologies in the
classroom e.g. ‘Echo 360’ and the
‘flipped classroom’ approach at the
University of Sheffield
Developing further MOOCs involving service
users and carers
Taking existing ‘virtual ward’ work
further e.g. focussing on Case-Based
Learning (CABLE), developing existing
software into a proper App and
adding more game elements
IPE
Limiting the number of students on
some courses (room size can be a
problem)
ENQuIRE
Ensuring that service user and carer
involvement in research is
appropriately financed and
sustainable
Ensuring that service users and carers
have appropriate training to be
involved in research e.g. on data
collection, basic research methods,
research ethics and writing for
publication
Focussing on improving dissemination
of work being done on service quality
improvement work (e.g. through a
student conference) in order to
generate more inter-professional
learning and collaboration
opportunities
A respondent from the University of
Leicester was organising a new
curriculum with QI teaching as an
integral part. Work was being
undertaken to train those who will
receive students into clinical areas for
QI projects
40
3.1.2
2: Creation of new sustainable inter-institutional networks for sharing, developing and showcasing good practice
As part of the project, four inter-institutional networks (working groups) were created as follows:
PPI
Lead(s)


Other

members







Kristen Clements (University
of Loughborough)
Rhian Last (Education for
Health)
De Montfort University: Jim
Dooher
Derby: Alison Kilduff
Education
for
Health:
Hannah Waterhouse
Leicester:
Elizabeth
Anderson
Lincoln: Paul Mansfield
Loughborough:
Alison
Stanley
Northampton: Ali Ewing,
and Sara Simons
Nottingham: Anne Felton,
Helen Laverty, Gemma
Stacey, and Joan Cook
IDT












Richard Windle (University of
Nottingham)
Heather Wharrad (University
of Nottingham)
De Montfort University: Jillian
Pawlyn
Derby: Chris O'Reilly
Education for Health: Judith
Brown, Melanie Burton
Leicester: Terese Bird
Lincoln: Andy Hagyard, and
Karin Crawford
Loughborough: Adam Pryor
Northampton: Sarah Cross
Nottingham: Yvonne Hood,
and Reg Dennick
Nottingham Trent: Beverley
Peel
Sheffield Hallam: Melanie
Lindley
IPE










Elizabeth Anderson (University
of Leicester)
Ali
Ewing
(University
of
Northampton)
CAIPE: Richard Pitt
De Montfort University: Jenny
Ford,
Derby: Dawn Forman, Wendy
Shaw, Fran Fuller, and Angie
Snow
Education for Health: Yvonne
Henderson
Lincoln: Sharon Black
Nottingham: Kirstie Hyndes
Sheffield: Patricia Cowell
Sheffield Hallam: Helen Bywater
ENQuIRE

Niro Siriwardena (University of
Lincoln)

Derby: Lorraine Henshaw and
Charlie Whiffin
Education for Health: Rhian Last
and Julia Neal
Leicester:
Philip
Pearson,
Graham Martin, and Mary DixonWoods
Loughborough:
Laurence
Gardiner, Stewart Robinson and
Zoe Radnor
Northampton: Cindy O'Dell,
Jackie Ridge and Ali Ewing
Nottingham: Justin Waring
Sheffield Hallam: Mark Faulkner
and Helen Bywater
QI Fellows (see below)







The ENQuIRE working group also included the following NHS staff working as QI Fellows or their equivalent in NHS organisations and academia: Sohrab
Panday, Tanweer Ahmed, Lucy Sitton-Kent, Chetna Modi, Karen McEwan, Jo Lamb, Suzanne Khalid, Diane Ketley, Shelley Gibson, Richard Fluck, Moira
Durbridge, and Lucinda Cumpston.
41
The patient and public involvement (PPI) working group lead reported that participating in the HEI
Challenge had also led to new links being developed, for example with organisations that were
awarded small (£500) project awards as part of this group’s activities.
A respondent from the inter-professional education (IPE) working group reported that the links made
with steering group members from other participating institutions could be valuable for future
collaborations, re-establishing former networks, and igniting new ones.
42
3.2 Medium-term outcomes and outputs
3.2.1
1: Measurable improvements in the range of work undertaken in each HEI
In the medium term, it was hoped that creating new inter-institutional ‘working groups’ that were
tasked with working collaboratively on the key areas of the HEI Challenge would lead to measurable
improvements in the range of activities undertaken by each HEI individually and collectively within the
key themes of the Challenge. In order to assess the extent to which this was happening, participants
were asked to complete a self-evaluation framework document at two time-points during the project
(November 2015 and April 2016). The purpose of this document was to capture their views on:

The rationale for the HEI Challenge

Details of the activity/activities undertaken by the working group(s) that they participated in

Key outcomes and outputs from these activities (including unintended outcomes and/or
outputs)

Factors that a) helped and b) hindered the activities undertaken by the working groups

Evaluation approaches used by the working groups to measure and reflect on the impact of
their activities

Service user, carer, patient, public and student involvement in the HEI Challenge activities,
and

Enablers and barriers to service user, carer, patient, public and student involvement
Data from the self-evaluation framework documents (n=11 in November 2015, n=4 in April 2016) were
thematically analysed alongside data from meeting records, and records of institutional visits
undertaken by the Project Manager.
Participants in the Challenge were also invited to submit case studies to show any new activities
occurring as a direct response to the Challenge, and the titles of these are also included below.
Rationale for the Challenge: The analysis suggested that participants across the Challenge perceive
the rationale for the project as:

Enabling institutions (their staff, students and patients) to share and learn from one another
– reviewing existing practice, sharing existing good practice and key achievements, and
identifying learning opportunities in relation to quality improvement
43

Enabling institutions to develop future work together – increasing and improving work
undertaken in relation to quality improvement

Offering an opportunity for personal development for staff and for service users, students,
carers and practitioners to increase their involvement with the work undertaken in HEIs

Providing wider networking opportunities, to both renew and improve existing relationships
and work, and develop new relationships and collaborative projects

Contributing to institutions’ aspirations to continually improve teaching and students’
learning experience, including embedding QI initiatives within the teaching curriculum and
further developing collaborative learning across disciplines

To progress opportunities at post-graduate level for healthcare staff to undertake research
projects on service development as part of an academic award, supported by experienced
academics and guided by joint academic-clinical supervision

To improve the level and range of service user and carer involvement within HEIs for
programmes with a care delivery component

To improve understanding of the benefits of PPI for education

To progress PPI work through use of additional funding for collaborative work

To improve quality in healthcare and patient experience

To bring together best practice in terms of the impact of PPI, IPE and technology on quality
improvement, and how research and education around quality improvement is undertaken
and delivered
In the long-term participants hoped that participating in the Challenge would:

Facilitate improvements in clinical practice and patient experience through joint projects and
embedding QI initiatives into clinical practice

Enable potential students, commissioners et cetera to see what each HEI offers across the
four HEI Challenge themes e.g. by showcasing of the institutions and their activities via the
established project website

Encourage collaborations with other HEI’s leading to the formation of long-term partnerships
44
Activities being undertaken by the working groups, their outputs and outcomes
The following sections detail the range of activities and learning that have emerged from the HEI
Challenge by each of the key themes within the Challenge:
Patient and Public Involvement (PPI) Working Group
Patient and Public Involvement Conference: the group arranged an event hosted by Loughborough
University in October 2015. This event, was attended by over 50 people from a variety of perspectives
(e.g. staff, learner, public), including representatives from a range of voluntary and service user led
organisations such as Healthwatch Nottinghamshire, the British Heart Foundation, the National
Centre for Physical Activity and Health, Leicester-Loughborough Biomedical Research Unit, CLASH, the
Alzheimer’s Action Alliance, Diabetes UK and the Carers Federation.
The conference aimed to provide a platform to explore what ‘patient supported quality improvement’
means from a range of perspectives, share learning about what does and does not work well, share
learning around best practice, explore opportunities for collaborative working between participants,
and inform principles for patient supported quality improvement in education and healthcare.
Participating institutions were represented by staff, service user, carer and learner voices.
The event raised awareness and understanding of the contribution that patient and public
involvement makes to quality improvement in education and health and social care services, and what
does and does not work in promoting PPI.
Key anticipated and unanticipated outputs and outcomes from this event included:

Creation and dissemination of a report about the event

Creation of a ‘Patient and Public Involvement is A.C.E.’ infographic following the event (see
Figure 2 below)

Production and dissemination of a video of the day

Production of a blog about the event

Networking opportunities, expanding roles and developing new links

Awards of up to £500 were allocated to support small collaborative projects as part of this
event, including:
o
£500 to Community Leicester Arthritis Self Help (CLASH) to make a short video of
musculoskeletal (MSK) activities in Loughborough
45
o
£500 to support the expansion of existing PPI activities and resources, particularly in
relation to a work around pre-hospital migrant healthcare
o
Support with the creation of two films around patient and carer experiences
(University of Northampton)
o
Support for a new module at the University of Leicester working with the Alzheimer’s
society. The module considers the relationships between health, social care, the
voluntary sector and the police.
Figure 2: Patient and Public Involvement is ACE Infographic
Thanks to Dr Julie Gosling and Shahnaz Aziz for the inspiration behind the ACE acronym.
46
Principles for practice for Patient and Public Involvement: an unexpected output from the PPI
working group was that their activities informed the development of Principles for Patient and Public
Involvement. These principles aim to provide a practical framework for institutions that wish to
engage patients and the public in health and social care education and research. The core principles
are:

Busting the pre-conceptions

Valuing the public (patients, service users, carers) as an ‘expert by experience’

Clinicians, educators and patients working together from the start of a health
professional’s education

Balancing the power between patient and clinician

Embracing principles of co-production and the value of feeling/being listened to

Creating a shared understanding, developing clarity of purpose

Capturing the human element embedded rather than ticking the box

Building the necessary supportive systems and processes

Sharing best practice, learning and working together
The principles are now available on the HEI Challenge website at http://enqire.org/principles-forpractice/patient-and-public-involvement/shared-principles together with examples of putting the
principles into practice and further resources.
Case studies of new work: Institutions have shared examples of new PPI work that they have
undertaken directly in response to the HEI Challenge. These case studies reflect a diverse range of
activities in teaching, learning, research and development. For example, this was evidenced by a case
study submitted by the University of Derby (now available on the project website) called ‘The impact
of the Experts by Experience Group (ExE) at the University of Derby on student mental health nurse
practice’.
Further unanticipated outcomes and outputs around PPI were a ‘Who will I be when I die’ video
produced by students on the Creative Expressive Therapies Programme at the University of Derby
(shown at the HEI Challenge Showcase conference – see below), and an associated art project at
Sheffield Hallam University. Further information about this work stream can be found at
http://enqire.org/principles-for-practice/patient-and-public-involvement
47
Inter-Professional Education (IPE) Working Group
Designing an inter-professional Health Care Team Challenge: the inter-professional education
working group had an ambitious plan to adapt the internationally acclaimed inter-professional Health
Care Team Challenge in which students from different health-related professions work in clusters to
respond to a complex scenario/case study which is relevant to all professions, and focussed around
patient-led concerns for service quality improvement.
In a Health Care Team Challenge event, students would look at what happened throughout the care
pathway in the case study/complex scenario, and how the quality of care could be improved. The case
scenarios would offer students an opportunity for inter-professional learning. Students would be
asked to prepare an eight minute PowerPoint presentation for the final event for this challenge. The
team challenge would offer an opportunity to showcase students and graduates from institutions
across the region, and to promote Inter-Professional Education widely. The IPE group originally
envisaged that the event would be supported by the UK Centre for the Advancement of
Interprofessional Education (CAIPE).
Through developing an initial pilot, participants hoped to create a reusable framework for running a
team challenge in the region and a new model of IPE teaching and learning that connects students to
improving the quality of care for patients.
Participating institutions would work as regional clusters: North (University of Sheffield, Sheffield
Hallam University and University of Derby) and South (University of Nottingham and University of
Lincoln, and University of Leicester and University of Northampton). The final student presentations
would be judged against an agreed set of criteria, and a winning team selected.
The IPE group modified their aim to fit the resources available and went on to hold two student
conferences based on the work that they had undertaken (see below), and a full Health Care Team
Challenge event may still be held in the future.
In addition, whilst it was not possible to host a full Health Care Team Challenge, a number of
anticipated and unanticipated outputs and outcomes were produced from the work that went into
planning such an event:

Networking - staff had regular meetings to share ideas and re-establish relationships between
institutions for working together on Inter-Professional Education
48

The individuals working towards hosting the events developed a shared understanding of the
format for a Health Care Team Challenge Event (which may be held in the long-term), and also
for the inter-professional learning on quality improvement events

There was patient and public involvement in the planning of the events – developing the
scenarios for students to consider – reflecting on what happens in care, and the University of
Leicester is making links with a new patient group

The Health Care Team Challenge is a new model of Inter-Professional Education teaching and
learning, and in the longer-term when the first event is hosted, it will connect students directly
to improving patient quality of care. Students within the participating HEIs will receive InterProfessional Education and be given the opportunity to participate in a student conference.
Student conferences: The IPE group held two student conferences in June 2016 which enabled
students to participate in workshops around quality improvement and to share their work and
innovative ideas about quality improvement in healthcare. One conference was held at the new
Centre for Medicine at the University of Leicester, attended by students from the University of
Leicester, De Montfort University and the University of Northampton. A second conference was held
at Sheffield Hallam University hosting students from the University of Sheffield, University of Derby,
and Sheffield Hallam University.
Hosting these conferences and planning for a Health Care Team Challenge event have enabled
participants in this work stream to create re-usable frameworks/models for inter-professional learning
on quality improvement for use by participating HEIs and their partners.
The conferences were evaluated using student conference evaluation forms (see ‘Approaches being
used to evaluate the working groups’ activities’ below).
Other key outputs and outcomes from hosting these events include:

Students were able to share their work and learning around quality improvement in
healthcare

Students learned to value team approaches to quality improvement and understand the
necessity of this

Universities collaborated to share the costs and work involved in organising the venues, food,
travel expenses et cetera
It is hoped that now that this approach has been modelled, it will offer a sustainable approach that
can be repeated in future years with a focus on longitudinal evaluation to improve the evidence base
49
around this work. Plans are already in place for a second conference in the ‘northern’ region with a
Quality Improvement theme next year.
Online learning resource: A collective online learning resource has been created around interprofessional learning on patient supported quality improvement for learners across health and social
care professions. This is available at http://tinyurl.com/healthcareteamchal
Q IPE groups: The IPE group are also working on supporting the formation of local Q IPE groups linked
to existing national and local QI groups and bodies such as HEEM, Open School and CAIPE.
Principles for IPE and QI: Finally, a set of shared principles for inter-professional education and quality
improvement has been established. This is available at http://enqire.org/principles-forpractice/interprofessional-education/principles
Overall, taking part in the HEI Challenge has enabled participants who are experts in inter-professional
education to reflect on how to link patient-supported quality Improvement work to existing interprofessional education curricula. The group plan to share their work at the next All Together Better
Health conference series in New Zealand in 2018.
50
Innovative Deployment of Technology (IDT) Working Group
Mapping learning journeys: the Innovative Deployment of Technology group developed and mapped
the concept of the healthcare learner journey within the education process. They then populated the
nodes (or stations) on this map to show examples of innovative deployment of technology that
contribute to quality improvement at each stage of the journey – sharing examples of best practice
from the participating institutions (see Figure 3 below).
Figure 3: Healthcare learner journey (Technology Related Innovation – Implementation Tool: TRI-IT)
Over 250 examples of practice were used to illustrate the learner journey. For example, case studies
included under the ‘curriculum design’ node include:

Electronic storyboarding tools

Electronic curriculum mapping

Electronic curriculum design and lesson planning tools

Using learning analytic data

Tools to showcase designs

Involving students in e-learning content design

Involving service users in e-learning content design

Gaming/simulations of courses

Electronic timetabling

Discussion boards/ blogs/social media to share ideas and discussion

Resource Repositories
51
The interactive map that the working group produced is available on the Challenge website at
http://enqire.org/principles-for-practice/innovative-deployment-of-technologies
and
at
http://www.nottingham.ac.uk/helmopen/tri-it/.
The practical and easily accessible tool can be used to help to plan how digital technology can be used
to improve the quality of learning – including lots of suggestions and examples from practice. In the
future, the group hope that it will also be possible to use the tool as an audit tool for evaluation work.
52
Quality Improvement in Research and Education (ENQuIRE) Working Group
The East Midlands Network for Quality Improvement (QI) in Research and Education working group
(ENQuIRE) built on existing initiatives and networks to showcase quality improvement and
implementation science research and education that is taking place in the East Midlands. The terms
of reference for this group listed objectives to:
1. Support sustainable networks for improvement and implementation science linking key
institutes, centres or groups across East Midlands partner institutions
2. Provide a support network for postgraduate students, QI fellows and academic staff working
in improvement science across the region
3. Develop information resources on regional QI initiatives:
o
QI educational (MSc, doctoral, standalone) programmes and seminar series
o
Models for joint NHS/HEI QI posts supporting improvement and enhancing
recruitment
o
Models for joint NHS/HEI QI programmes, projects and engagement
4. To evaluate the achievements/impact of the group activities
Register of QI activities: the group aimed to develop a repository of quality improvement activities
and courses taking place across the region. This repository will be co-ordinated by the Q-network (an
NIHR network of experts and fellows in quality improvement/service and care in healthcare). It will sit
within the HEI Challenge website, and will include examples of both successful and unsuccessful
initiatives to aid learning around avoiding the pitfalls in this area.
Principles for collaboration in evaluation between Universities and providers of health and social
care: Guiding principles have been developed for how higher education institutions and health and
social care organisations can effectively work together on the evaluation of interventions. The
document that they have developed is called ‘Principles for Collaboration in Evaluation: A practical
framework for universities working with health and social care’. This is available from the HEI
Challenge website at: http://enqire.org/principles-for-practice/quality-improvement-in-researchand-education/principles-for-practice
Thus key outputs from this group will be a register of QI activities and principles for collaboration.
There are also some further anticipated outcomes from this group’s activities - they will also focus on
strengthening links between higher education institutions, clinical audit teams and the NHS where
there is a focus on quality improvement/service and care improvement.
53
The group plan to ensure the sustainability of their work by making it part of the national Q Network
in the future.
Further information on this theme is available at http://enqire.org/principles-for-practice/qualityimprovement-in-research-and-education
Overall unanticipated outputs and outcomes
Participants in the Challenge noted some unanticipated outputs and outcomes. Some of these cut
across the themes within the Challenge, and others were specific to individual working groups:

Rhian Last, Education Lead at Education for Health and steering group member, was pleased
to facilitate two separate sessions on quality improvement and case study design, to support
the Challenge. One was for the steering group leads on 26th February hosted by University of
Northampton and the other was for a HEI Development Challenge Group on 18th March,
hosted by Nottingham University

The IPE working group hope to develop local Q students IP groups and have a method for
designing QI IP cases using service user experiences of health and social care

the organisation

The development of the Principles for Patient and Public Involvement

Programme at the University of Derby, and shown at the HEI Challenge Showcase conference
(see below), and an associated art project around service user-student partnerships at




54
Learning - factors that helped and hindered the activities undertaken by the working groups
As well as celebrating the successes of the project in terms of the many outputs and outcomes from
the activities of each of the work streams, it is important to reflect on what helped and hindered the
activities undertaken by the working groups.
Feedback provided on framework documents suggested that the following things were helpful:

Previous good working relationships between members of participating institutions had been
enhanced, and new relationships had been forged, which helped the groups to complete their
activities

Participants reported receiving good support from the Project Manager

The IPE group reported that their work was helped by setting regular dedicated meeting times
to focus on their activities
In addition, feedback suggested that the following things hindered the activities undertaken:

Lack of connection between the working groups - one respondent felt that more connection
between the steering groups for the different strands of the Challenge could have been
helpful

Respondents also reported that the activities that they were able to undertake in response to
the Challenge were limited by the resources (time and money) that they had. This was
particularly the case for the IPE group, who stated that pump priming would have enabled
them to offer the Health Care Team Challenge and to have designed a professional web-based
teaching resource

It would also have been beneficial to have more resources to support the engagement of
service users and carers in activities being undertaken in response to the Challenge

One respondent also reported being limited by perfunctory support from some colleagues

As yet under-developed learning for sharing learning across disciplines was a challenge

Multiple demands on staff time and energy also posed a challenge
Approaches being used to evaluate the working groups’ activities
The working groups were using a number of different approaches to evaluate their activities:
The PPI group conducted an evaluation of the PPI conference using an online survey administered
shortly after the event.
55
The PPI conference resulted in the award of £500 to several groups to support small collaborative
projects between HEIs and service user-led organisations. These awards will be evaluated towards the
end of the award period (approximately six months).
One respondent from the University of Northampton reported that their PPI work coming out of the
conference would be evaluated as part of an annual audit of service user and carer involvement which
will take place at the end of the 2015-2016 academic year.
Another respondent also reported plans to evaluate the impact of increased involvement by surveying
the views of staff, student, and participating service users and carers.
The IPE group used student and staff questionnaires to evaluate the conference days, and also plan to
invite students back to the University after they go into practice to find out to what extent they feel
that their education prepared them for health and social care practice, and how the quality of the
curriculum can be continuously improved. The surveys (n=16) returned for the conference attended
by students from the University of Sheffield, Sheffield Hallam University and the University of Derby
showed that 94% of respondents (students and staff from the three Universities) rated satisfaction
with the conference and conference format as ‘good’, and 6% as ‘excellent’. Similarly, 94% of
respondents said that they would attend, or recommend someone else attends next year’s
conference. All attendees returning questionnaires stated that there was sufficient time for the
presentations and that they received the information that they expected
Service user, carer, patient and student involvement in these activities, and enablers and barriers to
this involvement
Service users and students were involved in the conference organised by the PPI group as participants
and presenters.
Service users and carers have been part of the steering group for organising the Health Care Team
Challenge event and student conferences, and will be involved in running the events in the future.
Student timetables and workload and a lack of finances to support service users fully are seen as
barriers to involvement here.
Service users, students and carers also attended and presented at the overall HEI Challenge showcase
conference (see section 3.2.2).
56
3.2.2
2: Conference to showcase good practice
In the medium term, participants in the Challenge aimed to organise a ‘showcase’ conference. The
conference had two main aims – firstly, to showcase good practice, key messages and outcomes
resulting from the work undertaken by each of the new inter-institutional ‘working groups’ in each of
the key areas of the Challenge. Secondly, it aimed to give participants the opportunity to explore how
the work that began in the Challenge could be built upon in the future.
The conference was held in the Enterprise Centre, Derby on the 14th of June 2016. It was attended by
around 100 delegates from a range of organisations across the East Midlands and Sheffield and
included representation from academics, service users and carers.
The conference was opened by Rachel Munton from the East Midlands Academic Health Science
Network, followed by a presentation on the ‘HEI Challenge in Context’ from Kathryn Mitchell, ViceChancellor of the University of Derby, and an overview of the HEI Challenge approach from Rachel
Hawley (Project Manager, University of Lincoln). There were showcases for each of the work streams
followed by questions and answers, and then four parallel workshop sessions organised around the
work streams.
The afternoon sessions included a presentation from Simon Denegri (INVOLVE) around NIHR’s strategy
for improving service user involvement in research, INVOLVE’s priorities (equality and diversity;
learning and development; and co-production), challenges for the future (reach, relevance and
refinement), and future plans (including plans to develop regional forums in partnership with the
Research Design Service).
Programme at the University of Derby, was shown at the conference. This also went on to inform an
associated small art project around service user-student partnerships at Sheffield Hallam University.
Derby students met with the service user group and students in the Faculty of Health and Well-being
at Sheffield Hallam University. The video prompted discussion on how, through art, partnership
between students and service users in health and social care education could be represented. Three
pieces of artwork were co-produced and an e-poster is being developed that showcases the project
and acknowledges all participation. A photograph of these pieces of art (in progress) is shown in Figure
4 below. The workshop also informed a logo to represent partnership (Figure 5). The artwork will be
displayed in the Robert Winston Building and showcased at a partnership event in September.
57
Figure 4: Art projects (in progress)
Figure 5: Logo to Represent Partnership
58
A range of posters were also displayed at the conference on a wide range of topics, and delegates
were also invited to make a pledge and attach this to the ‘pledge tree’ as a means of ensuring
sustainability for the learning and outcomes from the Challenge. A representation of the pledge tree
is shown in Figure 6 below, and individual pledges made at both the HEI Challenge Showcase
Conference and a related PPI conference are listed after it.
Figure 6: Pledge Tree
The individual pledges made were as follows:

Continue to promote the involvement of local people in the provision, commissioning and scrutiny
of healthcare services. Putting their views is central to service design and delivery

I commit to spreading learning and engagement to support PPI though social media

Free my staff to participate in projects by careful prioritisation

Help with the evaluation and outcomes of the project around patient benefits

Bridge the theory-practice gap by providing a platform for effective collaborative working

Finding ways to identify £’s to enable sustainability

QIF16
59

Maintain the new connections made and collate case studies

Ensure that the voices of the seldom heard community are listened to

Support (introduce) someone to become involved in PPI

Submit a bid for a PPI coordinator time within the School

Help sustain PPI Networks across the HEI project (database with all PPI and connecting groups)

Help with computer-supported cooperative work

Maintain focus and consistency on the PPE project that started

Continue to develop ongoing community partnerships

Leadership – email Kath Ryan to ask if the Universities involved in the HEI Challenge have identified
PPI opportunities from within

I will carry on doing workshops with students to inform them of my experience and develop all
my staff

Devote time to ensure Faculty PPI becomes embedded and is funded

Accessibility – dissemination of my skills and knowledge to other staff – share best practice –
integrate PPI into training for students to take into practice

Email my colleagues at NCCPE Academy to discuss further

Make accessibility and diversity a national priority

Look at events using University buildings outside of the teaching year

Share information to interested parties

Involve new staff in PPI in HE – part of their role

Be open minded to all new quality improving ideas and projects

Work at improving communication: service users, students and academic staff

Work on involving ALL, listening to ALL
Feedback on the conference is being gathered via online questionnaires at the time of writing.
3.2.3
3: Website to showcase good practice
Individuals contributing to the Challenge also aimed to develop a website to showcase good practice.
This has been created and can be accessed at www.enqire.org .
The website includes information about all of the partner organisations that were involved in the
Challenge, and links to the activities undertaken by each of the working groups.
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There are also a wide range of case studies on the website around patient supported quality
improvement learning and activities across the institutions involved in the HEI Challenge.
In addition, the website includes links to:

National and regional networks such as the Q Initiative, the Centre for the Advancement of
Interprofessional Education (CAIPE), and the East Midlands Academic Health Science Network
(EMAHSN)

Patient stories

Books and articles
Participants in the HEI Challenge intend for the website to be sustainable. It will be linked in with the
Q Network, and all working group leads will be able to update the website as appropriate. It will act
as a ‘living record’ of activities that continue to be undertaken in response to the HEI Challenge.
Google analytics is being used to track use of the website. In the first month of the website being live
there have been 70 sessions of use, from 43 users averaging 7 minutes each and 6 page views. Users
to date have largely been from the UK (79%), with others from the United States (8.6%), Europe, South
America, Africa, and Hong Kong.
3.3 Long-term outcomes and outputs
3.3.1
1: Sustainable cross-institutional working in the future
Ultimately, through creating the initial inter-institutional ‘working groups’, participants in the
Challenge aimed to create sustainable cross-institutional working around quality improvement
education and research in the future.
Responses on the self-completion framework document showed that the working groups are planning
to use a variety of methods to continue their activities.
The IPE group are well established and will continue to meet. The ENQuIRE plan to continue as the
regional arm of Q, the national network being developed by the Health Foundation and NHS England.
PPI activities will continue in each institution with regional activities coordinated through the Patient
Senate of the East Midlands Academic Health Science Network.
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One respondent from the University of Northampton reported plans to share and sustain their
activities through a University Learning and Teaching conference, School Development Days, a
Learning and Teaching group, a service user and carers’ forum, publication of project work, and open
educational resources.
Others reported that they had made new links with staff across the participating HEIs as a result of
the Challenge, and were planning to develop these relationships with a view to undertaking more
collaborative work in the future.
There are examples of work that has grown from the Challenge that will extend beyond the life of the
Challenge such as the small-scale projects funded after the PPI conference, plans to repeat the IPE
student conferences and to further pursue investment for hosting a Health Care Team Challenge
event, and plans to further develop uses for the learner journey tool created by the IDT group.
3.3.2 2: Development and/or amendment of institutional level policies and 3: Development of
cross-institutional policies and quality indicators for the areas in the Challenge
As may be anticipated, these longer-term aims of the Challenge has not been achieved within the
timescale of the Challenge. However, each of the working groups developed ‘principles for practice’
in their areas, which have the potential to be used as quality indicators in future work. Likewise, the
IDT working group hope that their interactive learner journey tool will also be able to be used for audit
and evaluation purposes in the future.
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4. Discussion and Conclusion
The East Midlands Academic Health Science Network define ‘impact’ as
“Changes in practice, service or policy that make a distinct and material contribution that would
not have occurred, or would have been significantly reduced without the contribution of
EMAHSN”.
Overall there have been numerous anticipated outputs and outcomes from the HEI Challenge. These
are summarised below.

Map of existing activities – at the beginning of the Challenge, participating institutions
completed a survey to produce a map of their existing activities being undertaken within each
of the four key areas of the Challenge, and to highlight possible areas for development and
collaboration

Creation of new sustainable inter-institutional educational networks for sharing, developing
and showcasing good practice – four new inter-institutional networks were created around
the key themes within the HEI Challenge (PPI, IPE, IDT and QI Research and Education), which
have the potential to be sustained beyond the life of the Challenge

Hosting of a Patient and Public Involvement conference that raised awareness of the
contribution that PPI can make in education and health and social care services, and enabled
examples of good practice to be shared. The conference was documented in a report, a blog
and a video, and provided networking opportunities for staff (including both academics and
people from voluntary sector organisations), service users, carers and learners. Activities at
the conference also led to the production of a ‘PPI is ACE’ infographic, and to several small
awards being made for new collaborative projects

Principles for practice – several sets of principles have been developed: 1) PPI Principles – key
principles for institutions wishing to engage patients and the public in health and social care
education and research, 2) principles for IPE and QI, and 3) principles for collaboration in
evaluation

Planning and designing a Health Care Team Challenge event – although it was not possible
to hold a Health Care Team Challenge event without additional resources, designing and
planning for hosting such an event enabled participating staff to share ideas and re-establish
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relationships between institutions, and develop a shared understanding of the format for such
an event. New University-patient links were also established through this initial work

Inter-Professional Education student conferences – hosting two conferences around IPE and
quality improvement enabled students to learn and share ideas about inter-professional
learning and quality improvement in healthcare

Online learning resource – an online learning resource has been created around interprofessional learning and patient-supported quality improvement

Q IPE Groups – local Q IPE groups are being developed and linked to existing national and local
groups

Interactive learner journey – the IDT working group created an interactive learner journey
(TRI-IT) tool that contains numerous case studies that demonstrate how technology can be
used to contribute to quality improvement at each stage of the journey

Register of QI activities – a repository of quality improvement activities and courses taking
place across the East Midlands is being developed and will be co-ordinated by the Q Network.
This will contain examples of both successful and unsuccessful practice to facilitate learning

HEI Conference – a conference was held in June 2016 to celebrate and showcase the
achievements of those participating in the HEI Challenge

Challenge Website – a website has been created for the Challenge at www.enqire.org . This
showcases the work that has been undertaken within each of the work streams. It also
contains numerous case study examples of existing and developing practice within the
participating institutions together with outputs from the project (such as the principles for
practice), and links to supporting information and groups. This acts as a ‘living record’ of the
activities undertaken in response to the HEI Challenge
Participants also reported that the Challenge has produced some unanticipated benefits. For
example:

Rhian Last (Education Lead at Education for Health) facilitated two sessions on quality
improvement and case study design, to support the Challenge

The IPE working group have a method for designing QI IP cases using service user experiences
of health and social care

the organisation
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
Students from the University of Derby have produced a ‘Who will I be when I die’ video, and
gone on to work with students from Sheffield Hallam University who have produced several
art pieces around service-user student partnerships




Overall, the HEI Challenge has given participants the opportunity to establish and renew relationships
between institutions, and to build and refresh relationships with wider networks. All of the working
groups are planning for how the work that they have undertaken and the relationships that they have
built can be sustained in the future. The HEI Challenge website (www.enqire.org) will continue to be
updated beyond the life of the project, acting as a ‘living record’ of the activities undertaken in
response to the Challenge, and providing case study examples and resources for others wishing to
undertake work in relation to each of the key areas of the Challenge.
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References
Taylor-Powell, E., Jones, L., & Henert, E. (2003) Enhancing Program Performance with Logic Models.
Retrieved 21 July 2016, from the University of Wisconsin-Extension web site:
http://www.uwex.edu/ces/lmcourse/
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Appendix 1: Mapping to East Midlands Academic Health Science Network
impact dimensions
The work undertaken through the HEI Challenge mapped to several of the East Midlands Academic
Health Science Network impact dimensions as shown below.
1. Patient and public involvement working group
Impact Dimension
Actual Impact
Led to impacts on public or other audience
awareness, attitudes, understanding or
behaviour
The project has increased academic, public and
practitioner awareness of the practice leading
to new partnership working (formal and
informal) e.g. five collaborative PPI projects
established between participating Universities
and voluntary sector organisations
Influenced or changed commissioning of
education
Health Education England East Midlands are
supporting the roll-out
Enhanced service user and carer experience is
demonstrated through positive feedback from
participating service users and carers e.g. at
working group meetings / events
Research commissioned by Higher Education
Academy into recognition for service user and
carer contributions to teaching and learning in
higher education
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2. Inter-professional education working group
Impact Dimension
Actual Impact
behaviour
practitioner awareness of and identifies gap in
relation to patient supported quality
improvement in IPE. Service user and carer
engagement in scenario building has led to the
creation of an online learning resource
Influenced or changed commissioning
Adopting the Health Care Challenge approach
to scale is leading to longitudinal study to build
an evidence base. Work undertaken by this
group will be presented at the All Together
Better Health conference series in New Zealand
in 2018with the aim of influencing future
commissioning for IPE in the East Midlands
Assisted the adoption and spread of
innovation or research translation into
practice
The project has demonstrated benefit to the
wider learner community through new
partnerships widening inter-professional
learning opportunities. Numerous case studies
showcase examples of best practice for patient
and public involvement leading to new
partnerships between Universities in the East
Midlands and renewed partnership working
with CAIPE
3. Innovative deployment of technologies working group
Impact Dimension
Actual Impact
behaviour
Established a cognate map of the learner
journey leading to the creation of the Tri-it tool.
This innovation is providing an audit for the
medium and longer term evaluation of impact
practice
A large number of case studies established
showcasing examples of best practice for the
deployment of technologies
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4. Quality improvement in research and education working group
Impact Dimension
Actual Impact
behaviour
practitioner awareness of impact and
evaluation leading to shared principles for
collaborative evaluations between universities
and health and social care providers
It is anticipated that enhanced collaboration in
evaluation will benefit patient experience /
outcomes in the medium or longer term in ways
that will demonstrated through current and
future evaluation reports from East Midlands
Universities and partner organisations
practice
Numerous case studies showcase examples of
best practice for patient supported quality
improvement leading to new partnerships and
Networks e.g. QI Network
Shared principles for practice
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Higher Education Institution (HEI) Challenge for patient supported

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