Case study 1 - University Hospital Southampton NHS Foundation Trust
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Introduction
University Hospital Southampton NHS Foundation Trust (UHS) provides services to 1.3 million people living in Southampton and south Hampshire, plus specialist services to more than 3 million people in central southern England and the Channel Islands. The Trust is also a major centre for teaching and research in association with the University of Southampton and gained Foundation status in October 2011. The Trust employs 7,500 staff and is responsible for the revalidation of some 570 consultants, 35 SAS doctors and 110 doctors at clinical fellow and Trust doctor level.
Challenges
A major challenge that UHS faced at the outset was ensuring that appraisals happen consistently. While appraisals were taking place to varying degrees across the Trust, they were primarily being held for the purpose of awards or specific career progression, as opposed to continuing professional development.
Another challenge was communication, both disseminating the latest information and ensuring that appraisals were reported back fully to the central team. The Trust is so vast and so widespread that, in certain instances, appraisals may well have been taking place, yet records were not being processed through the correct channels.
Improving levels of engagement across the Trust was also vital. With a large and diverse network of doctors across a range of specialty areas, one particular difficulty was ensuring that guidance was not too generic but took into account the full spectrum of practitioners across the organisation. Promoting importance of supporting information in such a large organisation, and how to go about collecting it, was also a key area to get right.
Action
In early 2011 the Trust’s Medical Director and Responsible Officer, Dr Michael Marsh, appointed Dr John Stubbing, an anaesthetist, as the appraisal lead for the organisation and Gillian McKay as dedicated revalidation administrator. Dr Stubbing became the day-to-day appraisal lead which crucially gave the organisation’s revalidation project structure and accountability.
Dr Marsh made it clear to every doctor in the organisation that revalidation was a priority. To demonstrate its importance, Dr Stubbing’s first step was to form a team of appraisers. Eighty-five were trained (79 personally by Dr Stubbing) to the standard required for a strengthened appraisal process and their details were shared across the Trust.
To deal with the size of the organisation and the communication problems this created for appraisal, Dr Stubbing appointed an appraisal lead within each of the 12 clinical areas in the Trust. This group meets regularly to discuss issues, share best practice and disseminate views up to the Medical Director.
An online platform was also established, where information about the appraisal process, colleague and patient feedback, downloadable GMC documents, frequently asked questions and a supporting information checklist are housed. This easily accessible platform is continually updated with the latest information. Ensuring doctors are aware of its existence is a primary aim for the revalidation team.
This suite of material also includes a uniquely designed Form 4 tailored to reflect the four domains in the GMC’s appraisal framework:
- Knowledge, Skills and Performance
- Quality & Safety
- Communication & Teamwork
plus specific Trust priorities.
Such a move helped cater for the individuality of the Trust and the fact that its SAS doctors operate across a wide range of specialties, as Dr Stubbing explains: ‘The old Form 4 didn’t cover the four domains, so we included them in our amended version and added in some information relevant to us as a large teaching hospital, including a specific section on teaching, one on research and one on reflective practice.’ Frequent emails have alerted colleagues to these resources and how they can help.
Regarding colleague and patient feedback, the Trust had previously established a relationship with an external company specialising in information management that stipulated doctors had to provide 15 colleagues who would provide feedback on their progress.
This group included a doctor’s line manager and his/her peers, trainees and direct reports. The outcome was a detailed report breaking down a doctor’s performance in the eyes of their colleagues, an asset which is set to prove extremely useful for this element of revalidation.
Patient feedback has proved more complex, although the Trust uses its care groups, comprising appraisal leads from each clinical area, to share successful methods. ‘Some care groups are more advanced than others. Some are using preassessment questionnaires, for example,’ says Dr Stubbing. ‘It’s an issue we are continuing to work on, so sharing approaches – what works, what doesn’t - is very helpful.’
Results and benefits
The results are clear, with 83% of doctors confirming that they have had an appraisal in the last year. Dr Stubbing feels it is ‘fantastic’ that so many doctors are already engaged.
Dr Debjoy Malik, an ophthalmology SAS doctor and trained appraiser who has recently carried out five appraisals, feels progress is certainly being made: ‘It is a learning process and not every doctor is familiar with all the resources yet, but dissemination of information is good, particularly within my department. Having an appraisal lead within each department works well as they understand their colleagues’ needs, and having relevant guidance for our Trust in an easily accessible online place is better than having to contact a single person constantly.'
In terms of benefits, Dr Stubbing believes revalidation will provide a ‘mantra’ for patients, providing them with confidence that their doctor is ‘safe, up-to-date and fit to practise’. For doctors, Dr Malik is equally confident of revalidation’s benefits: ‘The process ensures quality control. It is a good way of making sure knowledge is continually built and it reinforces the appraisal process. It helps to identify and rectify any areas of concern and being revalidated will boost a doctor’s self-confidence and morale.’
Steven Harris, Deputy HR Director for the Trust, also feels strongly that revalidation will benefit doctors in their career development: ‘Doctors are responsible for the care of the vulnerable and so any measures to improve clinical performance should be welcomed.’
Key findings
- UHS made it clear to its doctors from the outset that preparing for revalidation was a priority for the organisation. Their project has had clear leadership – from the medical director and revalidation lead.