Training Needs Analysis Report summary

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The pilot sites report their findings for end of life care communication skills

22 September 2010 - National End of Life Care Programme
This report provides the first round of feedback from a training needs analysis (TNA) pilot project, set up to support the development of communication skills training for all those working in end of life care.

It provides some early outcomes and learning from 12 pilot sites around the country, each of which carried out its own local workforce TNA. We hope these initial findings will be useful to other organisations planning to carry out a TNA themselves, or to support the development of EoLC training plans. A series of 'top tips' are summarised in the document.

Publication by the National End of Life Programme which became part of NHS Improving Quality in May 2013

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Training Needs Analysis Report summary

  1. 1. Communication skills for end of life care Training for health and social care staff Talking Needs Action Training Needs Analysis: The pilot sites report their findings for end of life care communication skills Summary report
  2. 2. Summary report Purpose and scope of this report This report provides the first round of feedback from a training needs analysis (TNA) pilot project, set up to support the development of communication skills training for all those working in end of life care (EoLC). It provides some early outcomes and learning from 12 pilot sites around the country, each of which carried out its own local workforce TNA. We hope these initial findings will be useful to other organisations planning to carry out a TNA themselves, or to support the development of EoLC training plans. The TNA contributes to improved training provision for EoLC and supports the development of a skilled and confident workforce. This report is relevant to all those involved in or with an interest in EoLC and will be particularly relevant for: • Strategic health authorities’ workforce development teams • Local education commissioners • Commissioners of local health and social care services • Education providers including higher education institutes, further education institutes and specialist education providers • Local service providers • Health and social care staff and their managers. This project has been run by the National End of Life Care Programme (NEoLCP) in partnership with Connected©, the national communication skills training programme for cancer services.
  3. 3. Context and background The health and social care workforce involved in EoLC is extensive and is employed by a wide range of employers in a variety of settings. Workforce competence in communication underpins all good quality EoLC. It is essential that health and social care staff can have open and effective conversations with people, their families and carers about death and dying and the issues surrounding it. In this way, service users are well supported, their wishes can be properly discussed and personalised care plans can be put in place. Learning is a life-long process based upon individual interest, motivation, need, values and competences. The Department of Health End of Life Care Strategy 20081 has identified communication as one of the four competency areas that cut across all levels of practice. It recognises the communication skills that already exist in the workforce and aims to build on these to make sure that all staff have the ability to deliver quality care for everyone. Formal training and education are not the only ways that people develop skills and the opportunity to learn in the workplace through experience, role models and mentoring should be recognised. The maintenance and development of skills are a continuous dynamic process that can be supported by appraisal and continuing professional development. There are cost benefits to having a competent workforce that can initiate timely and appropriate conversations with people at the end of life: individuals’ needs will be identified promptly, resulting in the right care at the right time and avoiding unnecessary interventions – making best use of staff time and resources. The TNA, by identifying existing workforce competences and training need, supports the development of appropriately qualified staff who can deliver high quality care wherever it is provided. Key TNA findings • The majority of health and social care staff are involved in EoLC. The proportion of staff time involved in EoLC varies, depending on the setting and the staff role • Most have received some basic, generic communication skills training • Most believe they would benefit from further training to address the challenging demands of conversations with people approaching the end of life • Communication skills training is provided by a range of organisations including universities, colleges, in-house local service providers, hospices and independent organisations. Specialist palliative care staff provide most EoLC communication skills training • Provision of intermediate and advanced training is limited
  4. 4. • There is a need for more competencybased advanced level training in general and, in particular, improved access for staff who don't care for cancer patients Top tips for a TNA 1. Allow adequate time for thorough planning and preparation • Social care staff, particularly those working for private organisations, have more limited access to EoLC training than health care staff 2. Match the level of enquiry to organisational needs and set a realistic scope and timeframe • Service providers and staff are not always aware of local training opportunities 3. If the scope of the TNA is large, consider using a representative sample of employees and employers • There was a frequent misunderstanding about the term ‘end of life care’ with staff not appreciating their role in its delivery and, therefore, not understanding the relevance of EoLC training 4. Involving representatives from all partners in consultation and planning will improve engagement across sectors and improve the quality of data collected • Co-ordination of training across local areas is often poor, with examples of course duplication and gaps. Benefits of a TNA The pilots found that the TNA has provided them with a better understanding of the workforce engaged in EoLC, the existing competences and the training currently available. This supports a strategic approach to workforce development. Wide stakeholder engagement has enabled a more co-ordinated approach to training and education and the TNA has provided a structure for ongoing monitoring of competences and for evaluating the impact of training. The TNA process has had the additional benefit of raising awareness of EoLC and has identified enthusiasm for training. It has supported culture change – getting death and dying onto the agenda for the whole EoLC workforce. The pilots have established project structures that facilitate effective multidisciplinary, multi-agency and interdisciplinary working across organisational boundaries, and these will support ongoing development and provide a forum for future joint working in other areas. 5. Customise questionnaires, using language and terminology specific for each sector. Keep questions simple and focused, basing them on the core competences2 and taking into account that literacy and language issues can be barriers 6. If relevant, take advantage of the opportunity to incorporate other EoLC competences in the TNA 7. Piloting of questionnaires with all staff groups is essential to reduce incomplete and inaccurate data 8. Online surveys may not improve response rates but are useful for collation and analysis of data. Be aware that some staff groups have limited access to computers and may have limited IT skills 9. Telephone surveys can be useful for employers and training organisations 10. Improve response rates by marketing the TNA and following up nonresponders.
  5. 5. • Commission appropriate communication skills training and education, matched to need for staff caring for both cancer and non-cancer patients. For educators • Align training with the common core competences and the identified needs of the local workforce Lessons learned – key good practice tips For commissioners • Align workforce development plans with both organisational strategies and clinical governance systems for patient safety and risk management. Incorporate the expected outcomes, the cost and service benefits into wider project, resource and implementation plans • Specify the outcomes and quality standards of education and training that are required for commissioning and for risk management. Select training that has evidence of effectiveness, uses recognised methodologies and offers value for money • Accommodate individual training requirements, in terms of both knowledge and preferred learning style, according to accepted training principles. Apply adult learning approaches that are based on mutual trust, respect, personal responsibility and experience • Work collaboratively with other local providers to ensure that the range of training provided is responsive to changing needs, co-ordinated, comprehensive and well marketed • Encourage joint training across specialities and sectors as this has the potential to reinforce the value of multidisciplinary working • Consider supplementing the current core generic communication skills training with an introduction to EoLC conversations or scenarios and make use of the e-ELCA3 (End of Life Care for All) e-learning modules. For service providers • Determine the return on investment by developing evaluation criteria to assess the impact on staff confidence and competence and linking workforce development to patient experience • Align workforce development with corporate business strategies, governance systems, existing frameworks and clinical pathways • Specify the necessary skills, attitudes and training required for the workforce in service agreements and contracts • Link cost benefits of a competent workforce to training proposals and corporate business objectives • Oversee the commissioning of training at a sector or regional level and ensure clarity of responsibility for co-ordination of local provision • Embed EoLC communication competences in human resources and organisational development plans for recruitment and appraisal
  6. 6. • Create good data collection and record keeping systems - they are essential to monitor training and staff competences • Use your appraisal and personal development plans to identify training needs. • Link workforce development to patient experience in order to capture the benefits of training. Next steps For managers of staff • Job descriptions and personal specifications should accurately describe communication competences required for the role • Include communication skills in all appraisals of health and social care staff and incorporate them into continuing professional development • Provide the opportunity to develop communication competences in the workplace through mentoring, example and team support. For individuals • Take personal responsibility for reviewing, renewing and enhancing the competences, knowledge and skill required for your role in EoLC • Measure individual role specifications against the common core competences, principles and the underlying national occupational standards to identify the competences required The TNA has provided the pilot sites with an information base to support development of training and education that will meet the needs of their local workforce. It will now be important to monitor the delivery and uptake of training and to evaluate its impact on business objectives, the service user experience, staff confidence and competence. The final report for the communication skills pilot project will be published early in 2011. References 1. http://www.dh.gov.uk/en/ Publicationsandstatistics/Publications/ PublicationsPolicyAndGuidance/DH_086277 2. http://www.endoflifecareforadults.nhs.uk/ education-and-training/corecompetences 3. http://www.e-lfh.org.uk/projects/ e-elca/index.html The full TNA report is available online at: http://www.endoflifecareforadults.nhs.uk/ publications/talking-needs-action
  7. 7. Crown Copyright 2010 Edited and designed by: www.furnercommunications.co.uk www.endoflifecareforadults.nhs.uk

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