The use of action learning sets to enhance facilitation of ... · Action learning is a...
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The use of action learning sets to enhance facilitation of the Gold Standards Framework in Care Homes end of life care programme: the intervention arm of a cluster randomised control trial www.stchristophers.org.uk Registered charity 210667 www.harrishospiscare.org.uk Registered charity 1003903 Jo Hockley, 1 Jean Levy, 2 Rosanna Heal 3 and Julie Kinley 4 1,4 Care Home Project Team, St Christopher’s Hospice, London, UK 3 Quality & Audit, St Christopher’s Hospice, London, UK 2,4 PhD student, Lancaster University, UK Email: [email protected] Aim To use action learning sets involving nursing home managers (NHMs) as part of a cluster randomised control trial to see if it significantly enhanced the implementation of the Gold Standards Framework (GSF) into 24 nursing homes (NHs). Action learning is a ‘continuous process of learning and reflection supported by colleagues with the intention of getting things done’ (McGill & Beaty, 2001). Learning occurs within a confidential group of people (‘set’) where space is given for individuals to present and think through a difficult issue. The set provides ‘high challenge’ questioning and ‘high support’ to the presenter. A set of up to eight people contract to meet regularly. Method In this CRCT to look a facilitation of the GSF programme, NHMs from the 24 study NHs agreed to be randomised to either ‘high facilitation’ (HF) arm, or ‘high facilitation + action learning’ (HF+AL) arm. The 12 NHMs from the ‘high facilitation + action learning arm’ were then divided into two action learning (AL) sets. Each set lasted three hours and met monthly for nine months. They were facilitated by JH (JL was note-taker). The first couple of sets were used as ‘ice-breakers’ for NHMs to get to know each other which included exploring: the process of AL and critical thinking; the concept of leadership and influence; and a ‘trial run’ at presenting issues. Following each set NHMs were given a thought for the day on ‘leadership’ as an incentive to return the following month! The issues presented at each set were typed up and analysed. Following the final set, the experience of taking part was independently evaluated (RH) through a focus group with NHMs which was transcribed and analysed for categories and themes. Conclusion The action learning sets were well attended and valued. Using action learning helped NHMs feel more confident and less isolated. High facilitation was provided to both arms of the CRCT study but it was the provision of action learning that made a difference to those NCHs gaining accreditation. Ten out of 12 NCHs gained GSFCH accreditation in the HF+AL group compared to three out of 11NCHs in the group receiving HF only. It appears that both a ‘top down’ and a ‘bottom up’ approach helps NHMs to attain GSFCH accreditation. Action learning however is a new concept in healthcare for promoting critical thinking and further studies are needed. McGill I and Beaty L (2001) Action Learning: a guide for professional, management and educational development (2nd ed). Kogan Page Ltd: London B e i n g r e a l · B r e a ki n g i s ol a ti on · H elped t o be energi s ed · Le arning t o thi nk di ff er entl y · H elp e d t o e m b e d G S F C H P O S I T I VE A S P E C T S M o r e c o n fi d e n t a n d abl e t o m oti v a t e · M a de m e a bett er m ana g er · Gr e a t er abi li ty t o s ol v e pr o bl e m s T H E I N F L U E N C E O F A L ON N H MS N e e d s t o b e c o mm i tt e d · B ei ng cha ll eng ed · O peni ng up · Supporti v e P R O C E S S O F T A K I N G P A R T “No, no, it was good because it was a learning curve….very big learning to us all. But still some of the things were pretty heavy… or, even when someone else was being challenged… it actually took its toil” “Helped me clear the air” “Also, learning from other managers’ experiences… how to select coordinators [for GSFCH]” “It gave me more insight to problems of other people, you know, and solutions other people might have as well… and I should listen more. And I think that just made me a better manager” “People actually used the group as a source of strength… coming back and getting feedback and going back” “We are not having so many complaints as before.” “I felt that I wasn’t the only manager with problems” Results Eight NHMs (75%) attended six or more sets. The issues presented in the AL sets were similar. However, there were some issues that were highlighted more often by those attending. There were five issues which NHMs frequently presented and these included: complex and challenging residents/families; relationships with GPs and issues to do with DNaCPR; inappropriate hospital admissions/poor communication; time pressures, workload, shortage of staff; and, managerial pressures and organisational issues. Other issues presented included: getting night staff ‘board’; undertaking ACP conversations; staff fears of ‘opening up’ about dying; lack of experience in EoLC and ‘coding’ residents; keeping up motivation of GSFCH; and, difficulties with teamwork. The focus group evaluating the experience of undertaking AL highlighted three main categories: • Process of taking part (with four sub-themes) • Positive aspects (with five sub-themes) • The influence of AL on NHMs (with three sub-themes) “Courage is not the absence of fear, but rather the judgement that something else is more important than fear” Ambrose Redmoon “Leaders do not avoid, repress or deny conflict but rather see it as an opportunity” Warren Bennis 38658CH St Chris Action Learning Poster.indd 1 26/09/2012 11:15
Transcript of The use of action learning sets to enhance facilitation of ... · Action learning is a...
The use of action learning sets to enhance facilitation of the Gold Standards Framework in Care Homes end
of life care programme: the intervention arm of a cluster randomised control trial
www.stchristophers.org.ukRegistered charity 210667
www.harrishospiscare.org.ukRegistered charity 1003903
Jo Hockley,1 Jean Levy,2 Rosanna Heal3 and Julie Kinley4 1,4 Care Home Project Team, St Christopher’s Hospice, London, UK 3 Quality & Audit,
St Christopher’s Hospice, London, UK 2,4 PhD student, Lancaster University, UK
Email: [email protected]
Aim To use action learning sets involving nursing home managers (NHMs) as part of a cluster randomised control trial to see if it signifi cantly enhanced the implementation of the Gold Standards Framework (GSF) into 24 nursing homes (NHs).
Action learning is a ‘continuous process of learning and refl ection supported by colleagues with the intention of getting things done’ (McGill & Beaty, 2001). Learning occurs within a confi dential group of people (‘set’) where space is given for individuals to present and think through a diffi cult issue. The set provides ‘high challenge’ questioning and ‘high support’ to the presenter. A set of up to eight people contract to meet regularly.
Method In this CRCT to look a facilitation of the GSF programme, NHMs from the 24 study NHs agreed to be randomised to either ‘high facilitation’ (HF) arm, or ‘high facilitation + action learning’ (HF+AL) arm. The 12 NHMs from the ‘high facilitation + action learning arm’ were then divided into two action learning (AL) sets. Each set lasted three hours and met monthly for nine months. They were facilitated by JH (JL was note-taker). The fi rst couple of sets were used as ‘ice-breakers’ for NHMs to get to know each other which included exploring: the process of AL and critical thinking; the concept of leadership and infl uence; and a ‘trial run’ at presenting issues. Following each set NHMs were given a thought for the day on ‘leadership’ as an incentive to return the following month! The issues presented at each set were typed up and analysed. Following the fi nal set, the experience of taking part was independently evaluated (RH) through a focus group with NHMs which was transcribed and analysed for categories and themes.
Conclusion The action learning sets were well attended and valued. Using action learning helped NHMs feel more confi dent and less isolated. High facilitation was provided to both arms of the CRCT study but it was the provision of action learning that made a difference to those NCHs gaining accreditation. Ten out of 12 NCHs gained GSFCH accreditation in the HF+AL group compared to three out of 11NCHs in the group receiving HF only. It appears that both a ‘top down’ and a ‘bottom up’ approach helps NHMs to attain GSFCH accreditation. Action learning however is a new concept in healthcare for promoting critical thinking and further studies are needed.
McGill I and Beaty L (2001) Action Learning: a guide for professional, management and educational development (2nd ed). Kogan Page Ltd: London
Being real · Breaking isolation · Helped to be energised · Learning to think differently · Helped to embed GSFCHPOSITIVE ASPECTS
More confi dent and able to motivate · Made me a better manager · Greater ability to solve problemsTHE INFLUENCE OF AL ON NHMS
Needs to be committed · Being challenged · Opening up · SupportivePROCESS OF TAKING PART
“No, no, it was good because it was a learning curve….very big learning to us all. But still some of the things were pretty heavy… or, even when
someone else was being challenged… it actually took its toil”
“Helped me clear the air”
“Also, learning from other managers’ experiences… how to select coordinators
[for GSFCH]”
“It gave me more insight to problems of other people, you know, and solutions other people might have as well… and I should listen more. And I think that just made me a better manager”
“People actually used the group as a source of strength… coming back and getting feedback and going back”
“We are not having so many complaints as before.”
“I felt that I wasn’t the only manager with problems”
Results Eight NHMs (75%) attended six or more sets. The issues presented in the AL sets were similar. However, there were some issues that were highlighted more often by those attending. There were fi ve issues which NHMs frequently presented and these included: complex and challenging residents/families; relationships with GPs and issues to do with DNaCPR; inappropriate hospital admissions/poor communication; time pressures, workload, shortage of staff; and, managerial pressures and organisational issues. Other issues presented included: getting night staff ‘board’; undertaking ACP conversations; staff fears of ‘opening up’ about dying; lack of experience in EoLC and ‘coding’ residents; keeping up motivation of GSFCH; and, diffi culties with teamwork.
The focus group evaluating the experience of undertaking AL highlighted three main categories:• Process of taking part (with four sub-themes) • Positive aspects (with fi ve sub-themes) • The infl uence of AL on NHMs (with three sub-themes)
“Courage is not the absence of fear, but rather the judgement
that something else is more important than fear” Ambrose Redmoon
“Leaders do not avoid, repress or deny confl ict
but rather see it as an opportunity”Warren Bennis
38658CH St Chris Action Learning Poster.indd 1 26/09/2012 11:15
