Improving education: agent of change

When applications were invited for 10 places on a clinical education improvement fellowship it was open to nurses, midwives, and allied health professionals (AHPs) wanting to improve practice education across the south east region of England. Five out of the 10 places were awarded to physios, who led and developed improvement projects and gained valuable leadership skills that have enhanced and even transformed their careers.

Over a period of 12 months until September 2023, NHS England South East, the Florence Nightingale Foundation and Canterbury Christ Church University supported them to step away from their daily roles, while funding to temporarily fill their posts was provided to their employers. 

Each fellow pitched a project they were passionate about to drive innovation and quality improvements into practice placements within their local system, which would have lasting legacies and potentially a wider reach and impact.

Academic supervision and support from a network of partners was facilitated through Canterbury Christ Church University, working with the Council of Deans of Health, to assure the quality of each fellows’ work.

They also joined the Florence Nightingale leadership development programme to explore and discover their leadership style and develop the essential skills to be a courageous and confident leader. Sessions with the Royal Academy of Dramatic Arts boosted their presentation skills and they learned with the King’s Fund how to build authority. 

Dr Matt Liston, the CSP’s head of research and development, attended the fellows’ celebration event and was impressed by their achievements. ‘I was amazed to hear about the impact they have had as physios, outside of their normal jobs, through meaningful improvement projects,’ he says. 

‘They have had opportunities to develop leadership skills, drive stakeholder engagement, and grow and develop away from their fulltime posts, as well as create important projects.

What really came through in their projects was that clear link between the problem, the people who are involved and the solution.

The strengths of the programme were clear mentorship, teaching, supervision and opportunities, which informed the finished projects.’ 

Matt is keen to encourage CSP members to look for opportunities across the UK for developing leadership skills or clinically focussed projects.

‘Take opportunities when they arise, as it can lead to a big change that can benefit the users, whether that is patients, staff or students,’ he says.

‘There is a research team at the CSP that members can contact, and other opportunities may be flagged through membership networks.’

Belinda Twissell, Buckinghamshire Healthcare NHS Trust

Belinda has introduced learning using simulation to upskill interprofessional teams providing an urgent community response.

As more acute patients are being cared for at home Belinda was aware of the need for AHPs at work in the community to upskill to support patients and make decisions about whether they should stay out of hospital.

The fellowship gave me the opportunity to bring my two worlds together – my passion and love for education and bring that into my place of work and focus on a problem that we could address.

It gave me a chance to stop and look outwards from my day-to-day work in the trust,’ she says. 

‘It helped me to be more creative. For example, we have a fantastic simulation team, and we use it a lot with our physio students before they see real patients, but it is never used by our allied health professions.’ 

Using skills to influence gained through the programme she suggested that simulation is an effective tool to help staff learn new skills. 

‘I introduced it to our AHP community teams, including paramedics, nurses, physios, OTs and support workers. We created a simulated home environment. Staff learn how to go into homes in a safe way and how to escalate concerns about support, as well as work and learn together in scenarios. It’s a different way of learning to apply in clinical practice.’

Armed with the skills to network with the right people to make this happen, she had also gained an understanding of system level leadership and the bigger picture.

‘I would highly recommend a fellowship to other physios who have a good idea that can be addressed in a supportive environment,’ she adds. 

Helen Walcott, Frimley Health NHS Trust

Before joining the fellowship, Surrey-based Helen admits that she was at a crossroads in her career.  Shortly before she heard about the opportunity, she witnessed neurologists discussing writing an academic paper and wondered why, as an AHP with 15 years’ experience, that she had not.

‘It set me thinking about how allied health professionals get involved in research and that was the question to guide my fellowship project, which has also guided my career path,’ she explains.

She has returned to her clinical post as a neurological physiotherapist working on inpatient wards at Wexham Park Hospital but also is now a lecturer in professional practice at Brunel University London.

The fellowship pushed me out of my comfort zone, and this gave me confidence to project myself at interview for the lecturer position,’ she says. 

‘It also taught me how to articulate better, project and network and approach people that I might have thought were unreachable.

‘As my post was backfilled for a year this allowed me to step away and look at my role from a different level and see what is important. Now the way that I approach my clinical work is more structured and this has made me a better clinician. It has made an enormous difference to me.’

For her project Helen created an organisational implementation tool to enable trusts to support AHPs to be more research active. Since then, she has been invited to speak at away days for the trust to raise the profile of research and the tool has been circulated widely.

George Mathew, Basingstoke & North Hants Hospital

George, a chartered physiotherapist in trauma and orthopaedics, remembers an internal email landing in his inbox. Why did he apply?  

I feel at times that there is more to give than to receive from my experience and I aspire to expand and pursue further clinical leadership opportunities that will allow me to empower the next generation of the NHS workforce,’ he says.

George was keen to address the digital skills gap for staff through the time offered by the fellowship.  

‘If we want our healthcare workforce to be effective in looking after our service users, and we are introducing IT infrastructure and digitally enabled AI technology, then we must ensure all staff are digitally competent.  It must be embedded into other learning.’

His approach for a baseline measurement was to roll out a survey online and on paper to which 45 per cent of the trust workforce responded, to questions about digital confidence, competencies and what they needed to progress.

‘This led to the creation of a digital learning platform so when staff join a trust, they have a digital induction and see what their competencies are, so they can add it to their annual appraisals for sustainable learning.’

This has been passed to the integrated care board to link with all the trusts in the region.

George has benefitted further as he is currently on another fellowship in race equality.

His advice to other physios: ‘Keep an open mind and be willing to take a risk in moving into secondment roles or fellowships. It helps you look at the bigger picture.’

Angela Wright, University Hospitals Sussex NHS Trust

As the lead physiotherapist at an intermediate care unit attached to an acute trust, Newhaven Rehabilitation Centre, Angela had seen the number of beds double from 16 to 34.

‘Our nursing staff had little training in rehabilitation and although we all wanted to implement this, we hadn’t managed to because of staffing pressures,’ she explains.

She heard about the fellowship through an internal email. ‘It offered time out to focus on a project, grow as a professional person and make a difference for our staff and patients.  

‘One of the requirements was sustainability and spread. I wanted to use quality improvement ethos and methodology in a training environment and enable the staff to identify their own training needs and encourage those staff to deliver that training which leads to sustainability. 

‘The idea is that the staff group deliver bite-sized training units that can be repeated when new staff join – it is utterly multidisciplinary.’

Angela and the team are now developing a 12-topic training programme for staff across all roles, which she describes as embedded learning in practice – learning becoming the everyday. 

It’s ultimately about a change of culture so that we are all working together for the patient.

Her hope is that the training package will be rolled out across other settings, such as medicine departments, surgical, other rehab units and then spread regionally.

‘We had fantastic leadership sessions with the Florence Nightingale Foundation and the support from my fellow fellows was important and valuable.’

Charlie Colby, University Hospital Southampton

Charlie was a team leader in the acute medicine and emergency department when he applied for the fellowship, and he believes this contributed to his promotion to divisional therapy manager in a trauma centre.

The fellowship gave me such amazing skills in communication and leadership and a wider overview of the system, says Charlie.

He says he learned how to create a project, engage the key stakeholders, how to sell his story and passion in an appropriate space, deliver a system-wide project and follow it up to be sustainable with accountability for the future.

His project – debriefing allied health professional students on placement – focussed on the transition from placement into the workforce, exploring emotional intelligence and barriers to retaining newly qualified staff. 

‘I targeted students from several universities and specialities whilst they were on placement for their first clinical experiences,’ he says.

‘I gave them a psychologically safe space to debrief about their experiences with an experienced facilitator and explore how students have similar problems. A shared problem helps them feel validated and gives them the opportunity to learn from each other.’ 

He measured the emotional intelligence and found that during placement students’ confidence dips because they are in a new environment. ‘By using the clinical debriefing exercises, we managed to protect their emotional intelligence during placement which shows good evidence for their future careers in terms of protecting them.

‘The fellowship gave me the platform to scale up and create a sustainable project with a long-term solution. It’s also as much about our professional development as the project.’