Consultant Practice: Person centred, safe and efective care across systems through the 4+1

pillars

Prof. Kim Manley, CBE

England Centre for Practice Development

Canterbury Christ Church University

Aim •Purpose of the consultant capability and Impact

framework

•Assumptions - relationship with advanced level

practice

•The revised capability and impact framework – linked

to some of the research & models informing them

•Next steps

Purpose of capability and impact framework

• Providing clarity , consistency of expectations

• Development and self assessment

• Demonstrating value and impact

• Explicit career frameworks

• Helping public to understand the role

• Credentialing?

The relationship between Advanced Level Practice and Consultant Practice

Advanced Level Practice

• Not a substitution role but ‘value added’ from own profession/field of practice

• Shared competences with medicine in some areas as reflected in the HEE levels of practice document

• Beginning journey focusing predominantly on client- centred consultancy,

• Has professional expertise in own professional role and field of practice

• Beginning a journey of growing expertise in the other 4 pillars

Consultant Practice

• Expertise in all the pillars – integrating practice,

research and education – Boyer’s model with

system –wide consultancy

• Strong strategic and systems leadership role for

field of practice

• Flexibility in focusing on the four pillars depending

on the need of the system, organisation to meet

the needs of people/population

• Assumption is that working at advanced level

practice or having expertise in field of practice -

might look different for different disciplines or

contexts

Five Pillars of Consultant Practice across systems

1. Values Based

Health/Care

Practice

2. Strategic &

Facilitative

Leadership

3. Education for

learning,

developing and

improving in the

workplace,

developing and

transforming the

workforce

4. Research,

development,

improvement and

innovation

5.Consultancy in all pillars across systems

Revised framework following consultation

Purpose and scope of each pillar beyond advanced practice

VALUES BASED HEALTH/CARE PRACTICE ACROSS SYSTEM

PURPOSE: Enable and embed values based practice across pathways, service, organisation and system, working in partnership with individuals, families, carers, communities and others

Demonstrate tangible, measurable and sustainable improvements to quality of care.

Demonstrate the development of innovative and effective pathways aligned with systems of care.

Demonstrate significant involvement of people and citizens in co-production activities for service improvement and evaluation

Demonstrate significant progression of system integrated services.

Impact framework: PILLAR 1 –VALUES BASED PRACTICE

Transforming the workforce across the health economy

‘Clinical systems leadership was linked to the ability to draw on expertise in a number of different areas to enable contributing partners to work together towards a shared purpose and to create a culture that values and retains staff. The required skill identified in the data encompasses:

• clinical expertise and credibility for a specific client group;

• consultancy functions that share expertise within the wider system;

• leadership for culture change; developing, improving and evaluating person centered care; and

• creating a learning culture that uses the workplace as the main resource for learning.’

(Manley et al 2016)

Clinical/care systems leadership What is it?

‘is a concept we assigned to the leadership approach that drives

integration across boundaries based on specialized clinical credibility

working with shared purposes to break down silos and deliver person-

centered, safe and effective care with continuity. Clinical systems

leadership was linked to the ability to draw on expertise in a number of

different areas to enable contributing partners to work together towards

a shared purpose and to create a culture that values and retains staff.

The required skill identified in the data encompasses: clinical expertise

and credibility for a specific client group; consultancy functions that

share expertise within the wider system; leadership for culture change;

developing, improving and evaluating person centered care; and creating

a learning culture that uses the workplace as the main resource for

learning.’ (Manley et al 2016p)

Impact framework: PILLAR 2 – LEADERSHIP

STRATEGIC & FACILITATIVE LEADERSHIP

PURPOSE: Provide values based facilitative and strategic leadership across the care pathway/service and system within changing complex contexts.

Transformational and sustainable impact on staff, patients and service users

Seen as a key influential leader on strategic development of field of practice

Coaching and developing transformational clinical/care leaders

Demonstrable innovations implemented in changing complex contexts

Developing the standards for integrated facilitation

What is integrated facilitation?

‘Bringing together different purposes (learning, development, improvement, knowledge translation, inquiry and innovation) … to achieve a holistic approach to person centred care and improving public health outcomes’.

Three key foci to achieve higher order learning in and about the workplace :

• Purpose

• Context

• Effectiveness (outcome & impact)

Components of an Integrated Facilitation Approach in and about Work

Facilitation is increasingly recognised as a complex skill set essential to helping people achieve

effectiveness in and across different situations and contexts with regard to different aims or

purposes (after Manley and Titchen, 2016)

Learning

Development

Improvement Inquiry

knowledge translation

Improvement

Integrated

facilitation

Impact framework: PILLAR 3 – EDUCATION EDUCATION, FOR LEARNING, DEVELOPING AND IMPROVING IN THE WORKPLACE, DEVELOPING AND TRANSFORMING THE WORKFORCE

PURPOSE: Develop a learning culture across the system to develop staff potential, grow and transform the workforce, enable learning, developing and improving in and from practice to promote excellence.

Significant

influence and

modelling of the

development of a

learning culture

across the service

Demonstrates

measurable

outcomes on

organisational

learning as a skilled

facilitator

Identifies learning

and development

initiatives that

support workforce

development

Actively influences

and is a significant

contributor to the

development of

education curricula

that enables

students and

practitioners.

Research Related Activities Towards Consultant Practice

REGISTERED PRACTITIONER Manley & Titchen 2012 CONSULTANT PRACTITIONER

1. Using Best practice/national standards and evidence in own practice

1. Contributing to developing national best practice standards/NICE standards

2. Contributing to the development of a research and evaluation culture within local team

2. Developing a research and evaluation culture across team, service, organisation

3. Evaluating own practice

3. Leading service evaluation/developing and implementing practice/service evaluation strategies

4. Inquiring into own practice

4. Facilitating collective practitioner research

5. Participate in research as a member of a research team in relation to: Patient experience, Safe and effective care, Context/Culture of care

5. Leading a programme of research in practice in relation to: Patient experience, Safe and effective care, Context/Culture of care

6. Supervised in a research related project e.g systematic review/ evidence appraisal

6. Supervising teams and projects, peer review of research

7. Identifying research opportunities 7. Leading strategic bids, collaborative opportunities and multi-stakeholder research initiatives’

8. Contributing to strategic research agenda 8. Leading research strategy development

9. Familiar with systematic reviews and one approach/methodology to contributing to body of knowledge

9. Expertise in three different research approaches: Technical, Practical, Critical

Impact framework: PILLAR 4 – RESEARCH, DEVELOPMENT, IMPROVEMENT, INNOVATION

PURPOSE: Develop a knowledge rich and an inquiry culture across the service and system that contributes to evidence mobilisation, improvement, contributing to the knowledge base through research, increased capacity and capability, development and innovation

Provides leadership oversight on the implementation and use of evidence in practice.

Facilitates the development of a knowledge rich culture

Ensures the intelligent use of relevant system data is used.

Identifies/contributes to the appropriate evidence base informing person centred, safe and effective care.

Inspire and facilitate others to develop the competence and capability to engage positively with research and clinical academic pathways.

Caplan (1970) & Schein (1989) : the gurus in consultancy practice CAPLAN

• Client-centred: direct

• Client centred: indirect

• Administrative: direct

• Administrative: indirect

SCHEIN

• Purchase of expertise model

• Dr-Patient model

• Process model

• Transformative model

Impact framework: PILLAR 5 CONSULTANCY ACROSS ALL PILLARS – CLINICAL/CARE TO SYSTEM

PURPOSE: Enable spread of expertise across the system through using consultancy approaches and opportunities that maximise impact on specific fields of practice, communities and populations

Demonstrable, tangible, measurable and sustainable improvements from expertise and advice provided to service users and staff

Facilitates the optimal dissemination of expertise and advice across every level of the health economy in field of practice

Contributes advice and expertise to implementation and evaluation of integrated systems in field of practice

Coaching and developing systems leaders in implementing and evaluating integrated systems in field of practice

Next steps

• Develop an interactive self assessment tool linked to the capability and impact (Nov- Feb’19).

• Develop a cadre of stories to illustrate capabilities and impact across all the key disciplines ( Mar- May’19)

• Complete career development tool to support career progression how aspiring consultant can be supported (Jun- July’19)

Connect with us at:

Twitter:

• @ECP4PD, @kimmanley8, @ECPDCarolyn

Website:

• www.canterbury.ac.uk/englandcentreforpracticedevelopment

Email:

• Kim.manley@nhs.net kim.manley1@canterbury.ac.uk

• carolyn.jackson@canterbury.ac.uk

Facebook:

• www.facebook.com/groups/ecpd1