Transcript Presentation

User Foundation
Training Day
Session 1
Welcome and Introductions
Aims of Today
To provide user reviewers with the opportunity to explore
the process of peer review and their role as a reviewer
To provide an opportunity to identify and develop the necessary
attitudes, skills and knowledge to enable User Reviewers to
participate fully as equal team members in the National Cancer
Peer Review Programme
To promote confidence in order to inspire potential User
Reviewers
Learning Outcomes
By the end of the training session participants should be
able to:
• Understand aspects of cancer care/treatment that relate to
user involvement in Cancer Peer Review (CPR)
• Outline the key principles of CPR
• Describe the role and responsibilities of user reviewers
• Understand how CPR relates to the patient/carer
experience/user involvement
• Understand how to review evidence
• Define the essential elements of effective communication,
assertiveness and teamwork that enhance CPR
• Gain insight into appropriate questioning techniques
• Seek further advice/support/help for this role
Group agreement
• Valuing everyone’s contributions – We may not always
agree with what everyone says but we can at least
acknowledge their point of view and value their
contribution
• Taking responsibility for own learning - No question is
a silly question- all you are doing is asking for clarification
• Time keeping - Everyone to share responsibility for this.
• Confidentiality - Tips, hints or general factual information
feel free to share with others, BUT anything personal or
attributable to individuals, places or settings please keep
confidential. Confidentiality re peer review process is
addressed during the full day’s reviewer training
• Equal opportunity for all- only one person speaking at
any one time in the large group
• Mobile phones- switched off or to vibrate mode please
Session 2
Peer Review and the New
Political Environment
The White Paper
The key players
The key players
• NHS commissioning board
– Will be held accountable for NHS Outcomes
Framework
– Delivering high quality outcomes for patients
• NICE Quality Standards
– Commissioned by NHS Commissioning Board
– 150 Quality Standard in 5 years
• CQC
– Quality regulator
- Essential Standards
• Monitor
– Economic regulator
Key points of the white paper
Equity and excellence: Liberating the NHS (July 2010)
• Putting patients and the public first
– No decision about me, without me
– Choice and voice
– The Information Revolution
• Improving healthcare outcomes
– “To reduce mortality and morbidity, increase safety
and improve patient experience and outcomes for all”
– Outcome measures not process targets (Outcomes
Framework)
– Quality standards (NICE)
– Cancer Drug Fund
– Payments for quality
NHS Outcomes Framework
NHS Outcomes Framework
A new NHS Commissioning Board would be held to account for the
NHS Outcomes Framework - Delivering high quality outcomes for
patients
The NHS define quality as:
• the effectiveness of the treatment and care provided to patients;
• the safety of the treatment and care provided to patients; and
• the broader experience patients and their carers have of the
treatment and care they receive.
NHS Outcomes Framework
In terms of measuring these three areas, it is legitimate to look at:
• the structures of care – based on robust evidence, how should
treatment and care be structured in order to maximise the chance of a
good outcome for the patient?
• the processes of care – based on robust evidence, what are the
things that should be done to maximise the chance of a good outcome
for the patient? and
• the outcomes of care – what actually happens to the health of the
patient - the outcome - as a result of the treatment and care they
receive?
NICE Quality Standards
The NHS Commissioning Board will
commission NICE to produce the Quality
Standards. 150 over 5 years.
NICE Quality Standard for Breast Cancer
Aims of Cancer Reform Strategy
Refresh
• To align cancer strategy with the White
Paper
• To set the direction for the next 5 years
– Taking account of progress since December
2007
• To show how outcomes can be improved
despite the cold financial climate
The New Healthcare Environment
Ensuring Effective Levers
• Ensuring Peer Review outcomes are fed into the
Care Quality Commission legal registration
requirements
• Embedding Peer Review outcomes into the
Commissioning process
• Providing evidence that services are meeting the
NICE Quality Standards
Commissioning
• Ensuring the reports go to named individual
commissioners, SCG, GP Consortia
• Providing commissioners with a summary and
recommended actions
• Updating the Cancer Commissioning Toolkit
Care Quality Commission
• Mapping of measures to CQC registration outcomes
• 2009/2010 data incorporated into CQC Quality and
Risk Profiles (QRPS) in October 2010
• Immediate Risks and Serious Concerns reported to
CQC regional assessors
• Partnership working on CQC visits
NICE Quality Standards
• Peer review measures will map onto NICE
Quality Standards. Initial work has started with
breast cancer
• Peer review outcomes will demonstrate where a
MDT is a high quality service and this can be
used in the quality accounts
Session 3
Who's Who and What’s
What in the NHS
Structure of the NHS
The Card Game
Challenge
Session 4
Using Cancer Policy to
Improve Care and Treatment
Cancer policy
Calman Hine
NHS Cancer
Plan 2000
NICE
Targets
Cancer
Reform
Strategy 2007
Improving Outcomes
Guidance
IOG
development
( NICE)
NCAT and
Cancer
Network agree
action plans
Cancer Networks
(on behalf of SHA,
PCTs Commissioners )
Implementation
The Patient Experience
Clinical Pathways versus
Patient Journeys – is there a
difference?
Pathways
Refreshments
Please return in 15 mins
Session 5
What is National Cancer
Peer Review?
Scope of Peer Review
The national cancer peer review programme
is:A process undertaken to assess the quality of
cancer services against IOG for NHS patients
in England, enabling quality improvement
An integral part of the cancer reform strategy
(2007)
Supported by a set of detailed measures
Purpose of Peer Review
To ensure services are as safe as possible
To improve the quality and effectiveness of care
To improve the patient and carer experience
To undertake independent, fair reviews of services
To provide development and learning for all involved
To encourage the dissemination of good practice
How CPR is Organised Nationally
•
•
•
•
National Cancer Action Team
National Steering Groups
Zonal Advisory Groups
4 Zonal Teams :– North
– Central
– London
– South
The Peer Review Programme
Peer Review
Visits
Targeted
Externally Verified SelfAssessments
Sampled
Validated Self-Assessments
(annual)
All Teams
Handbook for the National Cancer
Peer Review Process
Contains details of the process from start to finish
including:
1.
2.
3.
4.
5.
The Peer Review Programme
Annual Self Assessment
Internal Validation
External Verification
National Schedule for Peer Review Visits &
Conducting the Review
6. Outcomes of the Peer Review Process
7. Identification of Concerns
8. CQuINS
Session 6
The Role of the Reviewer
Who are Reviewers?
Multidisciplinary teams of:• Service users ,Clinicians,
Managers, Commissioners
“Peers
are people who have
been trained and working in
the same discipline as the
people they are reviewing”
Reviewers will not normally
review their own network
The Reviewer Role
Review
evidence
Integrate
with review
team
Contribute to
compliance
discussion
Meet with the
team being
reviewed
Make notes
of the key
points
Contribute to
conclusions
and report
writing
Review
written report
for accuracy
Session 7
Becoming a reviewer
A patient/carer perspective
User Peer Reviewer
A bit about my cancer journey
Why I got involved with Peer Review
• Because I was asked!
• Service improvement
• Patient experience
• Self development
Peer Review experience - the first time
• Scary!
but
• Excellent team leader
• Lots of support
• Rapport and respect
Tips for a successful review
•
•
•
•
Preparation!
Teamwork
Tight timing
Don’t be afraid to ask questions …. and
keep asking
• Use the zonal team
What I’ve got out of it
•
•
•
•
Worthwhile
Stretching
Good practice
Enjoyment!
The Unique Role of the
User Reviewers
.
•Personal experience of total pathway
•Represent patient views as core team member
.
• Able to influence aspects of review
• Focus on the quality of Patient & Carer
experience and involvement
.
• Able to ask questions that are difficult for a
healthcare professional to ask
• Use transferable life skills
Lunch
Please come back at 13.30
Session 8
Reviewing as a Team
Reviewing as a Team
A team is a group of people who
share and are aware that they
share a common goal
Benefits of Team Working
•
•
•
•
•
•
Combines collective knowledge/skills/attributes
Creates cooperative action
Makes best use of individual strengths
Mutual support & learning on difficult problems
Common ownership of actions/decisions
Increases individual contribution & overcomes
domination
• Creates momentum
• Achieves consensus
• Increases significance of findings/conclusions
What Makes a Team Tick?
•
•
•
•
•
•
•
•
Keeping focused on real issues
Encouraging participation from everyone
Managing competitive activity/conflict
Encouraging positive attitudes
Avoiding compromise
Pacing & keeping to time/deadlines
Achieving the required result
Ensuring conducive environment
Making a Team Tick
Team Members’ Responsibilities
• Taking a lead
• Listening
• Making suggestions
• Asking for information
• Posing/answering questions
• Recapping /summarising
• Initiating solutions/ideas
• Testing for consensus
Formulating Questions
‘It’s not what you say it’s the
way that you say it’
Session 9
Reviewing the evidence
A focus on patient issues
Group Work
Spend 20 minutes reading the
documentation on your table and
recording on this proforma whether you
think
• the measure is met
• where you found the evidence.
• identify any outstanding queries
Key points from group work
• What conclusions did you reach after
looking at the evidence ?
• Where was the Evidence?
• What questions do you have that you
need to ask the team.
• 2C-102 2C-105, 2C-109, 2C-117, 2C-121
Session 10
Using Effective
Communication During the
Review
Formulating Questions
From the information you
gathered earlier formulate some
questions that you would want to
ask the team being reviewed.
Question types
Open
Encourage people
to talk
What, where, when,
why, how?
Closed
Checking facts
How many? do
you?
Hypothetical
Test contingencies
What if?
Probing
Greater depth
In what way? Tell
me more..
Leading
Pacifying
Use with care
You do, don’t you?
Multiple
Avoid
Who sends it, what
do you do and how?
Funneling questions
• Open - to explore
• Probing - to clarify
• Hypothetical - to
test contingencies
• Closed - to confirm
Listening
Listen before deciding response
– Be active
• summarise regularly
• ask confirmatory questions
– Let the Reviewees talk
– Encourage contributions from everyone
– What if they won’t stop talking?
Refreshments
Please return in 15 mins
Session 11
The Three G’s
The Three G’s
• 1) Gains- What you hope to gain from the
becoming a reviewer
• 2) Gives- What you’ll bring to the process
• 3) Groans- Any concerns you have
Session 12
Next steps
Next steps
This may not be for everybody,
but we are happy if you want to
give it a go!
Learning Outcomes
By the end of the training session participants should be
able to:
• Understand aspects of cancer care/treatment that
relate to user involvement in Cancer Peer Review
(CPR)
• Outline the key principles of CPR
• Describe the role and responsibilities of user reviewers
• Understand how CPR relates to the patient/carer
experience/user involvement
• Understand how to review evidence
• Define the essential elements of effective
communication, assertiveness and teamwork that
enhance CPR
• Gain insight into appropriate questioning techniques
• Seek further advice/support/help for this role
Acknowledgements
• User Reviewer members of the National User
Steering Group for NCPR
• Derek Stewart O.B.E. RIME & Reason Consultancy
Cancer Patient Advocate and Trainer for the use of
the patient and clinical pathway exercise
• Gillian Fletcher – Lead Trainer for Cancer Voices
for the use of her National Health Jigsaw
Close
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