Covid Response; Reflection on Growth of Delivery of Learning & Development Using Virtual Means during the Pandemic by Dr. Juliet Harvey @DrJulietHarvey #GGCAHPs

I am a practice development physiotherapist working for Acute Adult Physiotherapy Services in NHS Greater Glasgow & Clyde over several Physiotherapy and AHP workstreams. I have a special interest in participatory approaches to change that is collaborative, person-centered and clinician led.  In the past couple of years we have been in and out of varying degrees of measures restricting time away from clinical work as we navigated covid waves, which made it more important than ever that learning opportunities were flexible and accessible for staff.

Initial Response. March 2020 – June 2020

What was done?

Support for virtual learning and development was initiated quickly with the assistance of clinical teams linking with resources from NHS Education Scotland (NES) and the Chartered Society of Physiotherapist (CSP). My colleague Sarah & I developed Respiratory and General Rehab information hubs relating to covid-19 these hosted on our Staffnet site. The information within the hubs came from our clinical staffs’ knowledge and experience, along with national guidance.  These were shared with our colleagues in Partnership, to allow for learning of those who were potentially to be redeployed.  The hubs were launched week 1 (wb 23/03/20) and new were continually improved and added to over the weeks based on feedback and new knowledge. We shared learning opportunities via the Staffnet page and our monthly Physiotherapy Focus newsletter, including sessions provided by NES and the CSP.  Locally, using Health Sector WebEx Conference System, we facilitated virtual training via Q&A sessions and In Service Training (IST), see programme below.  Instructions for host and participants were developed and improved throughout the process.

In Service Training Programme

What was learned about digital?

We surveyed both users and presenters.  Over the 8 weeks, 21 sessions were organised, 20 delivered, rates of attendance at sessions varied from 8 to 200 attendees (the systems max), at 200 further participation was denied.  You only find out what happens when you have 200 logging onto a system by having 200 log on! Experience using Health Sector WebEx was varied, ranging from little issue with the session, through to the session being abandoned and moving over to another method of communication.  Major issues occurred in about 13% of total calls. The inconsistency of technical function causes unnecessary distress to the host and frustration to the attendees. The version of Health Sector WebEx is suitable for provision of training sessions to small (<25 attendees) where group members had access to and followed good webinar etiquette and there is good connection before and during the call.  The WebEx system depended on users linking audio using a telephone, this adds a layer of unnecessary complexity when other systems are able to use device audio.  However this was good for those whose computer did not have a microphone.

This ‘NEW NORMAL’ IS GOING ON A BIT…

June 2020 – September 2020

What was done?

It was decided that we should go ahead with our 2020 annual development event, learning & development at this time was more important than ever!  By this time MS Team was endorsed by NHS Scotland and is recommended as our means for Staff communication.  It was easy to use for meetings and the share screen function works well, documents could be shared, sessions can be recorded.  The system is constantly evolving, so sometimes function can look different when you enter the system.  Issues occurred with network access and people working with different versions of MS Teams.  We, the Development Event Committee, set about designing the 2020 development event, building on what was learned since March.  We were able to deliver 2 hour sessions over 5 days in September with the following themes: Well-being and Mental Health; Working Together; Physical Activity and Sedentary Behaviour; Communication; Leadership. 26 presenters shared work via webinar. The event was attended in real-time by 260 staff (with 52 – 70 staff members per day) and received favourable feedback.

What was learned about digital?

74 attendees provided feedback, in relation to digital 24% stated they would prefer future event to be face-to-face rather that digital (38% preferred digital, the rest didn’t know or didn’t mind).  Attendees reported being very satisfied with each of the elements of the virtual event: Logging On (4.8/5); Audio Quality (4.5/5); Video Quality (4.6/5); Able to Engage (4.5/5).  The feedback from this event and the support provided from the organisation towards use of this system made it the most favorable system for us to use and recommend to staff. Throughout this process considerable learning was achieved and best practice determined for delivery of virtual teaching and development opportunities. It is acknowledged we need make best use of digital technologies in the design and delivery of training and development, in a way, place and time that works best for the staff.

WE’RE Not going back!

November 2020 – October 2021

What was done?

The Acute Adults Physiotherapy Practice Development Team (N=3) went through a number of change cycles from March 2020.  Competence and confidence levels of were assessed and by September 2020 100% of the Practice Development Team were competent and confident to support and signpost Physiotherapy staff to available methods of virtual learning and development during restrictions of Covid-19 in line with the Scottish Government Digital Directive.

We have approximately 450 Acute Physiotherapy staff, approximately 150 Band 6 staff who are expected to deliver In Service Training (IST) as per their job description.  We, Practice Development, worked in the early stages of the pandemic to signpost, support and encourage knowledge sharing in relation to delivery of training and development and strive to employ a collective leadership approach.  From feedback received in this first rounds of work, the benefits of virtual delivery of learning over our large health board was apparent (see Force Field Analysis below). We needed to increase staff confidence and competence in being able to delivery learning and development via virtual means.  Band 6 staff are expected to deliver the majority of In-Service-Training (IST), some individuals were able to deliver via virtual means, but most stated they were unable to do this (39% confidence and 34% competent, November 2020 baseline data for this phase of the project).

Lewin’s Model Force Field Analysis for improvement in band 6 confidence and confidence in using virtual learning methods to deliver IST (N=125)

Lewin’s model force field analysis

The aim of the next phase of work was that by May 2021, 80% of Band 6 Adult Acute Physiotherapy Staff at NHSGGC who respond to the survey will be confident and competent in using virtual methods as a vehicle to delivering learning and development in keeping with service plan aligned to the AHP Learning & Development Strategy, NHSGGC Digital as Usual Strategy and Scotland’s Digital Health & Care Strategy. The deadline date for the aim had to be extended, but our target of 80% remains.

The model for improvement guided this continuous improvement work started with a scoping exercise using electronic survey via Webropol to all staff and virtual meetings with stakeholders. Outcome measures were established and baseline date collected. Throughout, staff were able to feed their level of confidence, competency and learning needs in using virtual means to deliver training.  Those already reporting high levels of confidence and competence were able to state how they achieved this. Process measurement were developed relating to the change cycles.  Based on scoping work and baseline finding an initial plan (see tree diagram below) was developed and first PDSA (plan-do-study-act) change cycle was initiated in December 2020.  Fuller description on Quality Improvement methods used can be found on our QI website.

Tree diagram to show organisation of project by theme and change ideas

Learning resources were brought together, along with opportunities for practice and sharing learning. An improvement group was formed of people who wished to improve and tailored support was offered. The run chart below summarises the progress of the report.  The end date has been extended to Jan 2022.

Run chart indicating progress by percentage of band 6 staff reporting competence in delivering training and development by virtual means.  The chart indicating median lines, target & main notes from PDSA cycles (Mar-20 to Nov 21)

What was learned?

Two outcome measurement were collected throughout the project to determine results relating to the aim statement. Now in November 2021, 78% of band 6 staff report confidence and 78% report competence in using virtual learning methods to deliver learning and development.  The most commonly reported activity for nurturing confidence and competence were: having time to work through system on own (84%) or with team (44%) and having opportunity to delivering training using virtual means (48%). The level of engagement of Band 6 staff in delivery of our annual acute physiotherapy learning event (delivered online the past 2 years) provides good evidence of confidence and competency in delivery of learning and development virtually. In September 2020 32% (N=9) of staff presenting at the event were band 6 staff; in September 67% (N=19) of staff presenting were band 6, a further 6 presented work by audio recorded power point.  Thus, supporting the evidence of growth in competent and confidence of band 6 staff.

Gaining Confidence and Competence Learning Activity QuestionPercent Nov 21 (N=63)
Taking Time to Work Through the System on My Own83%
Working with My Team to Learn the System44%
Delivering Training Virtually48%
Attending MS Teams Training Provided by Library Services in Real-Time30%
Watching MS Teams Training On-Demand19%
Presenting at Physiotherapy Professional Development Day13%
Instruction Sheets of NHS GGC Acute Physiotherapy Professional Development Series8%
Attended Physiotherapy Professional Development Day as an Attendee10%
One-to-One Help with Library Services or eHealth5%
Something else – 19% defined as:

Attending other presentations and being a part of other groups on MS Teams
Delivering patient sessions via MS Teams Help from Julie Harvey
Practice Development Using MS Team for another job
Participated in QIP training and it was fully explained
Information, files and links in the virtual delivery Teams channel
Self help instructions on MS Teams Website


4.7%
3.1%
3.1%
3.1%
1.6%
1.6%
1.6%

What’s next?

It is predicted we will reach our 80% target within the next two months, once the target is met we need to consider maintaining it!  Then, having focused on Band 6 staff, we need to consider Band 5 staffs needs in terms of digital literacy, especially our newly qualified practitioners.

Top Tips

Top tip for increasing capability and capacity for using virtual means for learning and development:

  • Build your network of experts, encourage sharing of expertise
  • Define different levels of training available to suit need
  • Host all information links in one place
  • Don’t over burden staff with information, but have open communication streams  
  • Have recorded training sessions that can be watched on demand
  • People need time to practise on their own or in small groups
  • When practising on own you don’t know what others are seeing, therefore group size of >3 is best you can also record your rehearsal.
  • Have practise/ Q&A sessions to allow people to put training into practice in a non-pressure environment with other people.
  • Practice sessions should be a times dictated by staff
  • Provide opportunities for people to present work

Top tips for hosting an online learning and development event:

  • Prepare easy to read, step by step, instructions for delegates and presenters
  • Host practice session for presenters
  • Ask delegates to log on at least 10mins before starting
  • Have a chair & facilitator with clearly defined roles (the chair ensures the programme is running to time, manages questions; the facilitator keeps registration, monitors chatbox, troubleshoots any issues, assists speakers and chair).
  • Reflect on and invite feedback after each event.

No practice developer is an island, it takes a community, with thanks to:

Andrew Millar, Allan Dodds, Andrea Shaarani, Andy Dolan, Barry Johnstone, Becca Adams, Christine Steel, Christopher Grant Pantrey, Clare Burke, Danny Norris, David Boiskin, David Craig, David Furniss, Emma Dodds, Emma Wilson, Erin Walker, Gillian Davie, Gillian Ferguson, Hannah Knox, Hayley McGrath, Heather Cameron, Helen Devine, Janice Gallacher, Jennifer Rainey, Jo Tramond, Julie McGuckin, Julie Reid, Kimberley Barton, Laura Walker, Laura Wilson, Lindsay Day, Lisa Morrison, Lorraine Freeman, Lorraine Wishart, Lynn Glen, Lynsey Warner, Nikki Munro, Pamela Vaughn, Paula Hourston, Paul Williams, Ruth McFadyen, Sarah Humphris,  Siobhan McGuire, Suzanne Palmer, CSP, NES & all the staff taking part in this improvement project.

Thank you for your time. Please get in touch if you have any ideas or advice or if you would like further information on this project.

Bibliography:

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