Training

Selecting and managing NHS trainers at Heatherwood & Wexham

Heatherwood and Wexham Park Hospitals NHS Foundation Trust is the main acute hospital service provider for east Berkshire, giving its expanding population access to district general hospital and community services.

Radiology and diagnostic imaging are key parts of the service offered and are critical to the successful achievement of the government’s 18-week waiting-time target.

The NHS National Programme for IT (NPfIT) is bringing modern computer systems into the NHS, including radiology and diagnostic imaging systems to dramatically reduce the time between diagnosis and treatment. It recently completed the installation of picture archive and communication system (PACS) at all trusts in England.

Heatherwood and Wexham decided to adopt the NPfIT-recommended solution for radiology and diagnostic imaging which consists of:

• GE Centricity picture archive and communication system (PACS);
• HSS Cris radiology information system (RIS); and
• Kodak DirectView computed radiography (CR).

The main change is that images are all digital and are viewed on a computer screen. The system is very reliable, removing the risk of lost hard-copy images and allowing images to be viewed instantaneously by any clinician involved in the patient’s care.

RIS is used to manage patients, appointments and reports. PACS stores and retrieves large numbers of images permanently and reliably. CR converts images produced by a traditional x-ray machine to digital form using special cassettes which are read by a CR reader and then stored in PACS.

NPfIT delivers training to the majority of end users by means of a ‘training cascade’ where the system vendor trains trust staff who then train end users. The Trust identified two main issues with this approach:

• lack of qualified trainers in radiology; and
• risk of taking staff away from normal clinical duties to become trainers.

Priorities for service continuity

Ideal Training was asked to propose a realistic solution to the issues around cascade training. The main priority was to ensure that all staff received appropriate and effective training on the systems they would use. This could only be ensured by using trainers with the ability to communicate skills and assess the satisfactory progress of trainees.

Another key issue was to ensure that only a small percentage of department staff were used to deliver cascade training and that sufficient cover was maintained to continue to deliver the normal high quality of service that patients and doctors expect.

A further requirement was that the staff in the department would need to acquire and maintain a ‘body of knowledge’ about the new systems. This would give staff and managers the confidence to adopt the new systems with support from super users in a timely manner so that services could continue to be provided without interruption.

The solution

The Trust had already begun the process of identifying staff who might be suitable to deliver cascade training but their aptitude and suitability had not been established.

Ideal Training recommended that staff be assessed for suitability to become classroom trainers, or mentors and super users. It further recommended that staff identified as classroom trainers should be given training in how to deliver skills on the new systems to end-users.

The company recommended that its own trainers should be used in conjunction with Trust trainers to deliver training to end users. Ideal Training provides professional clinical trainers to deliver training on all the systems being installed at the Trust.

Assessing trainers

Training NHS staff to use new systems is a very challenging task and specific skills are required. Radiology staff have the clinical skills required to explain the new systems to their colleagues but have not had the experience of a major rollout such as this.

The assessment consisted of three stages: questionnaire to establish suitability; follow-up telephone call to clarify questionnaire responses; one-day classroom training-delivery assessment.

The process started with the basic requirement that staff who were to become trainers needed a number of key attributes: aptitude for training; motivation to become a trainer; training or mentoring experience; and understanding of IT. Any training qualification that staff had was also taken into account.

A questionnaire was designed for staff and the content agreed with managers at Heatherwood and Wexham Park Hospitals NHS Foundation Trust. This was distributed to staff by managers at the Trust and responses were returned to Ideal Training. Questionnaires were then scored to make an initial assessment of the suitability of staff to become trainers.

Staff who were deemed to be suitable were then invited to a one-day practical classroom assessment where they were given some basic instruction and asked to prepare a short training session. Staff were assessed for their ability to perform the test and were scored against a set of criteria.

Training skills course

Staff who passed the classroom assessment attended a 2-day course covering all aspects of delivering training on radiology systems to NHS staff. This course included the following key sections:

• introduction to training in the NHS;
• the structure of a training session;
• the needs of learners;
• learning objectives;
• learning styles;
• large group dynamics;
• good communication with learners;
• feedback and interactivity;
• resistance to new systems;
• progress assessment;
• questioning styles;
• course materials;
• exercises and practical sessions; and
• the benefits of NPfIT.

Scores from each stage were compiled using numerical indicators, basing the assessment on objective criteria as far as possible.

Ideal Training staff met with Trust managers at the end of the training skills course to go through the results so that decisions could be made about which staff would become trainers, mentors and super users

Training end users

Ideal Training provided qualified HSS Cris and GE Centricity trainers to work alongside Trust staff to deliver end user training to all users of both systems. This enabled the training to be delivered efficiently and effectively so that the necessary skills were delivered to staff with the minimum amount of disruption to their normal duties.

The RIS and PACS trainers are clinically qualified radiographers, which means that they can communicate well with colleagues in the NHS and answer all questions, whether about the systems or how they are to be used in the radiology department.

The company's trainers worked alongside Trust trainers in the classroom to provide mentoring and backup to ensure that Trust trainers developed the confidence to deliver the material effectively. Trust managers were satisfied that appropriate steps had been taken to train staff to be competent to use the new systems correctly.

Ideal Training was able to offer contingency cover for Trust staff who were unable to deliver cascade training to end users because of unforeseen work requirements.

Benefits

Heatherwood and Wexham Park Hospitals NHS Foundation Trust benefited significantly from the training, experience and expertise provided and was able to meet all its objectives:

• all staff were given appropriate training;
• staff can support existing and new colleagues to use the new systems; and
• a high quality diagnostic imaging service was maintained throughout implementation.