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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 Thank You Please Complete your Evaluation form Have a Safe Journey Home....