1

On Becoming, a Programme of Empowerment:

Interim Project Report

Michael Bold – Programme Support Officer

Kate Burnett – Programme Lead

With special thanks to Sarah Frost (ref) for her advice and support with the

evaluation methodology, Nicholas Bradbury and Louisa Hardman for their

patients, connections, expert mentorship, coaching, facilitation and love. Ricky

Staniland (Chair of the North PA forum) for his honesty, and representation of

this profession.

2

Contents Overview Development;

1) Early Research and Stakeholder Engagement 2) Curriculum framework design 3) Design of educational interventions 4) Accreditation 5) Evaluation Framework 6) Resources

Early Evaluation Report;

Executive Summary ...................................................................................................................... 5

Introduction ................................................................................................................................ 5

Overview Development; .............................................................................................................. 7

Curriculum framework design ............................................................................................................ 7

Design of educational interventions ................................................................................................... 7

Programme Design .............................................................................................................................. 8

Accreditation ....................................................................................................................................... 8

Evaluation Framework (Process, Content and Impact) ...................................................................... 9

Resources .......................................................................................................................................... 10

Early Evaluation of Cohort One ................................................................................................... 13

Overview ........................................................................................................................................... 13

Content analysis ................................................................................................................................ 13

Reaction ........................................................................................................................................ 14

Organisational Support ................................................................................................................. 18

Behaviour Change ......................................................................................................................... 20

Results ........................................................................................................................................... 22

Discussion.......................................................................................................................................... 22

Process Evaluation ..................................................................................................................... 24

Introduction ...................................................................................................................................... 24

Introduction .............................................................................................................................. 25

Means of marketing .......................................................................................................................... 26

Brand ................................................................................................................................................. 27

3

Discussion.......................................................................................................................................... 28

Learning Achieved ............................................................................................................................. 29

Introduction ...................................................................................................................................... 30

Financial Analysis .............................................................................................................................. 30

Venues, accommodation and travel considerations ........................................................................ 30

Costs .................................................................................................................................................. 31

Unique set costs ............................................................................................................................ 31

Trainer fees ................................................................................................................................... 31

Venue costs ................................................................................................................................... 32

Travel............................................................................................................................................. 32

Accommodation ............................................................................................................................ 33

Overall module cost ...................................................................................................................... 33

Close .................................................................................................................................................. 35

Appendices ................................................................................................................................ 37

Appendix A: Influencing styles questionnaire ................................................................................... 37

Appendix B: Evaluation framework .................................................................................................. 42

Appendix C: Example of teaching resource ...................................................................................... 45

Appendix D: Self-evaluation questionnaire ...................................................................................... 47

Appendix F: Self-evaluation questionnaire responses ...................................................................... 51

Appendix G: Standard operating procedure (SOP) ........................................................................... 54

Appendix H: Financial breakdown .................................................................................................... 56

4

Summary

‘This is a course which empowers PAs to be leaders, which is particularly valuable for

pioneers of a new profession. It moved me out of my comfort zone, testing and analysing a

range of influencing styles and equipping me with a range of effective tools for coaching,

influencing, speaking with assertion, presenting with impact, changing attitude and

behaviour..... I would recommend the ‘On Becoming’ course to other PAs and I believe it will

be most beneficial early in their careers. I believe that participation on the programme has

improved my confidence, boosted my self-esteem and empowered me to lead.’(PAR)

‘I was delighted to be invited to attend the ‘On becoming’ ‘graduation day’ in Salford in June

2019. I wasn’t entirely sure what to expect, and was very pleasantly surprised. I have been

around the PA world for over 15 years (I like to say I have more ‘PA Pack years’ than any

other UK doctor) and would love to see a similar opportunity for all UK-trained PAs. The

course was clearly enjoyable and empowering; as someone who was found public speaking

difficult in the early years (I used to write myself scripts, including pauses and jokes) it took

me a good few years to be able to extemporise. And yet these relatively new PAs, many of

whom had, I understand, ‘made themselves do the course’ to try to develop their leadership

skills, including but not limited to public speaking, really impressed me.

I heartily recommend this experience to any newly qualified PAs’ (Prof. Jim Parle)

5

Executive Summary

The NHS is crippled with rising number of service users and a haemorrhaging of workforce.

Extensive research puts the cause of this haemorrhage workforce the prevailing NHS

culture. A system culture which is lacking is care and compassion. Workforce members

experience ethical erosion and relationship toxins, role nausea, role ambiguity and with

limited able to fully understand their own vulnerabilities, notice the psychodynamics that

surround them and respond appropriately. As such feeling and expressing care is almost

impossible.

The ‘On Becoming’ programme aims to activate humanistic principles within and for

Physician Associates within a shared kinship of care; a care that is felt and expressed.

Investing in person centred care for Physician Associates so they, in turn, can offer care for

patients, other staff and the NHS system in which they work.

The early evaluation of the On- Becoming programme shows that PAs as a new practitioner

into the system are experiencing projections from the vulnerabilities of others. This in turn

is having impact on the PAs confidence and their role content. The PAs themselves

recognise the need for more self-confidence and self-resilience and empowerment of their

role.

The ‘On Becoming’ programme is being met with positive emotion and has shown to build

the self-confidence and empowerment of PAs. This has impacted on their ability to change

some organisational policies to the advantage of improved delivery of patient care and

enhanced networks, in turn to the benefit of advancing diversification of and content their

roles. This should be in the advantage of the wider PA community.

Introduction

Whilst Physician Associates (PAs) have been in employment within the NHS for a number of

years, outside of a single programme provided by the Faculty of Physician Associates at the

Royal College Of Physicians (RCP) (March 2019) there are limited dedicated PA programmes

of personal improvement for them to take advantage of; of the training schemata that exist

for PAs the majority focus is on the ‘clinical’ skills aspect and not on the humanistic

development. No dedicated combined coaching and leadership development programmes

for PAs could be found nationally.

The ‘On Becoming’ programme aims to activate humanistic principles within and for PAs

within a shared kinship of care; a care that is felt and expressed. Investing in person centred

care for PAs so they, in turn, can offer care for patients, other staff and the NHS system in

which they work. This is linked to the NHS Constitution where it states:

6

‘The NHS belongs to the people. It is there to improve our health and wellbeing, supporting

us to keep mentally and physically well, to get better when we are ill, and, when we cannot

fully recover, to stay as we can to the end of our lives…… it touches our lives at times of basic

human need, when care and compassion are what matters most …..the NHS is founded on a

common set of principles and values that bind together the community and the people it

serves; patients and public and the staff who work for it (1, 2)’

The On Becoming programme has aimed to do all this while developing a politically

impactful community of practice for the Physician Associates (www.northforum.co.uk).

The ‘On Becoming’ programme is an essential pathfinder in bringing opportunity for PAs to

the fore. Empowering their personal aspirations and managing their talent, while developing

their knowledge, skills and attributes to enhance the quality of services offered to patients.

Specifically, by using the emotional, social and relationship intelligence with their healthcare

coaching conversational skills developed on the programme to deliver personalised

preventative care.

The On Becoming programme in its design has been easily adaptable to other healthcare

workers, and is being piloted with Foundation Doctors and multi-professional teams

working together, as exampled by the LIFT2. Interested stakeholders nationally have sought

to move it beyond these boundaries, to see it support the development of Emergency

Medicine practitioners and social prescribers.

7

Overview Development;

1) Early Research and Stakeholder Engagement

Curriculum framework design

The base competency curriculum for the On Becoming programme is derived from:

The European Mentoring Coaching Council’s Coaching and Mentoring competency Framework for a Foundation Healthcare Coach(3)

NHS Leadership Academy Medical Leadership Competency Framework(4)

Skills for Health NHS Person Centred Approaches Competency Framework(5)

There is some overlap observed within the above frameworks, these were used as the basic

frame (fig. 1) from which the On Becoming programme was developed.

Design of educational interventions

Educational interventions used vary according to the group and their collective learning

interests and needs. The ones listed below were implemented during the recently

completed cohort of physician associates.

Power pebbles

Push/pull exercise

Influencing styles questionnaire (see Appendix A) and practice

On Becoming..

Leadership qualities

Agency for innovation

and improveme

nt

Role mentorship

Devloping person centred

aproaches

Fig 1. Areas of focus for the On Becoming programme

8

5 step assertion model and practise

Seven step confrontation model and practice

Constellations exercise

Co coaching

Deep listening

Co consulting

Emotional regulation exercise

Praxis Groups

Presence exercise

Close event preparation

Programme Design

The programme is designed to be cyclical. Where participants initially make their learning

agreement with a faculty member, upon completion of the programme they then make

agreements with themselves to continuously work on their self-empowerment,

assertiveness and leadership skills. Further, they will come to agreements with their

coachees to empower and develop them, thus beginning the cycle anew.

Accreditation

The On Becoming programme will be accredited a Foundation European Quality Award

(EQA) with the European Mentoring and Coaching Council (EMCC). To achieve this

Fig 2. Programme Design

9

accreditation a full cohort must be completed and evidence submitted to the EMCC. To

achieve this, the On Becoming programme has been mapped across the EMCC competence

framework and uses the eight core values of the competency categories to focus the

training. These comprising of:

Understanding Self; Demonstrates awareness of own values, beliefs and behaviours;

recognises how these affect their practice and uses this self-awareness to manage

their effectiveness in meeting the client’s, and where relevant, the sponsor’s

objectives

Commitment to Self-Development; Explore and improve the standard of their

practice and maintain the reputation of the profession

Managing the Contract; Establishes and maintains the expectations and boundaries

of the mentoring/coaching contract with the client and, where appropriate, with

sponsors

Building the Relationship; Skilfully builds and maintains an effective relationship

with the client, and where appropriate, with the sponsor

Enabling Insight and Learning; Works with the client and sponsor to bring about

insight and learning

Outcome and Action Orientation; Demonstrates approach and uses the skills in supporting the client to make desired changes

Use of Models and Techniques; Applies models and tools, techniques and ideas

beyond the core communication skills in order to bring about insight and learning

Evaluation; Gathers information on the effectiveness of own practice and

contributes to establishing a culture of evaluation of outcomes

How the programme meets the above requirements can be found in Appendix [x].

Evaluation Framework (Process, Content and Impact)

Global evaluation for the On Becoming programme is based upon Thomas Guskey’s (2000)

evaluating professional development theories; whereupon he considers the hierarchy of the

five following factors necessary for ‘training’ to have an impact(6). The analysis of the impact

of the On Becoming programme is shown at all five levels. This evaluation is further

extended to an allow an iterative review of process of the programme; including

administration, supply of programme, demand for programme, sustainability of community,

content design and leadership.

Factor Intended outcomes for training to have impact

1. Reaction Participants engage with and enjoy the training.

2. Learning Participants learn what is being taught / programme taught what was expected

(EMCC EQA criteria)

10

3. Organisational Support

Trainees are supported by their colleagues, managers, and organisational

policies to use the learning in practice.

4. Behaviour Change

Participants put what they learnt into practice.

5. Results a) Participants’ behaviour has an effect on organisational aims leading to more effective and efficient systems.

b) Patients take greater responsibility in identifying and implementing changes they need to make to improve their health and well-being.

Given the humanistic nature of the programme the majority of the feedback collated is

qualitative in nature. Quantitative data is taken in several forms, specifically before module

1 and post module 4. All feedback is anonymised before evaluation. Evaluation has been

performed by the evaluative team. The framework for the evaluation is shown in Appendix

B.

Resources

Learning resources are under the intellectual property right of ‘On Becoming’ and are

available via password access at https://www.northpaforum.co.uk/on-becoming/.

Resources include:- A précis of voice coach Patsy Rodenburg’s description of her ‘Circles of Presence’ and link to her TED talk, found online here. Guidelines for receiving feedback Notes on journal keeping Developmental stages of personal development Notes on emotional vocabulary Intervention styles questionnaire An example of a learning resource is given in Appendix C. Curriculum

The curriculum is divided into elements that are needed for the care of self and others,

these include; identification of the role I said yes too, championing this role for self and

others; system leadership, knowing how I can be the best I can to support a system of care;

using person centred approaches to support care for self and others; becoming an advocacy

for improvement, through an empowered self.

Module contents

Prior to beginning the modules the candidates have an hour long discussion with a member

of the faculty. This is to ensure that the candidate understands that there will be some

‘brutal’ self-reflective practices and will be able to deal with such, also that they commit to

11

the completion of the entire programme. Following the talk the candidates are to being the

reflective process by submitting a self-evaluation questionnaire, see Appendix D, and a short

video of themselves answering the following questions:

Why is this programme right for you?

What are you bringing to this programme?

What are you hoping for?

What would you most like to develop and (importantly) why?

How will you know when you have achieved this?

What would you like to overcome or change?

What outcomes will you strive for?

What do you want to change in your workplace or in patient care?

How will you know when you are influencing events?

Module one is a two day beginning of their journey into care; exploring the facets of care

within a psychodynamic system of healthcare. Understanding the power of kindness in the

kinship of self, others and within the NHS system of care. In this module participants will

learn how to lead themselves in the context of system leadership; mapping the role they

said yes too, understanding and bringing it to life. They will understand what is unique

about them; they will discover how to be this unique and how not to be defined by what

they are not. They will discern what they didn’t know they said yes to and how that impacts

on them and their ability to care. They will activate self-authorisation. This module will begin

the process of Becoming system coaches in a system of care. This module explores the topic

of care and sets the goals for the programme activities.

Module two explores the options available to deliver care to themselves and to others. This

one day module explores how participants may sabotage themselves in the delivery of care

and their self-justifications for doing so. This module makes the humanistic principles found

in the NHS constitution6 explicit and encourages participants to contract for the use of them

in every day encounters of care. Module two will help participants use these humanistic

principles in relation to every person they encounter in their work. It will teach person

centred coaching and mentoring skills to contract for relationships of empowerment and

care, while maintaining clear boundaries to their role. The participants will be taught how to

use these conversations to on-board others and the systems to enable participants to

deliver holistic care to the patients. Participants will critically appraise what options are

open to them to empower themselves and others through the skills of coaching and

mentoring.

Module three explores how “I” am performing; helping participants move on from the

theory of care to distinguishing and using it in everyday practice. The module helps

participants reflect on their patterns of care praxis in the National Health Service (NHS) and

Healthcare society to date across modules 1-3, using their learnt agency of change, system

leadership and coaching skills to embed care that is felt and expressed into a community of

12

care. The two day module will explore, through self-reflection, the impact of the

programme’s connectivity and kinship. The module will use performance buddying to

support and challenge praxis of care.

This final half-day module brings together those who have been involved in this programme

of care to share knowledge, skills and behaviours; showing the impact on person centred

care for staff and service users by using intelligent kindness in a community of care. This

outboarding module will role model the importance of humanistic principles; worthiness,

respect, constructive empathy in giving recognition and reward to responsibility taken,

learning achieved and empowerment gained. Role modelling care at the centre of person-

centred care. This is, in essence, a celebration event for programme participants, allowing

them to showcase what they have learnt to expert guests.

Other learning tools

Other tools are provided to participants and include the following links to relevant

webpages and journals.

NHS Long Term Plan: https://www.england.nhs.uk/long-term-plan/

Putting Feelings Into Words: https://journals.sagepub.com/doi/abs/10.1111/j.1467-

9280.2007.01916.x - Matthew D. Lieberman, Naomi I. Eisenberger, Molly J. Crockett,

Sabrina M. Tom, Jennifer H. Pfeifer, Baldwin M. Way

Health Coaching, Better Conversation Better Health:

https://www.betterconversation.co.uk/health-coaching.html

Learning Journal self-reflective tool

Participants are required to keep track of their learning journey by keeping learning logs.

They are also required to use a similar tool to bring items for discussion or work to their

praxis group meetings. Both these can be found in Appendix D.

13

Early Evaluation of Cohort One

Overview

Given this is a programme of empowerment of care and compassion for a kinship of care

the commonly seen process of controlled demand for data return (for example you can only

have your certificate if you submit the feedback form) has purposefully not been employed

for this programme. Instead consent has been taken from delegates to use available data

from the educational process of the programme to show analysis and return on investment.

Data sources include:

1. Qualitative and quantitative analysis of process 2. Delegate Applications 3. Delegate Reflections 4. Organisational Sponsorship and References 5. Organisational Feedback 6. Interviews 7. Delegate Learning Portfolios (submitted video footage and written journal of

learning) 8. Social Media 9. North PA Forum analysis

An overview of the cohort one early evaluation to date shows:

Content analysis

Emotionally the PAs needs and desires are:

a) To be more resilient to the context, specifically to the emotional projection of others.

b) To be more self-confident, specifically for the benefit of themselves and their role as a PA.

c) To feel more authentic, specifically for themselves and for the benefit of the delivery of patient care

Other themes:

a) Initial difficulty felt by PAs to gain organisational support for attendance on the course

The programme has:

a) Met them with surprise, specifically 1) That Health Education England had gifted this level of support to

them. 2) That difference in delivery method of the programme compared to

their past experiences

14

3) The amount of positive impact gained from the above

The impact has been:

a) An improvement in self-confidence shown by PAs b) Delivery of

1. Process analysis 2. The Set-Up 3. The Impact 4. The Learning

Early evaluative data is shown below and illustrated by quotatives.

Reaction

The reaction to the programme has been assessed using the data areas shown in figure 3.

Delegates Need

Specifically, the delegates self-reported a need for self-confidence (as a response to their

perceived beginning low levels of confidence) and improved self-resilience (as a response to

their self-reported perceived difficulties when dealing with the emotional projections of

others. The content of the projection appeared to focus on negativity to the addition of

their role to the workforce and appeared to come most commonly from other health

professionals, junior doctors and advanced nurse practitioners. These themes are illustrated

Fig. 5 Reaction assessment criteria

15

by way of quote below; But 2 examples of quotes in for each domain and reference the

video

self-confidence (in response to low confidence)

Quotes to show desire for

This is also reflected in supervisors’ comments about the need for some participants to

'She would really benefit from improving confidence, in being assertive and leading’ (MoU 3)

‘I think this course would be beneficial for him to continue providing excellent medical care,

with giving him confidence in leading and making decisions within a team.’ (MoU 7)

Quotes to show desire for resilience

‘Felt belittled, questioned my ability- I didn’t feel self-assured or confident in my role,

questioned my ability and at the time, wavered on whether I agreed with the patient’s

perspective about the role of physician associates’ (pre-programme reflection 10)

‘Learn that I am a valued member of the team and that I should own my space/role/opinion.

I think this will come with time and increased confidence, but I want to feel part of of the

team in my work place rather than the new person or the ‘unknown role’. When we

discussed imposter syndrome that really hit home. This is something I really want to move

away from as it doesn’t reflect my personality outside of work.’ (pre-programme questionnaire 4)

Examples of emotional projection

Positive affirmation

The course appears to be met with positive emotional affirmation. Words used frequently to

describe their emotional affirmation include enjoy, interested, hope; as part of their

celebration event the graduates of cohort 1 put forward words on how they felt about the

programmes effects upon them and created the word image seen below (Fig. 4).

16

The reactions to the programme are illustrated by way of quotes below;

‘Sorry I know I'm cutting it fine with the deadline being today, but I hope you can accept it as

I would really like to attend' Application submission 16

‘The ‘On Becoming’ course looks interesting’ enquiry 19

‘I enjoyed writing the reflection as it was a good area to start thinking about what I want to

get out of the course’ course attendance number 3

‘I’m finding this course valuable in all kinds of unexpected ways, making a difference to my

practice, interprofessional relationships and I’m gaining skills towards membership of the

European Mentoring Coaching Council’ https://www.facebook.com/groups/288433565163176/, 02/05/2019

Surprise

The data shows an emotional response from participants of ‘surprise’. Specifically, the

participants describe that they were expecting a different method of facilitation; with rows

of chairs and use of PowerPoint. ‘Initially, I could see that the course would be unlike

previous academic courses I had attended…I was immediately stretched by the technicalities

and discomfort of providing a pre-course video reflection, but this was a valuable learning

Fig 4. Word image courtesy of Cohort 1 graduates

17

experience...[T]he course modules were delivered in a relaxed, informal fashion, seated in a

circle and always commencing with mindfulness and individual check-ins. It felt confidential

and safe...’ (ptcp. 8). The context is an important factor in the delivery of the On Becoming

programme. A close circle with programme participants and faculty seated facing into the

shared space of the learning system is used for a significant part of the course. This method

allows for development of the metaskills of connectivity. Connecting them as a system

together. In turn this aids a ‘family of origin’ to be created.. The facilitators felt that

‘openness, intimacy, honest, and trust’ had developed within the group by coaching the

system development in this way put in quote from Nicholas or Louisa here coaching the

system development in this way

Positive affirmation

Once over the initial surprise of different facilitation, participants showed positive

affirmation to the context used for delivery of the programme and the process facilitation

used.

‘My initial feeling was that we were about to undergo a form of group therapy. Having

completed the course, I can appreciate that my behaviour has been modified through a

succession of interactive activities with peer feedback. I certainly feel that I have participated

in a therapeutic process.’ (ptcp 8)

Learning (in progress – we need to look at this Mike

Fig.5 Learning evaluation criteria

18

Evaluation is taken from email communication regarding the course and from the

comparison of pre and post-programme questionnaires as well as post-module videos

submitted. In addition to these the participants are ran the final module where they

showcased what they have learnt in a series of activities and workshops.

Organisational Support

The data analysis thus far shows a difficulty to gain organisational support by some

interested potential participants. Specifically, a reluctance to sponsorship attendance for

these participants included a) Financial reasons b) Service delivery need. These themes are

illustrated here by way of qualitative quote;

‘Unfortunately I've not been able to secure the time away to take part.’

‘Whilst I would try to extend their professional leave quota to cover the full seven days of the

programme, I am concerned that their attendance also depends upon their rota also being

able to adequately cover their duties, as it is seen as discretionary leave.’

There have been a number of queries into the course, not all of which have resulted in an

application being submitted.

Fig 6. Organisational support

19

A small number were second year PAs or were employed in areas not supported,

Birmingham and the South East, and as such not appropriate candidates; though showing a

desire for the programme both in the future and outside of the NW.

Some organisations were positively supportive of their Physician Associates attending the

programme. Themes from the data are illustrated using qualitative quotes from the data

below;

Theme

a) Have a desire for their PA to advance themselves and their organisation

'I think this course would be beneficial for him to continue providing excellent medical

care, with giving him confidence in leading and making decisions within a team.'

‘I would like her to focus on projects on how to manage a ward round, then advance the

projects beyond this towards mentoring and teaching others and how to effectively

undertake QIPs. I believe that this would be of great value’

‘I would sincerely recommend she pursues this programme and benefit both herself and

our organisation from it.'

b) Feel a positive emotion towards their PA

‘She has excellent skills and it is now her turn to learn to lead others.’

'She would absolutely benefit from this programme as she is keen to help new doctors

right from induction and the foundation trainees learn plenty from her. Her leadership

skills would be enhanced to help her grow.

Fig 7. Queries and applications

20

‘Wow! That is a lot of investment that is being put towards this course. I am sure it

would be worthwhile investment.’

c) See a need to support development of a ‘community of PAs’ more widely

‘I would fully support this program to develop her personal and professional skills in

leadership and allow networking across the country.’ref MOI x

‘We are looking at new PA recruits pairing up with her, so mentoring skills would be very

useful.’

‘This is especially important as we seek to recruit more PAs in the future and need role

models and leaders to mentor the next generation'

Behaviour Change

Behavioural change Figure in here as per other sections Further data will be drawn from

work submitted post module 4.

Themes of behavioural change seen at present include

It appears some tools have been more useful than others. Specifically the assertiveness tool

Fig 7. Behavioural change

21

‘The 'how to be assertive tool' was really interesting and helpful given our new position in

the NHS workforce. I have used this a lot ‘(post module feedback 3)

Emotionally they appear to have improved in self-confidence and as such have advanced in

responsibility and delivery of service

‘I have used part of my learning to attain further responsibilities at work including changing

Trust policy to allow PAs to insert PICC lines…preparing to change and be in charge of the

junior doctor/PA rota on the Cardiology wards to include weekends. I also feel more

confident at work, and happy to take on jobs that I may have shied away from in the past

because I didn't feel 'knowledgeable' enough’ (post module feedback 3)

There is also an awareness of how the participants feel they have developed over the course

of the programme. Prior to the start of the programme and at the end the programme the

participants were given the same questionnaire to complete, Appendix D. The questions

were drawn from the questions used in their coaching learning log, Appendix E, and show

an across the board improvement in how they view themselves. For a detailed view please

refer to Appendix F.

There was temptation to change open question 3, ‘What do I need to

develop/appreciate/learn?’, to asking what they have developed over the course of the

programme. But On Becoming is not a panacea but, rather, the beginning of a journey of

self-awareness so the question was left as is to allow them to reflect on what they still want

to develop within themselves. Responses to this question include:

‘Appreciate own skills and power, and use potential to push for change.’(response 10)

‘Self-confidence, active listening and practice coaching skills’ (response 2)

22

Results

Again figure to show how we have collected the data from framework

The major theme that is appearing is that participants from this programme are changing

trust policy to allow advancement of their role;

‘I have used part of my learning to attain further responsibilities at work including changing

Trust policy to allow PAs to insert PICC lines’

‘My participation in the ‘On Becoming’ programme has also been appreciated by my

employers, who have since given me the opportunity to expand my role, facilitating in

simulation, as a member of the faculty of the North West Simulation Network. I was also

involved in facilitating in Advanced Trauma Life Support (ATLS). My consultant has been

particularly impressed with my teaching and mentoring of newly recruited overseas

registrars. Noticing my enthusiasm for teaching, I am being prepared to expand my role to

that of advanced practice education facilitator for the PAs and PA students at my Trust.’

Discussion

The physician associate is a new role within NHS and, as noted above, PAs appear to feel

challenged in the context of being this new additional role to the system. Onboarding to the

programme brought out the impact of this challenge, with a desire from them to achieve

Participants’ behaviour has an effect on

organisational aims Patients take greater

responsibility in identifying and

implementing changes to improve their

health and well-being.

Qualitative analysis of post module 4

feedback

Analysis of praxis goup learning

Quantitative analysis of number of mentor relationships set up

from the North forum. Qualitative survey

month 3, 6 & 12 post programme. Number achieving EMCC registration

Feedback from organisational

sponsors

Fig 8. Results

23

more confidence and improved personal resilience. The programme appears to have

delivered an improvement in self-confidence with the effect of widening the remit of their

role and allowing them to develop more effective relationship. Indeed this also appears to

have led to a change in some Trust policies and with a desire to from them to build further

better relationships within their community of practice. The On-Becoming programme has

allowed them to develop emotional, social and relationship system intelligence.

24

Process Evaluation

Introduction

As with any project in its initial stages of introduction, evaluation of all aspects of

implementation is an essential part of the process. The structures and processes used as of

the programme have been evaluated here to see the impact and plans for improvement

moving forward. Specifically, this has been evaluated using the following domains:

Administration (standard operating procedures)

Marketing

Financial Analysis

Improvement needed going forward

25

Introduction

Administration

The project support officer has designed all Standard Operating Procedures for this

Programme. These can be seen in Appendix G.

The selection of the venues at the start of the programme was at first mildly problematic.

This was, in part, due to the relatively short time between the start date of the project

support officer and the beginning of the module. This caused the venues to be dispersed

around the North West which had both a positive and a negative effect. The positive meant

that some of the venues where easier to access for PAs based closer to that area; the

negative was that for some PAs the location meant that it was too problematic to get to and

as such was a factor in the withdrawal of their application. Taking this into account there are

venues which have been selected as preferred locations based on ease of access, cost and

impressions from modules held there in cohort 1. It has also been decided that as it is

logistically easier to support the modules that those held within the NW should be held in

Manchester as first choice locale; should the On Becoming programme spread throughout

the North then it will need to be discussed as to the suitability of using also a central, easily

accessible city within each locale, Yorkshire & Humber and the North East.

Mike you need to add in some reflections / challenges/ what you have noticed here

Marketing

The analysis of marketing has been broken down into the following areas;

a) Market Analysis

Marketing analysis was undertaken at the start of the programme development. Specifically

significant amounts of data supports the need for a ‘wrap around care’ to be developed for

workforce members within the NHS(ref). In addition, conversational skills have been shown

to have considerable value in delivery of personalised preventative healthcare for patients

(ref).

Physician Associates represent a high risk population of healthcare workers in need of a

system of care (given they are a new practitioner into the NHS). Given this newness of their

role and given their present lack of prescribing rights, they are well positioned to be able to

deliver person centred care to patients with a view to prevention of ill health.

26

Research showed nationally no other programmes available that were dedicated to

Physician Associates aimed at delivering a kinship of care AND the healthcare coaching skills,

knowledge and attributes on the EMCC framework. Specifically, for the PAs to use to

promote prevention of ill-health.

In addition, the number of PAs graduation across the North West was increasing with the

second cohort of 125 graduating (Feb 2019). In total the number of PAs graduated and

employed in the NW was xxx Market analysis thus shows a need for this programme with

a potential client base of XXX

c) Marketing Strategy, Cohort details

Each cohort could accommodate up to 24 participants. The cohort dates are as follow:

Cohort 1 Cohort 2

Interviews: February 6 Interviews: March 15

Module 1 March 7/March 8 Module 1: April 24/ April 25

Module 2: April 3 Module 2: May 22

Module 3: May 7/ May 8 Module 3: June 13/ June 14

Module 4: June 10 Module 4: July 9

Cohort 3 Cohort 4

Interviews: June 25 Interview: October 14

Module 1: July 30/ July 31 Module 1: November 25/26

Module 2: September 3 Module 2: December 3

Module 3: October 2/ October 3 Module 3: January 14/15

Module 4: November 11 Module 4: February 13

Cohort 5

Interview: November 28

Module 1: December 19/20

Module 2: January 22

Module 3: February 20/21

Module 4: March 20

Means of marketing

Advertising for the On Becoming programme the following steps were uses:

1. Email sent to administrators responsible for PAs at Primary (and Secondary Care centres).

2. Email sent to administrator at each of the HEIs providing the PA course within the North West. The aim was to have the details circulated to PA-S’ due to graduate in March 2019.

27

3. Advertised on social media platforms available, these are Twitter, Facebook and LinkedIn. Responses via the Twitter feed seem to be more prevalent as indicated by queries from PA-R’s from outside of the North and PA-S’ due to graduate 2020.

4. Attendance at Primary Care recruitment events. These were attended by PA’s not in substantive employment as well as current and potential Primary Care employers. The programme was discussed face to face and paper flyers were handed out.

5. Advertised upon the North West Physician Associate Forum (NWPAF) website On Becoming specific pages. On these pages there is a specific section dedicated to the On Becoming programme, this is also where the On Becoming resources are stored.

6. Email sent to HEE area Primary Care leads to disseminate to primary care providers in their areas who employ PAs.

7. Word of mouth and recommendations

Brand

The brand ‘On Becoming’ was developed in collaboration with behavioural psychologists,

performance coaches, faculty members and Physician Associates themselves. On Becoming

was felt to be appropriate because the participants within their authentic self were more

than just their external role label of ‘Physician Associate’ or ‘Doctor’. Within them they had

many roles like rooms in a mansion, where each room represents a different bit of ‘self’

That they were something far greater than just their external role and that all of ‘self’

needed caring for. The ‘On’ of ‘On Becoming’ represented a journey of discovery to that

great depth of self; a journey that may last a lifetime.

The logo was chosen to be simple and strong representing a road to becoming.

Analysis of Marketing Strategy

Cohort Numbers

Cohort 1 accepted 13 Physician Associates. 2 of these did not continue onto the

programme. 11 participants completed cohort 1 programme. The two that did not progress

did so because of service need at their place of employment. One of these has subsequently

been accepted onto cohort 3.

Cohort 2 dates have been used to pilot On Becoming for members of the Foundation

Representative forum. These are Foundation Doctors who represent each Acute Trust in the

North West. There are 14 doctors on this cohort. 4 additional delegates did not progress to

the programme. Reasons given were due to service pressures at their employing Acute Trust

and/or they lacked professional leave.

Cohort 3 has been marketed to Physician Associates graduated and working in the North

West region. This cohort has 24 participants enrolled all of whom are PAs.

28

Cohort 4/5 dates are undergoing recruitment at present and offer an opportunity for a

further 48 Physician Associates to develop empowerment under this model.

Discussion

There was a lower than expected uptake on the first cohort of On Becoming. The reasoning

for this may include

1. Project Support Officer in post December 2018 with an application submission deadline of 31st January 2019

2. Short marketing period of 2 months (December and January) 3. No contextual previous knowledge of On Becoming programme before Dec 2018 4. North West PA Social Media Sites for advertising not live until January 2019, uptake

onto these sites build from Late January 2019 (so post submission deadline) 5. Those eligible for this development were taking national exams and so focus was not

on application to this. 6. The North PA forum website www.northpafourm.co.uk was not live until February

2019 so was not used in the marketing went live at the beginning of February 2019 7. Applicants require three activities to completed; the application form, a reflection

and a Memorandum of Understanding (MOU). The MOU requires organisational sponsorship and provision of a reference.

Other themes found in the Marketing Process

MOU as rate limiting step

MOU appears to be a rate limiting step for submission of applications to the On Becoming

programme and once submitted supports attendance and completion of the programme.

Organisational sponsorship was generally felt tricky for PAs to complete given their newness

to the system, early relationship with employing Trust. Other reason given included ‘winter

pressures so paperwork not completed’ ‘leave or sickness absence from sponsors’.

‘I have been chasing my clinical supervisor for the past week to complete the reference

and he has promised to do this, but I suspect he has being too busy to get to it.’(Application 2)

Desire for this programme reaches beyond the North West region

‘I have noticed a few spaces for physician associates have become available for this

programme. Is it ok to have more information regarding this event?’ (NHS Sandwell and West

Birmingham CCG)

‘This sounds a fantastic program.

I have graduated in the South East and very keen to hear more.’(South East, employer unspecified)

29

Recommendations from participants

Word of mouth recommendations from the delegates themselves are useful, and arguably

the best, for marketing:

‘I would recommend this course to PAs who've worked for about a year as it can be the

confidence boost you need. It facilitates discussion to allow yourself to develop in a

changing environment and reflect on other PA's experiences’ (Feedback 10)

‘………..today I was speaking to one of my colleagues … and she mentioned there might

still be places available for the next starting date of this course. I’m wondering if this is

the case and if I can apply?’ (Query 7)

Learning Achieved

Having reviewed the marketing strategy and update for this programme the following

learning has been achieved and will be employed for future marketing;

1) The timing of cohort 1 in the annual cycle was too early. This cohort needs to start in June to allow graduating PAs to settle into the employment

2) All cohort dates need to be advertise at the same time, ideally a minimum of 6 month in advance.

3) Update flyers and social media triggers with quotes of recommendation from current delegates.

4) Make the requirement and process of MoU clearer for applicants. 5) Use forum representatives to take with a short summary presentation about the

programme to the second years at the HEIs to advocate them to come on the programme

30

Introduction

Financial Analysis

The following is a summary of the cost of running the programme based upon the submitted

trainer quotes and including estimated costs of venues, accommodation and travel using

favoured locations and routes; this control cohort will then be compared the actual costs

incurred thus far in the running of the initial cohort of participants given the reduced

number of participants.

It must be noted that the estimated control costs are based upon there being a full cohort of

24 participants plus 2 trainers (26 in total).

Venues, accommodation and travel considerations

The choice of venues is based upon a combination of location and cost. For the control

cohort Liverpool and Manchester have been chosen due to their ease of access for those

participants not located within the area.

Venue 1, theStudio, is based in central Manchester and is in the mid-price range. Venue 2,

the Gateway Conference Centre, is located in Liverpool and has a lower price for NHS

sponsored events.. In addition to the cost consideration both venues have easy of access to

public transport. Thus the venues used for this programme are:

Control cohort Cohort 1

Module Venue Venue

1 theStudio theStudio

2 Gateway Conference Centre Halton Trust

3 theStudio Gateway Conference Centre

4 Gateway Conference Centre Salford Royal NHS Foundation Trust

Accommodation and travel follow the same considerations regarding location and cos. . The

accommodation of choice is a Travelodge located near to the venue which offers the

reduced ‘government’ rate.

A breakdown of each of the costs following can be found in the Appendix G.

31

Costs

Unique set costs

Though the remainder of this document will focus on costs per cohort there are some one-

off set costs to take into consideration at the outset and removed from the overall budget.

To actually put the programme into action it needs to have a lead and have administration

support. These are costed per annum at:

Lead £24,000.00

Band 4 administrator £20,150.00

Total £44,150.00

Designing the programme takes time and has been allotted 7 days, both for initial design

and time put aside for individual module design. The design of the programme has been

done by a team of behavioural psychologists, performance and healthcare coaches in

collaboration with the programme lead, project support office, asset based healthcare

research experts from Leeds university (Sarah Frost) and representatives from medical

education and the physician Associate forum. Notes from the design meeting can be found

in Appendix x Some of the design group needed quoted at £1500+VAT per day.. This is a one

off cost and is not needed for future cohorts.

Design days Cost per day Total VAT Total for both designers

7 £1,500.00 £10,500.00 £12,600.00 £25,200.00

Trainer fees

Each cohort runs over 4 modules; modules 1 and 3 are both 2 days in length and modules 2

and 4 area single day. In addition to these teaching days there is also an additional day set

aside where the trainers hold a series one hour long ‘interviews’ with the candidates. Each

of these days, 7 in total, is quoted as £1500+VAT per day per trainer per cohort. These are

reoccurring costs for each cohort.

Cohort days Cost per day Total VAT Total for both speakers

7 £1,500.00 £10,500.00 £12,600.00 £25,200.00

32

Venue costs

Context of the On Becoming programme is as important as the content of the programme.

The venues of choice may not be available. This introduces a variable, as can be seen below,

in the comparison between the control cohort and cohort 1. Venues are paid for on a cost

per delegate rating which have a minimum number required.

The reason as to why a delegate rating is preferred in these venues is simply that you get

more. Many venues charge an additional cost for such things as flip charts, stationary, etc.

(if they actually supply them) all of which are included in the delegate rate; the delegate

rate also includes lunch as well as welcoming and break refreshments, so as a whole it

works out cheaper.. NHS Trusts usually charge less for the venue, though food and

refreshments need to be ordered separately and stationary is an additional cost to take into

account if needed; module 4 for cohort 1 is held at Salford Royal NHS Foundation Trust,

where there is no charge for the room but a charge for all food and drink provided.

Modules have differing requirements. For example, in the control cohort both module 1 and

3 are located at theStudio in Manchester. But module 1 requires an additional room booking

for the afternoon of the second day incurring an additional cost to the module.

Travel

In most cases an off-peak return is used; Train travel from the required station to the course

location. A summary of costs from expected to real time is shown below;

Fig. 9 Venue cost

Fig. 10 Travel cost

33

Accommodation

Accommodation costs are based on best available (location, offering government rate,

availability) A summary of the actual costs of accommodation in comparison to expected

costs is shown below;

.

Overall module cost

Putting the figures together gives overall costs of:

On comparison it appears that the actual cohort taking place is set to come in under the

estimated costs. But if we break it down further to a per participant cost:

We now see that cost per participant is approximately twice that of the control cohort. This

is due to the number of participants on the first cohort. Return on Investment for each

Fig.11 Accommodation cost

Fig.12 Overall cost

Fig. 13 Individual cost

34

cohort will be maximised when cohorts are full (24 participants) At maximum efficiency

without set-up and leadership/ administration costs the cost to run this programme per

delegate is between (£1473.03 and £1332.52).

With that in mind was there justification to run a cohort with less than maximum numbers?

The minimum number required to run a cohort is 10, and it should be noted that prior to

the start of the cohort there were several more candidates who had to drop out at a late

stage; in addition to these factors it should be taken into account that this is the very first

cohort of the programme and should be looked at as a pilot of the scheme. Reduced

numbers therefore allow for a more focused approach upon examining the impact the

programme has upon patient care as well as patient and staff development, so in this

instance there is a strong argument in support of the reduced numbers.

The true benefits of the On Becoming programme will be seen after the cohort has been

completed and the participants have had an opportunity to practice and use the

knowledge, skills and attributes from the programme. . Only then will we be able to see

what impact the programme has had on the participants, their work places and their

patients. We have no doubt that the North West National Health Service users NHS benefit

from this programme.

Improvement needed going forward

The On Becoming programme is a ‘proof of concept’ for what may be of benefit the

healthcare workers in the current climate of the NHS with the requirements of the long

term NHS plan(7). This interim evaluation document is the start of the early outputs from the

programme. This early analysis looks favourable for the programme.

An end of programme reflection is illustrated here;

‘Pioneering a much-needed profession makes me powerful. I am in a strong position to

influence the direction of the PA profession, both at a local and national level.’(ppct 8)

Consideration of further adaptation of roll out of this programme has been done using the

domains seen in figure 14.

35

The following recommendations are made from this report:

1. Consider scaling the On Becoming programme nationally and for other professional groups

2. For NW graduate PA consider offering 4 cohorts per year (4x24) making attendance at the programme a mandatory part of the preceptorship.

3. The first cohort on an annual cycle starts in May/June to tie in with the financial year 4. Enhance marketing strategy for future cohorts 5. Use a single venue where possible to deliver all modules for a cohort 6. Further analysis is needed of data from future cohorts including comparing and

contrasting the themes seen in the return of data between the Foundation Doctor (FY)s, Physician Associates (PAs) and combined groups of PAs/FYs

7. If expanded throughout the North then run the modules in areas centrally based and easily accessible to the zone, i.e. York for Yorkshire and Humber

Close

The introduction of physician associates into the NHS workforce has met with some

resistance; whether this is from a lack of perceived clarity of their role or from not

understanding the positions that PAs have within the medical model does not matter yet

the PAs are the ones who have to confront these views from various levels of seniority. By

providing them with the tools to feel able to challenge these views and describe their role in

its supportive capacity, that PAs are there to help not replace, the participants of the On

Becoming can act as strong advocates for this role. By learning how to listen to these fears

they can help to allay them. And if they can ease one person’s concerns then that person

may then go on to another and explain physician associates in a positive light.

On Becoming

Programme adaptability

Of benefit to the service

Of benefit to patients

Improve workforce resilience

Fig. 14 Considerations on roll out

36

And we can also see in some of the feedback above that changes are being brought about

within Trusts which employ these participants. Whilst these are on a micro scale, within

single departments, it shows that if enabled with the knowledge of how to use right tools

then they can bring about change; they already have the right tools and the On Becoming

programme is the means to show them how to open the box and use them. And from there

it is a small step to see how the models incorporated within the programme can be adapted

to enhance other services, as is illustrated by its adaption to support junior doctors.

37

Appendices

Appendix A: Influencing styles questionnaire

38

39

40

41

42

Appendix B: Evaluation framework

Reaction - Participants engage with and enjoy the training.

Number of applications

Qualitative analysis of post module 1 and module 4 video feedback

Analysis of spontaneous qualitative comments social media recommendations of the programme by delegates on the programme

Qualitative analysis of post module feedback by facilitators

Qualitative analysis of spontaneous email traffic from delegates to faculty

Learning - Participants learn what is being taught / programme taught what was expected

Qualitative analysis of Journal entries against curriculum objectives

Achievement of EMCC accreditation

Qualitative analysis of Learning Journal mapped to EMCC coaching and mentoring competencies

Analysis of reflections submitted at the start of the programme and the end of the programme.

Feedback from each praxis group, feedback after each module

Analysis of any change in design of course

Organisational Support - Trainees are supported by their colleagues, managers, and organisational policies to use the learning in practice.

Qualitative analysis of learning journals

Qualitative analysis of reference of sponsor

Praxis groups - analysis of attendance, QI projects started

Analysis of PA preceptorship return/ time for consultations

Attendance at PA forum

Behavioural Change - Participants put what they learnt into practice.

Qualitative analysis of post module 4 video feedback

Qualitative analysis of learning journal

Design process shows change from feedback of delegates

Qualitative analysis of end of programme written reflection, submission of self-feedback from review of start of programme submitted video

43

Results a) Participants’ behaviour has an effect on organisational aims leading to more effective and efficient systems. b) Patients take greater responsibility in identifying and implementing changes they need to make to improve their health and well-being.

Qualitative analysis of post module 4 feedback

Analysis of praxis group learning

Quantitative analysis of number of mentor relationships set up from the North forum.

Qualitative survey month 3, 6 12 post programme. Number of ppts. achieving EMCC registration

Feedback from organisational sponsors

Administration analysis

Standard Operation Procedures - communication flow chat. File management.

Marketing analysis/ review

Programme Supply/ demand

quantitative analysis of numbers (enquiries, applications, admissions)

44

Sustainability of community

NW forum analysis

mentorship analysis of delegates / from delegates

Content Design and Leadership

Facilitator feedback post modules

Analysis of change of design format

Analysis of leadership time/ contribution. Via diary analysis

45

Appendix C: Example of teaching resource

How to get the best from your working style and reduce your patterns of stress

Be Perfect

Set realistic standards of performance and accuracy

Become realistic about making mistakes by imagining the best and worst possible outcomes of

making the mistake

Make a point of telling others that their mistakes are not serious, and can actually be an

important source of learning

Prioritise so that you can decide which jobs really warrant high degrees of accuracy and which

do not

Respect other people’s deadlines by planning in advance how much detail is needed, then give

the key information and stop before the other person is buried with facts and figures

If working with someone else’s ‘be perfect’, praise them for their achievements, be punctual and

keep appointments with them, and do not discount their worries.

Please Others

Ask people questions to check what they want instead of guessing, and listen carefully to what

they say

Please yourself more often and ask other people for what you want

Practise telling others firmly when they are wrong

Avoid being dumped with unrealistic requests and unimportant tasks, and say ‘no’ skilfully

To be respected by others it is important to set your own limits and priorities

Learn basic assertiveness techniques

Accept basic responsibility for yourself and allow others to be responsible for themselves

If working with someone else’s ‘please others’, praise them for who they are rather than what

they do. Confront them with patience and do not lose your temper with them

Hurry Up

Plan work in stages and set interim target dates to give satisfaction and avoid rushing to

completion

Plan sufficient time for tasks, especially the preparation stage which is likely to be skimped.

Concentrate on listening well to others until they have finished speaking and avoid interrupting

46

Consciously slow down so that others have time to absorb information

Ask others about their needs rather than making assumptions

Learn relaxation techniques

Be on time rather than fitting in ‘just one more thing’ before the next appointment

If working with someone else’s ‘hurry up’, praise them for taking time, and not for their speed or

ability to do several things at once.

Be Strong

Monitor your workload so that you do not take on too much work

Ask for help so that others have a chance to assist you. They may well have relevant knowledge,

skills or time.

Before taking on any new tasks, review the potential requirements and check that you have

access to the appropriate resources.

Learn to be aware of your own needs and to take as well as give. Your relationships with others

will probably improve when you let people help you.

Create interests for yourself out of work which you can really enjoy.

If working with someone else’s ‘be strong’, praise them for consideration because they are often

taken for granted. Be clear about instructions and don’t force them into expressions of

vulnerability.

Try Hard

Stop volunteering for every new project and find ways of planning all the stages of a task to

achieve satisfaction all the way through to completion

Check out the parameters of a task so that you only do what is expected

Try to control your boredom with the later stages of a project. Plan how you will enjoy your

success on completion of it.

Find creative ways of making mundane tasks more interesting

Notice when you use the words ‘I’ll try’ rather than ‘ I will’.

Be willing to distinguish between the things you can and cannot change

If working with someone else’s ‘try hard’, avoid getting into competition with them. Praise them

for finishing rather than for trying.

47

Appendix D: Self-evaluation questionnaire

Self-Evaluation Form

Name:

Pre-module 1

Qualities

Indicate the degree to which you feel you currently have the following qualities (1 = low; 5 = high)

Understanding self: Demonstrating your awareness of your

own values, beliefs and behaviours and recognising how these

affect your practice and using this self-awareness to manage

your effectiveness in meeting others’ needs and interests.

1 2 3 4 5

Commitment to self-development: Explores and improves

your own contributions and maintaining the reputation of the

PA profession

1 2 3 4 5

Manage needs and expectations: Establishing and maintaining

the expectations and boundaries of your professional

relationships

1 2 3 4 5

Building relationships skilfully: Building and maintaining

effective relationships 1 2 3 4 5

Enabling insight and learning: Working with others to bring

about insight and learning 1 2 3 4 5

Outcome and action orientation: Using skills to support others

to make desired changes 1 2 3 4 5

Use of models and theory: Applying models, tools, techniques

and ideas in order to bring about insight and change. 1 2 3 4 5

Evaluation: Gathering information on the effectiveness of

your own impact and contributing to establishing a culture of

evaluation of outcomes

1 2 3 4 5

Listening: Your ability to listen to others and not just hear

them 1 2 3 4 5

General review

What are my main strengths?

What did I need to do more of?

What do I need to develop/appreciate/learn?

48

Appendix E: Learning Logs

Reflective Log on Coaching Practice

EMCC Coaching Competency What this means Personal reflection on practice 1. Understanding self Demonstrates awareness of own values,

beliefs and behaviours; recognises how these affect their practice and uses this self-awareness to manage their effectiveness in meeting others’ needs and interests.

2. Commitment to self-development

Explores and improves their contribution and maintains the reputation of the PA profession.

3. Manage needs and expectations Establishes and maintains the expectations and boundaries of their professional relationships.

49

4. Building relationships skilfully Builds and maintains effective relationships.

5. Enabling insight and learning Works with others to bring about insight and learning.

6. Outcome and action orientation Uses skill to support others to make desired changes.

7. Use of models and theory Applies models, tools, techniques and ideas in order to bring about insight and change.

8. Evaluation Gathers information on the effectiveness of own impact and contributes to establishing a culture of evaluation of outcomes.

50

Learning Curriculum for Praxis Group Meetings

What I want to do or achieve How I plan to do this and what I need to learn do so

How I’ll demonstrate that I’ve done or achieved my plan to my Praxis

Group colleagues.

Example: 1. Make presentations confidently

Plan to lead at least two

presentations by the end of the Programme

Observe and learn from effective presenters

Learn: o How to use PowerPoint o Get used to presenting with

a clicker o To present information

clearly and briefly

Show colleagues feedback I’ve

received Record myself doing a presentation

and show this to the Group Volunteer to lead part of our

Closing presentation.

51

Appendix F: Self-evaluation questionnaire responses

52

53

54

Appendix G: Standard operating procedure (SOP)

1.1 In agreement with the facilitators and the programme director the dates for the cohorts are

arranged

1.2 Once dates are set the availability of favoured venues are checked, see below for the North

West; outside if the NW will need to be investigated

1.2.1 theStudio, Lever Street, Manchester

1.2.2 Ziferblat, Edge Street, Manchester

1.2.3 Gateway Conference Centre, London Road, Liverpool

1.3 Should the favoured venues not be available then other venues are to be sourced and secured.

Venues will need to meet the requirements below

1.3.1 Need to be able to fit 26 chairs in a circle with no table

1.3.2 Have access to AV/IT

1.4 In the off chance that there are no suitable venues on any of the dates put forward then an

alternative will need to be agreed. In this scenario the administrator should go back with dates

when there are suitable venues, again emphasis upon the favoured venues.

2.1 Notifications of the availability of the programme are to be sent out in the following means.

2.1.1 Update the On Becoming pages on North West Physician Associate Forum (NWPAF)

website with details.

2.1.2 Post the dates on the NWPAF social media (Twitter, Facebook, LinkedIn) with email

address for application.

2.1.3 Send details to the Primary Care and Secondary Care contacts with a request to

forward to PAs

2.2 Application requests are to be sent the application pack consisting of the application form, pre-

programme reflection form and memorandum of understanding with instructions

2.2.1 Application and reflection forms are to be sent back 2 weeks prior to the interview

date.

The organisation of the On Becoming programme (Physician Associates)

Classification: Standard Operating Procedure (SOP)

Author: Mike Bold

Revision: 1.0

Update: July 2020

Target: Members of the Forum committee

1. Initial setup

2. Pre-programme

55

2.2.2 Memorandum of understanding to be returned prior to the start of the programme

2.2.3 Queries/applications past this point are dealt with on a case by case basis

2.3 Application submissions are to be checked and acknowledged and should all details be present

the candidate is informed that a time will be arranged for a discussion with a member of the

faculty via Skype. Should details be missing this is to be chased at this point and discussion

arranged once received.

2.4 Details from the application forms are transferred onto a spread sheet, currently located upon

the support officers laptop.

2.5 Once cut off date reached discussions are scheduled and sent to faculty, along with the

reflections and application forms linked to the discussion rota.

2.6 Once confirmed with the faculty the candidates are informed of their discussion time.

3.1 Following the discussions the participants are sent the instructions on completing the video

reflection along with the pre-programme questionnaire to complete for evaluation purposes.

3.2 14 days prior to the start of module the participants are sent instructions on the venue and how

to get there. With a reminder about submitting any dietary requirements not specified in the

application form.

3.2.1 Should an applicant be accepted onto the course within this period they are sent the

above following their discussion with the faculty

3.3 7 days prior to the module travel and accommodation are arranged for the facilitators. Where

possible the accommodation should located within a short walking distance.

3. Pre-module

56

Appendix H: Financial breakdown

Venue Costs

‘Control’ cohort Cohort 1

Mod

ule Venue

Cohort

numbers

Cost per delegate

+ VAT

Total Cost

inc. VAT Venue Cohort numbers

Cost per delegate

+ VAT

Total Cost

inc. VAT

1 theStudio 24+2 £37 + Half day

room hire £275 £2,535.20

theStudio

11+2 (priced for

20 delegates)

£37 + Half day

room hire £220 £2,016.00

2

Gateway

Conference

Centre

24+2 £20.00 £616.00

Halton Trust

Education Centre 11+2

Room cost +

catering £444.00

3 theStudio 24+2 £37.00 £2,205.20

Gateway Conference

Centre 11+2 £20.00 £1,248.00

4

Gateway

Conference

Centre

24+2 £20.00 £616.00

Salford Royal NHS

Foundation Trust 20 approx. catering only £312.35

Overall cost £5,972.40

Overall cost £3,708.00

57

Travel Costs

‘Control’ cohort Cohort 1

Module 1 £55.15

Module 1 £55.15

Module 2 £50.55

Module 2 £105.30

Module 3 £55.15

Module 3 £51.55

Module 4 £50.55

Module 4 £55.15

Overall cost £211.40

Overall cost £267.15

‘Control’ cohort Cohort 1

Cost per cohort £31,980.80

Total Cost £30,189.00

Cost per delegate £1,332.53

Cost per participant £2,744.45

Accommodation Costs

‘Control’ cohort Cohort 1

Nights Rooms Total

Nights Rooms Total

Module 1 2 2 £213.00

Module 1 2 2 £213.00

Module 2 1 2 £85.50

Module 2 1 NA £0.00

Module 3 2 2 £213.00

Module 3 2 1 £382.00

Module 4 1 2 £85.50

Module 4 1 2 £180

Overall cost £597.00

Overall cost £701.50

58

References

1. Ballatt J, Campling P; 2015; Intelligent Kindness; Reforming the Culture of Healthcare RC PSYCH Publications Pg 15

2. Department of Health (2009) The NHS Constitution of England; The NHS Belongs to us all HMSO

3. https://emccuk.org/Public/Resources/Competence_Framework/Public/1Resources/Compet

ence_Framework.aspx?hkey=ad98bd86-8bb8-4435-913d-5258f6774375 (Accessed 12th June

2018)

4. www.leadershipacademy.nhs.uk/wp-content/uploads/2012/11/NHSLeadership-Leadership-

Framework-Medical-Leadership-Competency-Framework-3rd-ed.pdf (Accessed 20th July

2018)

5. http://www.skillsforhealth.org.uk/images/pdf/Person-Centred-Approaces-Framework.pdf

(Accessed 21st September 2018)

6. https://tguskey.com/wp-content/uploads/Professional-Learning-1-Gauge-Impact-with-Five-

Levels-of-Data.pdf

7. https://www.longtermplan.nhs.uk/