Leading change

The Deputy Head of Midwifery at Sheffield Teaching Hospital NHS Foundation Trust led the development and implementation of a new approach to mandatory training, preceptorship and appraisals across the Trust. The developed programme has led to improved outcomes and experiences by successfully supporting staff in their role.

Where to look

The Jessop Wing Maternity Unit is a purpose built maternity unit within Sheffield Teaching Hospital NHS Foundation Trust. Registered Nurses and Midwives are expected as part of their registration with the Nursing and Midwifery Council to maintain their skills and to work within their competence ensuring public protection is upheld always (NMC, 2018). In order to achieve this continued professional development, supervision and personal development appraisals as well as preceptorship are important parts of daily practice (Health Education England, 2016). The evidence base highlights that midwives value the opportunity to reflect on their practice and refresh their professional knowledge (Finch et al., 2017).

The Deputy Head of Midwifery identified from routine Trust data that the services weren’t meeting the Trust requirement of 90% attendance at mandatory training and 90% appraisal rate. Discussions with staff highlighted that, at times, traditional methods in providing mandatory training and appraisals conflicted with the clinical needs of the unit. This led to delays, as well as having an impact on the time available for effective reflection. The nursing team identified the need to address this unwarranted variation, to explore ways of ensuring staff were getting the education and skills training they needed to keep up to date with contemporary practice.

What to change

The Deputy Head of Midwifery and the nursing leadership team used audit data as well as formal and informal feedback from across the Trust to establish the areas of training and appraisal that warranted review and redesign. This included the following key areas:

• Mandatory training: In addition to not meeting the Trust target of 90%, some staff were also finding that the training was not delivered in the most effective manner. Some found PowerPoint slides difficult to engage with and tiring to watch for a whole day at a time;
• Appraisal and preceptorship: Trust data indicated that appraisal rates were in the region of 70% for all staff employed within the service. These would be led by the manager on the ward where the new starter completed their first year. Current practice within the maternity unit was that newly qualified midwives began working and rotating every four months between all clinical areas, to familiarize with the areas and consolidate their learning. However, as they rotated between clinical areas and managers, there was little time to reflect on their successes and to plan ongoing focus and development. Despite a comprehensive induction programme and preceptorship package, feedback demonstrated that staff felt there was scope for improvement in the support offered.

The midwifery team saw an opportunity to standardise annual appraisal processes, to ensure all information is available to appraisers. This had notably been problematic if staff had rotated across different clinical environments in the organization. The streamlining could support effective communication of staff development and ongoing needs. This would enhance planning for the subsequent appraisal period.

How to change

The Deputy Head of Midwifery led the development of a bespoke pathway, focused on the needs of individual midwives. This was implemented through the Listening into Action (LIA) process, which provides a structured approach to staff engagement and practice change. Members of the Trust’s central team and a multi-professional group of stakeholders met on a weekly basis for 20 weeks. Prior to the implementation, a baseline audit called the ‘The Big Conversation’ was undertaken, with suggestions gathered from staff, to be subsequently included in the revised training pathway.

Regular appraisal and a structured reflection process has been developed to support a smooth transition, supporting a new generation of midwives to be become resilient and motivated partners in their professional growth. This includes:

• Protected time for appraisal;
• Support with revalidation;
• A chance to progress and develop;
• Access to external courses;
• Post appraisal follow-up.

Mandatory training has been further developed and streamlined. It became scenario based and delivered over two rather than three days. A matrix of the learning needs of staff has been developed and through the development of a range of clinically relevant scenarios, it was ensured that all learning needs were covered. For example, a caesarean section scenario could cover learning about multi-professional working, documentation, infection control, mother-infant relationship building, feeding and skin to skin.

The two processes have been aligned to support simultaneous running of the appraisal and mandatory training, to support effective management and oversight as well as supporting protected time. Working closely with the corporate teams, as well as the rest of the multi-disciplinary team, the programme has been successfully rolled across the organisation. Key stakeholders understood the programme aimed to ensure that staff should get timely feedback about their work and contribution to the organisation.

Adding value

Better outcomes – Appraisal and mandatory training rates are now at 90%, having increased from 70% before the programme. As this new approach is further embedded, it is anticipated that this will continue to improve as the Trust embraces the support offer. By reducing the mandatory training days from three to two, the Trust released 265 shifts back into clinical practice to continue to provide effective care for patients and their families. Staff are available to support the clinical care and each other.

Better experience – This improvement has been reflected in feedback through the staff survey:

• ‘Overall really good. Well organised day’;
• ‘Good revamped course’;
• ‘Much improved – more interaction’;
• ‘Succinct content so all seems relevant’;
• ‘Friendly atmosphere. Good training and career advancement opportunities’;

Better use of resources – The reduction in days for mandatory training and overall streamlining of processes has freed staff time to support clinical practice, as well as carry out appraisals and preceptorship for other staff members. The evidence from the first year of the programme suggests it is a sustainable and effective way to support and educate staff. Now in its second year, the Trust are continuing to meet targets for mandatory training and staff appraisals whilst maintaining positive feedback from staff. The programme will be further evaluated for impact as it develops.

Challenges and lessons learnt for implementation

It can be a challenge to align midwives’ appraisals with the mandatory training over the year. However, by using a digital e-roster, disruption has been minimised.

The support of the matrons was key in supporting appraisals to be done before the mandatory training sessions.

Involving the whole team and stakeholders – making sure that everyone understands the importance of the goal in mind – is vital to success and needs to be looked at early in a programme.

For more information contact

Marie Reid – Deputy Nursing Director and Deputy Head of Midwifery,
Sheffield Teaching Hospital NHS Foundation Trust
Marie.reid@sth.nhs.uk