Health care professionals have a vital role to play in the design and delivery of a modern NHS. Unless they are actively involved in the planning and managing of health services these services will never meet the needs of users, no matter how much additional resource is found.

And yet HCPs are often ineffective designers of services because there are certain key areas in which they lack knowledge and skills and in which their behaviours are not always helpful. If these key areas are addressed then HCPs become more personally effective; they are able to devise organisational solutions to address the persistent and seemingly intractable problems they face; and they are able to argue effectively and cooperatively about resources.

Really Learning believes there are three major reasons why HCPs do not act effectively when it comes to designing and developing services. First, they do not have skills in (nor the tools for) the diagnosis and treatment of services as they do for individual clients. Thus the rigour that is applied to analysing a clinical case is not applied to the analysis of interpersonal and organisational situations nor to the development of coherent approaches to them.

Second, they are unaware of the ways in which they (implicitly) appraise evidence and reach decisions. This is true even in the directly clinical arena and even more so for decisions about service development. This leads to assumptions about best ways of providing services, which are dearly fought for and which are often rooted in personal experience rather than a consideration of evidence.

Third, sociologists have documented a ‘vocabulary of complaint’ among HCPs, and Really Learning believes that unless mindsets of self-righteousness and blame are challenged then HCPs will continue to be unable to deliver effective modern health care. These mindsets are a result of many factors, one of which is certainly the pressure on resources over a sustained period. There are other factors however which include the educational and socialisation processes of the professions themselves, and the perpetuation of inappropriate behaviours within and between professions.

Current training systems are inherently incapable of dealing with these causes

The NHS funds considerable amounts of education and training, and large numbers of modernisation initiatives, and yet these are not tackling the three fundamental problems outlined above. There are a number of reasons for this.

Being done to

Many modernisation initiatives involve inviting good people to work with the centre in developing guidance on best practice. Not surprisingly local professionals resent the guidelines that result, and do not engage with them with the enthusiasm that could have been available, had they been enabled to develop them for themselves.

Similarly many of the facilitated modernisation initiatives require participants to go through a prescribed process, akin to the programmes sold by management consultancies. They are rarely introduced to the underpinning theory and encouraged to develop local ways of applying this theory for themselves.

Gatekeepers

We can consider the skills needed for effective health care to fall into four categories:

• clinical/technical
• interpersonal/behavioural
• managerial
• research/ evaluative.

 Many of the gatekeepers to education and training have great expertise in the clinical/ technical and in some forms of research. Observers have noted that these are often considered to be of higher status than are the other areas of expertise. HCPs are therefore encouraged into further training in these areas at the expense of the others.

Gatekeepers are also often from the same profession as the HCPs they are guiding, and are working within the same mindset. The need for, and benefit of, HCPs taking a responsibility for interpersonal, service and organisational dilemmas is often not perceived by these gatekeepers who therefore do not promote learning in these areas. With the aggregation of training budgets into the Consortia and other specialist commissioners of education and training, the potential for the gatekeeper to inhibit learning in these areas is becoming greater and greater.

Lifelong learning

Life long learning with its emphasis on reflective practice has the potential to be influential, however there is considerable danger that the reflection will be undertaken in the spirit of self-righteousness described above and that the ‘lessons’ learned will perpetuate the current culture.

Academic providers

Many HCPs undertake demanding post-graduate courses in order to develop their careers and their services. When they do so they are often open to change, to new ideas and ways of thinking, and to approaching life differently. The individuals providing these courses are, however, often members of the same professional group as their students and are not specialists in delivering or commissioning quality programmes exploring organisational and management concepts. Even when they recognise the need there are few good teaching materials available to support them.

Training departments

There are training and development departments in many health care organisations whose members do recognise the need for learning in these areas, however they are often not able to engage with senior clinical staff. Frequently they are organisationally fairly junior, and they too, do not have access to high quality learning materials with examples and case studies that are relevant to the clinicians.

Time for training

Traditional training opportunities usually require staff to find sessions of prime time to devote to them, a day or half day for example. Yet this separation of learning from the workplace is often not educationally justified, and is a barrier to individuals participating. Many HCPs have shorter periods of time available during a day, which could be used for learning, and if the learner could address issues of concern to him/her personally and at a time of his/her choosing then participation in learning (especially about interpersonal and service issues) would almost certainly increase.

Costs of training

Programmes run by academic institutions must cover the full cost of the organisational infrastructure, much of which is geared to undergraduates. Thus HCPs attending university courses must finance library, residential and other resources which they do not need. Fees for good programmes are often beyond the means of the individual and of small training budgets available to departments.

Really Learning aims to overcome these inhibitors by:

• making learning opportunities directly accessible to frontline HCPs without any need for gatekeepers
• supporting developers, educators and lifelong learning facilitators, by providing high quality teaching materials (for all academic levels), programme design and bespoke assistance
• offering learning opportunities that can be undertaken in time fragments which are convenient for the learner
• keeping prices low
• addressing issues of real concern to real people
• ensuring that behavioural elements are addressed at the same time as analytical concepts
• combining learning-from-theory with learning-from-experience
   

For more information on Really Learning services click here or contact us at info@reallylearning.com

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