This case study relates to the Primecare Health redesign project. Please see that page for more information.
The opportunity
As part of the Primecare redesign there was a sub-group that focussed on training and had representation from frontline staff, trainers, a team leader and input from Scottish Care and Alzheimer Scotland. The opportunity was to develop a programme of training which was more focussed on dementia and supporting staff to work in a more outcomes-focussed way.
Primecare was experiencing key challenges in training
- Capacity: trainers were responsible for more than the design and delivery of training, and were carrying an unsustainable workload which included all supervision and substantial support to coordinators
- Engagement: staff were disengaged from training and would often fail to attend mandatory training top-ups
- Time and contact: at the beginning of the project, the induction training was delivered over the course of two days with limited opportunities to check in formally
- Classroom learning vs. experiential learning: trainers wanted to focus more on learning on the job rather than theoretical learning, as they believed that learning from working with actual people was much more beneficial
Primecare understood that in order to deliver a dementia specialist service, they had to embed more dementia training into their training programme. They also understood that the reasons for staff’s failure to engage needed to be addressed.
The change
The group was able to explore why staff were not engaging with training including:
- Lack of progression opportunities for staff who have been there a while
- Perception of lack of opportunities
- Perception of lack of reward
- Staff wanting to work as much as possible with people, rather than spending time in the office
The group also supported the introduction of the Framework for Excellence [link] and made key additions to their training programme:
- When new staff are interviewed, they are asked to complete at-home modules and group DVD informed-level training before beginning their induction. This means that all staff begin their work with an awareness of dementia.
- A three day induction programme which was able to focus more on dementia, and incorporate learning about dementia in other training (i.e. administration of medication, vulnerable adults training).
- Supporting all existing staff to work through the informed level training.
The group also began to build structures which they hoped would support ongoing training and change the culture around training including:
- Introducing local team meetings to reflect on learning and practice
- Support and supervision with all staff to identify learning opportunities and to build on learning on the job
- Developing personal development plans for all staff to be part of the ongoing supervision and appraisal process and to understand the training levels across the agency
- Exploring mentoring roles for long standing staff to support new staff in their learning and development
The outcomes
Although the group did not design a whole new training programme, they were able to really spend time understanding why staff weren’t engaging with training. The group felt that they achieved:
- A better understanding of why staff feel undervalued
- An approach to training and development which can be tested and refined over time
- Access to a structured framework which they can use to build a more robust dementia programme
- An understanding of the gaps in training and knowledge, particularly surrounding dementia
- The parallel work supporting staff through supervision has had an impact on engagement and trainers feel that staff are more willing to take ownership of their own learning
- The development of a mentors programme for more experienced carers to support new staff through observations, 1–1 time and supporting their learning; however, the group is still in the process of thinking about how to finance and incentivise this
- The introduction of a Personal Development Plan which is being trialled with new staff
There were several ongoing challenges through the course of the project:
- Trainers felt that they were under extreme pressure from the Care Inspectorate to have advanced training in so many areas and struggled to prioritise.
- Trainers had responsibilities that spanned far beyond training and development; at the time of the project they were responsible for observation, supervision and often covered shifts when they were understaffed.
- On reflection, the training group felt that they had needed much more facilitation and management to make process. They also reflected that there should have been more interaction between the working group and the training sub-group.
Take a look
Dementia: Promoting Excellence on NHS Education Scotland's Knowledge Network.