Promoting Quality in the Healthcare Built Environment

National Learning and Development Strategy for the Specialist Healthcare Built Environment Workforce (2021-2026)

Background and introduction

In response to high profile issues and incidents related to the built environment of new hospitals, the Scottish Government commissioned National Services Scotland (NSS) to: “create a new national body to strengthen infection prevention and control (IPC) in the design, construction and maintenance of major infrastructure developments within the NHS and play a crucial policy and guidance role regarding incidents and outbreaks across health and social care” (Scottish Government, 2019).

Consequently, NSS has designed and developed NHS Scotland Assure to improve the management of risk across NHS Scotland (NSS, 2020). NHS Scotland Assure becomes operational on 1st June 2021.

During the development phase of NHS Scotland Assure an Interim Review Service was set up to operate between April 2020-April 2021 (Year 0) and provide assurance to Scottish Government that specified new build projects and refurbishments were being delivered according to guidance, were fit for purpose and free from avoidable risk of harm.

NHS Scotland Assure will be the Quality Management System for the Healthcare Built Environment across NHS Scotland. It aims to establish an interdisciplinary and inclusive approach between built environment professionals, IPC specialists, clinicians, executive and non-executive health board members and include multiple professional groups, organisations and agencies. The HBE workforce is complex and includes both internal staff employed by NHS Scotland and external contractors.

It is anticipated that services will be delivered across Scotland at national, regional and local levels encompassing the entire life cycle of a build, from strategic assessment through planning, construction, completion, maintenance and decommissioning.

This ambitious approach will enable Subject Matter Experts in both clinical and technical disciplines to collaborate throughout each stage of the development of a healthcare facility to ultimately deliver safe environments that are free from avoidable risk. It will ensure that patients, their carers and those delivering healthcare are in an environment which is not only safe but also effective and person centred. The intention is for NHS Scotland Assure to improve the management of risk and patient safety across the health and care systems in Scotland, with the initial focus being the acute care sector.

Workforce education and development

Workforce education and development is a key element in developing an interdisciplinary and integrated workforce with the knowledge and skills to improve safety. NHS Education for Scotland (NES) have therefore been commissioned to produce an initial five-year National Learning and Development Strategy for the Specialist HBE Workforce (2021-2026). In this context the term ‘specialist’ relates to the workforce who are specifically involved in HBE projects or workstreams rather than those who are regarded as specialists in their own field.

The strategy has been informed by the Independent Review of the Queen Elizabeth University Hospital (Scottish Government, 2020) and the reviews of NHS Lothian, Royal Hospital for Children and Young People and Department of Clinical Neurosciences (Scottish Government 2019a; 2019b). The strategy will also be informed by the ongoing IPC workforce review being undertaken by Scottish Government. NES will work in partnership with NHS Scotland Assure to provide strategic leadership and coordination of specialist workforce education and development for the HBE to support the emergent service.

It is recognised that there may be extant or emerging education and development strategies for different professional groups e.g. Antimicrobial Resistance and Healthcare Associated Infection and Health Facilities Scotland. This strategy is intended to complement these strategies avoiding duplication and enabling sharing.

Purpose

To produce a progressive, cohesive and integrated approach to workforce education and development that promotes a culture of continuous learning and quality improvement. This national learning and development strategy for the specialist HBE workforce aligns with the overarching NSS/NHS Scotland Assure, Target Operating Model and NHS Scotland Values and demonstrates commitment and contribution to achieving these ambitions.

Vision

A knowledgeable, adaptable and confident interdisciplinary workforce with the skills and capabilities to prevent infection and other risks and improve safety in the Healthcare Built Environment.

Strategic intent

The strategy aims to facilitate the creation and development of an organisational culture of patient safety, quality improvement and continuous learning while ensuring the availability of high-quality learning resources, opportunities and pathways, that can be equitably and easily accessed by the specialist HBE workforce. Education and continuous learning will be crucial in facilitating the development of an interdisciplinary and integrated workforce with the knowledge, skills, capability and confidence to deliver and improve safety in the HBE.

Organisational roles and responsibilities

NHS Education for Scotland

NHS Education for Scotland (NES) is an education and training body and a national health board within NHS Scotland. NES is responsible for developing and delivering healthcare education and training for the NHS, health and social care sector and other public bodies. The organisation has a Scotland-wide role in undergraduate, postgraduate and continuing professional development including for non-clinical staff such as those in estates and facilities roles https://www.nes.scot.nhs.uk/about-us/what-we-do/ The Estates and Facilities Education Steering Group is already involved in education and development for the HBE.

NES cooperates and collaborates with regulatory bodies and other organisations involved with the development of the health and care workforce e.g. the General Medical Council, universities and other professional bodies. NES has well established networks and partnership arrangements with Health Boards, universities and other education and training organisations across Scotland. The organisation has recently embarked on a national joint venture with the Golden Jubilee National Hospital to develop the NHS Scotland Academy which will offer value added accelerated training for a wide range of subjects and professions. Discussion and collaboration with the NHS Scotland Academy is anticipated in the implementation of this strategy.

NES will work with NHS Scotland Assure and other key stakeholders to:

• promote a culture of life-long learning, continuous improvement and improved patient safety
• identify education and training needs across the specialist HBE workforce
• agree, prioritise and develop learning resources and opportunities
• monitor, evaluate and revise educational outputs.

NHS Scotland Assure

NHS Scotland Assure is a new service, that becomes operational in June 2021 as part of National Services Scotland with the responsibility to improve the quality of the NHS Scotland HBE. It is aligned to Scottish Government’s strategic framework and national outcomes. The service will have oversight of the design, construction, and maintenance of major infrastructure developments within NHS Scotland. It is designed to ensure an integrated ‘Once for Scotland’ approach to quality improvement and management of the HBE assuring compliance with best available evidence in all aspects of safety. NHS Scotland Assure will also ensure the HBE is fit for purpose, cost effective and capable of delivering sustainable services in the long term.

Relationships and connections

Who is involved?

The workforce involved in the HBE is wide ranging and diverse with different professional and workplace backgrounds, experiences, education and depth of knowledge. NHS Scotland Assure will bring together experts sharing and providing crucial guidance to minimise the prevention of infection and other risks in new builds and major refurbishment projects across NHS Scotland. Strong relationships and connections will need to be forged between the different professions and organisations to develop a cohesive approach and improve safety. NHS Scotland Assure plans to build robust relationships cross NHS Scotland to create a unique interdisciplinary team approach involving all relevant stakeholder groups to encourage innovation and embed integrated solutions. It will enable estates professionals and clinical colleagues to work in an integrated way.

NHS Scotland Assure will work closely with NHS Boards to deliver its services and will have joint accountability with NHS Boards for sign-off of key project stages. The service will also work with Healthcare Improvement Scotland to further develop and implement inspection methodology. NHS Scotland Assure will operate in an advisory, assurance and compliance capacity.

Collectively, the extensive and complex range of people that comprise the specialist HBE workforce is being brought together as one workforce for the first time. Many will be experts in their own field but may have little awareness or knowledge in other fields.

For instance, NHS Boards and contractors have different, essential skill sets. Not everyone can be, or would want to be an expert in all areas but it is crucial that everyone working in the HBE has an understanding of the roles and remit of others, an understanding of IPC risks and patient safety considerations and when they need to consult with colleagues who are experts in other fields.

A common language will need to be developed and learning and development needs will need to be explored and understood. The approach taken to learning and development will, therefore, be dynamic and iterative to ensure a HBE workforce that is adaptable and has the required skills, knowledge, capabilities and confidence to provide a safe environment by reducing infection and other risks and preventing harm.

Areas of focus

Over the five-year life of this strategy (2021-2026), circumstances will inevitably change as will learning and development needs. New evidence will become available with new insights and learning being gained over time. Progress in meeting the timescales for the Year 0 objectives has already been slower than anticipated due to the impact of Covid-19. New insights have already been gained from the publication of the Independent Review of the Queen Elizabeth University: Review Report (Scottish Government, 2020) and the two reviews of NHS Lothian Royal Hospital for Children and Young People and the Department of Neurosciences (Scottish Government 2019a & 2019b). Further ongoing public inquiries, research and new guidance are also likely to have an impact on the currency of the learning and development strategy. The ongoing IPC workforce review being undertaken by the Scottish Government will also have implications. The strategy will, therefore, be dynamic and agile to allow any additional learning and development priorities to be incorporated timeously.

The strategy has three key areas of focus for 2021-26:

1. Partnership and collaboration
2. Education and training for a knowledgeable skilled, capable and adaptable workforce
3. A highly effective and robust learning infrastructure/environment

These key areas encompass the identified priorities of: water, drainage, ventilation, fire safety, electrical safety and medical gases with their associated IPC considerations. The initial focus of the strategy is the acute sector.

1. Partnership and collaboration

Partnership working supports NHS Scotland Values and requires a culture of mutual respect, openness, honesty and trust. Commitment to developing new connections and strong partnership relationships which demonstrate these attributes will be essential in working with such a wide ranging and diverse workforce with different professional and workplace backgrounds, experiences, education and depth of knowledge. Partnership and collaboration will be particularly important for development of learning and development opportunities for external contractors.

The different professional groups will all have established education and training routes with associated education providers. Links will need to be made and collaborative relationships established. Partnership and collaboration will also be important in connecting national systems to local ones, accessing relevant expertise and collaborating across the whole system. NHS Scotland Assure has been designed using the Scottish Approach to Service Design methodology with a focus on user involvement. It has committed to developing robust and effective communication channels to continuously consult and engage with key stakeholders in all aspects of the service including learning and development.

The organisation is also committed to facilitating a culture of collaborative working using a continuous cycle of learning and improvement (e.g. training events, case studies, sharing lessons learned, quality improvement) to make it easy for people to do the right thing and know what is the right thing to do.

Partnership and collaboration are embedded into NES ways of working. Involving key stakeholders in educational advisory and development groups is part of educational governance processes and the organisation has well established partnership arrangements with NHS Boards and education providers. New connections and partnerships with organisations and education and training providers will, however, need to be established and existing ones strengthened. NES will engage with NHS Scotland Assure communication channels and endeavour to involve the right people, at the right time in educational advisory and development groups for all education and training. Engagement and involvement will be key to ensuring the understanding of learning and development needs, identifying existing resources and prioritising the development and delivery of subsequent education and training.

2. Education and training for a knowledgeable, skilled, capable, adaptable workforce

Learning opportunities and development will be required for everyone involved in this initiative to support life-long learning and a culture of continuous improvement. This includes understanding the roles of others and ensuring understanding of risks and the potential for harm. Patient safety is a fundamental requirement when delivering and operating our healthcare facilities. It is therefore imperative that our workforce have the education, knowledge and skills to ensure that healthcare facilities are designed, constructed operated and maintained in a way that minimises risks to ensure healthcare environments are safe but also effective and person centred.

Over the lifespan of this strategy NES aims to identify, deliver and evaluate progressive, flexible and cohesive learning and development opportunities, resources and career pathways to support the specialist workforce to develop the skills, knowledge, capabilities and confidence needed to create safe, effective, person-centred HBE’s. These learning resources and opportunities will be accessible and encourage individuals to develop their practice, progress their careers and support staff retention and sustainability. Career progression and staff retention are particularly important as many of those with expertise in this area are approaching retirement age.

This is a long-term programme of work and priority areas need to identified and prioritised. Workshops undertaken in 2020 clearly indicated that NHS Boards have learning and development needs related to the HBE across the spectrum of staff ‘from ward to board’. Further learning needs analyses will be required to determine the knowledge and skills required internally for NHS Scotland Assure services and externally for NHS Board staff and contractors.

Scoping exercises will also be undertaken to identify appropriate extant educational resources and opportunities that can be accessed by the HBE workforce. Initial work has already been undertaken to identify extant resources and further work will build on this to identify other resources that may be needed.

Findings from the learning needs assessment, consultation and scoping exercises will be used to identify the most significant aspects for education and training and used to either signpost to extant resources or in the planning, development and delivery of new educational interventions. NES will endeavour to ensure that learning and development resources and opportunities are interdisciplinary wherever possible while recognising that there will be occasions where a uni-disciplinary approach is required. The strategic partnership between NES and the Golden Jubilee Foundation (NHS Scotland Training Academy) will be utilised where possible to support development and delivery of education and training.

Priority areas already identified for initial learning needs assessment, identification of existing resources and delivery of education and training are:

• The internal Assurance Service within NHS Scotland Assure
• Executive and non-executive NHS Board members due to the level of responsibility and governance they hold in capital building projects
• External contractors to ensure an increased understanding of the HBE thereby improving project, service delivery and patient safety. It is anticipated that training frameworks and materials will be developed outlining the skills contractors are expected to possess to undertake specific roles.

Annual action plans will be agreed and implemented to progress the development, delivery, evaluation and updating of learning and development resources, opportunities and career pathways and reflect a progressive and agile approach.

Learning and Development (Knowledge and Skills) Framework

Work is currently progressing to articulate the knowledge and skills required to develop a Learning and Development Framework for the HBE. The Learning and Development (LND) Framework will be a key component in this strategy and will be essential in demonstrating cohesiveness and progression of learning and development opportunities and pathways. The LND framework will be interdisciplinary and outline the knowledge and skills required of individuals working at different levels of organisations and with different levels of expertise and knowledge.

The framework is structured around four levels, Informed, Skilled, Enhanced and Expert. Rather than being hierarchical, the levels are concerned with peoples’ roles and responsibilities which will vary greatly across organisations and sectors. This approach has been successfully used by NES for other interdisciplinary groups who have different levels of expertise and knowledge. The knowledge and skills included in each of these levels will be developed in partnership with key stakeholders and tailored specifically for the HBE workforce.

Informed level

Describes the essential knowledge and skills required by all staff to contribute to preventing and controlling risks to individuals within the HBE. This level also includes individuals from external organisations who work within NHS settings and need to be aware of their contribution to maintaining a safe environment.

Skilled level

Describes the more in-depth knowledge and skills required by ‘front line’ staff who have direct and/or substantial role(s) in preventing and controlling risks.

Enhanced level

Reflects the extensive knowledge and skills required of specialist staff with increasingly complex and explicit roles (professional/technical) which directly or substantially contribute to strategies/interventions that prevent and control the emergence of risks.

Expert level

Describes the advanced knowledge and skills required of staff, who have specialist/defined roles in developing, overseeing and directing governance measures designed to prevent and control risk.

3. A highly effective and robust learning infrastructure / environment

Learning and development resources can only be useful and fit for purpose if they are accessible. NHS Scotland Assure will deliver services at national, regional and local levels and the educational infrastructure will reflect this. NES already has an established modern, digital platform (TURAS) that can be accessed by anyone, anytime and on any device enabling sharing of resources and reducing duplication. TURAS is a single unified platform for health and social care staff and will form a key component of the educational infrastructure for the HBE. Accessibility is, however, is not the only important criterion. Learners also need to have the technological knowledge and skills to be able to navigate and use systems competently and confidently. Identifying and addressing digital learning needs will be essential.

The quality of support is crucial in engaging and motivating learners and creating a sense of belonging. Effective support also has an impact on retention. The diverse nature of the HBE workforce and the need to access expert advice and assistance at a distance makes supportive networks particularly important. Different organisations, professional bodies and agencies will already have their own learning and development programmes and support mechanisms in place. It will be important to learn from these to provide excellent networks/communities of learning and a highly effective learning experience for individuals. The use of existing appraisal systems and personal development planning with links to organisational objectives will also be an important component in supporting individuals and succession planning. NES will work in partnership with key stakeholders at national, regional and local levels to develop a supportive learning infrastructure and communities of learning.

Key outcomes

Partnership & collaboration

• Robust and effective communications channels established with key stakeholders and education providers
• Coherent approach to engaging key stakeholders in all aspects of learning and development
• Structured plans for creation and operationalisation of a culture of continuous learning and improvement

Education & training for a knowledgeable, skilled, capable & adaptable workforce

• Improved understanding of education and learning needs at national, regional and local levels.
• Increased knowledge of existing learning resources that are accessible and fit for purpose
• A cohesive, progressive learning and development (knowledge and skills) framework
• Structured plans for development and delivery of priority education/training
• Highly effective delivery of priority education/training particularly for the NHS Scotland Assure, Assurance team, NHS Board executive and non-executive members and external contractors
• A process for continuous review and evaluation of learning and development to reflect a dynamic and agile approach
• A process for recording attendance/completion of learning and development activities created

A highly effective and robust learning infrastructure/environment

• Improved accessibility of high quality interdisciplinary and uni-disciplinary training/learning resources and development opportunities
• Develop networks and support systems to support learning and development

Year 2 (2022-23)

• Continuous review of education and development needs to promote understanding
• Updated plans and frameworks incorporating lessons learned.
• Increased availability of agreed education and training resources and opportunities
• Educational interventions delivered to priority cohorts
• Draft of career framework and pathways to support succession planning

Year 3 (2023-24)

• Career framework and pathways available.
• Agreed educational interventions delivered
• Continuous reviewing, refreshing and updating of learning and development approach to reflect a progressive and agile approach.

Years 4 & 5 (2024-2026)

Specific outcomes agreed reflecting the iterative and agile approach.

• Continuous reviewing, refreshing and updating of learning and development.

Measurement of performance and management of risk

NES measures performance against activities and targets outlined in the annual action plans.

Risk will be managed using the NES Risk Management Strategy with regular review of risk registers by the Executive Team. Risk and performance management will also be reported to NHS Scotland Assure Senior Management Team.

Educational Governance and Management of Risk.

NES as a national education and training body has robust, well established educational governance processes. These include ongoing monitoring of achievement of outcomes and processes for evaluation, continuous improvement and risk management. Educational outputs from this strategy will be subject to existing NES governance processes with reporting to NHS Scotland Assure, Senior Management Team.

Resourcing

Investment will be required to fully deliver the outcomes outlined in the strategy. NSS/NHS Scotland Assure will work with NES and Scottish Government to determine an annual delivery plan and financial projections to achieve identified outcomes.

References

Scottish Government (2019) Protecting Scotland’s Future. The Government’s Programme for Scotland 2019-20

Scottish Government (2019a) NHS Lothian - Royal Hospital for Children and Young People & Department of Clinical Neurosciences. NHS National Services Scotland – Review of: Water, Ventilation, Drainage and Plumbing Systems

Scottish Government (2019b) NHS Lothian - Royal Hospital for Children and Young People & Department of Clinical Neurosciences. NHS National Services Scotland – Review of: Fire Systems, Electrical Systems and Medical Gas Installations

Scottish Government (2020) Queen Elizabeth University Hospital Review: Review Report (nrsscotland.gov.uk)

National Services Scotland (2020) Quality in the Healthcare Built Environment (QHBE). Target Operating Model. Glasgow, National Services Scotland