HEAPHY 1 & 2PLENARY

Angela DUXBURY

Sat 31st Aug 2013Session 1 / Talk 1

08:40 – 09:15

ABSTRACTThe need to keep practitioner skills evolving to meet changing context and agendas-name key workforce agendas / Francis report / Every contact Counts / Improvement Science, six C's and User carer initiatives etc.Changes in education commissioning and expectations-mandatory training requirements/service user involvements in admissions, curricular development, teaching etc...HCPC -regulatory body expectations now of service user involvement in training.Meeting service expectations-individual skills development to include management and leadership, strategic thinking, emotional resilience, entrepreneurial and interpreneurial skills (might use some of CoR research evidence on this) impovement science etc.The continued importance of research and knowledge transfer skills, evidence based practice etc. This would then lead into going through how easy it is to submit a paper for publication by a demo of the Editorial manager for the JRP. What makes a good paper , a good reviewer.I thought I would conclude with as a profession we have come a long way over the last 20 years since becoming an all graduate profession and demonstrate this by presenting some outcomes of recent relevant research and its importance to practice-published

Radiation Technologists:What does it take to Practice?

Professor Angela DuxburyDeputy Head of Department: Allied Health

Professions

The Issues to be explored• How do we rise to the challenges, contribute to service

improvement, and employ evidence based practice whilst working smarter, faster, safer, and with the right skills?

• What are the important practitioner attributes?

• What is the importance of innovation, ingenuity and entrepreneurialism?

• Research skills are key to evidence based practice. How do we overcome the barriers to undertaking research in the clinical setting, and share these outcomes?

Some facts

• In both the UK/NZ-massive increase in cancer, obesity and diabetes incidence and chronic disease

• People living longer

UK-a rise in chronic disease

Arthritis up 100% to 17mill by 2030

People with 3+ long-term conditions

up 100% to 2.9 m by 2018

Diabetics up 29% by 2025 to reach 4

million

People living longer with cancer

doubling by 2034 to 4 million

People living with dementia will more than double over

next 30 years to 1.4 mill

Changing world=we have some challenges!

New Zealand/ United Kingdom health care costs

• Funding health systems: mainly from-Vote Health- $14,655 billion in 2013/14

cost per head of population $3,271(£~1807)• NHS mainly tax payers- £111,400 billion in

2013/14 cost per head of population £2,082 (~$3769)

• In UK 10% of patients are harmed during their healthcare experience-900,000 people-impact on spending £1 billion per year (1)

1. Vincent C.Is health care getting safer? BMJ 2008;337;a2426

NZ: The Ministry of Health’s Statement of Intent 2013–2016 identifies three outcomes for the health system.

• New Zealanders are healthier and more independent.

• Health services are delivered better, sooner and more conveniently.

• The future sustainability of the health system is assured

National Health Service (NHS) objectives:

New emphasis: Achieving outcomes depends on the performance of people

• Telling and controlling the reality of the situation-through reports and policy agendas

• Regulation and training of staff• Doing things differently-we cannot afford

the growing demand for service or growing litigation costs-education and its people

It feels like....

NHS greater emphasis on patient voice and patient safety

Mid Staffordshire NHS Foundation Trust Public Enquiry:

The Frances Report

• A story of “appalling suffering of many patients.”

• 400-1200 deaths attributed to poor care

• First inquiry held in 2009

• First report in 2010 from Sir Robert Francis QC focused on Trust failings and patient / carer accounts of care – “patients not numbers”

• Second report published 5 February 2013 focused on system failures and need for system and cultural change – no heads have rolled!

• In total the report is 1776 pages long with 290 recommendations

Agendas

• The NHS constitution: access to service- right place right time

• Patient safety and patient voice• Values, ethics, compassion, adaptability of staff• Service improvement science agenda• Leadership-importance of taking responsibility• Reflective, resilient, innovative and entrepreneurial

staff

Listening to what patient’s want

RegulationHealth Practitioners Competence Assurance Act 2003 (NZ)

The Health Professions Order 2001Health and Care Professions Council (UK)

• Public Protection • Registration• Standards of Education• Standards of Conduct,

Performance and Ethics • Standards of

Proficiency• Tribunals

• health and safety of the public• high standard of treatment• requires update and improve

their skills• properly trained and qualified

before they can be registered• independent registering

authorities to register and monitor health practitioners

• independent Health Practitioners Disciplinary Tribunal

Frances report findings:

Spotlight on Education and Training greater emphasis on:

• Employability and Career Development• Graduate attributes• Resilience and Wistleblowing• Curricular design provides opportunity for

Entrepreneurship and Social Enterprise• Personal and Professional Development

Planning/Life Long Learning• Evidence based practice - Research

NHS Values and constitution-the brand

Excellent Education: Treatment Simulation

Competent & Capable Staff

NHS Constitution

Adaptive & Flexible Workforce: Responsive to Innovation and knowledge dissemination of new technologies, Best Practice, and Research and Innovation in order to Reduce Variability and Poor Practice.

NHS Constitution• NHS Values & Behaviors: Compassion,

values and behaviors to provide Person-Centered Care and improved patient experience by positive engagement with Continuing Professional Development.

• Widening Participation: Talent and Leadership flourishes free from discrimination and individuals and groups are able to progress to fulfill their potential in best possible patient outcomes

(not serious!)

• Patient-centred care-useful reminder of what we need to do for anyone prone to lapses of concentration

• Joined-up thinking-something we aspire to when you’ve mastered joined –up writing and joined up shoelaces

• Going forward-adds a sense of purpose to the idea of getting around to something at some point

Glossary of NHS Speak-Some of my favourites!

Must do things differently.....

• Emphasis on staff• Importance of people attributes

Skills and attributes

Importance of Culture? Personality, Attributes?

Different skills

Entreprenurial/ Intraprenurial• Internal entrepreneurs are independent

thinkers. They are willing to try new things. They don’t let past experience get in their way or cloud their judgement.

• They see possibilities where others don’t.

Entreprenurial/ Intraprenurial• They don’t sit back and wait for things to

become clear. They control uncertainty by acting. • Internal entrepreneurs are totally engaged

and energized by a challenge. They take on the toughest jobs.

Entreprenurial/ Intraprenurial Internal entrepreneurs are good at driving change. They are willing to take on risks to change their comfort zone. They make change happen.

Internal entrepreneurs are highly effective leaders. They are able to break down barriers and create new systems to support them. They lead through complexity.

Entreprenurial/ Intraprenurial

Internal entrepreneurs are good at execution. They have the discipline to stay focused and bring things to closure. They close the gap between strategyand execution. (2)

(2) Amo B, Kolvereid L. Organisational strategy, individual personality and innovation behaviour, Journal of Enterprising Culture 2005;13(1): 7-19

The skills and capabilities that were needed in the past are not the skills needed moving forward. The reality is that we all need to be entrepreneurs now and we need leaders who havethe entrepreneurial talent toshake things up and get things moving.

Project:• 2 Inspire: Increasing intrapreneurial skills

through pedagogy, increases innovation, retention and employability.

Dr Heidi Probst. Sheffield Hallam University Reader and Principal Lecturer

Some quotes from the 2INSPIRE project

• In response to a question about people starting out on the path to intrapreneurship:

• “ this is not going to be an easy road. If your not prepared to take that level of challenge…then it’s get out of the kitchen now”

• “to be an expert practitioner…in order to be confident in what you do you need to know that your underpinning theory is absolutely sound so that there is a commitment to learn about your subject…its about knowing you know”

Some quotes from the 2INSPIRE project

“ knowing your stuff is really important, expect to be challenged, and be prepared , but also it’s important to trust your institution and yourself….. and know that I am right”

Qu. What drives you to innovate, what are the motivators?

“a real passion for wanting to do research, and also wanting to do research that I knew would change the patient experience”

“when doors get slammed in your face...you just keep hammering away”

“ we could be doing this so much better, this was the motivation to make change”

Motivation...synonyms for....

Innovation/ingenuity.....

http://www.youtube.com/watch?v=Px8v70TdIk8

Adopt a new approach...

• Learning from your mistakes• Learning from your successes • And learning from the people around you ....to be the best you can

Innovation through ingenuity

To be the best we can be....

We don’t have to be super human......

Personality or Psychometric Testing?Dr Hermann Rorschach-Ink blot tests

Research: evidence based practice

• Importance of new practice and evidence based practice

• There are well documented perceived barriers to research

Original Article:Promoting radiation therapy research: understanding

perspectives transforming culture JRP 2013;12(2) 92-99

Authors: Turner, D’Alimore and Fitch• Identify challenges and opportunities that prevent RT led

research in their clinic• Insite gained to lead to strategies that encourage and

support RT research• Need to take a more active role and initiate own

research

Promoting radiation therapy research: understanding perspectives transforming culture JRP 2013;12(2) 92-99

• Barriers to research identified: Culture: attitudes changing but Dept not being

open to changes-de motivating• Time, support, education and training and

individual motivation-some didn’t think they were capable of coming up with interesting unique questions-own barrier

Article: Promoting radiation therapy research: understanding perspectives transforming culture JRP

2013;12(2) 92-99

• Leadership dynamics-transformational leadership one that promotes an entrepreneurial spirit promotes power sharing

• Creation of mentoring roles• Support must be a relationship between the

institution and the RT’s-deliverables-reward

Article: Australian RT’s rank technology-related research as most important to radiation therapy.JRP

2011;10(4) 228-238

Authors: Cox ,Halkett, Anderson, Heard• Conclusions:• The strongest interest on research in technical

research consistent with the rapid influx of new technology.

• Authors identify over 30 research questions that RT’s view as being important

Article: Attitudes to and perception of research for health science lecturers. Radiography 2013;19 (1) 56-61

• Author- Catherine Williams• Findings• All groups found barriers to research, lack of time

resources and skills. Perceived hierarchy of research. Those who were involved in research reported a feeling of isolation which reduced outputs.

• Some didn't want to be involved in research and had difficulty identifying this with part of their role

What holds us back?

• Importance of motivation or mission?• Importance of sharing the evidence base

to improve practice and patient care-we can’t argue with this

• Not difficult to publish!• You can do it.....here's how....

Publication in a Journal The latest JRP June 13

The Editorial Board

Rob Appleyard (Sheffield, UK)Andy Beavis (Hull, UK)Kathy Burgess (Liverpool, UK)Pam Cherry (London, UK)]Elaine Gannon (London, UK)Sue Griffiths (Leeds, UK)Jane Head (Peterborough, UK)Gillian Heap (Manchester, UK)Helen McNair (London, UK)Heidi Probst (Sheffield, UK)Noreen Sinclair (London,

International members

Amanda Bolderston (Canada)Peter Bridge (Brisbane, Australia)Bozidar Casar (Ljubljana, Slovenia)Mary Coffey (Dublin, Eire)Karen Coleman (Wellington, New Zealand)Penelope Engel-Hills (South Africa)Mark Trombetta (Pittsburgh, USA)TS Kehwar (Pittsburgh, USA)Ahmed Salem (Amman, Jordan)Peter White (Kowloon, Hong Kong)Caroline Wright (Melbourne, Australia)

Editorial Manager

• On line platform• All actions undertaken through this

platform-submission through to publication

• www.journals.cambridge.org/jrp

Some statistics

• 62 papers 2012, 57 through peer review process-5 rejected at outset

• Editor and two reviewers review the paper• First decisions made revise or reject• 47 revisions and 10 rejected• 40 revised papers 33 accepted, 7 further

revisions and these accepted.• 7 authors failed to do revisions

Peer Reviewers

• Journal has 130 reviewers from all over the world

• Qualifications-masters degree or higher• Guide for reviewers and annual award for

best reviewer Any volunteers?

Good peer reviewers• Experienced academic or writer• Give constructive and detailed feedback• Use headings to guide review• Access to MEDLINE to view similar papers• Need to understands etiquette of referencing e.g.

when to use et al./accessing web sites protocol-date of access, place of publication often missed out

Publication

• Once accepted-Typeset and checked• First come first served basis so that copy

is a bit of everything rather than one focus• Pagination needs to fit budget• Published online and in paper publication

• And finally.. what you learn by being a reviewer or reading Journals?

Recent research findings.....

Article: Cranberry in radiotherapy: dispelling myths: A literature review. JRP in press 2013

Author: Lynn Gordon• Conclusions: • A lack of high quality data was identified in the literature

reviewed and no firm evidence was found to support the continued recommendation of cranberry as part

of management of radiation induced urinary tract side effects. Well-designed RCT are required before further recommendations regarding the use of cranberry in radiotherapy are made.

Article: Oral candidiasis: Species identification and their antifungal susceptibility pattern in cancer patients receiving

radiation therapy. JRP 2013;12(2) 100-104

Authors: Mane and Pratyusha • Outcome:• The colonisation of candida may lead to development of

infections with drug-resistant strains and patients receiving radiation for head and neck cancers should undergo micro biological study for oral candidiasis

Article: A pain survey to support role development for Radiation Therapist in Ghana JRP 2013;12(2) 105-113

• Authors: Kyei and Engle-Hills• Findings:• RT’s could administer a limited pain questionnaire and use

this for clinical assessment of patients with pain, refer patients who need urgent medical attention to doctors, monitor patients receiving radiotherapy and adjuvant chemotherapy and provide suggestions to multi disciplinary team on pain management

• Role development and improved quality of patent care

Manuka honey mouthwash does not affect oral mucositis in head and neck cancer patients in New Zealand. JRP 2012;11 (4). 249-

256

• Authors: Parsons, Begley and Patries Herst• Findings• In contrast to previous honey trials in Malaysia,

Egypt, Iran and India, diluted manuka honey did not decrease the extent and onset of radiation-induced oral mucositis but did appear to ameliorate radiation-induced weight

loss and increase quality of life in the absence of cisplatin chemotherapy.

“Obstacles are things a person sees when he takes his eyes off his goal.”

“Change is a challenge and an opportunity; not a threat. ”

References1. Vincent C.Is health care getting safer? British Medical Journal 2008;337;a24262 Amo B, Kolvereid L. Organisational strategy, individual personality and innovation

behaviour, Journal of Enterprising Culture 2005;13(1): 7-193. Probst, H.(2013). 2 Inspire: Increasing intrapreneurial skills through pedagogy, increases

innovation, retention and employability. Sheffield Hallam University4. Turner A, D’Alimore L ,Fitch M.Promoting radiation therapy research: understanding

perspectives transforming culture Journal of Radiotherapy in Practice 2013;12(2) 92-995. Williams C. Attitudes to and perception of research for health science lecturers.

Radiography 2013;19 (1) 56-61 6. Gordon L. Cranberry in radiotherapy: dispelling myths: A literature review. JRP in press 7. Kyei, Engle-Hills P. A pain survey to support role development for Radiation Therapist in

Ghana JRP 2013;12(2) 105-113 8. Mane, Pratyusha.Oral candidiasis: Species identification and their antifungal susceptibility

pattern in cancer patients receiving radiation therapy. JRP 2013;12(2) 100-104 9. Parsons, Begley, Herst P. Manuka honey mouthwash does not affect oral mucositis in

head and neck cancer patients in New Zealand. JRP 2012;11(4) 249-256

Over to you.......

http://www.youtube.com/watch?v=Px8v70TdIk8