Background
Development of the Scottish Clinical Skills Strategy: Partnerships for Care
The ideas behind the Managed Educational Network have been directly informed by emerging government policy. Better Health, Better Care (December 2007), following on from Delivering for Health (2005), continues to place an emphasis on collaboration, co-operation and partnership. The Action Plan also stresses reducing inequality, reducing waiting times, providing more local treatment, improving patient safety, and developing new clinical roles.
In June 2006 NES held a series of meetings with key stakeholders regarding clinical skills training, stock taking current deficits as well as opportunities. These were organised by Professor Philip Cachia, Postgraduate Dean, and Beverley Beasant of NHS Education Scotland. The key issues raised were as follows:
- The need to enhance patient safety and reduce clinical errors, against the backdrop of potential litigation
- Changes in patient population, and limited population base in some areas.
- Increased focus on maximising effective use of financial resources through designing out duplication in the current skills training.
- The importance of buy in from all stakeholders involved in education and clinical practice.
The key priorities in developing a National Clinical Skills Strategy were to address issues of access; to ensure that clinical skills education in Scotland responded to the needs of the NHS in Scotland; and to achieve best value for the substantial sums of money already invested in clinical skills education by both NHS Boards and Higher Education Institutes. Therefore an effective clinical skills strategy has the potential to improve the patient experience (use of evidence-based simulation) and patient safety (as can be evidenced from high reliability organisations with an effective safety culture) and to make a significant contribution to reducing medical errors.
Patient expectations and experiences of health care are changing. They expect quicker and easier access to NHS services, and appropriate individualised treatment that meets their needs.
Changes in clinical practice have meant that many patients having surgical or invasive procedures spend less time in hospital resulting in a reduced availability of patients for traditional bedside teaching. Equally, those patients who have longer admissions for intensive or specialised treatment tend to be sicker and less appropriate for involvement in training.
Clinical skills training is also needed to equip staff with the skills they need to take on new roles under service redesign. Similarly, staff will need to be able to demonstrate maintenance of skills. Maximising the educational opportunities in clinical skills units will also help address the problem of reduced training time but has to be seen as a component of a managed educational process based around feedback and outcomes. Better Health, Better Care emphasises the importance of giving staff the opportunities to develop the skills and experiences they require.
About simulation techniques
Simulation techniques reproduce a real-life clinical setting for educational purposes. They require the use of simulated patients (volunteers or actors), manikins (ranging from simple models to highly complex computer-controlled whole body examples), computer-generated simulations or biological material.
The clinical skills required to communicate with and care for patients as a member of a healthcare team have traditionally been taught during supervised practice in clinical placements. The inevitable consequence of such an apprenticeship-based model is that students and junior staff have to practice and develop their skills from an early stage on patients undergoing treatment in clinical settings.
A major consequence of the drive for improved safety has been the introduction of simulation-based education techniques to complement more traditional supervised clinical teaching. In addition to the potential to reduce clinical errors, the use of simulation-based training is essential to achieve reduced working hours, extended role development, appropriate training for low frequency clinical events and the skills maintenance required as the Health Service is redesigned in line with Delivering for Health.
There are strong parallels with the airline industry where simulation-based education is an essential training component for both technical and non-technical skills (such as teamworking, communication and decision-making) driven by the need to maximise customer safety and experience.
At the national conference Clinical Skills Units: The future of skills development in Scotland (September 2005), Pat Croskerry explained that studies show the incidence of adverse events ranges from 3.7% - 16.6% and can include a wide variety of issues including wrong site surgery, equipment failure, medication errors, procedural mistakes and failure to recognise or provide the appropriate treatment. Around half of adverse events are attributable to error or negligence and, as such, are potentially preventable. Similar evidence has been found in NHS Scotland which was reported in Safe Today - Safer Tomorrow: Patient Safety - Review of Incident and Near-Miss Reporting (January 2006).
These errors are either caused by factors relating to the health system or the individual practitioner. Systemic errors include things such as workplace design, overcrowding, resource availability, information gaps, laboratory errors and report delays. Individual errors can be procedural (related to psycho-motor skills) cognitive (related to decision-making) and affective (related to the mental state of the healthcare worker at the time).
Therefore we have confidence that skills learnt in a multi-professional simulated environment have the potential to improve clinical team working which will ultimately improve clinical outcomes.
