Leading by example

The NHS Nursing Leadership Project is designed to liberate talent and is
proving to be a shining example of e-learning in action

We often think of a nurse taking someone’s blood pressure or dressing a
wound, but rarely picture them dealing with a difficult employee or assessing
an individual’s emotional intelligence. Plenty of nurses, however, have to
manage and deal with staff and so need to have the same leadership skills
associated with business.

Similarly, as one of the largest employers in Europe, the NHS has an ongoing
need to support and influence the workforce so it can adapt to change, improve
service and deal with challenges of new ways of working.

To address these needs, it introduced the National Nursing Leadership
Project, which is now the largest leadership programme in the world, involving
some 35,000 nurses. At the hub of the project is a website, launched in April
2001 (www.nursingleadership.co.uk),
through which a mass of information and resources, along with a growing
collection of e-learning courses may be accessed. Speaking about the programme
at the site’s launch, the Secretary of State for Health Alan Milburn, said that
"liberating the talents of nurses helps to expand the overall capacity of
the NHS, increases the productivity of the NHS and improves the performance of
the NHS".

From the outset, the Government wanted e-learning to play a vital part in
the programme. But while the directive for the training came from the top, the
demand from nurses and other clinical staff for leadership development was
equally high, as was the willingness to try the new training methods, says
David Dawes, e-learning development manager at the NHS.

Before embarking on the project, Dawes and his team carried out a major
research project designed to assess readiness of clinical staff and the
organisation for e-learning.

"We also wanted to ascertain how and when people preferred to access it
and to identify any barriers that might exist," he says. "Following
this, we looked at the effectiveness of the content and compared different
approaches to e-learning."

The research found that 70 per cent of registered nurses have internet
access, compared with 30 per cent of adults in the general population, and that
although 63 per cent of NHS clinicians had access to a computer at work, 59 per
cent of respondents preferred to learn at home.

"This told us that the e-learning had to work on a standard home
modem," says Dawes. "In terms of barriers, the biggest problems were
work-life balance, lack of funds and lack of time. The other main finding
related to the content of the courses. NHS staff felt uncomfortable with
references to sales, profit and other business terms – and they also wanted a
wide choice of modules. This told us we either needed to go the bespoke
e-learning route or source a provider with a broad portfolio and the ability to
help us customise content."

Following the research, the team spent six months on the exhibition and
seminar circuit talking to suppliers. Cost and time factors meant a full-blown
purpose-built e-learning solution was not an option. However, because of their
very specific needs, they knew that a wholly off-the-shelf product would be no
good either. After meeting with e-learning provider SkillSoft, it became
apparent that it would be possible to have a bit of both.

"We found that the organisations which were strong at customising
didn’t have a big enough range of courses and those that did have a decent
library weren’t able to offer customisation," says Dawes.

"Conversely, SkillSoft’s library contained more than 1,700 management,
business and leadership modules across 21 curricula – representing in excess of
5,000 hours of learning," he says.

The part-readymade, part-bespoke approach is not a typical solution required
by clients, says SkillSoft UK managing director Kevin Young, but one that was
understandable given the context of the learning.

"The feedback from users was that they found the learning points valid
but wanted to see them in an NHS context," he says. "Understandably,
within a public sector environment like the health service, people felt
uncomfortable with reference to sales and customers. As a result, the content
was modified so that, although there were no changes to the generic learning,
the images were changed to include doctors, nurses and a hospital environment.
The language was adjusted so that it was more NHS-specific."

SkillSoft licensed its Course Customisation Toolkit to the NHS team and
provided training so courses could be modified in-house. This allowed the team
to merge the generic content and the NHS dialogue and visuals at a fraction of
the cost of developing bespoke e-learning from scratch.

Dawes and his team can now customise a course in 10 days and frequently do
all the narration and writing themselves and, on occasion, star in the
e-learning programmes.

As a result SkillSoft’s involvement is now confined to a support role.
SkillSoft’s Young, says: "The job has reinforced how the economies of
scale associated with generic content can enable customers to cost-effectively
create an end result that matches their e-learning needs. It has also
emphasised the importance of being open and flexible in putting together a
solution that matches each client’s requirements."

The pilot

A pilot project was set up with 400 places allocated on a first-come,
first-served basis. The course was advertised on www.nursingleadership.co.uk (now
the gateway for all the courses) via an electronic newsletter, and on three
internet user groups.

Research had suggested there would be a high demand for the courses, which
was borne out within three days by which time 100 volunteers had already come
forward. After three weeks there was a waiting list (69 per cent of those
registering found out about the course electronically, the others by word of
mouth). The average age of volunteers was 41 years with 10 per cent over 50.

A number of factors unearthed in the research were substantiated by the
pilot. For instance, staff often do not complete post-course assessments even
though they enjoy the courses and apply them in practice. This, coupled with
the average time that staff spend taking a course (25 minutes) suggesting that
people prefer the bite-sized chunk approach – "going in, accessing the
knowledge they require, and getting out again," says Dawes.

"Any future e-learning assessment strategy needs to take into account
the reluctance of staff to complete courses in their entirety, even though the
knowledge and skills are effectively applied," he adds.

Valuable feedback

Sixty-nine per cent of students who had taken the SkillSoft course gave
examples of how they had used what they learned in practice (for example, in
dealing with workplace stress, managing competing demands and so on) and 85 per
cent said they would recommend e-learning to friends and colleagues. The top
five suggested improvements were to make the e-learning more NHS-orientated,
offer easier access, hold more group meetings and offer faster and more
information and guidance.

Dawes also reported back with a number of other findings after the pilot,
which he believes have a value for all sectors:

– E-learning appeals to a wide age-group and is in demand by health
professionals inside and outside the NHS – and the UK

– There is demand for leadership development at all levels – from director
level to the recently qualified clinician

– There is a high demand for e-learning – the motivation is primarily
personal development and personal interest, with less than 25 per cent
motivated by career development

– The most essential characteristic of an e-learning programme is that it is
free to users, and, ideally, offers some sort of accreditation

– Facilitated e-learning (that which has a supervising tutor and/or a
classroom component) seems to have similar starting, completion and
application-in-practice rates

"Facilitated e-learning does not appear to be significantly more
effective that automated e-learning," says Dawes, "although it
appears to be several hundred times more expensive."

Dawes estimates that the cost of each e-learning course per learner is 52p.

The NHS is now half-way through the second stage of the project, which aims
to train up to 40,000 staff over two years and Dawes has lots of interest in
the project from elsewhere in the NHS – doctors, health visitors, allied health
professionals and managers are all using it, although it is primarily aimed at

Five courses are currently up and running on the Nursing Leadership website
site including modules on emotional intelligence, stress management, time
management, project management, dealing with difficult people and dealing with
conflict. By Christmas it aims to have 20 courses up and running and based on
the success of the pilot, all future NHS training programmes will have an
e-learning element.

The NHS project proves that having a very dedicated in-house team, who are
prepared to not only research the needs of the workforce but to roll up their
sleeves and shape the learning to suit the learners, can make the difference
between success and failure in a project.

In summary
Success for The NHS leadership project

The NHS aim To provide a
programme of leadership training for nurses.

Why? To liberate the talents of nurses which in turn
will improve performance and increase productivity.

Is e-learning delivering? The 400-people pilot was a
great success and provided valuable user feedback. It is too early for ROI
figures, but Dawes reports that each course costs only 52p per learner, a
massive saving on previous classroom-based training.

NHS top tips

– Fit the learning around people’s
existing work-life balance and do not demand a large commitment

– Make content available over the internet

– Make it available in bite-size chunks

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