Implementation of the Best Practice Clinical Learning
Environment Framework: A case study for improving learning in the clinical setting using a novel quality improvement approach
Received (in revised form): 19th February, 2018
Donna R. Cohen
is Principal Consultant at Darcy Associates and Director of MEERQAT Pty Ltd. Following a successful career as a biomedical researcher in the 1980s–1990s, she shifted her focus to the health and higher education sectors, where she has been involved in research, programme design and implementation, policy development and stakeholder engagement. For the last ten years, she has been a significant contributor to Victorian initiatives aimed at improving and expanding the clinical education and training capacity of Victorian health services. She has a bachelor’s degree in Science, a master’s degree in Public Policy and Management and a PhD in Biochemistry & Molecular Biology. She is a member of the Australasian Evaluation Society.
MEERQAT Pty Ltd., 1/26 Robe Street, St Kilda, VIC 3182, Australia Tel: +61 3 9525 3234 E-mail: donna@meerqat.com.au
Philip J. Cohen
is a Director and Vice President of Business Development at MEERQAT Pty Ltd. He has trained as a social researcher and has worked for 20 years in research and health-related organisations within Victoria. He has been a consultant for the last eight years, specialising in research, evaluation, project management and quality improvement. He has a bachelor’s degree and a master’s degree in Sociology and is a member of the Australasian Evaluation Society.
MEERQAT Pty Ltd., Business Development, 1/26 Robe Street, St Kilda, VIC 3182, Australia Tel: +61 3 9525 3234 E-mail: phil@meerqat.com.au
Vitas Anderson
is Vice President of Software Development at MEERQAT Pty Ltd. His undergraduate training was in Engineering & the Medical Sciences, and he holds a doctorate in Biophysics. He is currently an Honorary Principal Fellow with the University of Wollongong and is an active contributor to national and international standards bodies dealing with radiation health physics. He also serves as an honorary technical assessor for the Australian National Association of Testing Authorities (NATA).
MEERQAT Pty Ltd., Software Development, 1/26 Robe Street, St Kilda, VIC 3182, Australia Tel: +61 3 9525 3234 E-mail: vitas@meerqat.com.au
Management in Healthcare Vol. 3, 1 24–40 © Henry Stewart Publications 2397-1053 (2018)
Implementation of the BPCLE framework
Mahyar Goodarz
is a Senior Policy Adviser at the Department of Health and Human Services (DHHS) Victoria. Over the past 12 years, his roles have covered clinical training governance, data initiatives, funding, project management and grant administration. Most recently at DHHS, Mahyar has worked on clinical training initiatives that seek to improve the quality, supply and distribution of the health and human services workforce across Victoria, including Placeright, Knowledge Bank and the Best Practice Clinical Learning Environment Framework. Mahyar has a Bachelor of Arts, a Graduate Diploma in Human Resource Management/Industrial Relations and a Master of Social Science (Policy and Human Services).
Department of Health and Human Services, 50 Lonsdale St, Melbourne, VIC 3000, Australia Tel: +61 3 9096 7280 E-mail: mahyar.goodarz@dhhs.vic.gov.au
Kade Dillon
is a Manager at the Department of Health and Human Services (DHHS), Victoria, and an experienced public policy and programme management expert. Kade began his career in health service management through the Australasian College of Health Service Management (ACHSM) Health Management Internship Programme. He worked in management roles across a number of Victorian rural health services before moving into public policy in DHHS in 2008. Kade managed the team at DHHS responsible for the delivery of a range of initiatives to improve Victoria’s capacity for, and quality of, clinical education and training, including the implementation of the Best Practice Clinical Learning Environment Framework. Kade has a Bachelor of Arts (Psychology), a master’s in Management and is an Associate Fellow of the ACHSM.
Department of Health and Human Services, 50 Lonsdale St, Melbourne, VIC 3000, Australia Tel: +61 3 9096 5041 E-mail: kade.dillon@dhhs.vic.gov.au
Kate E Weidemann
is a Senior Policy Adviser at the Department of Health and Human Services, Victoria. After obtaining a Bachelor of Optometry, she spent more than nine years in private practice as a primary eye care provider and clinical research optometrist. Kate transitioned into the public sector in the mid-2000s to take up the challenge of health workforce policy. In this role, she has been involved in the establishment and implementation of a host of programmes and policy initiatives that have positively impacted on the education, training, development and retention of the Victorian health workforce. This includes development of the Best Practice Clinical Learning Environment Framework. Kate has a strong interest in evaluation, quality performance and monitoring, with a particular focus on analysing the impact of programme implementation and identifying opportunities for improvement. She is currently completing a master’s degree in Evaluation at the University of Melbourne.
Department of Health and Human Services, 50 Lonsdale St, Melbourne, VIC 3000, Australia Tel: +61 3 9096 8904 E-mail: kate.weidemann@dhhs.vic.gov.au
Abstract High-quality healthcare requires a highly skilled and well-trained workforce, and consequently, there is growing interest in the pathways and processes by which clinicians are trained. In 2008, the Victorian Department of Health and Human Services commissioned a project to investigate the nature of successful clinical placements, through which learners undertake experiential learning in clinical settings. That project resulted in the development of the Best Practice Clinical Learning Environment (BPCLE) Framework. In 2013, statewide implementation of the framework commenced using a novel approach to quality improvement, termed map-enabled experiential review (MEER). The MEER approach uses map-based simulation of organisational processes to facilitate structured conversations among staff about their daily implementation of those processes. Feedback on the use of MEER from staff involved in framework implementation indicated that the approach was well received by end users, while, most importantly, data collected through MEER assessments revealed that implementation of the BPCLE Framework results in improvements to the clinical learning environment.
KEYWORDS: quality improvement, clinical learning environment, staff engagement, map-enabled experiential review
INTRODUCTION
While the quality improvement movement in healthcare has emphasised the importance of systems-based solutions, there is still a strong recognition that high-quality healthcare requires a highly skilled and well-trained health workforce. Indeed, there is growing interest in the pathways and processes by which clinicians are trained, particularly the experiential learning provided through clinical placements or rotations. In 2008, an Australian state government department — the then Victorian Department of Human Services (now Department of Health and Human Services; DHHS; the department) — commissioned a project to investigate the nature of successful clinical placements as part of a comprehensive strategy aimed at enhancing the capacity for, and quality of, clinical placements in Victoria. The objective was to develop guidance for health services in shaping their particular circumstances (staffing structures, physical resources and other cultural factors) into clinical learning environments that produce the best possible outcomes for learners, health services and, ultimately, patients. The project, referred to as the Best Practice Clinical Learning Environment (BPCLE) initiative, resulted in the development of the BPCLE Framework, which sets out six elements necessary for creating and maintaining a high-quality clinical learning environment (Table 1). The framework is intended to apply to all health professional disciplines and health service settings in which clinical education and training take place.
Table 1: The six elements and associated objectives of the BPCLE Framework
| Element number | Element name | Objectives |
|---|---|---|
| 1 | An organisational culture that values learning | Education is valued Educators are valued Learners are valued There is a career structure for educators Education is included in all aspects of planning Use of facilities and resources is optimised for all educational purposes |
| 2 | Best practice clinical practice | There is an organisational commitment to quality of care and continuous quality improvement Clinical staff are highly skilled, knowledgeable and competent The organisation adopts best practice into evidence |
| 3 | A positive learning environment | The environment is welcoming The environment is safe Appropriate learning opportunities take place There is clarity about educational objectives Clinical education staff are high quality Learners are well prepared There are appropriate ratios of learners to educators There are appropriate ratios of learners to patients There is continuity of learning experience There are structured learning programmes and assessment |
| 4 | An effective health service-education provider relationship | Open communication occurs at all levels of the partner organisations Mutual respect and understanding exist between the health service and its training provider partner The partners assist each other to optimise their contribution to the training of health professionals Relationship agreements codify expectations and responsibilities of the partners in the delivery of clinical education |
| 5 | Effective communication processes | Communication is not taken for granted by the organisation Communication informs actions, behaviours and decision making Communication facilitates feedback Communication facilitates improved teaching and learning |
| 6 | Appropriate resources and facilities | Learners and staff have access to the facilities and materials needed to optimise the clinical learning experience |
In September 2013, a campaign was launched to inform Victorian public health services about the statewide rollout of the BPCLE Framework. Introductory information sessions were conducted around the state to provide health service representatives with a background on the development of the framework, an overview of the implementation process and information about accessing BPCLEtool. Each health service nominated an in-house implementation coordinator who would serve as a point of contact throughout the process. Coordinators were provided with access to BPCLEtool and a suite of resources to assist them with preparing for and undertaking implementation.
The initial focus in 2013–2014 was on supporting health services to implement the BPCLE Framework and to complete various steps of the process within defined time frames. In 2015, a similar campaign was conducted with Victoria’s 31 registered CHS. Other health services in the public, private and not-for-profit sectors that deliver clinical education and training were also provided with access to BPCLEtool and encouraged to implement the framework, but their participation was not compulsory.
Although health services were not required to repeat their MEER assessment within a defined time frame, the department encouraged all health services to periodically repeat the assessment process. This would help organisations to track the effectiveness of their quality improvement action plans in addressing identified issues and provide a mechanism for ongoing monitoring of those aspects of the clinical learning environment not directly monitored by the BPCLE indicators.
METHODOLOGY
Evaluation of the MEER approach
In June 2014, implementation coordinators at each public health service were invited to complete an online survey about their organisation’s experience with the implementation of the BPCLE Framework. The survey collected quantitative and qualitative information about the approach used for implementation, as well as qualitative information about the process, the various implementation tools and resources, and the likely outcomes of implementing the framework across the organisation.
Analysis of statewide outcomes
A major advantage of using the online BPCLEtool to implement the BPCLE Framework in the Victorian context was the ability to collect data from across the state into a single database and to use these data to analyse the outcomes of statewide implementation of this quality framework. BPCLEtool collects a range of data inputted by individual health services, including node rating data collected during the MEER assessment step, information relating to the quality improvement action plan and information relating to the in-house monitoring of selected BPCLE indicators. Individual health services are able to extract all of their own data and benchmark their own assessment outcomes and indicator performance against de-identified data from other organisations.
RESULTS
End-user feedback on the MEER approach
Coordinators at each public health service used for implementation. The responses from the 73 coordinators that completed the survey, in relation to the MEER tool used for implementation, reveal a very positive reaction to the tool, in terms of overall satisfaction, usefulness and ease of use and as a driver of organisational learning.
DISCUSSION
The findings are likely to be of interest to healthcare managers. Data collected from participating health services demonstrate that implementation of the BPCLE Framework results in improvements to the clinical learning environment, showcasing a new approach to quality improvement, namely MEER, which has significant potential for application in service delivery sectors such as healthcare. It is imperative that strategies and initiatives continue to evolve to address staff engagement issues in quality improvement activities.