How to improve NHS nursing work force project Report

Project Briefing

This project briefing will support you to complete each step in the A3 Project Template. This coupled with the teaching materials and review of the literature will enable you to elaborate on each step to complete the 6000-word project write-up. 

Title of the project: 

• Here you will need to provide a clear and concise Title that showcases your project in 1-2 sentences e.g.

Introducing a modified skin assessment tool in community nursing practice to support the identification of patients at risk of developing pressure ulcers and moisture damage. 

Step 1 – Project Summary (Abstract)

1. You need to identify early on if your project idea is an:
   • Improvement – e.g. your idea is already in practice, but could be tweaked to improve safety – E.g.  the modified pressure ulcer tool.
   • Development – An idea that is not imbedded in your practice area but is being done elsewhere and is successful - You wish to introduce it in your area of practice.
   • Innovation – You have an idea for change in practice that is innovative, it is not being done anywhere in the NHS – if you choose to go this route, you will still need to find literature that relates your idea to ensure it has validity. 
2. Then give a very brief outline of your project idea, this summary will undoubtably change as your project progresses. The aim here is to provide your reader with a small paragraph which explains all elements of your project idea, change management processes and relevance to current practice! 
3. Top TIP: Find Journal articles that relate to your project to learn how to write an abstract!

Step 2 – Background and Context (Literature Review)

• The first step in change management whether it be an improvement, development, or innovation, is to assess the current state of the service – What is already being done or not done, as may be the case…?
• This would help you in identifying and evidencing the service gap (the need for your idea) and rationale (can be professional and personal) for service change (improvement/innovation/development).
• It is expected that you will read the literature to evidence the need for your idea (a literature review). Use the table at the bottom of the A3 project template to help you with this.
• Also consider Health and Social Care Policy, Guidelines, Law, and economics that relate to your project (TOP TIP: Review the Year 2 module teaching materials to support you here). 
• Also consider the role of the nurse in change management/quality improvement.
• Top Tip: Once you have decided on the title of your project in Step 1. You can break the title down into key words, and then use a thesaurus to find appropriate synonyms to create multiple key words. Then place these key words into the search engines of literature data bases to find as much literature as you can on your subject. 
• Another Top TIP: you can also ‘Snowball’ off appropriate literature you have found. Simply look at the reference list of an article that evidences what you are looking for, then identify other sources that match what you are looking for within in this articles reference list. Keep doing this until you are unable to identify appropriate literature, or the sources become a little too old to be relevant (say in the last 5 years, unless seminal). 

Step 3: - Vision and Goals

In change management projects you should always have a vision and/or goals to which you can set the idea/agenda of your project against.  

• Many organisations small and large have a vision I.e., how they wish to represent their company and the people that work within it. You might find that your project idea supports an NHS Trust Vision and Values statement, or your vision could simply be to improve safety and quality of care in relation to your project idea. A vision is normally presented in a statement format e.g.

Virgin Atlantic mission statement is “To grow a profitable airline, that people love to fly and where people love to work.”

NHS vision statement is “enabling people to live healthier and more independent lives through high-quality seamless care.”

• Goals – help to measure and evaluate success, but early in a project, they can simply be what you, as a project manager wish to achieve by undertaking this project (you can add SMART goals here too, but generally in project management these will not be identified until STEP 5: Analysis).  

Step 4: Stakeholders and the Project Management Team

• Here you will need to CRITICALLY identify the stakeholders and project team members involved in your project. Why have you included these people? What do they bring to the table? Why should they be involved in your project? Stakeholders will have an invested interest in your project (we will explore this in more detail during class).
• Project team members are those who will support and take part in the project, can include the stakeholders, but will likely involve members of your nursing team and MDT.

Example of the above:

‘Introducing a skin assessment tool in community nursing practice to support the identification of patients at risk of developing pressure ulcers and moisture damage.’

Stakeholders: NHS Trust Senior management, Clinical Education Team, Datix Team, and Tissue Viability Nurse (can be involved in the physical delivery of the project, but if not, they like to be kept informed of progress and resources AKA invested interest.

Project Team Members: Can include the above and HCA’s, NA’s, Staff Nurses, Sister/Charge Nurses, wound care specialists, ward/community management, social workers, OT’s etc. Often this group will be involved in the physical delivery of the project and will each be given role and or/actions to complete i.e. SMART goals. 

Step 5: Analysis

This is where you really get into the building blocks of your project with regards to change management theory and process!

Firstly, you need to consider the leadership and management style that you need to employ to lead on your project. Remember that you may need to employ more than one depending on the situation. Be critical with the literature here and explain why e.g., transformational leadership as recommended in the Francis report. Top TIP: week 1 of this module recaps on this and you can look back at the learning materials from years 1 and 2).

Now you need to ‘kick off’ the analysis part of the project…Normally, you would undertake this analysis with the support of your stakeholders and project management team. However, there are circumstances when you might need to provide evidence in the form of data, to get people interested in your project idea or to showcase why it is needed – e.g., patient safety, resource savings, improved quality etc. These 3 areas normally raise eyebrows…and for good reason, but you will need to critically discuss why in your project!

• You will want to consider if there is already known data on your project idea? I.e. is there survey data that you can access or do you need to carry out a survey to evidence the need for your project idea. 
• Not all projects need this step, but if you were, for example, looking into introducing a pressure ulcer tool to reduce the amount of pressure ulcers on your ward, you would need data that evidences the problem e.g. Datix data showing the number of pressure ulcers over a period of time and your concerns regarding patient safety and quality of care. ‘Generally, numbers (data) do not lie’ and can provide convincing evidence as to why your project is needed!
• The next step is to utilise change management methodology to fully appraise and pull apart your project idea, examples include, but not limited to:
  • Route Cause Analysis
  • 5 ‘whys’
  • Fishbone Exercise
  • Process Mapping
• These methods and more will be explained in your teaching sessions, you will need to decide which work best for your project idea and you MUST include the need for stakeholder and project team member involvement in these processes.  TOP TIP: this will require critical discussion to fully appraise your reasoning!
• The information you gather from undertaking the above processes will support the development of SMART goals and or Counter Measures, which you can then discuss in more detail in Step 7: PDSA Cycle. You can outline your SMART goals/Counter Measures here, but you will explain them in detail in Step 7. 

Step 6: Risk Management and Mitigation

• With all change projects comes an element of risk! You will need to identify the potential risk in your project. 
• Once you have identified the potential risk in your project, you should then critically discuss how you might mitigate the risk (Remember, we cannot always completely remove the risk, but we can manage it with good leadership!)

Step 7: Plan Do Study Act (PDSA Cycle)

You project will then utilise a PDSA cycle format to evidence the methodical process of project management in relation to your project Idea. You will need to split this section into the PDSA cycle’s constituent parts. Up until this point you have identified Steps 1 -6. This should now give you all the information you need to start thinking about how you might go about introducing your idea in practice. Top tip: You need to use the PDSA cycle to evidence a HYPOTEHITCAL process for introducing this change into your practice area. 

Plan

• What steps will you take to introduce your idea into practice and why?
• What are your SMART goals/Counter Measures? 
• Who will be responsible for what? (Stakeholder and project management team)
• How do you intend to monitor progress and achievement?
• How will you a manage and mitigate risk or identify new risk?
• What resources might be needed? People, Time, Money, Equipment… 

DO

• Discuss what could happen in practice when you introduce your idea e.g., Barriers/Challenges/loss of interest or momentum.
• Who will be doing it? Who will be supporting its progress? Project champions?
• Will it be a small pilot before you take it to the wider team?
• Always relate back to your smart goals here, how would you monitor progress to achieve each of them?  And what would the potential outcomes be? Could there be challenges/barriers to achieving them?
• What would success look like to you? How would it be identified? How might it be measured?

Study

• Here you need to explain how you would monitor the success of your project
• This normally includes an evaluation of progress, here you have to decide what methods of evaluation you might use to monitor the progress e.g. staff opinion, focus groups, surveys, Data collection e.g. data from Datix which evidences a sharp drop in pressure ulcer development or an increase if your project it not working…. (This does happen!)
• What would you expect to see (good or bad) because of your project idea?  Top Tip: You will need to ask the ‘What if’ question here…. To think of hypothetical outcomes!
• Refer back to step 5: Analysis and critically evaluate your SMART goals – how would you know if you are achieving them at the time the project idea is being tested? 
• Consider risk management and mitigation

Act

• This is where you would again, evaluate the success of the whole project at this stage, smart goals, and review.
• If it has worked, what will I do next, if it does not work, how might I change my ideas or change management methodology. Again the ‘What if?’ question…
• Remember that this project is hypothetical – so you will need to use the literature to explain why you would do a PDSA cycle and how each section of the PDSA will support the project idea you have.
• You will not be able to provide an in-depth PSDA review as you are not physically undertaking your projects, but even project managers must think about what might happen… What if? What am I hoping to see? How might I evaluate that this is working? This helps us to stay one step ahead of the challenges, barriers, potential risk, and project failure! 

Step 8: Evaluation Methods

• A good project manager and project team will understand that project evaluation starts right at the beginning of any change idea/process. This is to say that you do not want to wait until the end of your PDSA cycle to realise that you have missed something, or had you evaluated a specific area of your change idea earlier, you might have saved resources, reduced risk, and ultimately lessened the risk of project failure (Remember: 70% of change management projects fail, but why?)
• In this section you will need to critically discuss the evaluation methods you would use throughout your project. It is expected here that you will consider all steps of the A3 template from 1-7 and the evaluation methods that you might employ to support the success of your project! You will need to find and critically discuss the literature! ‘keep searching the Literature until you exhaust the findings on your subject and read widely, there is copious amounts of literature in project evaluation!’

Step 9: Conclusions and Recommendations for Practice

• Here you need to provide a conclusion of what you have learnt by summarising all key points in your 6000-word project. Remember that nothing new should appear here, it is simply an opportunity to highlight/reiterate what has already been said. 
• Recommendations for practice – here you would outline why you feel your project is needed.  The information/evidence from Step 2 and Step 3 of the A3 project template will likely be used as support for these recommendations. 
• Top Tip: Remember to use passive language when introducing your recommendations e.g. ‘It could be suggested that…’ or ‘The literature recommends that…’

Step 10: Reflection of Learning

• Look back to the assignments you undertook in years 1 and 2 in leadership, management, and teamwork. You can use the themes in these assignments to progress a reflective piece that showcases your learning throughout the 3 years at University/Practice and how you will utilise this knowledge in your own nursing practice.
• I recommend using Gibbs model of reflection for this, but you do not need to outline the theory behind Gibbs, just use it to structure your reflection.
• And yes, you can write in the 1st person for Step 10 only.  

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