In a climate where NHS training budgets are diminishing, numbers of specialist staff are shrinking and diabetes caseloads increasing, it is essential that the diabetes workforce has the knowledge and skills necessary to improve and deliver excellent diabetes care. Diabetes UK created the Tomorrow’s Leaders (TL) programme to give diabetes specialist nurses (DSNs) and dietitians the skills and confidence to lead improvements in diabetes care. The programme not only supports participants to develop leadership skills, it also boosts their confidence and motivation to develop and deliver high quality diabetes care.
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The Diabetes UK DSN workforce surveys demonstrated that 50% of DSNs would be retiring in the next ten years. A new approach to supporting and growing DSN leaders was needed and a working group was put together to develop support for future generations. This led to the development of an innovative, free 24-hour leadership training course, with a one-day follow-up session two months later. Traditional education for DSNs and dietitians focuses on building clinical skills. The ‘leadership’ training that is available through the NHS is designed to grow ‘managers’, taking people away from their clinical specialism. This course is unique and innovative in that it gives participants the opportunity to develop their skills to lead improvement in diabetes care. It combines the clinical context of diabetes with a practical and theoretical programme to facilitate change and enable tangible improvements in diabetes care. It provides participants with the platform to share aspirations and challenges, as well as develop a peer support network.
The course includes sessions on the NHS, effective communication, sources of power and tackling barriers to delivering service improvements. Participants then work with a coach to develop an action plan and an ‘Elevator Pitch’ to support this plan. The follow-up session provides an opportunity for reflection and a review of progress on action plans. It also includes workshops on emotional resilience and meeting facilitation. The course was piloted in September 2014, with seven DSNs taking part. Participants evaluated the content, facilitators and the overall programme. The feedback was used to shape future sessions. The course was then run once in 2015 and multiple times in subsequent years owing to demand. To date, the programme has been attended by over 150 nurses and dietitians. It has been heavily oversubscribed each time. In January 2016 the course was opened to dietitians, as they also lead service improvement.
The programme objectives are assessed through course evaluations and through capturing reflections from the participants. A key part of the course is developing an action plan with support from a coach, and then pitching the plan to the rest of the group to develop presentation skills.
These action plans focus on making a specific change to improve diabetes care in their local area, eg improving communication between primary and secondary care, developing a diabetes education programme, or implementing virtual clinics. Progress made with action plans informs the evaluation of the course, detailing the tangible changes that participants have made, and the impact for people with diabetes. The development of leadership skills for improving diabetes care is the primary aim of the programme. Successive course evaluations have shown that 100% of the participants felt more confident leading improvements in diabetes care and felt more confident as a leader as a result of this training, demonstrating the success of the course. Another important aspect of the programme is to facilitate peer learning and provide a platform to share best practice. Participants value this opportunity to learn from colleagues and find out what is happening elsewhere. Through developing the confidence and leadership skills of participants, this programme aims to support them to deliver high quality services to people with diabetes, as well as to champion the profession and encourage others to improve their own diabetes care. Examples of action plans participants have implemented since attending the programme include: development of an improved team working strategy, resulting in more cross-site working and helping to standardise care for people with diabetes; the setting-up of an accredited education programme to improve diabetes knowledge in primary care; improvement of young adults’ services, and introduction of telephone consultations, involving the DSNs in the team to improve access to services for people with diabetes. Common themes of improvement work undertaken by participants include: transitions services; staff and patient education programmes; virtual clinics; dietetics services; insulin safety, and conduct audits. Feedback from participants has indicated better leadership, more cohesive team working and improved engagement within multidisciplinary teams, leading to better services for people living with diabetes. Several participants have progressed to other leadership roles within their team or local area, demonstrating that this programme encourages participants to take on positions of increased influence to transform diabetes care. All course participants would recommend the course to DSNs and dietitians looking to increase their knowledge and skills as a leader. This programme allows more people with diabetes to receive accurate information and enables Diabetes UK to grow a network of healthcare professionals to improve diabetes care across the country.
Sustainability and Spread
The programme has gone from strength to strength over the past three years, with good geographical coverage across England. This year it will be delivered in Belfast for the first time. Participants are delivering tangible changes in diabetes care which are shared via various media.
Diabetes UK initially invested to develop the programme. It is now sustainably funded through commercial sponsorship. Learnings from the programme have been used to address challenges elsewhere in the diabetes workforce. Examples include a bespoke primary care leadership programme that will be launched for diabetes, and the creation of a programme for pharmacists. Elements from the programme have been used to shape Diabetes UK’s ChangeLabs – a series of short, focused workshops designed to accelerate improvements in diabetes care.
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