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United Lincolnshire Hospitals NHS Trust – Implementation of Clinical eLearning About the Trust The United Lincolnshire Hospitals NHS Trust (ULHT) is one of the largest Acute Trusts in England. It provides a wide range of healthcare services – medical, surgical, paediatric, obstetric and gynaecological – to 700,000 people in Lincolnshire.

The Trust operates four hospitals – Pilgrim Hospital, Boston, Grantham and District Hospital and Lincoln County Hospital - has a presence in County Hospital Louth, and runs services from three other hospitals – John Coupland, Gainsborough, Skegness and District General Hospital and Johnson Community Hospital, Spalding.

Background United Lincolnshire employs 7,800 highly trained staff and volunteers. Historically the Trust has used traditional methods of teaching but was keen to embrace new educational models.

Although locally developed e-Learning programmes were available, they did not interface with ESR, so it still fell to administrators to update learners’ records individually. As the Trust doesn’t have an e-Learning Team, the ability to produce a broad catalogue of resources was limited.

Piloting clinical e-Learning Russell Outen-Coe, the Clinical Lead for Professional Development explains: “in November 2009, we applied for funding to run a pilot e-Learning scheme for the clinical staff at United Lincolnshire. The team was given three months to run the pilot and 200 clinical staff of various levels were selected to take part in the project”.

“At the time we were running a one day course called The Essentials Skills Programme and we had four of these courses booked during the duration of the pilot,” says Russell. “We simply

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chose four pieces of e-Learning content that emulated the content of the Essential Skills training course and asked the learners who were booked on to the course to come and be involved in the pilot instead.”

“Then we emailed the clinical staff involved and their managers to tell them that the Essential Skills Programme was no longer available to attend in person and by accessing NLMS, they could undertake the same training at any time, as long as it was completed by 31st January 2010.”

The Challenges Unfortunately, the pilot ran into some early technical difficulties – the Trust’s PC Checker gave half of the users error messages and stopped them from logging in to NLMS.

But the challenges weren’t purely technical - the pilot also highlighted a huge barrier to successful e-Learning implementation in terms of the participants’ diverse skills and approach to training.

The second half of the participants left their training until the last minute and chose to turn up on the day of the pre-arranged course as they would have done anyway. This meant that they were left with no option but to complete the training there and then on hastily provided laptops in a very busy library!

“It was a sharp learning curve for me,” says Russell. “I realised that there was a deep-seated culture within the organisation – previously, clinical staff had been told when and where to attend for training. It was hard for them to work autonomously because they simply weren’t used to doing things that way.”

He realised that, in order to change that culture, there had to be both strong leadership from the Board and deeper engagement between Clinical Training and Development and the clinical staff. A Project Board Implementation Team comprising key people within Nursing, HR, IT, Research and Education was created - and this helped to embed the flexible eLearning message within the organisation.

Additionally, a series of meetings with the nurses, ward sisters and charge nurses addressed the challenge of how to encourage learners to re-think traditional learning methods and understand how flexible and efficient technology can be in delivering training.

Large scale cultural change is difficult for any organisation, and the project team recognised from the outset that they would need to win the hearts and minds of staff. As part of their project plan they used a variety of communications tools to help raise awareness of the

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project and its anticipated benefits. Tools included the staff newsletter, the county-wide NHS newspaper, Trust screensavers, road shows and email cascade as well as a newly developed NLMS page on the Trust’s intranet. The intranet page provides comprehensive information about how to get a Smartcard and log in to e-Learning - and is linked to Adobe Captivate Programmes where staff can access interactive training presentations.

“It was a great idea in principle and a convenient way for staff to access training and information centrally,” he says “but the reality is that not everyone works in the same way. We found out that people don’t necessarily read all the detail found on websites.”

For some of the participants, the process was made easier by going back to basics and having the information printed out and laminated so they could read it while they were logging in and completing the training.

Implementation and Training 120 people out of the selected 200 finally completed the pilot, despite encountering another technical error; some of the programmes wouldn’t show as being completed, even though they had been. A Service Request was raised and in due course this was resolved.

The Trust then started to implement NLMS on the Preceptorship Programme, a nine month long programme for all newly qualified, registered nurses, return to practice nurses and new to clinical area nurses at ULHT. The programme focuses on developing the knowledge and skills required to ensure the safe and effective transition from student to registered professional.

The Preceptorship Programme was rolled out in a controlled way over a six month period until the Clinical Training and Development team was certain that it was working reliably.

During the latter part of 2010, e-educator sessions were held for Band 6 & 7 clinical staff to enable them to cascade training and mentoring to other staff. A step by step guide was produced and rolled out between January and March this year and the training materials, guides and resources have all been made available on the intranet. On 1st April 2011, United Lincolnshire Hospitals NHS Trust went live with NLMS and after developing an SLA with IT, all clinical staff now have access to NLMS via their Smartcards. A small pilot group is currently exploring staff access to NLMS out of the hospital environment with great success so far!

At the same time, the technical aspects of running NLMS were handed over to IT.

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Benefits There are clear benefits in having a centrally updated system which is able to provide course content far in excess of anything our local Clinical Training and Development could hope to deliver.

ULHT staff now enjoy a varied, flexible and accessible method of education. NLMS takes care of the provision and exploration of subjects in a more intimate way, which frees up more time (and training rooms) for clinical lecturers to deliver quality face to face teaching and workshops and support those subjects less suitable to being taught electronically.

Informal feedback suggests that clinical staff have really embraced NLMS. One very positive nurse commented that he loved the ability to ‘hop on and hop off’ his NLMS e-Learning programmes and thought the way in which Clinical Training had used the Dementia module as pre-learning for the Dementia seminars had been particularly useful.

The process is a much more efficient way of working. All training has to be identified either at appraisal or via a clinical supervision session and advocated by a line manager. This ensures that the learning meets both the employee’s individual objectives and the requirements of the organisation, locally and nationally.

When the e-Learning course has been identified, the manager gives them the course title and the date by which they need to complete it. The learner completes the training and sends a notification when it has been completed.

The Clinical Training and Development team runs a regular report which lists all training undertaken and time taken - and this information notifies the line manager to cross check for parity with the learner’s email. This ensures that staff involved are remunerated accurately and that the learner has met the course outcomes. •

The process ensures a greater level of Trust-wide compliance with CQC and NHS LA standards

Staff receive relevant and targeted training, specific to their area

The Trust only pays for training that is approved at manager level.

NLMS also has huge cost-saving implications for the future in terms of the Trust no longer having to rent rooms and venues or pay expenses to staff physically travelling to training courses. In a county the size of Lincolnshire, this saving is substantial!

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The Future The Trust is currently developing an NLMS policy but once all clinical staff have accessed NLMS at least twice in the N3 environment, ULHT is planning on rolling out e-Learning to all staff for home access by April 2012.

The next step will be to set up learning pathways and group courses so that the needs of particular clinical areas can be accurately reflected.

For More Information To find out more about how United Lincolnshire Hospitals NHS Trust has successfully implemented clinical e-Learning and the lessons learnt, contact Russell Outen-Coe at

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