Quality

Quality Strategy and Framework Refresh

In 2016, HEE published its first Quality Strategy and Quality Framework. The Quality Strategy is underpinned by the HEE Quality Framework, which makes clear the quality standards expected of clinical learning environments, safeguarded through the NHS Education Contract.

What we did

The HEE Quality Framework underpins our Quality Strategy and provides an overarching set of multi-professional quality standards for the clinical learning environment, organised around six core domains.  It applies to the quality of all healthcare education and training, across all clinical learning environments within which learners are placed, including an increasing variety of settings in the primary, secondary, community and independent sector.

As the quality schedule of the NHS Education Contract, the Quality Framework is applied to assess the quality of delivery of the education and training that HEE funds and it also reflects HEE’s statutory obligation for the safety and protection of trainees, students and patients.

Our refreshed Quality Framework has taken account of what we have heard from our stakeholders:

• It gives greater clarity and focus to equality, diversity and inclusion

• It promotes learner wellbeing and the wellbeing of those who support them

• It emphasises our key role in improving quality as well as our commitment to the future workforce development 

Key points to note:

Domain 1. Learning environment and culture

Our expectations:

The learning environment is multi-professional, with a culture that is fair, promotes equality, diversity and inclusion, and values and facilitates learning opportunities and support for all learner groups.

Policies and processes are in place to promote equality, diversity and inclusion (and challenge exclusion) within the learning environment and ensure impartiality. Relationships between diverse groups are fostered.

Domain 2: Educational governance and commitment to quality

Our expectations:

The governance arrangements promote and support the development and sharing of equality, diversity and inclusion good practice in education and training and there are named senior leaders with responsibility and accountability for equality, diversity and inclusion in education and training.

Domain 3: Developing and supporting learners

Our expectations:

Learners receive appropriate supervision and support, clinically and educationally, to enable them to gain the knowledge, skills and behaviour required by their curriculum / programme. It also requires providers to promote and support equality, diversity and inclusion.

Strategies are in place to reduce the potential for differential attainment (based on protected characteristics) through excellent and inclusive education and training, including:

• tailored training resources that help respond to local EDI issues
• enhanced induction for international learners and those new to the NHS
• enhanced supervision to identify support needs early coordinated enhanced support, including resources/ training in communication, portfolios and exam preparation awareness building and promotion of local networks, buddying/mentoring schemes and equality, diversity and inclusion champions
• supervisor development/training to support equality, diversity and inclusion themes and the response to differences in attainment.

NETS survey

What we did

HEE uses a variety of tools and channels to listen to and respond to the voice learners and to gather intelligence on the quality of learning environments. One tool that is used is the National Education and Training Survey (NETS). The NETS is the only national survey open to all undergraduate and postgraduate students and trainees undertaking a practice placement or training post in healthcare as The NETS asks 32 questions covering the main aspects of student experience in the placement learning environment, including induction, clinical supervision, facilities, learning opportunities and teamwork. It also collects data that will help to ensure that we can make better sense of where quality is with regards to equality, diversity and inclusion and the gaps that we need to address to ensure that learning environments are equal and inclusive.

The National Education and Training Survey (NETS) Data  - What we learnt

The last National Education and Training Survey (NETS) was live from 22 June to 23 July 2021 and there was a total of 19,815 responses across healthcare professions. The survey asks a series of optional demographic questions which have been analysed to provide an insight into the reported experience of learners with respect to Equality, Diversity and Inclusion.

Six key questions from the NETS survey were analysed to evaluate whether there was a correlation between certain demographics and learners’ likelihood to rate their experience poorly. The questions the analysis was conducted on related to:

1. Induction

2. Clinical

3. Supervision

4. Overall Educational Experience

   Completing Unsupervised Tasks that Trainees were not Prepared or Trained for

5. Bullying and Harassment

6. Likelihood to Recommend

June 2021 EDI Analysis Results

The results below show the output by demographic group for each question. We have only included results where it was determined that there was a statistically significant correlation (p-value ≤ 0.05) between the independent (demographic) and dependent (survey response) variables.

Induction

• Doctors in training were 49.2% more likely to rate their induction as unsatisfactory or in need of improvement than other learner groups
• Women were 14.4% more likely to rate their induction as unsatisfactory or in need of improvement than men
• Learners from minority religious groups were 15.0% more likely to rate their induction as unsatisfactory or in need of improvement than Christian/non-religious learners

Clinical Supervision

• Doctors in training were 35.7% more likely to rate their clinical supervision as unsatisfactory or in need of improvement than other learner groups
• Women were 13.7% more likely to rate their clinical supervision as unsatisfactory or in need of improvement than men
• Non-White/Caucasian learners were 16.3% more likely to rate their clinical supervision as unsatisfactory or in need of improvement than White/Caucasian learners
• Learners who are not heterosexual were 19.9% more likely to rate their clinical supervision as unsatisfactory or in need of improvement than heterosexual learners
• Learners from minority religious groups were 10.0% more likely to rate their clinical supervision as unsatisfactory or in need of improvement than Christian/non-religious learners

Overall Educational Experience

• Doctors in training were 57.3% more likely to rate their overall education experience was unsatisfactory or in need of improvement than other learner groups
• Women were 7.6% more likely to rate their overall education experience was unsatisfactory or in need of improvement than men
• Learners who are not heterosexual were 24.4% more likely to rate their overall education experience was unsatisfactory or in need of improvement than heterosexual learners

• Learners from minority religious groups were 15.8% more likely to rate their overall education experience was unsatisfactory or in need of improvement than Christian/non-religious learners

Completing Unsupervised Tasks that Trainees were NOT Prepared or Trained for:

• Non-White/Caucasian learners were 25.9% more likely to rate their likelihood of completing unsupervised tasks as sometimes, often or always, than White/Caucasian learners
• Disabled learners were 31.3%% more likely to rate their likelihood of completing unsupervised tasks as sometimes, often or always, than learners with no reported disability
• Learners who are not heterosexual were 27.0% more likely to rate their likelihood of completing unsupervised tasks as sometimes, often or always, than heterosexual learners
• with every additional year of age learners were 2.1% more likely to rate their likelihood of completing unsupervised tasks as sometimes, often or always

Bullying and Harassment:

• Doctors in Training were 44.7% more likely to experience bullying and harassment than other healthcare learners.
• Women were 25.0% more likely to experience bullying and harassment than men
• Non-White/Caucasian learners were 94.9% more likely to experience bullying and harassment than White/Caucasian learners
• Disabled learners were 53.2% more likely to experience bullying and harassment than learners with no reported disability
• Learners who are not heterosexual were 60.6% more likely to experience bullying and harassment than heterosexual learners

Likelihood to Recommend Placement:

• Learners who are not heterosexual were 22.5% more likely to be extremely unlikely or unlikely to recommend their placement than heterosexual learners
• Learners from minority religious groups were 12.5% more likely to be extremely unlikely or unlikely to recommend their placement than Christian/non-religious learners
• Age: 2.4% increase with every additional year of age
• With every additional year of age learners were 2.4% more likely to be extremely unlikely or unlikely to recommend their placement

EDI Analysis – June 2021 vs November 2020

Headlines from the comparison of the results from June 2021 to the same analysis conducted after the November 2020 NETS:

• Doctors in training had increased rates of dissatisfaction and discrimination for every question analysed.
• Women were less likely to experience bullying/harassment and have dissatisfaction in their induction and educational experience in June but were more likely to have poor supervision.
• People who identified as not white were more likely to experience bullying and harassment and be asked to complete unsupervised tasks compared to last year. However, they were less likely to have a poor experience with their induction and supervision.
• Disabled individuals were more likely to be asked to complete unsupervised tasks, but they experienced less bullying & harassment compared to last year.
• People who did not identify as heterosexual had increased rates of dissatisfaction and discrimination for every question analysed except for induction.
• People who identified with minority religions had increased levels of dissatisfaction for their induction, supervision, educational experience and placement recommendation compared to November. However, for June there was no correlation between religion and completing unsupervised tasks and bullying/harassment.
• Individuals who were older were less likely to recommend their placement.

Quality Intelligence Managers

What we did

HEE has invested in regional quality intelligence managers who will undertake intelligence gathering activities including triangulation of data from NETS with existing sources of data and intelligence e.g. GMC National Trainee Survey (NTS), National Students Survey (NSS), regional Quality team intelligence. A key area for analysis will be around Equality, Diversity, and Inclusion data. QIMs will undertake a review of local and regional EDI including (working collaboratively as required with other HEE teams).

Our new quality analysts and information managers will both measure and support quality teams in regions to develop local action plans for ongoing measurement of quality improvement.

A national EDI Quality Improvement Plan has been developed that every Postgraduate Dean will oversee for their local office. This can be found in Appendix B.

Equality, Diversity, and Inclusion Data - What we will do

HEE will undertake a review of local and regional EDI including

• To collate a baseline recruitment date from TIS: protected characteristics of those who enter training.

• Look at full registration, CCT and ARCP progression each year to ensure that the numbers are in keeping with the original cohort 

• Triangulate these findings with learner survey data such as NETS and GMC data

• Review GMC referrals as part of the revalidation function and look to see if we over refer a protected characteristic.

• Input and help to monitor the regional / local action plan.