Supporting the redesign of the ECEPC pathway in Princess Alice Hospice
The European Certificate in Essential Palliative Care (ECEPC) is the flagship course managed by the Education and Research team at Princess Alice Hospice (PAH). It is a highly respected qualification in palliative care, delivered by multiple sites and coordinated by PAH. The course has been running for over 25 years and has grown over time from small cohorts, delivered face-to-face, to larger groups of approximately 400 candidates learning remotely at their own pace, in countries throughout the world. The course is run two times a year.
The team at PAH wanted to make the course bigger and better, to enable the widest possible delivery of the highest standards of palliative care. However, the underpinning process of managing the course was holding back the team’s ambitions. PAH has an ongoing supportive partnership with Ad Esse who were brought in to observe and coach the change practitioners who were leading the improvement project.
Clare Lawrance is a Lecturer & ECEPC Course Coordinator at PAH. Here are Clare's thoughts on the project below.
The Challenge
The course application process was admin heavy and largely paper-based. Once registered, multiple systems meant time consuming data entry with the risk of errors and rework as candidates progressed through the course or requested deferrals.
Some members of the team had not previously had the opportunity to engage with a redesign process so were uncertain about the benefits. However, once it was understood the aim of the project was to release capacity to focus on course delivery, everyone fully embraced the change because they could see the benefit.
The project
For this Rapid Improvement project, we had three days in a workshop using Value Stream Mapping to review how we manage the ECEPC course. Firstly, we documented the existing administrative process, then with Ad Esse and our Business Improvement team, we co-created an improved process involving automation and available technologies and finally set an implementation plan to introduce the new process. This was aimed at improving the efficiency of all administrative tasks, as well as the candidate's experience.
The workshop was facilitated jointly by an external consultant (Rebecca Gamlin) from Ad Esse and by the hospice’s Continuous Improvement, all of whom had been trained in using Value Stream Mapping (VSM).
Reflections on the process
Before the workshop, I hadn’t experienced a process mapping exercise and I learnt a huge amount from the presentation, carrying out the activities, and from reflecting on them afterwards. It was particularly valuable as I was just starting an apprenticeship programme as a Learning and Development Consultant, and it gave me a great insight into the effective use of business tools to review and support improvements and change.
I was amazed how detailed the process ended up being when captured on paper – it was 5 metres long!
It felt quite intense, having to document each and every part of the current working practice and scrutinise it from all angles, then going back over it again. But it really helped us gain a better view from both the course lead and course candidate perspective.
I found I did need to remind myself at times that problem solving needed to wait. I was keen to find solutions to issues as they arose, but I was encouraged to see that it’s far better to document it ‘as-is’ and leave the review until after.
Rebecca Gamlin from Ad Esse was great at keeping the exercise on track and offering explanations. It was also useful to be with the other Hospice colleagues who we don’t usually work with, as they helped act as ‘critical friends’, asking the right questions to make us explore our rationales.
From the diagnostic VSM and customer journey mapping, we discovered lots of data transfers, handovers between multiple people, checking steps, and spreadsheets.
Designing the solution
The redesign principles were to create a simplified process. For example, we reduced the number of clicks and actions required to manage a candidate, as well as the need for uploading/downloading/emailing of documents. We made use of automation/digitisation where possible and increased the consistency and accuracy of data collection. Transparency was increased with clear responsibilities, clear expectations, and rules for all other sites to manage their cohorts by. Also, we now collect robust data to better understand performance and make informed decisions.
Outcome of the project
It's been a long two years, but we've achieved a huge amount. As the project is now nearing the end of the monitoring phase, we are starting to see the tangible benefits of all the work and changes. The data available now is far more comprehensive than before and gives insight into the course and candidate performance that we would not have been able to access before. Feedback from candidates and other sites that deliver the course has been positive and it feels that the working relationships have been strengthened.
Princess Alice Hospice, and the ECEPC course specifically, are now in a good position to facilitate expansion to new sites, increase candidate numbers, and further the reach of the course, enabling more healthcare workers to gain the knowledge and skills to deliver excellent end of life care.
Overall, the experience of doing this has really helped me to see beyond the role I currently have day to day and see things from a broader perspective. I feel I’ve gained new knowledge and learnt how to use some simple tools to effect real change which I can apply to other work areas with the course, such as collaborating on developing content and assessments and managing relationships with the other sites. We’ve grown in confidence and seen that an improvement project can be done whilst continuing business as usual.
“I would absolutely recommend ad esse’s services! The project was one of a number that ad esse have supported Princess Alice Hospice with, and I feel lucky we had the benefit of their skills and experience to help bring our vision to reality.”
(Clare Lawrance, Lecturer & ECEPC Course Coordinator at Princess Alice Hospice)
Clare Lawrance, Lecturer & ECEPC Course Coordinator at Princess Alice Hospice, shares her thoughts in this case study