Developing Professional Skills
Why Professional Skills?
Clinical competence alone is essential but not sufficient for a fully functioning healthcare system. Non-clinical professional competencies are an essential, but overlooked, part of quality patient care and effective institutional management. In Somaliland, professional skills are neglected in both the formal and informal curricula, meaning that health workers receive little to no training in these areas. As a result, the few that that do have these skills are under enormous pressure and often unable to delegate tasks to colleagues, clinicians do not routinely collect data with the intent of using it to improve services, and the evidence base policy for the local and national levels is weak.
Accordingly, KSP’s partners requested support to foster the following skills in the health workforce: leadership and healthcare management; quantitative and qualitative health research; and evidence-based clinical practice.
Improving Patient Care by Fostering Clinical Leadership
- 26% of the medical workforce and 13 nurse tutors have completed KSP leadership training
- 20 quality improvement projects, including clinical audits, conducted by participants, supervised by volunteers
Somaliland health workers leave this annual 8-week training course understanding the fundamentals of clinical leadership, including team work, professionalism, clinical ethics and the use of information.
During the course I realised that no matter how you improve your personal skills, you can’t improve patients’ health unless you get skilled at teamwork
Leadership and Professionalism Course Participant, 2013
Participants are also required to work in small groups to complete a clinical service improvement project. In addition to putting the skills they have learnt into action, these projects – standard practice in developed healthcare systems, but rare in Somaliland – have been used as the basis for improving clinical services. In one striking example, a project demonstrated that 0% of monitoring of routine vital signs on the paediatric medical wards adhered to local guidelines. In response, additional training was provided to nurses responsible and a local initiative was set up to create competition between wards. In 2015, the course participants were re-audited, finding adherence had increased to 30%, a change that has potentially saved lives.
Example Quality Improvement Projects
Routine vital signs monitoring in the paediatric medical ward at Hargeisa Group Hospital
This audit was completed by two doctors at Hargeisa Group Hospital in 2014, and showed that none of the monitoring of routine vital signs in on the paediatric medical wards adhered to local guidelines. Following the audit, results were shared with the nursing team on the ward, and additional training was provided. A local initiative was also put in place to create competition between wards. In 2015 the authors re-audited showing 30% of vital sign monitoring now adhered to guidelines.
Infection control in HGH theatres
This audit was completed as part of the 2015 Leadership and Professionalism course by 3 nurse tutors and a junior doctor working at Hargeisa University and Hargeisa Group Hospital. The audit revealed adherence to aseptic technique in theatre at 63%, with some variation within the surgical team. As a result of the audit, the team developed local infection control standards which is currently awaiting sign off from the Somaliland Ministry of Health.
Building Research Capacity
- Published 13 papers with Somaliland co-authors, representing 35% of Somaliland’s entire research output to-date.
- Trained 11% of Somaliland’s medical workforce in basic research methodologies.
Since its early days, KSP has supported its volunteers and clinicians in Somaliland to collaborate on research and publishing papers. Research capacity, almost non-existent when KSP first arrived, is a key priority for Somaliland partners.
Much emphasis should be given now to research. Before we were working hard in filling the gap in the work force. Now we have to work in a way to get data to see the impact of the work. Where there is no information there is no policy; where is no policy there is no plan, and where is no plan there is no implementation. We can do this through research and then make a change to the health situation of the country.
Dr Walhad, Principal, Amoud College of Health Sciences
KSP is providing an in-country, online and blended training package for doctors and medical students that covers qualitative and quantitative methods. Our latest course enables Somaliland participants to write post-graduate level research protocols, and is run in parallel with King’s College London MSc in Global Health.
Providing Somaliland Health Professionals with Direct Access to Senior UK Mentors
- Introduced the 360 Degree Feedback to the clinical context in Somaliland.
In 2014, at the request of Somaliland partners, King’s began researching a new mentoring project for junior doctors in Somaliland, with the aim of reducing feelings of professional isolation, and improving professionalism.
Somaliland doctors apply and are matched with a senior UK mentor and meet regularly for a minimum of 6 months. The interaction takes place online and sessions may cover a range of topics determined by the mentor and mentee, including: clinical issues or cases, career development, and ethical dilemmas.
The differentiating feature of the 2015 mentoring programme is the introduction of 360 Degree Feedback. This technique, also known as multisource feedback, is a system in which individuals receive confidential, anonymous feedback from the people who work around them. Participants in the KSP course get feedback from colleagues (junior, senior and peers) on their ability to communicate, interpersonal skills, conflict resolution and professional behaviour. 360 Degree Feedback is widely used in the UK to review the performance of trainee doctors and consultants, and is considered a useful tool for encouraging professional development. An internal KSP literature review on mentoring in low and middle income countries found no prior examples of this technique being used in similar contexts.