Enhance: Embedding Environmentally Sustainable Quality Improvement into Post-graduate Healthcare Education

Introduction

The education of healthcare professionals is typically limited to the material within their specialty. The Enhance program is the response to the Future Doctor report, which set out how education and training can evolve so that our Future Doctors are equipped with the right skills to respond to population need in an ever-changing health care landscape. Enhance provides training across 6 domains of generalist skills. It is designed to create leaders of the future. In the East of England, Enhance is being offered across the multiprofessional school, to allied health professionals and doctors.

Environmental sustainability is one of the six domains. The East of England (EoE) Deanery is delivering this module via online learning, face-to-face Hub days, and long term placements, which allow a sustainable quality improvement project to be undertaken.

The GLIC

Traditionally, junior doctor hospital rotations have been arranged sequentially. The Enhance Program in the East of England, has introduced the Generalist Longitudinal Integrated Clerkship, or GLIC, for foundation year 2 doctors.

The GLIC rearranges the rotations, for FY2, so that Doctors have one community placement that runs for the entire year, for 2 days of the week, alongside two 6 month hospital placements for the other days of the week.

Benefits of the GLIC are: following patients from community to hospital; having placements over a longer time frame. Placements over a prolonged time frame allow junior doctors to undertake larger, more impactful projects.

The Enhance Program

The Enhance program is a national initiative, delivery of which is down to individual regions. The East of England Deanery is a trailblazer site, which has a multiprofessional offering of the Enhance program. Enhance covers six domains of learning, one of which is environmental sustainability. EoE currently has 40 Foundation year 1 trainees in the Enhance program. From August 2023, FY1s move to FY2, and the program rolls out to a new cohort of 42 FY1 Doctors, as  well as pharmacists, dentists in training, and physicians associates.

Environmental Sustainability

The Environmental Sustainability domain within the East of England Enhance program is aimed toward giving healthcare professionals the tools and expertise to undertake a quality improvement project, which has environmental sustainability in mind. For Enhance trainees, the East of England offers a set of e-learning modules, face to face environmental sustainability hub learning days, and foundation year 2 doctors placements arranged in a GLIC which gives a prolonged timeframe to undertake projects.

There are four sections to the e-learning module, covering the following topics:

1) The Climate and Ecological Emergency, its Impacts on Health, and the NHS’s commitments to Climate Mitigation.

2) Change management, The Triple Bottom Line and the Principles of Sustainable Healthcare

3) Integrating Sustainability into Quality Improvement

4) Sustainable Quality Improvement Project Development Template

The module was developed with the Centre for Sustainable Healthcare. By giving learners the tools to effect sustainability changes, we can drive change across many parts of the healthcare system. The Environmental Sustainability Hub days offer facilitated group work, focussing on the using sustainable quality improvement process for the learners’ own improvement projects.

Quality Improvement Embeds Practice

Teaching early career healthcare professionals the methodology to carry out effective environmentally sustainable quality improvement projects will create a cohort of staff that have expertise in this area. In future, they will be empowered to give guidance on embedding sustainable practice into other systems; to teach their junior colleagues how to embed sustainability into systems. This should give their career momentum to undertake larger, even more impactful projects as they increase in seniority.

Further Reading

1) https://heeoe.hee.nhs.uk/foundation/training-programme/enhance-eoe

2) https://sustainablehealthcare.org.uk/