Innovation
An evidence-based pedagogy for the enhancement of intrapreneurial behaviour and intrapreneurial self efficacy for health sector training.
A small interpretive research project was undertaken to develop understanding of the learning experiences and the path to intrapreneurship within the field of radiation oncology. Therapy radiographers (that were identified as intrapreneurs) were interviewed using a Grounded Theory approach to explore the key skills of an intrapreneur and the learning approaches that had helped them develop those skills.
Seven practitioners were interviewed and four key concepts were identified from the interviews. The concepts were used along with evidence from the literature to develop a typical path to intrapreneurship; an intrapreneurial pedagogy was developed from this modelled path. The pedagogy was then applied to a Masters module (Breast Cancer Radiotherapy) with the aim of increasing intrapreneurial skills and innovative behaviour in oncology staff specialising in breast cancer treatment.
What prompted innovation?
In 2007 the UK National Radiotherapy Advisory Group (NRAG) report to ministers identified that in order to meet the government objective set out in the NHS Cancer plan of providing services among the best in Europe a dramatic revision of workforce provision needed to be considered; recommending increased use of the advanced and consultant grades.
Where these grades have been employed in other disciplines (such as nursing) there has been demonstrated efficiency, reduced waiting times, and a more patient focused service. Development of professionals into advanced roles can only happen with concurrent knowledge development. Research shows formal education increases the confidence of those moving into specialist roles; intrapreneurship is particularly relevant to these roles but the development of skills for enterprising activity is rarely attended to in NHS training. Furthermore, the Department of Health QIPP (Quality Innovation, Productivity and Prevention) agenda requires practitioners to consider efficient and productive ways of providing safe care for patients; this agenda needs innovative, intrapreneurial practitioners across a range of professions to drive change.
With the development of a new M-level module specifically aimed at those specialising in breast cancer we felt there was a need to use a learning approach that increased knowledge while encouraging and enhancing the opportunity for intrapreneurial activity.
What makes innovation different?
The intraprenurial pedagogy provides an opportunity to focus on the development of relevant skills for NHS practitioners equipping them with the tools and mindset to implement service changes. The model focuses on how health care workers can learn skills of an intrapreneur rather than specific skills of entrepreneurial learning that is the focus of much of the literature. It is more relevant to intrapreneurship than previous models on entrepreneurial learning by considering the impact of the organisational culture and includes consideration of learning from failure absent from some nursing entrepreneurial learning initiatives. The pedagogy is transferable and has been adapted and currently being used to augment the development of research skills in AHPs.
Changes in practice
The intrapreneurial pedagogy has been implemented on a masters module for advanced practitioners (Breast Cancer Radiotherapy) that is part of an MSc in Radiotherapy and Oncology and has prompted consideration of intrapreneurial activity in the development of a new MSc course in Prostate Cancer Treatment due to start this year. The pedagogy has also been used in another initiative to develop research skills in AHPs using smartphone technology.
Impact
In the first cohort where the intrapreneurial pedagogy was implemented online discussions from students indicated all students had demonstrated learning from the problem based learning (PBL) scenarios presented. More importantly a quarter of the cohort indicated actions that they had already implemented locally (as opposed to intentions to implement change) to improve services as a direct result of the PBL activities.
Case examples of the impact of learning on patient services:
A nursing student in PBL task 1 was asked to consider the role of reduction mammoplasty as a solution to the technical difficulties and poor outcomes for women with larger breasts undergoing radiotherapy for a breast cancer. Following a review of the literature the student contacted the surgeons locally to discuss the issue. After identifying an interest locally from an Oncoplastic surgeon work continued to develop eligibility criteria for patients that would be suitable. The student went on to develop her final summative assessment (an outline business case) with the multi-disciplinary team (MDT); proposing a service for eligible patients to have the choice of reduction mamoplasty as part of their breast conserving treatment.
A Radiation Therapist student as a result of task 1 identified a gap in their service. The key issues were discussed locally by the student with the multi disciplinary team (MDT). In collaboration with the MDT the student developed an outline business case for a special breath hold technique to reduce the dose to the heart in patients treated for a left sided breast tumour; this business case is currently being taken forward by the student within her local Trust. If implemented the deep inspiration breath hold technique can displace the heart out of the breast fields and has been found to significantly reduce the dose to the left anterior descending artery (LAD) for selected patients with unfavourable cardiac anatomy.
As breast cancer is the commonest cancer in women these changes implemented locally by these practitioners have the potential to improve the outcomes for significant numbers of women.
Dissemination
The work has been presented within the organisation at the Higher Education Research and Scholarship Group conference, externally at the College of Radiographers conference on Advancing Education in Radiography and through a short communication in the Higher Education Academy Health and Social Care Journal.