Deja vue

Fiona's Blog

The teaching excellence framework seems familiar to those working in healthcare education, writes our director of research, Professor Fiona Ross CBE.

That the government should assume teaching is not “at the heart of the system” and needs a good shake up is both challenging and combative. But its response—a teaching excellence framework—is not entirely new. A very similar system has been in place in healthcare programmes for almost a decade, although it was designed to improve employer rather than student choice. Subjecting all university programmes to the kind of performance management already seen in healthcare both feels like deja vue and offers an opportunity to share some lessons.

It was Margaret Thatcher’s ideology of the internal market that led to the purchaser-provider split in healthcare education in the late 1980s. At the same time there was a mass move of large contracts for nursing and midwifery into higher education. Universities became, in the language of that government, “providers” of healthcare education for nurses, midwives and allied health professions and subject to performance assessment. Although the health portfolio can be a large business and strong income stream for universities, this performance management is often hidden from view. It it tends to be managed in-house by faculties and separately from the rest of the academic portfolio. But perhaps it won’t be invisible for much longer. And it offers useful insights as universities prepare their responses to the consultation on the teaching excellence framework.

The Quality Contract Performance Management System was introduced in London in 2007 and later aligned to the Health Education England national education outcomes framework. The focus of the “contract performance” was about value for the NHS investment in universities and to ensure newly qualified professionals were “fit for purpose”. The system measures outcomes across domains that have evolved since its inception, which include recruitment and widening participation, research and practice innovation, placement learning, student satisfaction, progression, attrition, pass rates and employment. Universities return quantitative data quarterly, which is enhanced with qualitative evidence—for example to support claims in applied research and innovative education. Red/amber/green ratings are applied to the contract performance indicators and annual reports are produced for each profession, which are published externally as league tables. Financial penalties are applied for attrition and performance influences annual commissioning decisions about growth or disinvestment in student numbers. The metrics have been used as benchmarking data in the process of competitive tenders that have led to provider market exits. There are such powerful parallels with the proposed teaching excellence framework that I almost wonder if civil servants do talk to each other across government.

From managing one of these teaching excellence framework lookalikes, I have learned that it is overwhelmingly and disproportionately resource intensive. Although there was no new money, my organisation decided to prioritise a strategic leadership role to oversee the process and invest in building data-analytical capacity within the faculty. Managing the data is crucial; having a devolved system of data handling and reporting paid dividends and ensured there was ownership and understanding by module leaders right the way up to heads of school. Attention to detail is also crucial. On many occasions the eagle eyes of our data analysts spotted mistakes made by the commissioners that could have made a significant difference in the institutional rating.

Leadership is vital to avoid the organisation becoming preoccupied with feeding a data-hungry system on an industrial scale without seeing the broader opportunity to build a system that improves quality. Data can be used to identify priorities, support organisational change and make improvements to teaching and learning. For example, we introduced values-based recruitment, to ensure we were selecting students who were motivated by the right things, and initiated a system of facilitated peer-led learning in small groups to encourage early interventions when students showed signs of struggling.

Yet there are differences between the healthcare and teaching systems. The first is that the teaching excellence framework narrative is about incentivising good teaching to benefit students and enable choice; universities that achieve excellence will be able to charge higher fees, whereas the NHS has a fixed price for students and penalties imposed on universities for poor outcomes. The narrative around the teaching excellence framework focuses more on excellence and sharing, whereas in the NHS it is on identifying the bad and rooting it out. Messages around the teaching excellence framework emphasise the need to ensure teaching has parity with research, whereas health commissioners have traditionally been ambivalent as to the value ascribed to research in teaching. The plan is for assessment of teaching to be done largely by peer review and to produce better information for students, whereas the NHS system is a top down inspection regime to provide metrics for employers to make commissioning decisions.

Everyone wants to see students getting the best education and that means good teaching, informed by cutting edge research and scholarship. The big risk of the teaching excellence framework is that it will end up being a burden, measure what is easy to count and fail to capture the hallmarks of quality, such as reflective and critical thinking. However, as long as leaders argue the case for balance and proportionality, these kind of metrics do have a place. My experience from healthcare is they can indeed be valuable in driving good practice and improving the student experience.

Professor Fiona Ross CBE is director of research at the Leadership Foundation for Higher Education and formerly executive dean of the faculty of health, social care and education, run as a partnership by Kingston University and St George’s, University of London.

This article was originally published in Research Fortnightly. To find out more click here.