Published: 14/10/2004, Volume II4, No. 5927 Page 20 21

The National Primary Care Development Team has helped raise the level of boys'achievement at secondary schools by changing the organisational systems of learning and teaching

The National Education Breakthrough Programme for Raising Boys' Achievement is the result of a partnership between the Department for Education and Skills, Innovation Unit and the National Primary Care Development Team.

This project has been testing and adapting the methodology which the NPDT has already used effectively in healthcare. Its first wave began in October 2003 and concluded in August 2004.

The focus was on raising boys' achievement in participating secondary schools, and the first wave involved 30 secondary schools across England, at key stages 3 and 4 (years 9 and 11).

The participating schools represented a spread of socioeconomic backgrounds. Our aim was to help boys achieve their potential by working to change the organisational systems of learning and teaching.

We were keen to work in education, in no small part as an upstream public health intervention. The aim of key stages 3 and 4 is to ensure that pupils get five or more A-starred GCSEs. Research consistently demonstrates that boys at this age have lower educational attainment than girls, and we know that these boys with low attainment are much more likely to be unemployed, and much more likely to be affected by chronic diseases.

The NPDT's work in primary care centred on the 'collaborative' methodology.A collaborative works by spreading existing knowledge to multiple sites which share a common aim (originally health - but now tried in education). It looks at the best examples of organisations with improved results, and seeks to understand what it is about that organisation's system that is different.

A collaborative codifies the special factors of these organisations into a small number of change principles, and then gets participants to implement these in a systematic way.

NPDT was commissioned by the DfES last year to find out if our work could 'translate' into education. At the end of the first wave of the programme, the evaluations - both our own and independent work - answered that question with a resounding 'yes'.

When we looked at the examples in education, where schools had already made significant inroads into raising boys' achievement, the common features were:

creating an environment for change with strong leadership;

focusing on teaching and learning methods that were 'boy friendly';

using mentoring and targeted intervention with pupils;

creating capacity (skill mix);

using data to drive improvement.

The programme that was introduced as a result of NPDT's work got results. One school which was on special measures increased its percentage of 'satisfactory and good' teaching by 60 per cent, as measured by their Ofsted inspection. Another school eliminated the difference in educational performance between boys and girls in the year. Some schools used the methods not just for boys' performance, but to change how they operated as a school.

Our background in health gave us some useful tools. One participating school had a 'sanctuary' for pupils with behavioural problems.We found that nearly two-thirds of the pupils in the 'sanctuary' had had nothing to eat or drink before coming to school. Simply providing these pupils with toast and coffee before school improved their behaviour.

The DES has now asked us to do another wave of the programme, and has given us funding for 40 schools. Over 160 schools applied to participate in this wave, so it seems pretty popular.

There have been some very useful lessons we can bring back to the NHS, having taken our collaborative methodology into education. Perhaps the most interesting of these was around information.We found that the level of data in some schools is very high and sophisticated. If the NHS had as much knowledge of its patients as these schools did of their pupils, there would be a huge improvement. In this particular respect, I think We are getting there with the quality management and analysis system and the quality and outcomes framework in primary care, which will give rich data source for epidemiology.

We also saw some excellent e-learning tutorials for pupils, which took them through particular topics in a very structured way. These look totally transferable for patients with chronic diseases, to help them understand more about their own condition and to assist them in self-care.We hope we can pursue that thinking.

Next year, NPDT will have residents of communities working with us on nutrition and falls in older people; schools working with us on these same two areas; and general practices and PCTs working with us on chronic disease management: all of this going on in the same geographical area.

All of these groups will have learnt the same basic methodology, and it doesn't take a huge leap of imagination to think of getting these groups together. Indeed, they can work across organisational boundaries on topics such as teenagers and drugs (or alcohol).

This is in line with NPDT's over-arching strategy: to create capacity and capability for public service improvement: even though we are just a small team.

How to drive change

Asking yourself these three fundamental questions will help when trying to engender change systematically.

What are we trying to accomplish?

This is meant to help you be clear about the improvements you would like to make; what results you would like; and how you would like things to be different.Having a clear vision of the aims of improvement is vital.

How will we know that a change is an improvement?

Without measurement, it is impossible to know whether you have improved.Think about how you want things to be different when you have implemented your change, and agree what data you need to collect.

What changes can we make that will lead to an improvement?

Finally, you need to decide what changes you will try in order to achieve the results you are looking for.What evidence do you have from elsewhere about what is likely to work? What have other people done that you could try? Gather as many ideas as you can; these will form the basis for your PDSA cycles.

PDSA cycles are traditional learning cycles where you 'Plan'a change, 'Do' it, 'Study' the results you get, and then 'Act'on the results.The key to them is to try out the change on a small scale initially, and to rely on using many consecutive cycles to build up information about how effective your change is.This makes it easier to start, gives results rapidly and reduces the risk of something going wrong.

If what you try doesn't work as well as you hoped, you can go back to how things worked before.When you have enough information to feel confident about your change, you can then implement it as part of your system.

HSJ forum: The NHS Towards 2008

Sir John Oldham will be speaking on the National Education Breakthrough Programme for Raising Boys'Achievement in a breakout session at this year's HSJ Forum, 'The NHS Towards 2008', on 16 November.With more than 20 speakers confirmed - including former prime minister's adviser Simon Stevens, Deborah Roche of the Institute for Public Policy and Research, Lord Victor Adebowale of Turning Point and Professor Edward Peck of Birmingham University, this is HSJ 's premier conference event of the year.For more information on attending visit www. hsjforum. co. uk.

Sir John Oldham is head of the National Primary Care Development Team.He was speaking to Andy Cowper.