Course evaluation summaries were received from fourteen participants who took part in the third ELHI programme held from September 2005 to October 2005 in England, Sweden and Denmark (ELHI 3).

As in the two previous evaluation reports feedback from ELHI 3 participants remained largely positive and course participants appeared to have found it a valuable learning experience.

Although most participants felt that the overall pace of learning was about right, some did think that the first week of the programme had been rather slow and the second week rather "stressed". It was considered that a shift in the balance between the two weeks might address this.

Only six of the fourteen participants completed this section and the most common participant objectives were identified as:

• To develop leadership skills through networking, communication and strategic thinking
• To gain a deeper and broader insight into health improvement activities in different healthcare systems and in different countries
• To gain opportunities to see and discuss healthcare interventions that benefit populations in different countries and to learn about leadership styles in other countries
• To enhance leadership skills to appreciate the levers of the healthcare system that have been developed in particular
• To be better equipped to deal with changes in healthcare and in the change process
• To gain an understanding of global trends to facilitate preparation of relevant strategies for the future
• To take the opportunity to reflect on where the future lies
• To be better equipped for working on a consultancy basis or in a remote environment
• To compare leadership styles in the different countries taking part

The participants were asked to rate the content and delivery of the overall ELHI programme and also to comment on logistical aspects of the course such as accommodation and booking arrangements.

The results were scored according to satisfaction with each element and average scores for the group are given below, where a score of 1 represents low satisfaction and 4 represents high satisfaction.

Scores for ELHI 1 and 2 are shown in brackets, for comparison

There had been a clear improvement in almost all aspects of the course. The course content and delivery were both rated very highly.

Some of the practical considerations were again raised in terms of the participants' preference to stay in city centres and to have more free time to appreciate the culture of the country.

Manchester was not considered a particularly good venue. For a programme focussed on health improvement the facilities were deemed to be inadequate (no leisure facilities) and the programme was hectic especially in the second week.

Placements need to be not more than 1¹/₂-2 hours travelling time from accommodation.

It was suggested that funding and payment arrangements should be made more explicit. Some pre-course literature was also suggested.

The percentages of participants stating that they had met their original objectives to the following extents are show below:

• 43% had achieved their objectives to a great extent
• 50% had achieved their objectives to a reasonable extent
• One participant did not respond to this question

When asked about how they felt about the overall pace of the programme:

• 7% felt it was too fast
• 0% felt it was too slow
• 86% felt it was about right
• One participant did not respond to this question

Three of those who agreed that the pace was "about right" felt that the first week was a bit slow and the second week was bit pressurised.

The positive comments noted were that:

• The programme was presented in a relaxed atmosphere with good facilitation
• By allowing participants to describe their organisations it helped people to get to know each other without putting them under pressure
• The assignment arrangements were adjudged to be "interesting" but most people were happy with the assignment way of working and thought that the "forming of the group" stage was good

The negative comments noted were that:

• That the introduction was too lengthy
• There was a lack of clarity around the different health care systems in different countries
• Some anxiety in the groups where there were a few 'dominant characters'

The positive comments noted were that:

• The main benefit was around learning from the assignment groups
• The method was considered to be "different" but good
• It was a good concept for people to learn together
• There was a lot of clarity around the assignment plan and the group found an equilibrium and way of working
• It was interesting and relied on the effort of each individual
• Set assignments were helpful and groups on the whole worked well

The negative comments noted were that:

• More time for discussion would have been helpful
• Coaching information could have been reduced
• Not feeling very productive in terms of "my future camp'

The positive comments noted were that:

• Useful to meet "other" staff rather than just other leaders
• Many good interviews - good impression gained from English hospital
• Clinical Skills Laboratory was fascinating and fact finding was very useful
• Easier than anticipated, very open and learning a lot
• Interesting and open discussions in top leaders group - more engagement from the "floor" would have been useful
• Quick alignment with group and group task
• Very well organised and well explained programme, enthusiastic and dynamic team, good site visits

The negative comments noted were that:

• Would have liked the opportunity to meet more clinical directors rather than people involved with non-clinical education
• Visit not very well organised. Some initial problems but the group adapted well
• Some interviews not very productive
• Set presentations left little chance to explore areas specific to the task
• Felt frustrated and tired

The positive comments noted were that:

• Good discussions, good experience, focussed sessions, good presentations, great social evenings in Copenhagen

The one negative comment noted was that:

• More time for consultancy teams was suggested

The positive comments noted were:

• Very successful with opportunities to learn through others in the group
• Teams of 3 made it easy to work together and generally teams functioned well
• Learned a lot through this type of working
• Worked well with individuals adapting to natural roles
• Very powerful discussion with Chris Ham

The one negative comment noted was that:

• There were some problems in adapting on plenary levels

The positive comments noted were:

• It was OK and there was enough time given to write

The negative comments noted were:

• Would have liked more time to talk about results
• Should have discussed how to write the report earlier
• Since each person wrote a part it made it difficult to put together a well structured report, it took a long time to write at the end of a very long day
• People were a bit stressed but it was recognised to be a good learning process

The positive comments noted were:

• Interesting discussions, particularly on European health care
• Needed time to rehearse but it went well and stood up under questioning

The one negative comment noted was:

• Not clear what was expected - too focused on HR

Overall this section evaluated well with more positive than negative comments.

The introduction assessed well and enabled participants to relax in each other's company and learning more about each other's ways of working.

The assignment groups were also well received and provided a good environment in which to work and learn from each other.

The positive comments noted were:

• Participants worked well together
• Future camp worked well
• Good to meet other people from other countries, possibly for exchange in the future and to learn more

Suggestions for improvement:

• Would have preferred discussions about problems in organisations today rather than about EU health care
• Pre-course reading on some key document in English on health care systems would be helpful
• Reflection on "what to explore" during visit and interviews would make time more productive

• Knowledge or organising health services in other countries and how it might impact on people, quality and organisation
• Provide productive and dynamic leadership
• Improving method of communication in plenary and smaller groups
• Knowledge aspect will feed into discussions and developments
• Focus on clinical engagement
• Focus on the end point of implementing IT
• Release doctors/clinicians properly to manage/support change
• To believe in motivational leadership
• To use reflection time - it has a huge impact
• Specification knowledge in the health system from very competent lecturers
• How to focus on strategic issues instead of "daily trivia"
• To aim at listening/interviewing staff and others and analysing
• How to think beyond the given and interpret real issues - move thought, less reactive
• My problems are everyone's problems
• To stand back more and be harder in decision making
• To introduce "coping" strategies
• Critical thinking and questioning
• Leadership and communication with leaders
• Performance management framework
• Handle change better
• Think of people before structure
• Focus on micro-systems, small teams that do the delivery
• Specific knowledge about my topic has given me sills and motivation to apply some of learning to my own job
• Learning about differences across countries which will give a wider perspective and look at systems in a different way
• Opportunity to reflect on own management style and identify ways to improve own practice

• Gain a better knowledge of what needs to be done to change an organisation and what a leader needs to be aware of
• To have more exchange with other organisations
• Take more time to reflect with colleagues
• "Be braver"
• Conduct review of services in a similar way to assignments
• Share projects with relevant people back at base
• To clearly develop the vision when leading change
• Listen more to the team
• Work in a more focussed way to ensure local ownership
• Spend more time to communicate core values within the team
• Take a new approach - 2006 situation in Denmark
• Participate in further coaching/training, change way or working (more team focussed) and build in more time for contemplation
• Take control of the future and seek out new opportunities, perhaps in different environments
• Attend similar programmes after a suitable interim time
• Continue the network contact, meet regularly with CEO and share thoughts and ideas
• Use performance assignment to develop stronger performance management framework for clinical directors

All participants had developed skills or gained knowledge from this programme, those specified are listed below:

• Improved presentation skills
• Tried to focus on more development in the organisation
• Report writing skills developed
• More focus on own reflections and importance of communicating to colleagues
• Answering questions directly
• Knowledge of IT
• Improved leadership and teammanship
• Improved listening skills
• Strengthened diagnostic/problem solving skills
• More strategic approach to problems/changes and greater confidence to address these issues
• Involvement in "harder" decision making
• Team working/networking and understanding different skills
• Improved performance management frameworks
• The importance of clear leadership
• Understanding the importance of micro-systems
• Thinking around the core organisation
• "How to sell" a topic (negotiating skills)

• Some recommendations I think will be analysed and used
• CMO at Frederiksburg discovered some things he didn't know
• Definitely - project learning very relevant and will be used in own organisation
• The aim of the assignment team was always to give something back to the host organisation - only they can say if this aim is achieved
• More useful to them than us
• Interviews were stimulating

The International learning aspect of this programme has evaluated as being extremely successful. Comments made were:

• The approach of the Scandinavians and some of the systems we saw we need to implement
• Definitely understand more about alternative ways of organising health care, the advantages of a centralised system and the differences associated with different funding methods
• Recognising the opportunities lost by separating health and social care in England
• Great - very beneficial
• Brilliant - same problems/same solutions
• Excellent - never experienced an opportunity to work with European colleagues
• Interaction excellent
• Two-way benefits from participants in other countries

The main benefits raised were:

• Sharing and observing different learning styles
• The importance of a team approach
• The importance of motivational leadership/champions
• Insight into new systems
• Transferability of skills into other health care settings in the UK and possibly in Europe
• Positive reinforcement of good things we do
• Time to think and reflect
• Developing a new network on both the programme and through the visits
• Better overview of how the private sector matches with the public sector
• Enthusiasm of other participants

• "I had been braver"
• I had been a in group with less dominant characters
• There had not been any language barriers
• There had been a little more pre-course information

• Plan my future better
• Have a clearer vision with specific goals
• Use the experience to influence future career decisions
• Reflect on how to deal with conflict
• Lead teams more effectively
• Improve performance and problem solving
• Have a better perspective on things that can be done better and differently
• Stand back, reflect and be more decisively
• Improve the style of leadership

• Creative more reflective time
• Review the environment to enable others to succeed
• Diagnose difficulties more effectively
• Involve clinicians more directly in management structures
• Improve performance in 2006 and identify areas where it is crucial to do this
• Identify the main strategy
• Effectively input into Top Team decisions
• Develop robust performance management frameworks
• Enable other to lead
• Contribute more on leadership and knowledge

• Identify a venue with more character, better leisure facilities
• The need to spell out payment arrangements who pays for what and when and perhaps more dinners in restaurants
• The need to have more balance in the workload between week's 1 and 2 (second week too focused on assignment and report writing)
• Maybe to do a European health care system in week 1 to balance out the programme
• The option to self-select discussion partners in assignment groups
• Keep doing it
• Assignments would have benefited from an opportunity to influence content of visit programme
• Evaluation of "My Future Camps" might be a useful addition - as these were seen to be very good

A number of additional comments were received in feedback from participants and these are noted below:

• Content of programme was generally excellent
• Fantastic programme, enjoyable and stimulating and has been organised and led skilfully
• Very interesting
• Excellent exchange with others
• Speakers good
• Quite a marvellous course
• Fantastic opportunity and very sophisticated approach to learning