Course evaluation summaries were received from twelve participants who took part in the fourth ELHI programme held from 18-23 September 2005 in England and 5-12 November 2005 in Sweden and Denmark (ELHI 4).

As in the two previous evaluation reports feedback from ELHI 4 participants remained largely positive and course participants appeared to have found it a valuable learning experience.

All participants expressed the opinion that the programme had provided opportunities to meet their three core objectives which they had identified at the outset of the course, not only on a personal level but in terms of benefits to their organisations.

Comments received focussed on additional benefits gained from the opportunity to visit organisations to see how they work and more particularly to work together with participants from other countries and learn about the different healthcare systems in those countries.

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.

As reported in the last report, scores for ELHI 3 were the highest of the three programmes run to date but ELHI 4 scores surpassed this and are shown below in comparison with ELHI 3.

The delivery of the course was adjudged to be of the highest standard and the content also rated highly.

Practical considerations showed a marked improvement although there were still some suggestions for improvements in areas around the length of travel time to assignments, shortening of the working day by providing some more leisure time and leisure facilities. There was also a comment about the cost of sundries charged to the participants.

The mystery tour event evening was however deemed a great success.

Some pre-course information about the UK health service for the Danish and Scandinavian participants was also suggested.

The figures from ELHI 3 (which included one "none" response) have been included in brackets for comparison purposes to emphasise the significant improvement in terms of meeting participants' original objectives and their view of the overall pace of the programme.

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

• 92% (43%) had achieved their objectives to a great extent
• 8% (50%) had achieved their objectives to a reasonable extent

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

• 0% (7%) felt it was too fast
• 8% (0%) felt it was too slow
• 92% (82%) felt it was about right

Only one participant responded to these sections and his comments were as follows:

The session on learning about the structure of the UK/Swedish health care system was excellent and provided a very good way of learning which could be used in the daily work situation.

This activity was challenging particularly when going into an unfamiliar area of the healthcare system. Learning the SENSIA was found to be useful

The interviews enabled participants to work together as a team and the external review was considered to be transferable into participant's own workplace. The other positive points noted were the high level hospitality and the general enthusiasm in the group.

The team working element of the programme was positively highlighted because of the excellent spirit that was generated between the participants and, despite coming from different environments, they all worked well together.

The comment made regarding report writing was that it would have been better to start writing the report earlier to enable time to reflect on it and complete the following day.

This was considered to be a very powerful way of providing feedback from clients to teams.

• The need for good communication
• Greater knowledge of mental health services and other healthcare systems (seeing the bigger picture)
• The opportunity to produce better outcome measures
• Self awareness of potential prejudices which might affect the scope for strategic working
• Moving vision forward
• An understanding of the tools needed to motivate teams in order to make them more functional
• The importance of standing back and taking time to assess across the organisation
• To have more confidence in own ability as a leader and to develop leadership in others
• How to reflect on the way I work in my own organisation to become a more effective leader
• The importance of networking and influencing people as well as supporting other leaders
• To make time to reflect on day to day working
• Not to form judgments about people and situations too quickly
• To be aware of different types of leadership for different situations

• Challenge more robustly existing prejudices
• Seek information and advice from colleagues
• Communicate plans for staff in a better way
• Set up "peer review" programmes
• Take time to reflect on own leadership and focus on own personal development
• To continue to identify good leaders and emulate those parts of them that make them effective and to develop leadership in others
• To continue to focus on own personal development as a leader
• The importance of networking (particularly with other ELHI participants), developing personal networks and visiting areas of good practice
• Provide opportunities for others to develop the leadership role
• Will build in time for a reflection process in meetings with directors

All participants felt that they had developed skills or gained knowledge from this programme. Areas specified by participants were as follows:

• in clinical leadership and development
• the value of competition and local political engagement
• lessons from the project which were applicable in own organisation
• maturity as a leader
• clearer plan on how to move forward
• how to structure interviews
• greater confidence in self and to develop vision and ideas
• performing assignment type reviews in own organisation

The general consensus of opinion amongst the participants was that certain areas of the work covered will be and, in some cases, has already been of use in their host organisations. Areas specified by participants were as follows:

• the positive and constructive criteria contained in the report which can be applied within host organisations
• as long as feedback is received by those staff engaged in the process
• teams had already taken this work very seriously and were committed to delivering a quality product
• in complex areas it will required joint working and common understanding

The International Learning aspect of this programme has evaluated as being extremely successful. Many cited working with international colleagues as one of the most beneficial aspects of the programme and confirmed their intentions to network with each other in the future. The shared learning was a valuable asset to the programme which brought richness and diversity to everyone as well as creating a "rich realism" to the formal information provided about health systems.

Greater self confidence and personal development were the most frequently expressed benefits, together with the international learning and networking.

The following more detailed comments were provided by participants.

• Great networking and a better understanding of policy direction
• Insight into the European health systems and an awareness of the "bigger picture"
• Understanding of change and how to lead it
• A real challenge to leadership skills and better understanding of strengths and weaknesses
• Insight into new systems
• Opportunities to develop new partnerships and learn together across clinical/managerial international boundaries
• Learning how to lead effectively

• If I had known more about the UK health care service
• If I had had more time for preparation

• Share knowledge gained
• Adapt leadership style and work better
• Take the organisation forward and modernise more effectively
• "Lead" as opposed to "Manage"
• Challenge more and understand wider perspectives
• Appreciate the leadership of others more as a learning tool
• Support others to develop their leadership skills
• Develop further as a leader taking the health community forward
• Communicate my vision

• Share experiences and develop others through future programmes
• Be more visible
• Work more effectively outside my organisation
• Lead better
• Become more visionary and push forward change
• Establish clinical leadership programmes
• Develop links with other sites across the UK
• Be more visible as a leader

Most of the comments on the participants evaluation sheets indicated that the programme required little or no change two very positive comments were put forward by participants:

• It was excellent - don't change too much
• It is a first class leadership development experience with real long term impact

However comments taken from the flip charts suggested:

• In terms of "house-keeping" more clarity required about what is covered and what is not - problems with sundries being added to the bill and being unable to claim them back
• Would like to see a more equal balance of English and Scandinavian participants
• More information required about site visits, i.e. better briefing about the task of the group, people visited are not necessarily key people
• Time taken to travel to some sites can be lengthy
• More time required to write the report to ensure that the end result is a good one

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

• Thanks for the privilege - it has been fantastic
• I go home with my batteries charged and keen to get things moving
• An excellent opportunity for learning and developing into a leader
• A totally fantastic experience
• Leaving the course I felt energised, confident and motivated to lead my organisation
• A great privilege to be invited
• An experience and learning that will remain with me
• Basing it around assignments - fantastic
• It was a fantastic experience which clearly brought me much further in my development as a leader than I expected