Aim and objectives
In undertaking this project, our aim was to utilise learning gained through experience to develop a capability maturity model which describes the essential capacity required to establish a new children’s nursing education programme.
Objectives were to:
- Identify the full range of supportive conditions that must be in place to enable the development of new children’s nursing education programmes;
- Describe the key functions and responsibilities of the major stakeholder groups who need to contribute to the development of new children’s nursing education programmes; and
- Access collective expertise by consulting with the community of children’s nursing education practitioners in southern and eastern Africa.
Our intention was that the resulting capability maturity model could enable stakeholders to assess their current level of capability maturity in relation to each domain, stimulating reflection and process improvements, ultimately supporting the development of high-quality sustainable training provision for children’s nursing, primarily in Africa.
We followed methods described by McCarthy et al.10 and Measure Evaluation Systems9. The process of developing the capability maturity model involved six main phases of activity, as follows:
- Identification of relevant processes, practices and behaviours;
- Specification of the levels of process maturity;
- Development of domains with definitions;
- Characterisation of different levels of capability;
- Consultation with stakeholders; and
- Incorporation of consultation responses and finalisation of the model
The authors are two nursing academics who worked together to complete all stages of the process. A monitoring and evaluation specialist external to the programme provided additional facilitation of the process. The process was completed between July and October 2020. A record was maintained of the process followed, together with reflections on the process. The stages of development are reported below in such a way that others could reproduce the process.
i) Identification of relevant processes, practices and behaviours
In order to identify the organisational processes, practices and behaviours (the supportive conditions) that contribute to the establishment of a new children’s nursing education programme, we began with a review of published records and accounts of relevant new training programme development (e.g. Coetzee et al.14) and unpublished programme documentation including travel and seminar reports, annual reports and conference presentations. This was intended to ensure that the model would be grounded in the collective experience and knowledge of establishing new children’s nursing educational programmes within the southern and eastern African region.
ii) Specification of the levels of process maturity
The processes, practices and behaviours identified through review of programme documentation were used to develop macro-descriptions for five levels of process maturity (see Table 1), guided by completion of the statement: ‘A successful sustainable children’s nursing education programme has/is...?’. We found it helpful to begin at the end by describing full maturity, before working backwards.
The macro-descriptions of the levels were intended to describe all relevant aspects of the process at high level. The intention was that the macro-descriptors should contain sufficient information about the ‘whole picture’ so that the essential elements would be visible to any stakeholder as part of an integrated process. Information contained in the macro-descriptors related to conditions that enable necessary actions/progress, guided by the prompt: ‘What needs to be in place to enable all actors to do their work?’.
iii) Development of domains with definitions
The review of programme documentation described above included a framework to guide stakeholder collaboration which was developed at a colloquium of South African stakeholders in children’s nursing education (2012) and has been routinely used by CNDU as part of new educational programme development activities with teams in other African countries subsequently.15 This framework was used to structure the domains of the Capability Maturity Model (see Table 1) in order to meet the need to describe processes, practices and behaviours at both individual and organisational tiers, as noted above.
We identified definitions for each domain from the literature and recorded these to reduce ambiguity and enable consistent application. As we identified definitions, we found this assisted us in clarifying the steps in a process from nascent to established. For example, applying the definition developed by Deverka et al.16 helped us identify a progessive description of stakeholder collaboration as detailed in Table 1.
Table 1: Domains and definitions
Education system capacity
The perceived abilities, skills, and expertise of leaders, teachers, faculties, and staff in education institutions to execute or accomplish something specific, such as leading a school-improvement effort or teaching more effectively.17
Clinical system capacity
A capacitated clinical system able to support the establishment of new training programmes has adequate appropriately trained and motivated health workers, a well-maintained infrastructure, and a reliable supply of medicines and technologies, backed by adequate funding, strong health plans and evidence-based policies.18
Human resources for health information and planning capacity (HRH)
The concept of Human Resources for Health comprises planned endeavours intended to increase the capacity of the health workforce in order to optimise health system functioning and ultimately enhance health.
The health workforce is defined by the WHO as “all people engaged in actions whose primary intent is to enhance health”.19 Hunter, Dal Poz and Kunjumen describe the health workforce as a key building block of health systems,20 with health workforce strengthening identified as a priority for action for strengthening those systems in global policy directions.5
Regulatory system capacity
The action or process of officially recognizing an individual practitioner or an institution as having a particular status or being qualified to perform a particular activity. Nursing and midwifery legislation and regulations provide for i) the children's specialist nursing role ii) category of professional registration for children's nurses iii) defined Scope of practice, iv) licensing process v) accredited children's nursing training provision including curricula and institutions.10
Deverka et al.16 define stakeholders as individuals, organizations or communities that have a direct interest in the process and outcomes of a project, research or policy endeavor. Bi-directionality is an important component of mature stakeholder collaboration. Five levels of stakeholder engagement are defined:
minimal awareness and interaction; consultation; engagement; participation; and bi-directional collaboration among stakeholders enabling opportunities for reciprocal learning and shared decision-making. The ultimate goal of the process is partnership between stakeholders.16
In addition to the four single-stakeholder domains of the education system, clinical system, human resources for health (HRH), and regulatory system, we defined a fifth multi-stakeholder domain which we called stakeholder collaboration.
vi) Characterisation of different levels of capability
The processes, practices and behaviours identified through review of programme documentation and other literature were allocated to the relevant stakeholder domains. Steps within the domains of human resources and the regulatory system were both readily summarised since we were working from the existing Capability Maturity Models for health information systems8 and regulatory system capacity10. Similarly, classification of levels of stakeholder engagement were developed with reference to Deverka et al.16
For each aspect of capability, a statement describing full capability maturity was developed first and recorded under Level 5, followed by statements describing capability at the other levels. After developing the initial statements under each level, the horizontal and vertical alignment of the statements was reviewed to achieve consistency with regard to chronology and sequencing of interdependent events and conditions.
v) Consultation with stakeholders
The resulting draft model was presented to leading practitioners from each stakeholder domain for comment and input before finalisation. Consultation was via three routes. Firstly, the draft model was presented to 30 participants representing 11 schools of nursing across nine African countries at the Children’s Nurse Educator Forum in September 2020 via an online video presentation and brief facilitated discussion. Secondly, forum participants as well as additional consultees from each stakeholder domain were provided with a copy of the draft model and invited by email to contribute to the consultation through a structured questionnaire using Google Forms. Thirdly, two online video call sessions were held which were open to any consultees who preferred to offer their feedback through dialogue with the researcher. These sessions were structured to explore the same questions as the online questionnaire.
Consultees were asked to state, based on their own experience, the three most important conditions that need to be in place to establish a new children’s nursing training programme. They were then guided to assess the extent to which these conditions were included in the draft model. Consultees were asked to comment on how closely the organisational processes, practices and behaviours described matched the consultee’s own health system. Finally, consultees were asked to provide suggestions for improving the relevance, applicability or understandability of the information presented.