A practical approach to improving productivity

1. A practical approach to improving productivity Filao Wilson Skills for Health

2. Improving workforce productivity – 5 key factors • Being there: addressing staff absence and leave entitlements • In the Right Place: Issues of geographical location • At the Right Time: Matching staffing with workload • Doing the Right Thing: Being more responsive to patient needs and making the best use of skills and competencies • Doing things different/doing different things: Improved training, management, enhanced roles etc Source: Buchan, James (2005) Scaling up health and education workers: increasing the performance and productivity of an existing stock of health workers. Literature Review. DFID Health Systems Resource Centre, London

3. How it all fits together Functions / Competences Level of Skill Context x x = Competence based roles Role specific education Existing Skills & Knowledge Content & Level Qualification Skills Passport

4. Operating lists increased by 16 per week through introduction of a new surgical care practitioner role Norfolk and Norwich University Hospitals FT Productivity impact - Reduced waiting times Waiting times for myocardial perfusion stress testing reduced from 72 weeks to 2-6 weeks through introduction of an advanced practitioner role Cardiology service at North Cumbria University Hospitals

5. Macmillan Clinical Nurse Specialist NTR EXAMPLE CF level 7 DESCRIPTORS Core NOS for CF level 7 • Research • Leadership • Communication CANCER pathways specific NOS + employer specific NOS ‘pick & mix’ NOS BASED LEARNING PACKAGE SPECIFIC TO ROLE

6. “The extended scope hand therapist role has reduced consultant waiting times for selected hand and wrist diagnosis first appointments from 10-12 weeks to 2 weeks; and follow-up appointments from 6 to 2 weeks. It has also delivered cost savings in consultant time which can now be diverted to increased surgery time.” Elizabeth Maclennan Head Occupational Therapist Guys & St Thomas NHS Foundation Trust

7. Productivity impact – Reducing costs and preventing unnecessary admissions South Central ambulance service reduced patient transfers to emergency departments by 30% through introducing the ECP role Reduced costs of attendance – ECP attending 999 costs approx 30% cheaper than sending an ambulance Increased patient satisfaction Fewer clinical and administrative processes

8. “The effect of using emergency care practitioners has been phenomenal. In some areas of the Trust, up to 90% of 999 cases are discharged without needing further emergency care. Emergency departments are the lynchpin of an acute trust, so reducing the pressure on a unit in this way has a major beneficial impact on the whole hospital.” Consultant Emergency Care Practitioner Mark Ainsworth-Smith South Central Ambulance Service NHS Trust

9. 80% interventions in NHS Greater Glasgow Rehabilitation and Assessment Services by Advanced Nurse Practitioners resulting in: Care provided more quickly Medical capacity released /reduced impact of EWTD Staff delivering care for which they are trained and competent Better career opportunities for nursing staff to progress Productivity impact – working smarter, faster and more flexibly

10. “The Therapy Assistant roles… have made a significant contribution towards enabling the hospital to achieve bed saving days for neuro-stroke patients and care of older people. We found the quality of care improved and in future there is potential for reduced re-admittance rates.” Adrienne Simons, Service Manager for Physiotherapy, OT and Rehabilitation Whittington Hospital NHS Trust Productivity impact - Improving efficiency and the quality of care

11. 3 key principles of role design & development to improve quality and efficiency Patient is the driver Start with function WHAT before WHO No role exists in isolation

12. We want to make role development easier • Library of 60+ Proven role templates • Competences required • Career Framework level • Indicative learning & development • Systematic process to define new and refine existing roles • Database of 1,500 competences (National Occupational Standards) • Expertise in whole system approach - across whole teams and services No need to reinvent the wheel!

13. Benefits for Employers Innovate service delivery around optimum skill use Improve productivity and reduce costs Create clear and consistent role definitions that meet local needs Address governance issues through roles based on national standards Improve staff motivation, confidence and competence Avoid the common pitfalls of new role introduction

14. Helping you improve productivity - not-for-profit services Service 1: Rapid and objective workforce review Service 2: Role redesign and development Service 3: Care pathway analysis and workforce mapping Service 4: Customised Career Framework development