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Eve Mitchell

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About Eve Mitchell

  • Rank
    Starter

Profile Information

  • First name
    Eve
  • Last name
    Mitchell
  • Country
    United Kingdom

About me

  • About me
    I created Establishment Genie - a NICE endorsed safe staffing workforce planning and benchmarking tool - out of frustration at workforce and staffing decisions in health and social care driven by financial imperatives rather than focusing on quality and safety outcomes that are best for our patients and staff and are ultimately more cost effective.
  • Organisation
    Creative Lighthouse Ltd
  • Role
    Director

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  1. Content Article
    Over the last couple of weeks I have been engaging in one of my favourite pastimes – chatting. I realise this seems a little frivolous, but after the more formal ‘meetings’ of previous weeks, chatting seemed appropriate. There is a serious reason behind this, the impact of ‘emotional labour’. Emotional labour is defined as “having to induce or suppress feeling in order to sustain the outward countenance that produces the proper state of mind in others”.[1] Or, in layman’s terms, pretending you are OK. For my colleagues and clients across health and social care, and particularly for frontline nursing and care staff, there has been an even greater need to deliver compassionate patient care whilst managing their own emotions during the pandemic, and somehow with the easing of lockdown some of the façade has started to fail. Through conversation, it has become clear that there is a new impact of COVID-19 on the mental health and wellbeing of healthcare staff: absorbing the anger of the public, patients, and their carers. In a previous post I mentioned that there was fear from some colleagues about potential litigation once the pandemic was over. Looking for someone to blame for what was and was not done. This is not an unusual reaction, but showering staff with vitriol does seem a little unprecedented. For example, in the care homes I work with every home has received letters or complaints about the care of their residents from family members: "you did not care for my mother"; "you let my father die alone"; "my mother died of loneliness as you wouldn’t let me see her"; "it is down to your lack of care that my brother died"; whether the home had COVID infections or not. The upset this has caused is palpable, with exhausted staff bearing the brunt for doing their job in the most difficult of circumstances. A similar story is heard from GP practice nurses and reception staff – patients refusing to wear masks, accusing the nurses and doctors of wilfully letting them suffer and refusing to see them when they were in need, demanding to see a professional immediately, refusing to leave the premises. A massive change for the surgeries who earlier were being given gifts of cake and chocolate and sent messages of gratitude. Hospital staff seem to have faired better, although as outpatient appointments come back online there is an expectation that the pent-up fear and frustration will be released in this setting too. Maybe it is not only health and care staff who suffer from compassion fatigue – it has happened to the general public at the same time as the clapping stopped and the next normal dawned. However, it is not clear how we should deal with this. Ensuring the welfare of staff across all settings of care should remain at the forefront of workforce planning and is enshrined in the new NHS People Plan; but it doesn’t tell us how to navigate and dissipate the anger of the public, and whilst this remains unaddressed it is our frontline staff that will bear the brunt, sending them ever closer to burnout, and puts the future of our health and care workforce at risk. And anything that impacts on staff safety, impacts on patient safety. References: Hochschild AR. The Managed Heart: Commercialisation of Human Feeling. Oakland: University of California Press: 2012. World Health Organization. Mental Health and Psychosocial Considerations During the COVID-19 Outbreak. Geneva: WHO; 2020.. Patient Safety Learning have set up a community page on the hub to capture insights from staff on their safety. World Patient Safety Day on Thursday 17 September this year focuses on staff safety. If you have been affected by the issues raised in this blog and want your voice to be heard (whether attributable or anonymously), please share here. Patient Safety Learning will use such insights to highlight the staff safety issues and call for action.
  2. Content Article Comment
    Claire, I am so sorry you feel like this. As I reflect on your words and feelings it makes me think of the three psychological phases of crisis: 1) Emergency where we have shared goals and a sense of urgency which make us feel energised, focused and even productive, which then moves to 2) Regression, where we realise the future is uncertain and lose the sense of purpose, feel tired, irritable, withdrawn and less productive (which is where so many of us seem to be right now) and then to 3) Recovery, where we begin to reorient, revise our goals, roles and expectations, and focus in moving beyond rather than in getting by. My question is how do we work to take the positive from all that has happened so we have ‘post traumatic growth’ rather than distress. Leaders have a choice to support their teams and to codesign a future that works and is stronger. I hope they use their choices wisely.
  3. Content Article Comment
    The SNCT tool has a number of benefits and limitations as identified by the study. The authors report that the actual and required staffing levels varied considerably between the hospital trusts, between wards within trusts and also within wards, which we also identify using Establishment Genie across all settings of care (and is one of the reasons we created the Genie). The levels of variation don't always make sense even when professional judgement is applied, and are often more to do with subjective judgements on acuity and dependency based on experience, risk aversion, or other environmental or organisational factors. The SNCT tool measures 'on the day' and so planning an establishment for a new model of care or service is not possible, and every day we are seeing necessary changes in the delivery of care through increased access and use of technology, changed roles and responsibilities, and different working practices. Safety of our patients and our staff should be paramount in establishment setting. An 'on the day' tool used for 30 consecutive days to review the establishment is a good start and temperature check, but should not be used in isolation. Triangulating with other tools, peer review, benchmarking, and most importantly measuring and tracking patient and staff outcomes is the best way to design and measure an appropriate establishment to ensure we are able to deliver safe care. However, we must also make sure that we do not close our eyes to new ‘untested’ models of care, and we learn to embrace and adapt to new possibilities as the health and care landscape continues to change. Traditional workforce models are unsustainable based on current demand and capacity, and unless we try something different our system will become so rationalised that care from cradle to grave will be a forgotten dream rather than a celebrated reality.
  4. Content Article
    Case study examples The following case studies show how trusts have been using the tool. Roles and responsibilities of staff have been reviewed and new workforce plans have been co-designed with staff at the frontline to deliver new ways of working that put the patient at the centre of care – whatever the setting. The Hillingdon Hospitals - Safety Supervision and Savings.pdfThe Hillingdon Hospitals - Ward Reconfiguration for Safety.pdf GIG Cymru NHS Wales - Residential Nursing homes Case Study.pdfChelsea and Westminister Hospital Case Study - Empowering Staff.pdf GIG Cymru NHS Wales - District Nursing Principles Case Study (1).pdfBerkshire Health Community Nursing Case Study.pdf Organisational benefits Integrated care levels, costs and common language enables clinical and corporate leads to collaborate and meet the requirements of a next-generation health and social care workforce: Precise staffing profiles and options appraisal support CIP development and budgeting. Gap analysis compared to budget and standards for exact hours and WTE requirement for each band. Uplift for leave is specific to each role and expected joiners, avoiding blanket uplifts that may not fit the needs of the unit. Governance and control underpinned by agreed, costed roster templates, with ready reckoners to keep within range. Improved recruitment and retention with evidence of staffing levels and support. Outcomes track quality, with benchmarking to assure. Clinical benefits Professional judgement in workforce planning is supported by this NICE-endorsed tool: Planning care levels and WTE for expansion, efficiency, reconfiguration and new service models. Evaluating alternative shift models to reorganise, invest or save. Modelling skill-mix and impact of new roles. Understanding and validating variation. Challenging peaks and troughs in cover to improve safety, release capacity and release cost savings. Benchmarking and triangulation of patient care levels, with outcomes for correlation. Mapping other staff group input across each setting. Background on 'Establishment Genie' Creative Lighthouse was founded in response to frustration at the focus on financially led decisions in health and social care management that did not consider the safety and care of patients or staff. We set out to build a platform that would allow all management groups in the healthcare sector to collaborate on safe staffing and financial governance. Creative Lighthouse self-funded the development of a unique workforce-planning tool under the brand name ’Establishment Genie’, endorsed by the National Institute of Health and Care Excellence (NICE) in 2017. In April 2017, the Creative Lighthouse team were awarded a grant from Innovate UK to continue to develop the tool to include all settings of care in the knowledge that patient safety and workforce planning is not only the responsibility of acute services, but of all providers and commissioners of care. This is a critical aspect of enabling the improvement of quality and patient outcomes in a cost effective way, whilst providing data driven analytics to support professional judgment. About the author I am a healthcare professional with over 15 years’ experience working in and consulting to public and private health and social care organisations. I have worked with a variety of health and care sector clients in the delivery of complex change, from transformational change and organisational design process to programme leadership and execution. I am passionate about the safe staffing agenda, recognising that in order for any organisation to ensure appropriate care and evidence for professional judgement, there must be consistency in approach and a way of linking staffing levels to quality outcomes that can then be benchmarked within and across organisations. This passion resulted in the birth of ‘Establishment Genie’.
  5. Community Post
    Many organisations, like East London NHS FT (ELFT), publish information about their staffing in terms of 'fill rates' - the difference between planned and actual staffing - and also using 'Care Hours Per Patient Day' (CHPPD). However, as can be seen by the published data, this doesn't really tell us very much about staffing capacity or capability, more whether there were more or less staff on the units than planned in the roster - and in the majority of cases in ELFT this shows that the units were 'over-filled' with staff i.e. more staff than planned were distributed to each area. So, this begs the question whether the plan was right in the first place? If we wind our memories back to the Keogh Mortality Review, there was a recommended ambition that "nurse staffing levels and skill mix will appropriately reflect the caseload and the severity of illness of the patients they are caring for and be transparently reported by trust boards." It is hard to see how data on over- or under- filling against a roster gives transparency to the board if they do not know what was being filled in the first place, or on the acuity and dependency of the patients being cared for. The NQB guidance, first published in 2013, was updated in July 2016 with additional guidance to help organisations think about their workforce to include questions and inclusion of outcome measures and measures of patient safety https://www.england.nhs.uk/wp-content/uploads/2013/04/nqb-guidance.pdf We need to remember that the purpose of the recommended bi-annual establishment review is to ensure that the Executive Board is satisfied that nursing and midwifery staffing is set at an appropriate level to deliver safe care. This does not mean that we should not monitor our fill-rates and CHPPD monthly, but does mean that we need to be sure that our workforce plan is appropriate through understanding and comparing our levels of care both internally and with peers, looking at our outcome measures, and through thinking about the training and skills that are required now and into the future so our staff both within and outside of organisational boundaries have the skills, capability, capacity and support to deliver great, safe, person centred care whatever the setting.
  6. Content Article Comment
    Many organisations, like East London NHS FT (ELFT) publish information about their staffing in terms of 'fill rates' - the difference between planned and actual staffing - and also using 'Care Hours Per Patient Day' (CHPPD). However, as can be seen by the published data, this doesn't really tell us very much about staffing capacity or capability, more whether there were more or less staff on the units than planned in the roster - and in the majority of cases in ELFT this shows that the units were 'over-filled' with staff i.e. more staff than planned were distributed to each area. So, this begs the question whether the plan was right in the first place? If we wind our memories back to the Keogh Mortality Review, there was a recommended ambition that "nurse staffing levels and skill mix will appropriately reflect the caseload and the severity of illness of the patients they are caring for and be transparently reported by trust boards." It is hard to see how data on over- or under- filling against a roster gives transparency to the board if they do not know what was being filled in the first place, or on the acuity and dependency of the patients being cared for. The NQB guidance, first published in 2013, was updated in July 2016 with additional guidance to help organisations think about their workforce to include questions and inclusion of outcome measures and measures of patient safety https://www.england.nhs.uk/wp-content/uploads/2013/04/nqb-guidance.pdf We need to remember that the purpose of the recommended bi-annual establishment review is to ensure that the Executive Board is satisfied that nursing and midwifery staffing is set at an appropriate level to deliver safe care. This does not mean that we should not monitor our fill-rates and CHPPD monthly, but does mean that we need to be sure that our workforce plan is appropriate through understanding and comparing our levels of care both internally and with peers, looking at our outcome measures, and through thinking about the training and skills that are required now and into the future so our staff both within and outside of organisational boundaries have the skills, capability, capacity and support to deliver great, safe, person centred care whatever the setting.
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