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Eve Mitchell

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Everything posted by Eve Mitchell

  1. Content Article
    The full impact of COVID-19 has not yet been realised, but what we do know is that we have been navigating with no roadmap or star to guide us. In terms of the three psychological phases of a crisis, we have worked through the initial state of ‘emergency’ where we have had (largely) shared goals and an urgency that made us feel energised, focused and even productive. However, this phase feels like it is in its descendancy and most of us are now in the next phase of ‘regression’ where the future feels uncertain and we have lost that sense of purpose. In my work with colleagues from across health and social care to understand what phase three ‘recovery’ looks like in workforce and wellbeing terms, it is clear that both aspects are starting to get the focus they always should have had but maybe not in the way we would have expected. It has not been cries of ‘more’ staff or money that have been echoing through the corridors, but the cry for ‘different’ and the freedom to make decisions without the shackles of bureaucracy and hierarchy holding the tide of necessary change at bay. In the past, workforce planning has had little shared meaning, and has often been more recruitment planning for a continuation of the same as opposed to thinking about what we need from our teams in terms of availability, skills, expectations, roles and the delivery of care designed around the person receiving it. Wellbeing seemed to be something that only HR considered if there was a staffing issue or high sickness, or even more cynically a poor outcome in survey results, resulting in lots of workshops, fabulous plans, but very little sustainable change. In the initial stages of the pandemic, I worked with a number of acute teams to look at staffing in the short term to face the initial onslaught of COVID-19. This meant looking at variation and where we could adjust care levels safely, planning to deploy a moderated skill mix of staff, and working through the cost of plugging gaps in largely traditional models of care using temporary and volunteer staff, with the hope that the 20% sickness rate wasn’t breached too often leaving us exposed to the hazards of unblocked holes in the workforce. This was acknowledged as an unsustainable and haphazard way of providing care for both staff and patients, which after the ‘emergency’ phase results in burnout, higher sickness, increased turnover, and certainly lacks in the resilience required to continue to manage COVID-19, non-COVID urgent care, elective care and the wellbeing of staff and carers. So, what do we need to do as we plan for recovery, or more precisely ‘post traumatic growth’? Despite an apparent increase in interest in joining the nursing profession since the start of the pandemic, the reported 40,000 gap in nursing numbers is not going to be closed overnight, so it seems that planning for different and capturing and capitalising on the innovation that has flourished in some areas is the only way forward. How do we do this? As an example, let me turn your heads to colleagues in social care who have known for some time that their current state was unsustainable. This has been compounded by COVID-19 and the (inevitable) delayed recognition by government of the essential role of social care in protecting the NHS and some of our most vulnerable people. Therefore, they chose to do for some what is unthinkable – they took their nurses away from direct patient care. In some of the teams I work with there was an expectation that they would have 50% of staff available to be deployed, and would have slower and more limited access to other services to support – including temporary staffing or volunteers. They collaborated swiftly both within and across organisations, changed models of care completely based on some of the data collated by Establishment Genie, and moved to a model of all registered nurses in a supernumerary supervisory role, providing support to staff in their own care home directly and also in other homes via ‘virtual’ collaboration, and using technology to connect, share, teach and learn ‘on the job’. This of course questions the future role of the nurse in these homes but is also an example of how we all may need to re-think roles and responsibilities to meet the challenges of today and the future in order to keep the people in our care – patients, residents and staff – safe. As we begin to reorient, revise our goals and focus on moving beyond rather than on just ‘getting by’, it is important that we look at all settings of care so we can learn from excellence, build on the best, and support a faster response in the future if required. The response to COVID-19 for many has been an example of how a system succeeds in varying conditions; a ‘Safety-II’ approach where humans are the necessary resource for system flexibility and resilience. We need to take the time to understand where things have gone right, to celebrate and acknowledge this, and then co-create a health and social care system that people want to work and be cared for in.
  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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