District Nursing Workload & Workforce Calcula6on Tool Paul Labourne November 2014 Acknowledgement Sue Thomas & Carolyn Wallace
Jul 15, 2015
District Nursing Workload & Workforce Calcula6on Tool
Paul Labourne November 2014
Acknowledgement Sue Thomas & Carolyn Wallace
Aim
• To cover the Process • To highlight the key learning • To update where we are to date • What are the next steps
Professor Jean White CNO for Wales
Carol Shillabeer PtHB Director of Nursing
Paul Labourne PtHB Assistant Nurse Director
Methodologies Strengths Weaknesses
Professional Judgement
• Clinically based • Handles complexity • Is good sense check • Enduring • Simple soOware calcula6ons
• No objec6ve quality measure • Less sophis6cated can be subjec6ve • Workload intensive • Management view • Awkward to calculate manually
Staff to Pa6ent ra6o
• Evidence base • Excellent to benchmark • Free soOware • Used in mul6ple seUngs
• Upda6ng is costly • Which numerator / denominator • Workload is fixed • Throughput is ignored • Open to manipula6on • Hidden variables
Acuity / Dependency
• Accounts for most variables • Workload based • Flexible • Quality weighted • Measures throughput • Free soOware
• Can be subjec6ve • Requires addi6onal data collec6on • Audi6ng not standardised • Time required to gather data • Can be complex to analyse
Timed Task / Ac6vity
• Evidence base • Accurate • Easily automated • Easily updated • Linked to care pathway
• Costly as usually commercial • Missing care groups • Task orientated • May lead to tradi6onal staffing / skill mix
Regression / Ac6vity based formulae
• Cheap • Basic forecas6ng
• Lacks ownership • Commercial systems costly • May lead to tradi6onal staffing / skill mix RCN (2010)
Wider Scoping • Queens Nursing Ins6tute Report (2013) – Presenta6on of this work (4/4/14) – Methodology / process followed
• Welsh Audit Office – Presenta6on of the 2014 audit (14/2/14)
• Buurtzorg Dutch Community Health & Social Care Provider – Presenta6on of this organisa6on following study trip (4/4/14)
• NICE work on Community Nursing yet to commence
Available Tools
• ScoUsh Tool (presenta6on 21/6/13) • English Tool (presenta6on 5/11/13), Hurst(2006) • Northern Irish Tool eCaT, Kane (2014) • Eire Popula6on Health Informa6on Tool: PHIT, Health Service Execu6ve (2011)
• Brighton Tool, RCN (2010) • Lincolnshire Tool,
Context
District Nursing
Private members
Bill Care
Closer to Home
CCIS
WAO
QNI
NICE
FoC
Cost neutral system
Welsh Perspec6ve
• Workshop 29th May 2014 – The outcome of the workshop was to demonstrate both the variance and similari6es within District Nursing in Wales.
– The workshop demonstrated that describing the workload of a District Nurse involves covers more than just a dependency and acuity score and would be best ar6culated using the same domains as:
• Community-‐based Pa6ent Complexity Instrument (CI). Under development (2014)
Assessment of Tools #1
• The tool in its self does not give the answer the tools require a sense check against professional judgement and the outcomes of pa;ents especially nurse sensi;ve outcome indicators.
• The available tools have been assessed against the Community-‐based Pa6ent Complexity Instrument (CI). Sept 5 Thomas (2014).
• Not one tool covers the full Complexity however is was possible to assess what the tools assess.
Assessment of Tools #2 • ScoUsh Tool is a deriva6ve of the Hurst tool • Northern Irish Tool eCaT, is a commercial tool with a cost and evidence base is currently being developed
• Eire PHIT, did not read across into District Nursing • Brighton Tool, regressive tool, lihle evidence base • Lincolnshire Tool, regressive tool, no evidence base • Hurst Tool is mul6faceted (dependency scoring, ac6vity and quality outcome based) but as with Scotland would need adapta6on to suit Wales and a appropriately sized data set is required to drive the tool
Acknowledgement to Sue Thomas Oct 2014
Next Steps • Develop Hurst tool to fit Wales – (base line ac6vity data driven from WAO results) – (Quality outcomes based on FoC audit) – Calcula6ons to take account of ways of working in Wales eg Leg Clubs
• Pilot / Test and evaluate the tool • Develop an op6on appraisal on the implementa6on across Wales
• Make recommenda6ons to CNO and Nurse Directors
• Publish
References Health Service Execu6ve (2011) Popula'on Health Informa'on Tool (PHIT).
Health Service Execu6ve, Ireland Hurst K (2006) Primary and community care workforce planning and
development. Journal of Advanced Nursing. 55(6), 757-‐769 Kane K (2014) Capturing district nursing through a knowledge-‐based
electronic caseload analysis tool (eCat) Bri'sh Journal of Community Nursing. 19 (3), 116-‐124
Queen’s Nursing Ins6tute (2013) Report on District Nurse Educa'on in England, Wales and Northern Ireland 2012/13. QNI, London
Royal College of Nursing (2010) Guidance on safe nurse staffing levels in the UK. Royal College of Nursing, London
Thomas S (2014) Community-‐based Pa6ent Complexity Instrument (CI). Sept 5 2014 Unpublished PhD Work