Effectiveness Day : Case Load Weighting

Friday 29th November 2013

Where People Matter Most

Case Load Management

Case load weighting – mechanism to ensure that the demands on care coordinator time are manageable and to support delivery of a high quality service (Care, Communication). Committed to improving the service user experience by providing high quality clinical interventions that promote recovery and well being (Compassion, Commitment) Need to ensure clinical staff are empowered and enabled to spend a significant proportion of their time (at least 50%) in direct client face to face contact (Courage, Competence).Ensure that direct clinical care is provided in line with evidence of best practice and effectiveness is managed and organised in a clinically safe way that minimises risk (Care, Compassion, Competence).

Case Load Management Tool

Lead professionals have been working together to pilot and evaluate a case load weighting toolTool from North East London NHS Trust; full review of tool / study in Nursing Times 2007*. Recognise limited tool for measuring performance as it does not take account of the quality of the contacts, need to be used alongside service user reported outcome measures as well as internal quality assurance tools

http://www.nursingtimes.net/workload-weighting-in-community-mental-health-teams/201880.article ‘Workload weighting in community mental health teams’, 17 April, 2007, VOL: 103, ISSUE: 16, PAGE NO: 32-33

Aims

to promote the delivery of high quality clinical services.to ensure clinical staff have manageable caseloads.to ensure equity of clinical caseload between clinicians and teams.to ensure individual clinicians and teams have caseload levels that are clinically safe and appropriate.to support performance management of teams and individual clinicians.

How does it work?

Three identified ‘routine’ indicators of demand on care coordinator time alongside an additional category ‘extra-ordinary / additional demand’. The routine demands are:A Level of risk /vulnerabilityB Care co-ordinatingC Time commitment

Extra-ordinary / additional demand category: D Indirect professional demand/additional responsibilities

Scoring

Normally agreed within supervision between manager and care coordinator Every open, allocated case scored against each of the three main indicators (A, B and C) on a scale running 0-5 risk/vulnerability 1-5 in terms of Care co-ordination/advocacy 1-10 for Time Commitment D is scored by time spent in activities – working on an agreed set of activity times for our Trust225 WTE (all 4 scores together)

Pilot

Looked at 13 cases loads and scored A-C – desk top exercise Shared with care coordinators to establish WTE and additional non-caseload commitments (D) Useful tool to enable consistency across teams and standardised approach (FACS / Clustering aligned to scores)Useful to identify step up and step down in care pathwaysKey to work with care coordinators and mangers in supervision Further work required to establish Trust approach

Next steps

Trust wide Guidance Average / standard time for non case load commitment / activity Roll out for all teams to use and feedback results Clarity on resources and pressures Further recommendations

Management supervision - monthly basis with pro forma to record scores and discussions

Monthly management audit forms to be completed

 Update amigos to include a supervision tab for recording discussions re case and plans for service user