District  Nursing  Workload  &  Workforce  Calcula6on  Tool  

Paul  Labourne  November  2014  

Acknowledgement  Sue  Thomas  &  Carolyn  Wallace  

This  is  an  all  Wales  Approach    in  Partnership  

Aim  

•  To  cover  the  Process  •  To  highlight  the  key  learning  •  To  update  where  we  are  to  date  •  What  are  the  next  steps  

Process  

The  Journey  

Professor  Jean  White  CNO  for  Wales  

Carol  Shillabeer  PtHB  Director  of  Nursing  

Paul  Labourne  PtHB  Assistant  Nurse  Director  

The  Journey  

The  Journey  

The  Journey  

The  Journey  

The  Journey  

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)  

The  Journey  

The  Journey  

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  

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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,  

The  Journey  

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Context  

District  Nursing  

Private  members  

Bill  Care  

Closer  to  Home  

CCIS  

WAO  

QNI  

NICE  

FoC  

Cost  neutral  system  

The  Journey  

The  Journey  

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)  

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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  

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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    

 

Diolch  yn  Fawr  Any  Further  Ques6ons