News and updates from today’s conference looking at delivering safe staffing and improving nurse staffing levels and skill mix in practice.
Safe, sustainable and productive staffing: National Workstream Update
Ann Casey, Senior Clinical Workforce Lead, NHS Improvement
Ann discussed implementing the recommendations from the recently launched draft improvement guide ‘Safe staffing improvement resources: adult inpatients in acute care’ which following consultation is due for final publication later this year. Draft guide available here. The recommendations include:
- anticapting problems, vacancies, looking at the age profile of your teams and planning ahead, reducing time between vacancy and recruitment
- steamlining methods of care to patients through lean and productive ward
- rostering: local policies and KPIs to appropriately review
- retaining staff with flexible working and reduced hours.
For advice and further information contact NHS Improvement firstname.lastname@example.org
Safe staffing – the evidence
Professor Peter Griffiths, Chair of Health Services Research, University of Southampton
This presentation will focus on evidence around staffing levels. Having the right number of staff is a necessary, if not sufficient, prerequisite for delivering care that is not only safe but which also meets the standards of care and compassion that professionals should aspire to which all of us would expect for our family, friends and indeed ourselves.
Starting with a brief review of the evidence used to inform the NICE guidance on safe staffing in adult inpatient wards, published in July 2014 I also consider some more recent evidence, including the evidence reviewed for NHS Improvement as part of their ‘improvement resource’ for the same clinical areas.
The evidence reviewed for NICE consisted mainly of large cross sectional studies. This clearly establishes an association between nurse staffing levels and patient outcomes, including mortality. Although this evidence cannot directly demonstrate cause and effect it is, overall, convincing that nurse staffing levels has some causal role. On the other hand higher numbers of assistant staff and lower skill mix are generally associated with worse outcomes.
Unfortunately, the evidence does little to identify the ‘correct’ staffing level. Looking a the limited evidence that gives the association between outcomes and specific staffing levels in the UK shows why NICE suggested manager should be alert to increased risk when nurse to patient ratios fell below 1:8. However, it also clearly shows why this should not be regarded as a target ‘safe staffing level’. Most evidence suggests that outcomes are improved, when staffing is, on average, higher than 1:8.
Finally, I consider what should be done in a context of registered nurse shortages and difficulty recruiting combined with pressures to reduce headcount. There are no magic numbers and no magic solutions but valuing nursing staff and supporting positive practice environments is an essential step to retain staff which will, in turn, reduce recruitment challenges.
NHSP – A National view on Temporary staffing and sharing best practice: How to get the best out of your bank in a brave new world
Maria Nicholson, Head of Workforce Insight, and Jay Patel, Regional Director, NHS Professionals
Transforming healthcare delivery requires wholesale change in how we utilise all of our NHS staff: substantive, bank and agency. Getting the right people in the right place at the right time is the challenge. Neighbouring Trusts working together collaboratively improves utilisation of scarce resources and helps reduce reliance on staffing agencies.
Jay and Maria will give insights into the National Agenda on temporary staffing and effective eRostering from their wide ranging experience. They will share information on best practice as well as Case Studies that could be utilised by others to help optimise current staffing as well as manage temporary staffing demand.
Changing working practices to improve care hours per day
Becky Sutton, Transformation Programme Lead, and Pamela Rumbell, Transformation Lead, Derby Hospitals NHS Foundation Trust
Derby Teaching Hospitals NHS Foundation Trust provides both acute hospital and community based health services, serving a population of over 600,000 in and around Southern Derbyshire. There are two hospitals: the Royal Derby a busy acute teaching hospital, which incorporates the Derbyshire Children’s Hospital and London Road Community Hospital.
Understanding the problem
A key priority was to ensure that the right teams with the right skills were continuing to deliver high quality patient centred care, and spending as much direct contact time with patients to better meet their needs and improve their experience. It was anticipated that an enhanced workforce would lead to increased productivity and efficiency, whilst operating within the same financial envelope. Senior leaders were confident that staff delivering care would be best placed to assess the situation and explore ideas for change and improvement given the time and tools to do so, rather than to prescribe changes.
Three multi-disciplinary ward teams applied and were selected. These were given the time and space to participate in one week long Rapid Improvement events (RIE) to critically review clinical activity, level of team working and to develop their roles, supported by the nursing leadership. The intention was to help teams gain a better understanding of the clinical and operational challenges that were impacting on consistent delivery of safe reliable care and to spend more time examining roles and activity to increase direct contact time with patients.
Results and Impact
By the end of the week teams and individuals demonstrated:
• a cohesive team approach - shared ownership of wicked problems
• increased enthusiasm and motivation for the work
• increased quality improvement knowledge and skills
• an engaged workforce willing to speak up and share concerns - supported by executive team
PDSA results - increased team contact time:
• Ward A average 4 mins per patient per hour increased to average of 18
• Ward B average of 12 mins per patient per hour increased to average of 26
• Ward C average of 11 mins per patient per hour increased to average of 24
“Showing how we can work as a team bringing everyone together, showing how thinking differently to gain better working day can benefit everyone. To be more efficient and have more time for patients”
Future events of interest:
Measuring & Monitoring Patient Safety: Patient Safety Surveillance in Real Time
Improving Out of Hours Care in Hospitals: Hospital at Night Summit
Developing the role of the Nursing Associate
Friday 9 June
De Vere West One Conference Centre, London
22 February 2017