In this article, Amanda Bassett, national lead for workforce innovation; and Laurence Ansell, director of sales at McKesson Workforce, examine how employee engagement and workforce intelligence systems can help NHS organisations satisfy divergent Quality and Cost objectives
The NHS’s current strategic goals place both significant and justifiable emphasis on improving the quality of patient care. It’s the Q in the QIPP agenda. But the same well-known mnemonic is accentuated by a silent ‘e for efficiency’ that places the focus on quality in a yet-more-challenging context.
To progress, NHS organisations must consider moving away from traditional top-down, hierarchical approaches to workforce planning
Providers and commissioners face relentless pressure to design patient-centred services within constrained and indeed diminishing resources. But one particular cost is largely set in stone; 77% of NHS finances are spent on the workforce. Reducing it is not an option. Making the most of it, however, is key.
Effective service transformation will almost certainly require leveraging the knowledge, insight and competencies of the NHS’s most-precious commodity: its people. The question is: how can local NHS organisations e-QIPP themselves to do it? The answers lie within.
The NHS workforce is its greatest asset. But as demand increases, the need to ensure that resources are optimally deployed has become a major priority. To progress, NHS organisations must consider moving away from traditional top-down, hierarchical approaches to workforce planning. To date, despite developing and introducing new roles, there has been a trend for NHS organisations to ‘slot’ workforce into existing staffing models, rather than using these new positions to drive change in the way they think about staffing a particular service. Moreover, trusts often layer new roles onto existing teams without meaningful consultation at the ground level – and then expect staff to realign themselves with new models without any understanding of the rationale. This can leave the workforce feeling demotivated, disengaged and overlooked. What’s more, it rarely delivers the desired outcomes.
The approach is no longer enough. Organisations should instead focus on more transparent workforce engagement to ensure role creation is aligned with both patient needs and workforce competencies. From an employer’s perspective, greater engagement can lead to a shared understanding of organisational challenges and facilitate workforce buy-in to new ways of working. Better still, it can create a positive stimulus for employee-led workforce innovation – and the collaborative development of broader roles that fully optimise the skillsets of existing individuals.
Hearing voices
In recent years, the NHS has worked hard to ensure that the ‘patient’s voice’ is heard across the service. Local NHS organisations must now work with similar endeavor to ensure the valuable voices of their own staff are used to help inform workforce planning – and drive efficient pathways that improve patient satisfaction and outcomes. Staff working at the NHS coalface have the greatest visibility of patient/service interaction and, as such, are well-placed to understand how resources could be deployed to derive maximum patient benefit. Despite this, healthcare organisations’ historical approach to workforce planning has done little to help them capitalise on these crucial real-world insights. As a consequence, there is often a disconnect between the board and the ward – and the inherent risk that staff deployment fails to align with patient priorities or maximise workforce capabilities.
A ‘bottom-up’ approach to workforce innovation, built around open, transparent and documented workforce engagement, can help NHS organisations generate real-world evidence that informs responsive staffing decisions. Moreover, empowered by the right tools and access to the best information, the workforce can evolve from being perceived as a significant factor in NHS Cost, to ensuring it’s regarded as a high-value component in NHS Quality.
Evidence-based tools
The most pro-active trusts have recognised the value of an informed and engaged workforce and are piloting innovative workforce solutions across single services to help them design evidence-based staffing models
The national focus on workforce optimisation has intensified in recent years. The Francis Report outlined the need for the NHS to develop a patient-centric ‘evidence-based workforce’ rather than one that is system-focused. This has been followed by National Quality Board guidelines that include a monthly requirement for all hospitals to publish data detailing the number of nursing and midwifery staff working on inpatient wards – and reinforced as recently as July 2014 by NICE guidelines for safe staffing in acute hospitals. These moves underline NHS England’s belief that high-quality care is contingent upon hospitals deploying the right staff, in the right place, at the right time and with the right skills. But how can NHS trusts ensure they are meeting this commitment and that, in a dynamic healthcare environment, staffing models allow for effective-yet-flexible workforce planning?
The answer lies in good informatics. At present, many NHS organisations have inadequate processes and systems for the collection of quantitative and qualitative data relating to the workforce. This leaves them with no effective means of evaluating the current workplace environment, let alone the opportunity to develop future workforce models. But tools to help facilitate Francis’s ‘evidence-based workforce’ not only exist, they’re increasingly being deployed by local NHS organisations to inform staffing models.
These solutions bring together existing but disparate datasets such as patient flow, financial and workforce data – as well as data from national patient and workforce surveys. This is combined with qualitative data generated by ongoing workforce engagement – and presented in a meaningful format that is specific to the local workforce. Simply sharing this information with staff alone can provide an invaluable context for the organisational factors driving workforce decisions. But the benefits go well beyond that.
The most-effective tools create a powerful platform for workforce innovation – equipping service leads with meaningful data that enables them to understand the baseline position within their services, and unlock opportunities to develop innovative career pathways. Moreover, they can provide quantifiable real-world evidence to support staffing proposals and, where necessary, ward off the intervention of Turnaround teams in resource-strapped healthcare organisations.
In a cash-starved NHS where 77% of the health budget is invested in the workforce, solutions that help organisations measure and achieve workforce optimisation can play a key role in satisfying seemingly-divergent Quality and Cost objectives. The most pro-active trusts have recognised the value of an informed and engaged workforce and are piloting innovative workforce solutions across single services to help them design evidence-based staffing models. The approach is enabling them to release significant benefits for patients, and allowing the workforce to contribute to organisational agility in an ever-changing healthcare environment.
It’s time to get to heart of the matter.
