Safe, Sustainable And Productive staffing NQB 2018

Question 1

What is QNB?

Answer 1

National Quality board - provides coordinated leadership for care quality

Question 2

What is NQB trying to achieve with the safe, sustainable and Productive Staffing 2018 document?

Answer 2

Leadership is key and or leaders have a complex task of managing many factors when planning staffing.
Getting ratios right
Impact of physical environment
Skill mix
Productivity and efficiency of the team
Quality of the team to develop staffing plans

To provide SAFE, EFFECTIVE, COMPASSIONATE and RESPONSIVE care

Question 3

What does evidence and research show that is needed for the very best practice?

Answer 3

Combination of:

Professional judgement

Professional standards and benchmarking

The use of appropriate staffing model/dependency tool

Robust evaluation of outcomes and feedback from families to ensure the staffing approach works

Question 4

It builds on which other sources?

Answer 4

NICE quality standard QS4- neonatal specialist care 2010

DH Health - Toolkit for High quality neonatal services 2009

British association perinatal medicine BAPM - service standards for hospitals providing neonatal care 2010

Question 5

To determine staffing levels neonatal services must?

Answer 5

Strategic multiprofessional staffing review at least annually. With a mid year review. Should asses current staffing still meets requirements

ODN should share workforce planes and strategies for recruitment and retention

Regular skill mix review

PROFESSIONAL JUDGEMENT MY ROLE used together with appropriate workforce tools

Data from badger net and Dinning tool (if BWC has)

Training and development linked to approval

Need to recognise flexible working patterns to meet the needs of the fluctuation service

All units agree with pathways agreed with the ODN and specialised commissioners

All neonatal units input into badgerNet to enable national benchmarking

Areas of concern highlighted by family or staff should be scrutinised and appropriate actions to address them

Question 6

To ensure safe, effective, caring, responsive and well led care on a sustainable basis, trusts need to do what?

Answer 6

Employ the RIGHT staff with the RIGHT skills at the RIGHT place and at the right time

Question 7

Minimum staffing Standards have been set by which organisations?

Ie 1:1, 2:1, 4:1?

Answer 7

Nice Quality standard 2010

DH 2009 toolkit - standards for safe care in the neonatal setting

Question 8

What can make it difficult to determine how many nursing staff will be required on a shift by shift basis?

Professional judgement is needed!!

Answer 8

Neonatal care is a low volume, high cost specialist commissioned service

It covers all levels of care

Acuity and dependency vary depending on the neonate

Question 9

Right staff

How to ensure we have the right staff?

Answer 9

Follow national standards

Workforce planning to ensure units are safely staff undertaken by unit managers and clinical leads. Must be aligned to the operational planning process

Current and future staffing should be considered by the ODN.

Assessed using agreed processes and tools

Take into account European working time directive

Due consideration to possible skill mix

Ensure workforce is suitable trained and experience and can offer most flexible means of achieving recommended staffing levels

Question 10

Right staff

How do we determine workforce requirements when workforce planning?

Answer 10

Determined demand and activity

Available capacity in terms of cots

Some variation needed due to shift to shift variation in workload

Must be adequate to absorb peaks and troughs in activity and workload

Question 11

Right staff

The workforce plan should consider the following stipulations from the Toolkit…

Answer 11

70% of nursing establishment should be QIS

A minimum of two qualified nurses one should be QIS

Supernumary shift leader

Question 12

Right staff

What are the Workforce plan considerations?

Answer 12

Unit capacity

Unit designation

Unit workload (cot days)

Need to address: total nursing establishment and shifts required

Factor in: AL, sickness, absence, study leave, compassionate leave

Shift to shift cover based on minimum levels based on average unit occupancy of 80% (DH 2009)

Question 13

Right staff

What workforce planning tools can be used?

Answer 13

BadgerNet: provides information on whether staff is shift according to national standard

Bank and agency staff calculations

NIC responsibility to ensure this is up to date!!

Dinning: may be used?

Calculates local staffing based on historical workloads.

Total number of cot days over 12 months. Then calculates number of nurses needed.

Professional judgement:

Used to plan safe level depending on clinical
Workload.

It is subjective and should be used together with appropriate workforce tools.

Triangular approach: professional judgement, tools and NICE guidance

Additional factors:

Unit layout

Question 14

Right staff

Benchmarking/peer review by the ODNs

Answer 14

Need to follow standards set out and is like for like to ensure staffing is comparable and no variation in care

The badgerNet is useful as all units are using it

Quarterly to annual reports produced by ODN

Network dashboards show lots of info
Sickness, bank etc to show shortfalls

Question 15

Right Skills

Role of nursing In the multidisciplinary team

Answer 15

Staff need to be flexible in care provision and skilled in all elements of care due to variability

Units operate within networks. Networking is important to ensure staff are moved appropriately

Staff need a wide sill set. From ItU to community

Question 16

Right skills

Leadership my responsibility as NIC…

Answer 16

Safely staffed and workforce is effective

Feel more prepared as have been trained in management and leadership

Effective deployment of staff

Capacity management

Safe transfers

Effective working with ODN fulfilling network responsibilities

Completing RAG scoring on staffing

Entry of staff onto badgerNet

Effective liaison with medical and AHP teams

Question 17

Right care at the right time

How do we ensure the right care at the right time?

Answer 17

Effective workforce planning to ensure the right staff

Rosters fair and adequate

Should support flexible working patterns whilst ensuring service needs are met

Babies are born where there needs can be met, otherwise transferred

Question 18

Right care, right time

How to ensure Productive working/eliminating waste and duplication?

Answer 18

All units should have staff that can resuscitate and stabilise

Only 5% of activity managed outside the ODN

To ensure productivity:

Staff to national recommendations DH 2009 and NICE 2010

Allocate tasks to non registered staff to maximise time trained staff spend providing specialist care

Enter data into badgerNet to allow national benchmarking

Question 19

Right care, right time

How to ensure Efficient rostering/flexibility and responsiveness?

Answer 19

Flexible working patterns should be offered to help attract and retain staff while ensuring adequate staffing

Staff satisfaction/sickness/retention should be reviewed regularly as they provide a barometer of staff satisfaction

Local policies managing rest periods must meet working time reg - reduces staff fatigue and safeguards staffs health and wellbeing

Question 20

Right care, right time

How to ensure efficient employment/minimise agency?

Answer 20

Day to day demand can be unpredictable even if yearly demand remains - this results in requirements to ensure staffing is safe daily

Effective escalation polices to meet demand

Units within the ODN work together to ensure that a min of 95% can be acted for in the right unit.

Bank staff need to be appropriately trained

Neonatal units to collaborate with maternity to ensure babies are born in a unit that can meet the needs

Collaborate with the ODN, transport to ensure smooth running and NCOT

Question 21

Right care, right time

How to Measure patient outcomes, people productive and financial stability?

Answer 21

Still variation of death rates despite lowering of rates. These are in deprived areas And younger/older mothers

Improved outcomes of babies 26 weeks and below

HIE outcomes in specialist care similar
To developed world

Commissioners should consider human and financial cost of the system of long term morbidities of babies born before 26 weeks

Getting staffing right reduces mortality and morbidity. This includes:

BadgerNet data
Dashboards network and national
Number of serious incidents
Number of incidents
Number of reported shifts with insufficient staffing
Number of medication errors
NNAP reports
Staff satisfaction surveys
Bliss records
ODN board reports

Skill mix should be regularly reviewed to ensure roles are undertaken by correct staff. To ensure safety and senior members are not called upon to fill gaps in the rota at levels lower than they are employed which effects the sustainability of the service.

Question 22

Right care, right time

Report investigate and act on incidents

Answer 22

The unit should follow best practice on incidents following the serious incident framework. Using root cause analysis as a tool

Staff should be encouraged to report and staffing

Staff members should be aware of their professional duty