Safe, Sustainable And Productive staffing NQB 2018 Flashcards
What is QNB?
National Quality board - provides coordinated leadership for care quality
What is NQB trying to achieve with the safe, sustainable and Productive Staffing 2018 document?
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
What does evidence and research show that is needed for the very best practice?
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
It builds on which other sources?
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
To determine staffing levels neonatal services must?
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
To ensure safe, effective, caring, responsive and well led care on a sustainable basis, trusts need to do what?
Employ the RIGHT staff with the RIGHT skills at the RIGHT place and at the right time
Minimum staffing Standards have been set by which organisations?
Ie 1:1, 2:1, 4:1?
Nice Quality standard 2010
DH 2009 toolkit - standards for safe care in the neonatal setting
What can make it difficult to determine how many nursing staff will be required on a shift by shift basis?
Professional judgement is needed!!
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
Right staff
How to ensure we have the right staff?
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
Right staff
How do we determine workforce requirements when workforce planning?
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
Right staff
The workforce plan should consider the following stipulations from the Toolkit…
70% of nursing establishment should be QIS
A minimum of two qualified nurses one should be QIS
Supernumary shift leader
Right staff
What are the Workforce plan considerations?
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)
Right staff
What workforce planning tools can be used?
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
Right staff
Benchmarking/peer review by the ODNs
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
Right Skills
Role of nursing In the multidisciplinary team
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
Right skills
Leadership my responsibility as NIC…
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
Right care at the right time
How do we ensure the right care at the right time?
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
Right care, right time
How to ensure Productive working/eliminating waste and duplication?
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
Right care, right time
How to ensure Efficient rostering/flexibility and responsiveness?
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
Right care, right time
How to ensure efficient employment/minimise agency?
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
Right care, right time
How to Measure patient outcomes, people productive and financial stability?
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.
Right care, right time
Report investigate and act on incidents
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
