People and practice: new roles and new ways of working
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This document discusses workforce transformation in healthcare. It provides an overview of new roles and ways of working that can improve patient care and experience. The document uses the example of Mrs. Andrews' care pathway to show how using different workforce roles, skills, and values could have improved her experience. It emphasizes that innovative new care models require a workforce with the right skills, numbers, and behaviors to deliver high quality care. The learning outcomes focus on gaining understanding of workforce transformation, critiquing patient pathways, and applying the lessons to future roles.
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People and practice: new roles and new ways of working
- 1. People and practice: new roles and new ways of working Naomi McVey, Programme Manager - AHP Workforce Into Employment, University of Salford, February 2016
- 2. Overview • Introduce workforce & transformation • Quick policy context • Patient story & real-life examples of using workforce differently • Making it happen
- 3. Learning outcomes 1. Gain a better understanding of the role of workforce transformation in improving healthcare quality and patient experience 2. Be able to critique an example patient pathway and identify ways to improve care through workforce roles, skills and values 3. Increased awareness of other useful sources of information 4. Be able to apply learning to your assignment and future roles
- 4. People with the right skills and values, in the right place, at the right time
- 6. ‘We can design innovative new care models, but they simply won’t become a reality unless we have a workforce with the right numbers, skills, values and behaviours to deliver it’ www.england.nhs.uk/ourwork/futurenhs/
- 7. Your placements • Did you work… – in single profession teams? – in any integrated, multiprofessional teams? – with Advanced practitioners? – with Assistant practitioners? • What did good look like?
- 8. Mrs Andrews’ Story How could care & the care pathway for Mrs Andrews be improved by using the workforce in different ways?
- 10. Is this what you would want for your family member? Is this what you would want for your family member? Opportunities to use NHS staff differently & more proactively? Opportunities to use NHS staff differently & more proactively? Did you recognise some of this? Did you recognise some of this?
- 14. The Guardian Jan 2016; North East London Foundation Trust and London Ambulance Service NHS Trust
- 15. ‘Frail and vulnerable patients should be managed assertively but holistically … and their care transferred back into the community as soon as they are medically fit, to avoid them losing their ability to self-care’ NHS England
- 17. Integrated Assessment team UHSM Integrated Discharge Team, BSUH A workforce for for the future
- 20. Mrs Andrews' Story – what went wrong?
- 22. Workforce transformation is more than just budget and numbers… “Employees who believe that management is concerned about them as a whole person – not just an employee – are more productive, more satisfied, more fulfilled’
- 25. What skills and values do we need as AHPs to help influence and shape new roles and models of care?
Editor's Notes
- Intro to me & role I’m going to spend the next hour focusing on the role of the NHS workforce in improving care and outcomes for patients If you’re on handheld devices these slideshare- I’ve tweeted the link using the module hashtag and they’ll also be available through the university
- One of the key enablers for service change and improvement is the way we use the skills and skill mix of NHS staff As the third largest clinical group in the NHS, we as AHPs needs to make sure we are responsive to changes in care, now and in the future. SO, over the next 45 minutes I’m hoping to get you thinking about how we can use the NHS workforce differently and some of the opportunities this brings. I am going to…
- I wont read through these but I am hoping that this is what you’ll get out of today’s session – it’s a big topic to cover in a short session so the slides include hyperlinks to more information
- In a nutshell workforce transformation is making we have people with the right skills and values in the right place, at the right time – both now and being proactive and innvoative for future needs and developments
- So in terms of the current NHS workforce we have some challenges that we need to respond to in terms of knowledge and skills
- So, I know Helen Baxter has already covered the Fiver Year Forward View so I won’t go over it again but just to highlight that we can’t redesign services and do things differently without focusing on staff. And there are 3 keys areas to this: Having enough staff Up-skilling the current workforce Developing and promoting new ways of working
- So, juts a couple of minutes in pairs have a quick discussion about your experience on placements
- So, I am going to show you a video animation of patient story which is based on real life stories; It’s a story of how care can go wrong and the impact this has on people’s lives and I want to use it to help us think about different ways to use the NHS workforce to provide better care So – it’s around 5 minutes long - as you’re watching it make a note at each stage of how care & the care pathway for Mrs Andrews could have been better by doing thing differently
- Send MP4 with slides Link here if needed: https://www.youtube.com/watch?v=Fj_9HG_TWEM
- So this is a story of how care for a frailer older person went wrong – and for me the events are very familiar, both as a physiotherapists and also as a granddaughter And a lot of what happened could have been avoided by making sure there were the right staff in the right place at the right time So – what are some of your initial reactions? Is this the experience you would want for a family member? Hands up if you recognised some of this from placements or lived experience? if you identifies some opportunities to use NHS staff more proactively and innovatively? So I’m going to focus on 5 keys parts of the story and suggest some ways to do things differently – and use some real services as examples
- So, this first thing is that we know from the animation that Mrs Andrews is 84, has been getting unsteady, has had a previous fall, is on 4 medications, might have some memory problems, and has postural hypotension. So, ideally she should already have proactive and supportive community services in place – and there lots of good models for this…
- One example would be A Falls prevention service in line with NICE guidance – a good example of the is the service in North Manchester which provides a multiprofessional service, with an initial unified falls assessment carried out by a nurse or AHP. I managed a falls prevention service where we had a similar model, we provided a ‘one stop shop’ in terms of initial assessment – in a clinic or persons’ own home and a team of nurses, AHPs and support staff were trained to lead Postural stability exercise classes
- So, in terms of blue light to hospital there are a few options here depending on how painful her hip was and whether signs of a fracture – the key thing here is the need for a professional with the right skills in Mrs Andrew’s home to determine if she needs to go to hospital and to arrange timely support if she doesn’t
- One example is developing the role of paramedics to provide services that keep people on their homes through skilled assessment, decision-making and onward referral – this can include community paramedic practitioners and there are 2 examples linked here In North East London a nurse and paramedic provide a home-based emergency assessment and treatment service for people who fall They visit patients in a rapid response vehicle and carry out a comprehensive assessment, and have access to some simple equipment to enable patients to remain at home and close links with a range of community services
- Next area – absence of routine physio or OT over weekends – any thoughts on this? I think there are a few important factors: It delayed her referral to home rehabilitation for 3 days It meant she stayed in bed for 3 nights as assessed as high risk of falls It probably meant she stayed in hospital for longer than she needed All this meant she deteriorated quickly in hospital
- So – does it need to be a physio or OT that carries out a mobility assessment? Do we need to think a bit more about these centre circles in terms of the wider team?
- 7 day services can also prevent unnecessary admissions and delayed discharges, and there’s also examples of fast track discharge teams working in emergency care One examples is the integrated discharge team in Brighton…
- So – hands up think this was likely to be a reasonable assessment for Mrs Andrews? I think this is a term that should be used with caution – and is often used too quickly in the wrong place For many older people you can’t assess this properly within an acute hospital environment And it’s possibly an indication of knowledge and skills of the workforce in working with older people with complex needs, especially those with dementia
- So instead she should have had access to reassessment ore review within the community - with home-based rehab or re-enablement and falls prevention; or respite with active monitoring, review or support But to do this we need the tight teams in place with a range of skills in supporting people with complex needs There are really good examples of community rehabilitation and enablement services with the skills to assess and support people following hospital discharge – so able to see people in their own homes or other community settings – there are 2 linked here There are also good examples of reablement services where people receive extra support and encouragement from carers, with a focus on increasing independence rather than a more passive model of giving care
- So, hopefully that’s given you a few examples of the way the NHS can use the workforce differently, and there’s a really good video commentary on the video here with some other ideas
- So, how do we make some of these changes happen? We need to start doing some things differently, but change can be challenging and takes us out of our comfort zone
- So – tis first things is that numbers are important, but that there’s much, much more to getting workforce transformation right It’s about leadership and times of change at all levels of the health service
- Change brings opportunities Opportunities to work in diverse teams, in different ways, and make a huge difference to patient experience
- So what skills and values do we need as AHPs to help influence and shape new roles and models of care? Clinical skills are a given so my top 5 are Care and compassion System awareness – see the bigger picture and how this impacts on patients and your service Communication and influencing skills Being comfortable with change Creativity