NHS Safe Staffing – 6 Key Findings

nhs-Safe Staffing

In our last blog we discussed the increased pressures facing the NHS and how organisations such as NICE, are offering their guidance on achieving safe staffing in the NHS through technology and toolkits. Kronos hosted a series of ‘safe staffing’ workshops with NHS trust managers which offered some valuable insight into the challenges facing NHS trusts today. Of course each trust has quality patient care top of mind, but when it comes to achieving this, there are a number of operational issues they must overcome.

From the three workshops we hosted, the top operational challenges facing trusts at the moment are:

 

  1. Planning efficient rosters and robust ‘sign off’ of those rosters

After much discussion, it was evident that many of the trusts are still battling to successfully embed eRostering into the culture of the trusts. The effective implementation of any technology relies on senior management and CEOs. It requires their understanding and evangelising of the benefits of the solution to the whole team. Furthermore, making is clear how the solution will be used and enforce the processes rigidly.

A recent report from the Royal College of Nursing (RCN) revealed that 72% of staff reported that staff shortages occur frequently. A further 66% have also considered leaving the health service because of increased workloads and the stresses of the job. This makes it clear that action must be taken to keep the workers on the side of the NHS. When these workers feel stressed and overworked it can negatively impact the work they do and patient care they provide. Senior NHS management must therefore recognise the importance of technology in supporting safe staffing initiatives.

 

  1. Inefficient data collection

Inefficient data collection regarding the actual attendance of staffing is a serious issue for three reasons. The first is that the lack of real-time data capture of activity, means ward managers have an administrative overhead caused by retrospectively entering the data. The second is how manual data entry results in the data being more likely to be inaccurate. Lastly, the lack of real-time visibility from this data collection method means important staffing decisions are delayed, ultimately resulting in the quality of care being compromised.

These issues can be resolved if trusts implement time and attendance (T&A) solutions to record, using real-time data capture, the presence and availability of the nursing team.

 

  1. Alignment of the digital data held within trusts

Staff are currently using a range of different technologies in their day-to-day roles. They would like to see how all these technologies and devices could strategically ‘talk’ to one another where possible. This would improve the quality of data gathered because it could be cross referenced with the different measurements being made. It was good to see that, following concerns raised by NHS employees about staffing levels on more than 2,500 occasions in the last year, a government spokesperson said that a national framework for the “reporting of adverse events” will be rolled out. It’s crucial that we begin to see more consistency across trusts in terms of technology and reporting, in order to keep the service aligned and quality of care monitored effectively.

 

  1. High level visibility of actual staffing on shift by shift basis

The operational management of safe staffing was a heavily discussed area in our panels. The process for many trusts would entail a ‘breakfast staffing’ meeting at Matron-level each morning to go through the plan for the whole day.

The general consensus was that scenarios could still change throughout the day, and therefore, the morning meetings can be lengthy and costly in terms of time and efficient use of senior staffing. Systems such as Kronos OptiLink and T&A provide management of staff with the holistic visibility into the staffing on their wards and across the whole trust, freeing up time usually spent on morning planning meetings.

 

  1. Compliance and validity of acuity recording within trusts

It was found to be quite challenging to measure how effective the decision-making is of the nurse logging the acuity recordings. Without an investment of staff resource to either do the recording corporately or to scrutinise the data, there is no real way of measuring this.

Kronos OptiLink makes the capturing of acuity data simple and efficient, using tablet devices. Having acuity data on the tablet devices also helps with handovers between nurses, giving them the ability to review and discuss the recorded conditions of the patients easily.

 

  1. Commissioning

Trusts were keen on the idea of being able to consider detail at a commissioner level and how impactful this could be on future contracts being awarded to a trust and equally, investment in services. They saw the value in being able to articulate the service need more figuratively and identify trends, as well as how this could have a positive outcome.

For more information on Kronos for healthcare solutions visit www.kronos.co.uk/healthcare

 

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NHS – The Operational Challenges of Safe Staffing

NHS Safe StaffingAs an election year looms, the pressure on the NHS continues to build. The future of the service continues to be a heavily debated topic and a clear battle ground for the main parties. The issue of privatisation remains prominent with many public thinkers expressing doubts over whether the service will soon cease to be free. Whilst others suggest taking the pressure off hospitals and GP clinics by spreading patient treatment across pharmacies instead.

Undoubtedly, the biggest concern for all must be the quality of patient care. The NHS care watchdog recently warned of a risk to patient care due to a shortage of doctors and nurses. Then its annual report assessing NHS and social care services, the Care Quality Commission (CQC) said recently that while much care is excellent, “the variation in the quality and safety of care in England is too wide and is unacceptable”.

Against this backdrop, organisations are continuing to offer their guidance to NHS leaders in order to improve patient care. For example, recently the National Institute for Health and Care Excellence (NICE) endorsed a decision support toolkit to be used alongside its guideline on safe staffing for nursing in acute hospitals.

It’s clear that as the service continues to face financial challenges, technology will play a key part in supporting staff in their roles.

Kronos recently hosted a series of NHS workshops following the initial guidelines published by NICE. These were attended by a broad spectrum of healthcare professionals from NHS trusts across the UK. The aim of these workshops was to help NHS trust managers meet safe staffing obligations, control labours costs and improve patient care. Through the discussions at these workshops, a number of consistent challenges were highlighted.

One of these issues were the Unify reports. These report templates are a government requirement for trusts to report their staffing levels. But there appears to be inconsistencies and a disparity in the way trusts are reporting safe staffing. These inconsistencies arise from Trusts recording the supernumerary/supervisory status of nurses as clinical hours or not. In addition, there are some discrepancies with how the wards are recording the hours in terms of long or short days.

The unify report simply asks for hours on day and hours on night shifts. With enough detail lacking in these logs, it could negatively impact some trusts, especially if they are logging reports differently. The hope is that soon enough, there will be thorough guidance provided on reporting expectations.

But, how is the staffing data impacting upon patients right now?

The consensus here seems to be that patients are not using the data or they cannot understand the data. Staffing numbers are not currently being quoted in complaints, for example. Trusts believe that patients are either not interested in the numbers, or are not aware of the relevance. This will change though, and it will be interesting to measure the impact upon service requirements for those having patient choice for surgery, etc. There was a clear consensus from our panels that whilst data is not used during normal clinical visits, it could be used in future complaints or legal cases. Therefore, in the future it is imperative that trusts will need to have access to accurate records. And those that fail to manage this process will find themselves under immense scrutiny from public sector leaders and the public.

Keep an eye out for our next blog, where we’ll discuss the operational challenges facing trusts today.

10 Common Challenges for Workforce Management in the NHS

nhsLast week Kronos hosted its annual conference for the EMEA region – Kronos Live EMEA. The event is naturally one of the highlights of Kronos’ year. Spending time with customers and prospects talking about their workforce management challenges and requirements is invaluable and vital to ensuring that, as a business, we continue to meet the needs of our users.

Ahead of the main conference I also had the pleasure of hosting an intimate dinner for workforce management professionals within the healthcare sector. The discussion was led by LSE professor Dr. Tony Hockley, who recently authored the report – NHS Staffing: Not Just a Number.

It’s clear that NHS Trusts across the UK are all at different stages of technology implementation and – to some extent – their experiences and user demands are unique. However, there are also many commonalities which exist, regardless of a Trusts location, size or the type of care it offers to patients.

Here are my 10 observations – in no particular order – which the NHS faces when approaching workforce management.

  1. Nurses and administrative staff should be proud to be workforce management trailblazers. Some might feel that nurses have been ‘picked on’, as they comprise the majority of health professionals who are currently utilising workforce management or eRostering technology. I think the opposite. Nurses and admin staff are leading the way and inevitably other health professionals (medical and other services, etc.) will follow.
  2. Transparency through technology is essential. The NHS relies on the good nature and professionalism of its employees. But too often this can then be open to mismanagement or abuse. Technology can help to remove guess work and provide evidence around hours worked, shift patterns and workforce anomalies.
  3. Accuracy, accuracy, accuracy! Transparency is only of value if the data is precise and – crucially – provided in real time.
  4. Ratios of staff to patients are important, and collectively we have to get it right and respond positively to proposed government targets. But patient care will never be an exact science. Across all forms of care there are anomalies, inconsistencies and exceptions.
  5. We all want a simpler life… I am always astounded to hear stories from across the NHS about how many shift patterns exist across a Trust. Whilst it’s vital to offer employees the flexibility to fit work around other commitments, greater standardisation and simplicity of shift options means greater efficiency. In one instance a Trust consolidated an unwieldy 68 shift options to just six.
  6. Workforce management solutions are still in their infancy in the NHS. We can certainly learn from private sector industries, such as retail and manufacturing, which are now well established and in their third or fourth iterations of technology deployment. But it is wrong to try and compare like for like. The NHS is different from the private, sector and we have to recognise that.
  7. We all need help to become better managers. One consistent challenge which does exist across private and public sector is that continuous development and training is essential. Nurses shouldn’t be expected to become team managers without investment in management training and learning. The best technology in the world can’t help if managers aren’t confident, empowered and up-skilled to make managerial decisions based on the insight IT solutions provide.
  8. Build a justification case for implementation. In tough economic times, all tech decision makers are under pressure to show the value of their investments and ROI. As technology vendors, it’s our responsibility to help our customers do this.
  9. Change management is the key to success. The NHS is driven by people and behavior. No tech implementation or change to processes and practices will succeed without the buy-in of staff.
  10. Finally, it’s all about the patients. In a climate driven by cost saving, efficiency and cuts, we must never lose sight of the fact that we are all here to serve the best needs of the patient.

 

How good is your vision?

Better VisibilityWhether you agree or disagree with the age old adage of “You can’t manage what you can’t measure”, the fact remains that having better visibility sure makes life easier.

Take driving for instance. If we didn’t have side windows, and relied only on the windscreen, at some stage we would inevitably get side-swiped by something we didn’t see or anticipate. The same goes for business too. We stand a much greater chance of meeting our business objectives if we are able to anticipate, visualise and react to the changing needs of our internal and external customers.

One of the most rewarding things about my role is meeting our customers and learning how our solutions are making a positive impact to their organisations. On almost every occasion, at some stage during our discussions, the customers will cite “greater visibility” as being one of the key benefits of their Kronos workforce management solution.

A brief story…..

On a recent visit to one of our UK hospitality customers I asked their operations manager what benefits Kronos is delivering. It was fantastic to hear him say the solution was delivering a 6% to 8% saving on labour costs as a result of improved labour demand forecasting and scheduling. However, he went on to say that the true benefit to him personally is the ‘visibility’ the solution delivers. Having detailed labour data at his fingertips means he can now have meaningful conversations with each of his general managers. He is able to discuss and review the impact that programmes and activities, such as staff training or additional labour budget allocations, are truly having on their sales performance.

When building a business case for a workforce management solution you need to focus on the tangible benefits, which in the main will be around cost reduction. However, once the solution is live it’s the intangible benefits that start to materialise and make a positive impact on the business and the individuals.

In the case of this particular customer their business is growing significantly, and so is their labour budget. But having visibility into key labour metrics is allowing them to maximise their return on labour budget and build an even stronger business. www.kronos.co.uk

Neil Pickering, Twitter: @ZamberP

 

Reliable systems will help the NHS fight fraud

NHS Fraud

The NHS has suffered a great deal of scrutiny recently – as the service tries to battle with public sector cuts and increasing demand from patients, it must now respond to the latest blow: the cost of fraud in the NHS. A BBC Panorama programme which aired last month revealed that NHS fraud and error is ‘costing the UK £7 billion a year’. The last thing the service needs is to lose money to fraud and error when the pressure to save and cut costs has never been higher.

Given that the biggest areas of fraud are found to be payroll and procurement budgets, we must focus on these processes to determine where the faults can be fixed. Payroll fraud can happen in a number of ways: some examples include employees claiming overtime for hours not worked, false expense reimbursement claims and lastly, unauthorised changes to an organisation’s payroll systems (such as an employee adding ghost employees to the payroll who either do not exist or do not work for the organisation).

A report from the National Fraud Authority echoes this and states that payroll fraud costs the public sector £335 million a year. In reality, the figure is probably even higher– not all payroll fraud is accounted for because it can go unnoticed with unreliable systems in place. Fortunately, this doesn’t have to be the case.

Many parts of the NHS still rely on “weak data” to run their payroll and workforce management systems, rather than leveraging real-time data to show staff availability and validate that rosters are being worked as planned.Yet, the latter is important not only for accurate shift allocation, but even more so for patient safety. For example, a recent report from the London School of Economics and Policy Analysis Centre shows that even an inaccuracy of 0.09% in the NHS payroll equates the cost of the employment of up to 2,000 additional nurses!

In order to eliminate payroll fraud, NHS leaders and staff need to embrace the latest Time and Attendance (T&A) systems and integrate them with payroll. The London School of Economics and Policy Analysis Centre report supports this by voicing potential savings of £71.5million from the use of T&A systems in the NHS.

For this vision to become a reality, the image of industrial-style “clocking-in” systems must be scrapped. Modern self-service biometrics terminals allow staff to quickly, easily and securely record their activity, thereby ensuring accurate payroll and preventing fraud occurring. The Royal College of Nursing (RCN) issued guidance earlier this year, describing good quality data as “the cornerstone of effective staff planning and review”. Now, when the topic of fraud arises, NHS leaders must remember that good quality data and reliable systems will be the answer for prevention.

Zero Hours Contract Debate Rumbles On

ZeroIt looks like the zero hours contract debate will be rumbling on in 2014 according to the Chief Executive of ACAS. In an article published in HR Magazine this month, Anne Sharp welcomes the Government’s decision to institute a 12-week consultation to produce guidelines for employers and employees to help clear up confusion. As ACAS have seen an increasing number of enquiries from employees concerned with changes in their terms of contracts this can only be a good thing. Zero hours can offer flexibility to both employers and employees but with a second reading due in the House of Commons of a Private Members Bill seeking to prohibit zero hours contracts – it is clear that some strong guidelines to protect employees and inform employers are necessary if they are to remain a part of the flexible working toolkit available to maintain the agile workforce required to support economic growth.

The key to ensuring fairness in the workplace is by being able to track and monitor zero hours workers time and attendance and put in place processes and rules that will show employers and employees are getting the best out of this kind of working practice.

I have always maintained that businesses need to be as agile as possible, however a mix of full-time, part-time and the highly flexible zero-hours contract workers are essential to retain talent and ensure business objectives are met. If you want to keep abreast of the zero hours debate you can find out more by visiting the ACAS or the Government websites:

http://www.acas.org.uk/index.aspx?articleid=4468

https://www.gov.uk/government/consultations/zero-hours-employment-contracts

Real Time Information – Are you ready?

Simon MacphersonMany of you will know from 6 April 2013 employers will have to start reporting PAYE information to HMRC in real time. You may see this referred to as Real Time Information – or RTI.

This means that employers (or their accountants, bookkeepers or payroll bureau) will have to send details to HMRC each and every time they pay an employee, at the time they pay them and use payroll software to send this information electronically as part of their routine payroll process.

Although I am sure most organisations will already have electronic payroll solutions in place, I do wonder how many organisations have an efficient workforce management solution in place delivering accurate payroll hours and data to that system. I can only begin to imagine the chaos when organisations try to rectify the inevitable mistakes created by collecting hours manually, loading them into an electronic payroll data system and then loading all those errors in “real time” to a government system! It’s situations like this that makes me so proud of what we do for our customers.

Using a workforce management solution that automatically captures employee time electronically via terminals, biometrics, mobiles, laptops or tablets reduces payroll errors to zero and ensures accurate payroll, in “real-time”!

It will be very interesting to review the news after the first payrolls are processed in April and the mistakes roll in. I’d be very interested to hear from you with your experiences.