Supporting NHS Wales to Deliver World Class Healthcare Good Practice in Role Redesign in the NHS in Wales

NLIAH and the Workforce Development Unit Service Improvement Leadership and Organisational Development Workforce Development Workforce Planning Education Commissioning and Contracting Education and Qualification Development NHS Careers Workforce Development Support - Regional

“Designed for Life” 10 year Strategy to deliver a world class health Service for the people of Wales Involves reshaping services Investing in the development and skills of our workers Service and Role Redesign feature strongly “Designed to Work” 10 Year National Strategy for the workforce Role Redesign Best practice in HRM Workforce Planning and Workforce Development Planning HR Plans with Social Care partners on a local, regional and national level Linked to education commissioning WDECU

Aims of Role Redesign Improve patient experience Tackle areas of pressure or staff shortage Extend opportunities for staff development Deepening and broadening existing roles Optimalising efficient working Making the most of human resources including staff time, knowledge, skills and understanding. Assist in moving barriers to service change Bridging gaps between services and sectors Provide career opportunities

Role redsign is relevant where: Staff skills are not being optimised Improvements need to be made The service is not fully relevant to the emerging needs of patients The service has not changed significantly despite advances in technology Service demand is exceeding the capacity to deliver care Service demand has dropped

Role Redesign Process Aims SWOT and PESTLE analyses Focus on the Patient Who are they? Characteristics and demographics Focus on the Product Process Patient Pathway Product Process pathway Referral Reception Treatment Observation Recuperation Discharge Aftercare Receipt Record Prepare Label Process/Test Record Communicate

Process PROCESS INPUTS Methods People and Skills Materials, Equipment and Facilities OUTPUTS Letters, reports Events

Map the journey Agree the beginning Agree the end Map the process in between

Start large, work down All the steps performed - By one person - in one place - at one time

Role Redesign Process Focus on the Workforce Right Service in the Right Place at the Right Time with the Right Staff with the Right Skills and using the Right Technology

Task and Function Analysis QuestionSource of information Who are our staff?Staff list Where and when do they work? Staff rotas What are their roles and functions? Job descriptions, person specifications, KSF Post Outlines How much of their time do they spend in direct clinical tasks Time sheets, activity diaries

Workforce Analyses Skill Mix Age Profile Attendance study Morale Survey Culture map TNA (Training needs analysis)

TNA or Staff Development Analysis Use the KSF PDP learning objectives Amalgamate and count Commission learning based on amalgamated data Linked strongly to Organisational Objectives Review and evaluate

Focus on the Service Volume of Service Delivery Analysis How many referrals do we get? Of what kind? How often do we get them? When do patients receive the service? Are there times of significant pressure, bottlenecks or lulls? Who delivers the service? Who does what? To whom? When? Where? Analyse activity according to location, personnel and time of activity and time taken. What are we doing well? Why is it doing well? What is not going so well? Why?

Other considerations Other Analyses Boston Matrix? Value Chain PPI Options Appraisal Benchmarking Planning Prepare a business case

Business Case Summary Background Proposal Costs Service Quality Risk assessment – Likelihood v Impact Conclusions Recommendations

Communication Communicate the need for change To all stakeholders – develop a checklist CategoryNameCommunicationContact details StaffA.N OtherNewsletter, stakeholder discussion groups. Internal Patients (PPI)Mrs J DoeNewsletter, PPI groups 1 Main Street Blaina Tel:

Action Plan Priority 1:Critical – must be dealt with urgently because there is an immediate risk to the service or to patients/the public (Short Term) Priority 2:Important – should be dealt with because there is a significant adverse impact on the service (Medium Term) Priority 3:Desirable – if the issue was dealt with it would make a worthwhile improvement to the service (Long Term)

Specifics What effect will the new role have on the existing structure? Who will manage/supervise the role? Clinical supervision? Are there funding implications? Where will the funding be sourced and when will it be available? Is the post full time? Part time? Available as job share? How will the duties be covered in the event of absence? What is the level of autonomy of the role? What are the limits and demarcations? Will the role cross traditional/professional boundaries? Are there any clinical governance considerations? Are there regulatory considerations? What are the likely education, training and CPD needs? For how long is the post likely to be sustainable? Will the role set a precedent?

Recruitment What are the recruitment issues for the post? How will you recruit? Have you completed an agreed Person Specification and Job Description? Have you completed a full KSF outline for the post? Has the post been evaluated?

Monitoring and Evaluation Set in place systems to monitor the impact of the new role on the service. Set a time and criteria to evaluate the effectiveness of the role Link to performance measures, preferably those required by the Trust as part of performance monitoring

Principles of Good Role Redesign Changes to roles follow good practice in Human Resource Management and are fully legally compliant. To ensure this, key stakeholders must be involved; staff affected by the proposed change staff representatives Human resource staff Staff development and training representative Local KSF lead

Principles of Good Role Redesign The patient experience is demonstrably improved as a result of the change. This should be achieved through evaluation of the change. This might include; Reduction in waiting times Better access to treatment Higher quality Better management of demand and other pressures Reduction in staff turnover and thereby greater consistency for patients Greater focus on customer care

Principles of Good Role Redesign A thorough risk assessment is completed, particularly where more complex tasks are a feature of the new role or where greater staff autonomy is created. The risk assessment shows that the safety of the patient is accounted for The changes are based upon a careful analysis of the service, the existing roles and patient pathways. Emerging and accepted good practice feature strongly in the resultant change

Principles of Good Role Redesign Skills development is properly accounted for, and that CPD for staff in new roles is assured. Recognition is given to the transferable skills, professional development and lifelong learning of those affected by the change A business case for the change is created which is based on established methodology which should include service analyses, issue identification and service and role development planning. The change is sustainable and supported

Contact Mike Cole Senior Workforce Education and Development Manager Workforce Development Unit National Leadership and Innovations Agency for Healthcare Innovation House Bridgend Road Llanharan CF72 9RP Direct Line: “Supporting NHS Wales to deliver world class healthcare”