Community Nursing Research Strategy Conference, Cardiff, 5th November 2014

1. District
Nursing
Workload
&
Workforce
Calcula6on
Tool
Paul
Labourne
November
2014
Acknowledgement
Sue
Thomas
&
Carolyn
Wallace

2. This
is
an
all
Wales
Approach
in
Partnership

3. Aim
• To
cover
the
Process
• To
highlight
the
key
learning
• To
update
where
we
are
to
date
• What
are
the
next
steps

4. Process

5. The
Journey

6. Professor
Jean
White
CNO
for
Wales
Carol
Shillabeer
PtHB
Director
of
Nursing
Paul
Labourne
PtHB
Assistant
Nurse
Director

7. The
Journey

8. The
Journey

9. The
Journey

10. The
Journey

11. The
Journey

12. Methodologies
Strengths
Weaknesses
Professional
Judgement
• Clinically
based
• Handles
complexity
• Is
good
sense
check
• Enduring
• Simple
soOware
calcula6ons
• No
objec6ve
quality
measure
• Less
sophis6cated
can
be
subjec6ve
• Workload
intensive
• Management
view
• Awkward
to
calculate
manually
Staff
to
Pa6ent
ra6o
• Evidence
base
• Excellent
to
benchmark
• Free
soOware
• Used
in
mul6ple
seUngs
• Upda6ng
is
costly
• Which
numerator
/
denominator
• Workload
is
fixed
• Throughput
is
ignored
• Open
to
manipula6on
• Hidden
variables
Acuity
/
Dependency
• Accounts
for
most
variables
• Workload
based
• Flexible
• Quality
weighted
• Measures
throughput
• Free
soOware
• Can
be
subjec6ve
• Requires
addi6onal
data
collec6on
• Audi6ng
not
standardised
• Time
required
to
gather
data
• Can
be
complex
to
analyse
Timed
Task
/
Ac6vity
• Evidence
base
• Accurate
• Easily
automated
• Easily
updated
• Linked
to
care
pathway
• Costly
as
usually
commercial
• Missing
care
groups
• Task
orientated
• May
lead
to
tradi6onal
staffing
/
skill
mix
Regression
/
Ac6vity
based
formulae
• Cheap
• Basic
forecas6ng
• Lacks
ownership
• Commercial
systems
costly
• May
lead
to
tradi6onal
staffing
/
skill
mix
RCN
(2010)

13. The
Journey

14. The
Journey

15. Wider
Scoping
• Queens
Nursing
Ins6tute
Report
(2013)
– Presenta6on
of
this
work
(4/4/14)
– Methodology
/
process
followed
• Welsh
Audit
Office
– Presenta6on
of
the
2014
audit
(14/2/14)
• Buurtzorg
Dutch
Community
Health
&
Social
Care
Provider
– Presenta6on
of
this
organisa6on
following
study
trip
(4/4/14)
• NICE
work
on
Community
Nursing
yet
to
commence

16. The
Journey

17. The
Journey

18. Available
Tools
• ScoUsh
Tool
(presenta6on
21/6/13)
• English
Tool
(presenta6on
5/11/13),
Hurst(2006)
• Northern
Irish
Tool
eCaT,
Kane
(2014)
• Eire
Popula6on
Health
Informa6on
Tool:
PHIT,
Health
Service
Execu6ve
(2011)
• Brighton
Tool,
RCN
(2010)
• Lincolnshire
Tool,

19. The
Journey

20. The
Journey

21. Context
Private
members
Bill
District
Nursing
Care
Closer
to
Home
CCIS
WAO
QNI
NICE
FoC
Cost
neutral
system

22. The
Journey

23. The
Journey

24. Welsh
Perspec6ve
• Workshop
29th
May
2014
– The
outcome
of
the
workshop
was
to
demonstrate
both
the
variance
and
similari6es
within
District
Nursing
in
Wales.
– The
workshop
demonstrated
that
describing
the
workload
of
a
District
Nurse
involves
covers
more
than
just
a
dependency
and
acuity
score
and
would
be
best
ar6culated
using
the
same
domains
as:
• Community-­‐based
Pa6ent
Complexity
Instrument
(CI).
Under
development
(2014)

25. The
Journey

26. The
Journey

27. Assessment
of
Tools
#1
• The
tool
in
its
self
does
not
give
the
answer
the
tools
require
a
sense
check
against
professional
judgement
and
the
outcomes
of
pa;ents
especially
nurse
sensi;ve
outcome
indicators.
• The
available
tools
have
been
assessed
against
the
Community-­‐based
Pa6ent
Complexity
Instrument
(CI).
Sept
5
Thomas
(2014).
• Not
one
tool
covers
the
full
Complexity
however
is
was
possible
to
assess
what
the
tools
assess.

28. Assessment
of
Tools
#2
• ScoUsh
Tool
is
a
deriva6ve
of
the
Hurst
tool
• Northern
Irish
Tool
eCaT,
is
a
commercial
tool
with
a
cost
and
evidence
base
is
currently
being
developed
• Eire
PHIT,
did
not
read
across
into
District
Nursing
• Brighton
Tool,
regressive
tool,
lihle
evidence
base
• Lincolnshire
Tool,
regressive
tool,
no
evidence
base
• Hurst
Tool
is
mul6faceted
(dependency
scoring,
ac6vity
and
quality
outcome
based)
but
as
with
Scotland
would
need
adapta6on
to
suit
Wales
and
a
appropriately
sized
data
set
is
required
to
drive
the
tool
Acknowledgement
to
Sue
Thomas
Oct
2014

29. The
Journey

30. The
Journey

31. Next
Steps
• Develop
Hurst
tool
to
fit
Wales
– (base
line
ac6vity
data
driven
from
WAO
results)
– (Quality
outcomes
based
on
FoC
audit)
– Calcula6ons
to
take
account
of
ways
of
working
in
Wales
eg
Leg
Clubs
• Pilot
/
Test
and
evaluate
the
tool
• Develop
an
op6on
appraisal
on
the
implementa6on
across
Wales
• Make
recommenda6ons
to
CNO
and
Nurse
Directors
• Publish

32. References
Health
Service
Execu6ve
(2011)
Popula'on
Health
Informa'on
Tool
(PHIT).
Health
Service
Execu6ve,
Ireland
Hurst
K
(2006)
Primary
and
community
care
workforce
planning
and
development.
Journal
of
Advanced
Nursing.
55(6),
757-­‐769
Kane
K
(2014)
Capturing
district
nursing
through
a
knowledge-­‐based
electronic
caseload
analysis
tool
(eCat)
Bri'sh
Journal
of
Community
Nursing.
19
(3),
116-­‐124
Queen’s
Nursing
Ins6tute
(2013)
Report
on
District
Nurse
Educa'on
in
England,
Wales
and
Northern
Ireland
2012/13.
QNI,
London
Royal
College
of
Nursing
(2010)
Guidance
on
safe
nurse
staffing
levels
in
the
UK.
Royal
College
of
Nursing,
London
Thomas
S
(2014)
Community-­‐based
Pa6ent
Complexity
Instrument
(CI).
Sept
5
2014
Unpublished
PhD
Work

33. Diolch
yn
Fawr
Any
Further
Ques6ons