The NHS staff shortage? – ‘manage it or measure it’ that is the question.

NHS Short StaffedAround six years ago the NHS was being challenged to reduce costs by around £1.52B and an estimated reduction in 30,000 staff. If reports of today are to be believed the targeted savings are now £20B. One can only imagine how that will translate into “aligning” the headcount – to use a modern day management euphemism.

All this represents the backdrop behind one of the most controversial report ever published on the NHS and its duty of care to patients:  The “Review into the quality of care and treatment provided by 14 hospital trusts in England: overview report” by Professor Sir Bruce Keogh KBE.

The report has generated quite a stir politically, professionally, and continues the almost endless media frenzy about scandals in the British healthcare service; the NHS own web site a good place to start for further reading.

Out of the 14 nhs hospitals subject to rigorous review every one had short staffing ‘flagged’ as an underlying issue. Of particular concern was staff felt they could not speak openly about staff shortages. These staff felt unable to share their anxieties about staffing levels and other issues with their senior managers, which suggested that staff engagement at some of the trusts was not good.  Four facilities in particular are taking forward actions to improve whistle-blowing policies.

Given  staff shortages are a hallmark of poor management at senior level these revelations are hardly surprising, and neither are the responses which are as predictable as they are going to prove expensive.

All 14 hospitals have recommendations in their action plans relating to workforce issues; and NHS foundation trusts are planning to recruit 10,000 more clinical staff in a £500m recruitment drive. The moves are being linked with these growing concerns over the quality of hospital care in the wake of another landmark Francis report into the Stafford Hospital scandal.

I wouldn’t hold out much hope for action plans relating to workforce issues, or the vast  amount of cash about to be thrown at the problem. In fact the NHS has been exhibiting this kind of behaviour for years, it’s just the numbers are getting bigger. So if you were running a NHS Trust and wanted to do something about reducing the risk of ‘staff shortages’ where would you start?

Let’s start with two basic observations before looking at some practical action:

  1. A new way of thinking is needed where staff deployment rosters are concerned. For example, statements like “The [rostering] system must produce a roster that allows individual preferences to be a primary consideration …” is unlikely to be a sentiment that is shared by patients and their families. The notion of “The ‘Off-Duty’ roster” similarly is outmoded and outdated where team skill  coordination is key.
  2. It is a fact poor staffing levels at weekends and on nights, is always a problem not just in the NHS; and the high absence revealed in the review is a strong indicator of staff compensating for higher levels of fatigue. Put another way, what hours are being worked are poorly structured.

With this in mind we can make a start:

  1. Appoint someone to manage the staff duty schedule for the healthcare facility or unit, and above all has the authority to make it ‘stick’. Get away from the ‘free for all’ and  underlying ‘buddy’ systems. This part has to be right. Get it wrong and everything else that follows will be. Believing staff can work out their own roster is naïve and generally a management ‘cop out’.
  2. A computer aided rostering system will enable this to be done faster and better. It does not have to be expensive, and should be easy to understand.  One of the most powerful feature sets available including training can be obtained for a 50 staff facility for less than a couple of days unplanned overtime costs.
  3. Publish duty schedules at least 6 months in advance, 12 months or more so much the better. This will significantly reduce short notice changes and ‘swap around’. Short scheduling horizons are expensive, longer scheduling horizons are not. 
  4. Define the service delivery and demand. Sometimes referred to as staff supply demand match (SSDM) analysis. This is not as difficult as it sounds, and is usually well understood by managers anyway. Experienced observation will point to how many staff are needed at different times of the day – weekends should be treated no differently to weekdays.
  5. Have a record of every member of staff as well as name and contact numbers include their work availability schedule or any flexible working agreement that may have been agreed. Once staff levels can be counted in double figures you need a formal and comprehensive system to manage working arrangements. Relying on memory, ad hoc notes and ‘understanding’ simply does not work. Corporate HR systems rarely support staff deployment strategies.
  6. Adopt a structured scheduling approach that maximises rest periods, and incorporate shift patterns that are ‘body clock’ friendly – these are well documented. This is where the greatest gains are likely to be made and well worth the investment. Too often the simplest spread sheet arrangement dominates because it’s easy, unfortunately they are generally the worse and will constantly invite change because it never looks finished – it signals a ‘free for all’.
  7. Monitor staff working hours and rest periods, or other scheduling conflicts against any agreed working arrangements. This can be done automatically allowing you to change things in good time. It is unlikely this can be done manually save for a basic hours count. The modern day workplace is way too complex to manually track flexible working arrangements in the context of due beneficence to the rest of the team. Flexible working all too often becomes a game of ‘winners and losers’ and it’s getting a bad name.
  8. Publish to the web and by email to keep staff updated and enable them to access their schedules at any time. Convenient access to scheduling information reduces costs and the administration burden.

Where a structured staff deployment and monitoring system is locally absent in the workplace, up to around 64% of staff costs in that facility (not including training and equipment) can fall victim to wasted energy and inefficient production hours due to uncoordinated team work.

For further reading:

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  1. […] those of you that have been following my commentary about staff nursing levels highlighted in what has become a string of scandals in the NHS, it probably comes as no surprise […]

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