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#IGNursing17
Tracy Selsby-Orlandi
Head of Occupational Health
Derby Hospitals NHS
Foundation Trust
Inside Government
The Importance of Promoting the Health and Wellbeing of the
Nursing Workforce
Presented By:
Tracy Selsby-Orlandi – Head of Occupational Health
Derby Teaching Hospitals NHS Foundation
Trust
Over 8000 staff
30% (2452) of our workforce are nurses
Based across two sites
Serving a population of over 600,000
people in and around Southern
Derbyshire
6,000 babies are born in its maternity unit
annually
72,000 elective operations take place
every year
320 patients seen in the Emergency
department every day
1,100 beds
Recognising the positive impact of staff health and wellbeing
on patient experience, benefitting from increased patient
satisfaction and staff engagement and retention
Staff
Health
Absence
Presenteeism
Productivity
Efficiency
Customer/Patient
Care
Recruitment/
Retention
Clinical
•Chronic Disease
•Genetic
Lifestyle
•Exercise
•Diet
•Smoking/Alcohol
Socio-economic
•Carer
•Commute
•Debt
Em
plo
ye
r ca
n in
dire
ctly
influ
ence
Work Related
•Employment Security
•Relationships
•Job design
(autonomy, control,
interest and
challenge)
•Reward/Recognition
•Environment
•Work/Life Balance
•Development
Em
plo
ye
r ca
n d
irectly
influ
ence
•Health Improvement•Counselling•Training
ManagementPractice
Individual
•Improved
Health and
Wellbeing
•Enhanced
Motivation and
Engagement
Organisation
•Attendance
•Performance
•Patient Care
•Retention of
staff
Local Needs Influences on Health and
Wellbeing
Interventions Outcomes
Strategic Approach to Health
and Wellbeing
5 Year Strategic Summary on a Page
Our Vision – Taking Pride in Caring: To be a beacon for all that is best in the NHS delivering 21st
Century healthcare. We will be part of a flourishing network of health and social care partners to integrate care for our patients, deliver clinically excellent results and be financially sustainable
Putting Patients First
Right First Time
Investing Our Resources
Wisely
Developing our People
Ensuring value through
Partnerships
P R I D E
Our Pride Objectives
Our CARE Values
Compassion Attitude Respect Equality
Our ambition for the next 5 years
The most patient centred, harm free and caring
teaching hospital in England
To deliver effective,
sustainable services with no avoidable delays
To attain a level of financial
independence by reaching and
maintaining a sustainable
surplus
To be the top NHS employer
and educator in England
To improve care and efficiency
across the system through
purposeful partnerships
Delivery - Integrated Performance Report (IPR)
GOLDEN THREAD
Putting Patients First Right First Time
Investing Our Resources Wisely
Developing our People
Ensuring value through
Partnerships
R • Clinical Service
Strategy• Transformation
Strategy
I• 5 Year Financial
Model• 5 Year Capital
Plan (incl. Estate, IT and Equipment)
D• People Strategy
(including workforce plan and OD & Leadership)
E• Partnerships
including STP, Burton and others
Our ambition for the next 5 years
The most patient centred, harm free and caring teaching hospital in England
To deliver effective, sustainable services with no avoidable
delays
To attain a level of financial
independence by reaching and
maintaining a sustainable surplus
To be the top NHS employer and educator in
England
To improve care and efficiency across the
system through purposeful
partnerships
Enabling Strategies
P • Quality Strategy
Divisional Plans
Divisional Plans
Divisional Plans
BOARD
EXEC
DIVISIONS
Ass
ura
nce
–Su
bco
mm
itte
es
(Qu
alit
y, P
eop
le, F
inan
ce a
nd
Per
form
ance
RIS
K (
BA
F an
d H
LRR
)
DEVELOPING OUR PEOPLE
Education and Innovation
Workforce Transformation
Recruitment and Retention
Health and Wellbeing
Engagement
Our ambition for the next 5 years
Apprentice Development
Centre for E&T Delivery
MSC Programmes
Nursing Associates
International Workforce
Development
New Career Structures
Team Development
Workforce Plans –including new roles
linked to STP / Collaborative working
Embedding new roles
Place based development
Corporate Function Collaboration
Embedding Service Transformation
Further develop concept of new roles
International Recruitment
Optimised Transactional
Process supporting business needs
Identification and Intervention on Retention Issues
Employer Brand
Culture of Health and Wellbeing Development
Delivering Attendance Targets
Mental Health Support including
culture
Rapid Access for Staff
Enabling Opportunities
Top rated for organisational engagement
Staff able to contribute to
improvements at work
HSJ top 100
Staff FFT
LEA
DER
SHIP
AN
D O
RG
AN
ISAT
ION
DEV
ELO
PM
ENT
Patient Outcomes
Divisional Plans
INC
LUSI
ON
Recognising the Importance of
Nursing Workforce Health and
Wellbeing
Absence
Reduced Sickness absence reduced from 4.49% to 3.8%
Reduction in days lost from stress from 43,218 to 30,364
Reduced average length of absence for stress from 28 days to 15 days
Reduction of absence in ED from 12% to 3%
Health and Wellbeing
Increased engagement of wellbeing services by 30% (13,615 unique contacts)
Access to Mental Health and Physiotherapy services
Wellbeing App
Feedback/Survey
Patient – (6575 surveyed) 94% of our patients would recommend us
Staff – Staff morale 71 to 92, nursing vacancy 8.1% (bridged by internal bank)
Compliance
NICE Guidelines for Workplace Health from 55.7 (National Median 59.2) to 87 (National Median 67.2)
Finance
Delivered on a cost neutral basis
Commercial income of over 1 million (40% profit margin)
Regional savings of over £200,000 for partner organisations
Reduction of agency spend
Engaging with staff to identify key areas of importance
including managing stress and focusing on mental health
Engaging with Nursing Staff – ED case study
High sickness absence (12% - in the main stress-related down to 3%
after the work done)
Vacancy rates (3%) posed a real challenge to service continuity, staff
morale and performance.
Overall 5% increase in attendances, continuing increases in
attendances, higher patient acuity (11% increase in patients requiring
the resus room and an 11% increase in over 80 year olds)
Failure of the ED 4hr target
“ED team felt they were at breaking point”
Engaging with Staff
8 staff focus groups were held
75 staff attended equating to approximately 30% of the ED workforce.
Staff who could not attend were provided with the opportunity to
feedback individually
Intended Outcomes
To ensure that the ED Teams are aware that the Trust has considered
their feedback and are looking into creative solutions into some of the
key areas of concern.
To engage with staff to find out what their views are and what the
potential solutions are.
Gather information to help inform the departments risk assessment,
which in turn will inform the action plan.
The Good, the bad, the ugly
The Good The Bad
The Ugly Solutions
We deliver the best patient care we can
The team we work with are great (well most of them)
The hospitals is nice
The shifts are good
Equipment is often broken and no one puts it away to
be fixed
You need a huge bunch of keys to get into restricted
areas
Car parking is awful
IT is can be a problem
111 and dentist actively tell people to come to us!
The four hour target is stressful
Patient pathways can be an issue in some areas
Standard of management is variable
We only see managers when it is going wrong
We are short staffed and no one wants to stay
We cant recruit into the department
Can we get key pads instead of keys
Can we do a communication to make sure people don’t
put broken equipment back in the store
Can we contact dentists and 111 to educate them
Can we have more visible leadership
Can we look at a better recruitment package
Can we promote why ED is actually a really rewarding
place to work
Stress Risk Assessment
Demands
- Increase in patient activity and type of activity
- Reduced Staffing levels
Control
- Frustrations with external factors reducing control
Relationships
- Identified issues with patient pathways (internal)
- Identified issues with external stakeholders
Support
- Training
- Equipment
Change
- Internal and external
Role
- Lack of clarity of roles (managers)
- Clear on my role but get pulled in to cover other aspects when short staffed
Actions Taken
Leadership training – Band 6 and above
Proactive and reactive attendance management
- Case review of 4 occasions or more
- Attendance and Stress Management training
- 4 occasions of absence invitation to wellbeing check
Business case for investment in staffing levels and resources
Engaging with internal stakeholders to improve patient flow
Engaging with external stakeholders to reduce attendance to ED
Structured health and wellbeing programme, focussed around the 6
c’s
Outcomes
Commended by the National Emergency Care Intensive Support Team (ECIST) for driving up
performance and achieving real engagement and cultural change within the Department.
Jennifer Walker (ECIST) said: "The changes you've made to the health and wellbeing of your staff
has made the department fit for future years to come. This has led to the sustained delivery of the
4hr target and positive staff and patient feedback.
Exploring the next steps following the ‘Get Healthy, Stay Healthy’ campaign
Reducing sickness absence and improving productivity through investing in staff health and
wellbeing
Health and Wellbeing Services
Health and Wellbeing CQUIN
In March 2016 NHS England announced a health and wellbeing CQUIN,
linking 0.75 per cent of provider income to improving staff health and
wellbeing.
Introduction of health
and wellbeing
initiatives
Healthy food for NHS
staff, visitors and
patients
Improving uptake of
flu vaccinations
• Introducing improved mental health initiatives using NICE
guidance.
• Introducing physical activity schemes.
• Improving access to physiotherapy for those with MSK
issues.
• Submitting data on food suppliers operating on NHS
premises.
• Banning price promotions on foods high in fat sugar and
salt (HFSS).
• Banning advertising on HFSS foods.
• Stopping the sale of HFSS foods at checkouts.
• Ensuring healthier meals are available out of hours.
• Achieving an uptake of flu vaccinations by frontline
healthcare workers of 75 per cent by December 2016.
Promoting Positive Mental Health
Policy and Process
Stress Policy
Mental Health
Guidance
Health and
Wellbeing Strategy
Attendance
Management Policy
Support and Advice
EAP
Self referral to Occ
Health
Clinical
Psychologist
Specialist Mental
Health Nurse
Bespoke sessions
for departments
Lifestyle Checks
Mediation Training
Communication
and Engagement
Focus Groups
Staff Survey
Brand
recognition
Road shows
and events
Annual Plan
Training, Education and
Development
Stress Awareness
Stress Management
Coaching
Leadership
Programme
Positive Assertiveness
Coping with Change
Evaluation and
Reporting
Wellbeing
Dashboard
Clinical
Outcomes
Routine
Evaluation
¼ reports with
hotspots and
trends
Business Unit
Reports
Project Managed Approach
Musculoskeletal
Physiotherapy Outpatients Occupational Health Occupational Therapy
Rapid Access
Single source of data collection
Streamlined Evaluation
Business Continuity
Physical Activity
Flu Jab Dashboard
75.24% of Trust Frontline Healthcare Staff Vaccinated
Staff Group Percentage
Doctors 68.61%
Qualified Nurses/Midwifes 63.66%
Other Professionally Qualified 74.90%
Support to Clinical Staff 95.65%
Total 75.24%
Burning Question
How do we ensure that we continue to achieve sustainable results in relation to staff health and
wellbeing and measure the impact on patient care?
How do we increase engagement in our Nursing workforce?
- Strategic Plan
- Exec support
- Engagement with staff
- Accessible services and support
- Good management practice
- Eat, sleep, rave repeat!!!
Questions
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