Workforce modellinggetting it right Alison Leary Ph D

Workforce modellinggetting it right Alison Leary Ph. D FRCN FQNI Professor of Healthcare & Workforce Modelling @alisonleary 1

District nursing work is really complex! There is no magic solution, no magic number

“I want to know how many nurses we need. It should be easy as they only do four things. ”

Compassion Empathy Virtues i. e. courage Psychological care We say who we are, not what we do Skill, knowledge, expertise, alleviation of suffering

The current approach

Understanding the challenge • We focus on staffing as an endpoint, not on safety • We don’t define what safe is • We only measure harm, not safety • Should safe be the endpoint or should it be therapeutic levels of staff? • Boom-bust, reactive approach to modelling the workforce

Why is a nursing workforce hard to model? Poorly defined input/output Many levels of practice Plastic Workforce Reluctance to articulate contribution or claim attribution Demand is never modelled Complex non linear work Misperceptions of nursing & its function in 21 st century

False assumptions about nursing work • Nursing is linear-Nursing is a series of primarily physical tasks that occupy time • Nursing is the application of a task based skillset with little decision making • Nursing can be measured i. e. time and motion type of activity. • Caseload same as Workload/Nurse to furniture ratios • All work is completed in time allocated • It’s a service industry. A F E S L

The work is not linear

Dangers of reductionism

Things that help • Think about demand-understand workload • How complex is the work? Who can manage what? • Think about risks-how unpredictable/sick are the patients? • Think of nursing as a safety critical profession • Help others understand the complexity of nursing practice & the risk it manages

Things to avoid • Underestimating workload by being selective • Division of labour models • Time and motion type activity • Thinking of ratios as a model not a failsafe • Not asking questions of people who have “easy” solutions

Model workforce Risk based, rather than task based workload redistribution Expert, able to use justifiable deviance Graduate experienced decision maker “Rookies” (novices) & assistive workers Complexity & unpredictability of work

Legislative & regulatory framework for crowd safety

What safety regulation & legislation offers us • Clear accountability & responsibility • External scrutiny • A framework for risk based approaches to safety & staffing, including failsafe • The opportunity for justifiable deviance to better meet need based on evidencesafety is dynamic • Better workforce modelling based on demand • A form of assurance

Things to consider • Different approach-start with demand & wrap workforce around it • Different approaches to valuing the workforce-ie supporting “rookies”, recognise workplace issues such as incivility • Different approaches to safety-more than the absence of harm • Helping others understand that nursing is a safety critical profession • Cultural shift-the workforce as a valuable asset not an expensive burden

“If you think its expensive to hire a professional to do the job, wait until you hire an amateur!” Red Adair

Thank you alisonleary@yahoo. com @alisonleary 1