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Established on 1 April 2000, the East and North Hertfordshire NHS Trust manage Hertford County Hospital (Hertford), Lister Hospital (Stevenage); Queen Elizabeth II Hospital(Welwyn Garden City) and Mount Vernon Cancer Centre (London).

Having undertaken and participated in a number of reviews of the nursing service (including the Audit Commission Acute Hospitals portfolio process), we were commissioned to conduct an external validation exercise of current nurse staffing establishments within the East and North Hertfordshire NHS Trust. The objectives of this review were as follows:

  • To conduct an analysis of the present workforce position of all services both clinical and non-clinical influencing nursing service delivery.
  • To identify the optimum staffing levels for nursing delivery, including administrative and support services who directly or indirectly impact on care delivery, throughout the 24hr cycle.
  • To identify the optimum skill mix per ward/clinical area.
  • Development of a formula identifying a fixed ratio and grade of staff to patient dependency or diagnosis related group.
  • To link staffing levels and skill mix to patient dependency.

Methodology

Our Transformation Team utilised a mix of methodologies in the review of nurse staffing establishments within the Trust. In general service areas, ‘Timeframe Analysis’ provided the mechanism for identifying the requirement for nursing resource, both registered and unregistered. Timeframe Analysis is a grounded theory research-based methodology that takes full account of research and changes in patterns of service delivery, particularly the increased dependency/acuity and throughput of patients. The methodology has been used in over 300 hospital sites throughout the United Kingdom and Ireland.

Timeframe Analysis utilises a combination of semi-structured interviews and desk-top analysis and is underpinned by our belief that staffing systems are most effective when conducted in conjunction with staff responsible for wards/departments (promoting ownership of outcomes and ensuring all factors impacting on staffing requirements are properly taken into account) and that nurse staffing systems should be patient focussed, developed around typical flows of demand for care within ward environments (not shift systems).

Timeframe Analysis is also used in conjunction with other methodologies e.g. Intensive Care Society guidelines etc.

Following the successful completion of the Limited Review of Nurse Staffing Establishments, we were commissioned to deliver ‘in-house’ training in ‘Timeframe Analysis’ methodology, subsequently used by hospital staff to review wards not included in the original external review.

Outcome

Our Transformation Team presented the findings of the review to the Director of Nursing, identifying the requirement for nurse staffing for all service areas in juxtaposition with a ‘target staff establishment’- the output of our review. The report comprehensively identified both whole time equivalent and ‘Agenda for Change’ band alteration (and associated costs) necessary to properly meet the demand for care within the service areas.

The report provided a strategic workforce plan for the future management of the nurse staffing resource.

Following the design and delivery of an ‘in house’ training manual for ‘Timeframe Analysis’, the Trust extended the review of nurse staffing establishments throughout the Trust, each service review being conducted by operational managers.