Glasgow Clinical Workforce Redesign

1. Glasgow Clinical Workforce Redesign Hospital At Night GCWRP

2. Glasgow Clinical Workforce RedesignGroup • Group set up July 2003 • Multidisciplinary Group including clinicians (surg, med, anaesth, radiol) • Background: Widespread failure to achieve New Deal & EWT targets across Glasgow • Task: Imaginatively consider and deliver new ways of working to provide a safe, efficient and high quality service.

3. Glasgow Clinical Workforce RedesignPressures • New Deal & EWT: reducing juniors hours and increasing costs. Out-of-hours duties affect day-time training time. • Modernising Medical Careers: shortening training time, reducing trainee numbers and decreasing trainee involvement in service delivery. • Population Demographics

4. Clinical Workforce Redesign • The status quo is not an option • Change is unavoidable: by design or default

5. Hospital at Night: what is it? • HAN aims to redefine how medical cover is provided in hospitals during the out-of-hours period. The project requires a move from cover defined by professional demarcation and grade, to cover defined by competency. • The HAN model consists of a multi disciplinary night team with the competencies to cover a wide range of interventions and the capacity to call in specialist expertise when necessary. • This contrasts with the traditional model of junior doctors working in relative isolation, and in specialty-based silos.

6. Glasgow Clinical Workforce RedesignImportant Principles • Medical Manpower is not cheap option: it must be used efficiently and appropriately • Must provide appropriately trained staff to carry out non-medical tasks • Avoid duplication of activity • Patients must see a doctor who possesses the relevant skills • Team working is critical

7. Hospital At Night • NHS Modernisation Agency • British Medical Association • Academy of Royal Colleges • Royal College of Nursing

8. Workload Falls After Midnight Source: NHS Modernisation Agency

9. Hospital At NightActivity after Midnight • Non-medical skills • Most medical problems require generic medical skills irrespective of specialty • Specialty skills usually require senior input • Non-urgent work spills over from daytime • Duplication of work: seen by multiple individuals

10. Hospital At NightPrinciples • Adequate cover during the evening to avoid backlog • New workers with general skills • Team approach • Fewer doctors after midnight • All necessary skills appropriately available

11. Hospital At NightSteps To Establishment • Recruit and train non-medical workers • Identify Workload • Identify essential set of skills: frequency and urgency of requirement • Identify who can provide each of the essential skills • Identify skill providers needed on-site • Streamline processes eg clerk-ins/bleep policies

12. Hospital At Night Team • Enhanced evening cover & reduced overnight numbers • On-site Team: generic medical skills, non-medical skills, senior acute assessment & management skills including airway support • Patient seen by person with the most appropriate skills • Off-site support: skills required less frequently and less urgently (>30mins)

13. Hospital At Night: Benefits • Care becomes pro-active rather than re-active • Better patient care (decreased arrest rate in some pilot sites) • Efficient cost-effective working: resources targeted at service improvement • Less nights for trainees and more time spent on daytime training and education • Addresses EWT issues without compromising quality of care and training