Let’s keep it simple and discuss our current workforce planning assets and how to maximise them. Though I’m a staunch supporter of innovation, cutting-edge technology, and out-of-the-box thinking, right now, let’s hone in on a singular focus. What is the best way to workforce plan with our current tools and resources? What does good look like?
We should all be in agreement that planning is essential to providing a well organised and productive workforce. A workforce all set to meet the demands of providing quality patient care in a timely manner.
Very early on in life many of us were taught the mantraI, ‘Poor planning leads to poor performance’. I may have left one word out but the essence is true. This is not something you can wing and hope for the best, especially in healthcare. It is also not something you can bury your head about and hope will go away.
So if we are going to plan, how do we know we are doing it right and what does it take to get there?
If you have read any of my previous articles or blogs you will already be familiar with my view that at present workforce planning is not where it needs to be, not even close. You will also know that I believe that standalone job planning systems don’t work and have no impact on workforce productivity. This is due to systems being designed and implemented to only solve one part of the workforce equation, capacity. Of course you absolutely need to understand your resource capacity, but the other side of the equation is as, if not more important. Imaging trying to punch 10 ÷ ? = into a calculator, you can’t and even if you could the answer would be meaningless. So I am not saying systems do not work or have an important role to play, just not in isolation.
Before we utilise these systems we have to understand how we approach the problem.
So what are key elements to good planning in the NHS?
Start with Demand
What is the ask? How many patients do you typically see, what is the backlog, what do the waiting list look like and what are the trends.
But surface data is not enough.
Demand is not just the number of people you see, it is the demand each of them has on your time.
Let’s take an individual patient who has been referred to a particular service, an outpatient clinic. Simply knowing the number of referrals is not enough. You need to understand:
- Are they New or Follow ups and how much patient facing time does that typically take.
- How much in clinic admin time do you need for each patient?
- How much post clinic admin time do you need?
Although this is a basic example, it shows that understanding the holistic demand on time and resources each individual may extract from the doctor, multi disciplinary team and service is vital.
Working out all of the data and nuance of patient demand sounds complicated. It isn’t, but it does require a detailed forensic approach and lots of hard work to collate and understand the pre existing data. It isn’t easy but it is achievable.
Once you have the demand data you have demand models. The missing part of the equation above. You now have the ability to use this as a benchmark to compare against your capacity. This leads me to the second step.
Get Your Capacity Data and Engagement Right
Ensuring your capacity data is accurate, codified, consistent and utilises standard language is as important as getting good compliance. The data you collect needs to be meaningful and optimised for the next important stage Gap Analysis through team job planning. Most job plans that currently exist in systems do not meet the above requirements. Simply stating that you have a clinic on a monday for four hours is not useful.
It needs to define subcategories and activities. What clinic are you running, who is it for, where is it? Without this information the data doesn’t allow you to draw a clear comparison against demand. Moreover it is imperative you utilise standardised language, so multi job plans reflect the reality of what you provide and are consistent.
Finally, you absolutely have to drive towards full engagement and compliance. It is no good trying to create a workforce plan if you have 75% of your capacity to compare against 100% of your demand. The gap will be caused by not having the data, not by an actual gap. Currently 88% of all doctors have access to job planning systems, and on average only 18% engage. Why? Well to be honest as mentioned previously, it is seen as an administrative task as the information required doesn’t go anywhere and it certainly isn’t compared to demand, so why would they engage?
Trusts need to be aiming for nothing short of 100% compliance year on year. We get there by making it a meaningful process. We need to understand what your capacity is in its fullest and most complete state. If used properly systems are more than adequate to allow you to capture this.
Team Job Planning (Gap Analysis)
Having quality data is integral, but it is what you do with it that will make the difference.
This is the stage where you take your demand models and compare them to your capacity data. If done correctly you will then be able to see clearly, where demand matches capacity and where it does not.
You may imagine that this comparison will simply tell you that you are under-resourced. Something you already knew. The difference here is, firstly, this isn’t always the case, some departments we see have capacity outstripping demand. Secondly, knowing something anecdotally, and having clear demonstrable evidence to both back this up and show the scale of the problem are totally different.
To get the ‘right fit’ model for your service, you need to understand:
- What areas of the service are we A. Over investing in and B. Under investing in?
- What is the scale of this problem? Either way.
- What options you have to resolve any issues (such as reinvest over spend in time and money, recruitment, redesign the service, rely on agency staff)
You can only strategically both understand and act if you have clear forensic level data to provide evidence for optimal decision making.
We also need to consider that if done correctly your demand data will include backlog information for each service. Are they growing exponentially, maintaining a level or reducing? Armed with this information when comparing demand with capacity you are also in a position to understand what changes you need to make to resolve this problem.
Additional benefits to this approach are that if services do this year on year they will be able to feed data back centrally. Why is this important? Well it deals with both the current service demands as well as the future demands. Anecdotally we all know finding qualified individuals to fill positions in Child Psychiatry is like finding hen’s teeth, but this will show the scale of the problem and be backed by data. In turn this evidential data can provide focused future recruitment to training places for specific specialities.
Be Consistent Year-on-Year
It is vital that you undertake this process year on year, a one off will only be as useful as the period you do it for. You need to think about trend data, interruptions to normal service and budget and resource constraints.
Each year will look different to the last, although if you have the process down it will only require tweaking rather than starting again. In an ideal world, planning would be a regular and ongoing process, tied to building rotas. That is maybe for another time. Workforce planning does not stop. Demand and capacity will change constantly, the best way to approach it is to stay on top of it.
Control what you can.
Picking the Right Hill
So, with the best intentions we thought about how we could best serve the NHS. The answer we came to was a hill I would have happily died upon at the time. It was to provide great workforce systems to make processes easier. I mean if it is easier to do things, that’s better, right? Better is good? Right? Over the next 11 years that hill turned into a small mound and over the last 12 months, I have stomped what remained of that mound into the ground, and have recognised the potential error of my ways. This trait is one I have come to cherish. Understanding and embracing that you can be wrong is more empowering than you can imagine. We should all do it more often.
So there you have it, these are the basic principles you need to effectively plan your NHS workforce using just what you already have at your disposal. A quick recap:
- Start with demand
- Get your capacity data and engagement right
- Team Job planning (Gap Analysis)
- Update and repeat
As I mentioned at the beginning of this article, this is a simple four step approach to workforce planning. There is nuance and expertise required to ensure this approach is optimised. There is more a Trust, department and services can do to make this process better, leaner and more timely. Something I will explore in a future article.
There is no point in sugar coating it, this takes attention to detail and hard work. It can feel like a mountain to climb. It isn’t easy, but it is essential.
Following the ‘what does good look like’ approach above will bring some order to chaos, and the benefits will be transformational. Ultimately, the better a service or Trust plans the greater potential for improved patient outcomes and quality of care to be delivered.
I am always interested to get others’ opinions on this, I do not profess to know it all, and am happy to consider new ideas and approaches. At the moment I just want to share what I have learned so far and hope that it helps.