Hawke’s Bay District Health Board (HBDHB) is committed to the CCDM programme, it's strong data collection methodology and partnership approach. Chief Midwifery and Nursing Officer Chris McKenna says the programmes strong emphasis on data collection and full-time employment (FTE) calculations has meant there is now an accurate picture of staff numbers required to deliver safe patient care.
"HBDHB piloted the CCDM software for FTE Calculations in 2016. Since then the DHB has completed two more cycles of annual FTE calculations across a total of 13 wards. These FTE calculations have been completed in partnership with New Zealand Nurses Organisation (NZNO) and there have been positive impacts for the staff at the front line”. Mrs McKenna says the DHB’s experience with FTE calculations revealed many implementation insights, primarily the importance of working in partnership in a complex process.
Today there are several services within HBDHB enjoying the benefits of the FTE calculation process. Table 1 below shows the number of new nursing and support staff employed.
Table 1: New nursing and support staff employed
* Staff increases associated with DHB/NZNO Nursing and Midwifery MECA requirements, additional funding from the Ministry of Health and DHB initiatives to improve safe staffing.
This article focus's on outcomes in the Paediatric Ward
Nurse Director of paediatrics Jill Lowrey said the FTE calculation process for the Paediatric Service was completed in May 2018. This recommended an increase of 4.35 FTE in the Special Care Baby Unit and 4.5 FTE in the Paediatric Ward. The increase was approved and positions were fully recruited to in February 2019. Mrs Lowrey said nurse leaders noted that the increases in FTE meant they could cope with rising demands of patient care safely, while safeguarding staff wellbeing. While the roster has only recently been in place, the service is already seeing the benefits of:
Quality Patient Care:
- Increased ability to spend more time on quality initiatives.
- Increased ability to release staff to attend meetings such as the Health and Safety Committee.
Quality Work Environment:
- Ability to safely support two new graduate Registered Nurses, which was previously not possible
- Ability to ensure rosters throughout the year met changes in patient demand.
- Supported meal relief between SCBU and Paediatrics resulting in minimal unrelieved paid meal breaks.
- Increased ability to move staff between SCBU and Paediatrics during busy periods.
- Increased ability to give ad hoc annual leave.
- Decrease in safe staffing incident reports; at the time of writing this report, zero in the past 8 months.
- Clinical Nurse Managers are now able to dedicate time to leadership responsibilities and provide strategic/operational over site of the service.
Best Use of Health Resources:
- Reduction in overtime use, casual use and paid meal breaks.
- Increased ability to gift staff to adult inpatient areas when these services are under stress.
- Increased ability to absorb long-term sick and ACC leave.
Mrs McKenna said when the FTE calculation process began the CCDM Council and working group participated in a series of workshops and data integrity checks facilitated by Colette Breton (Safe Staffing Healthy Workforce Unit Informatics Consultant). This meant the DHB and NZNO could move forward with the FTE calculations in a fully informed, well engaged partnership.
Although the FTE calculation process was ultimately successful, the organisation, overcame a range of challenges:
- FTE Calculation Experience and Complexity: The working group identified the members had a wide variation in knowledge about budgeting processes and accounting language. This added to the complexity of the FTE calculations. To navigate this HBDHB’s working group accessed support from the SSHW Unit to guide them through the process.
- Data Integrity: TrendCare data must meet SSHW Unit data integrity standards to proceed with FTE calculation. Achieving these standards requires all members of the clinical and leadership teams to work together to support high quality data entry. Some areas were not able to achieve data integrity standards and were therefore, not eligible to participate in this cycle of FTE calculations.
- Business Cases and Release Time: The process at HBDHB means Nurse Directors prepare a business case containing recommendations from the FTE calculations to be signed off by the DHB’s leadership group. This process required a significant time commitment to complete a full business case.
- Time Lapse: The FTE process took a long time, with the 2018 cycle taking 10 months from commencement to all the recommendations to sign off.
- Communication: Clear communication to staff during the FTE Calculation detailing the methodology, process and outcomes is a key requirement of the CCDM FTE Calculation. Care was taken to ensure that the information shared was easily understood by a broad target audience.
- Fiscal Challenges: Approving the FTE Calculation recommendations proved challenging considering the budgetary constraints that all DHBs are faced with. The DHB mitigated this by examining current overspend and recognising the FTE Calculation recommendations very closely approximated the current overspend for staffing.
- Recruitment: Recruiting staff to fill the newly approved positions was challenging. This is a challenge many DHBs will face. HBDHB mitigated this by employing new graduates and using novel recruitment methods including a new online recruitment video.
HBDHB credits its success in these early FTE calculations to a range of factors:
- Partnership: A strong and active partnership with NZNO underpinned by a culture of mutual trust, respect and focus on the common goal of safe staffing. This promoted an environment of knowledge sharing and good communication with NZNO members. Active, well informed and professional NZNO delegates engaged early in the process, positively influenced TrendCare data integrity and communication with staff.
- Nurse Leader Engagement: Nurse Directors were empowered to dedicate time to this and other CCDM activities which meant they could complete business cases and pre-empt recruitment needs.
- Finance Team Engagement: Early engagement with the Chief Financial Officer and business accountants enabled them to trust and understand the process every step of the way.
- Executive Leadership Commitment: A commitment to the process, CCDM and achieving safe staffing from the Chief Executive and Chief Nursing and Midwifery Officer helped get the recommendations approved.
- Business Rule Development: Local business rules to guide the FTE calculation process were developed after the first round of FTE calculations. This enabled the DHB to develop consistent decision-making principles. Over consecutive years and different areas those rules were adapted to ensure the best match of staffing to patient demand in the HBDHB context.
FTE calculations are an ongoing annual requirement of the CCDM programme. HBDHB is well positioned to continue this journey. The DHB has TrendCare improvement plans in place to support areas with data integrity issues with the goal of completing all FTE calculations by 2020.
In the future it is important the process continues in a partnership approach between NZNO, nursing leadership and the finance team. HBDHB plans to improve the process both in terms of speed and ease of completion. It also wants to enhance communication with staff, ensuring all stakeholders continue to be well informed active participants.
Photo: Paediatrics Team, Hawkes Bay DHB