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Your quarterly update from the Safe Staffing Healthy Workplaces team at TAS
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Nau mai, haere mai to your CCDM e-news: Focus on CCDM FTE calculations

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In this issue

What is the CCDM Full Time Equivalent (FTE) calculation and why is it critical for safe staffing?

Whilst some District Health Boards (DHBs) have been implementing CCDM for many years, it will not be until FTE calculations have been undertaken for all eligible hospital wards that nurses, midwives and health care assistants will see and feel a tangible difference. This is where the rubber hits the road.
 
The CCDM FTE calculation is a systematic, validated method for generating a recommended roster and budgeted FTE. Patient acuity data from the past 12-months is combined with staffing information to generate a recommended roster. An FTE is then calculated. The calculation includes the Multi Employer Collective Agreement entitlements and allowances. The FTE should be re-calculated annually prior to setting the budget.
 
Having the right roster model by shift and by day-of-week is the best way to provide quality patient care. The right roster model means less staffing changes and the right budgeted FTE. The right budgeted FTE means employing the right number of staff. And this means better outcomes for both patients and the staff that care for them.


                       

The CCDM FTE calculation supports:

  • Attainment of Health and Disability Service Standards (2.8.1 There is a clearly documented and implemented process which determines service provider levels and skill mixes in order to provide safe service delivery).
  • Attainment of the Health & Safety Act, NZ Triple Aim & NZ Health Strategy.
  • Right staffing backed by research.

CCDM FTE calculations pay off for Hawke’s Bay District Health Board


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.

Impacts
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.
Challenges
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.
Enablers
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.
The Future
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 

SSHW Unit Director's Update 


Photo: Bridget Smith, SSHW Unit Director


New national reporting framework launched
The national reporting framework is a tool for enabling District Health Boards to report on CCDM implementation progress against a set of milestones. The national reporting framework has been built into the CCDM software because it is easy to use and people are familiar with the software already.
 
Reporting using the CCDM software will provide a clear view of progress with CCDM implementation at multiple levels – national, DHB, hospital site, service, team and ward. The first quarterly report is due 20 October 2019. The CCDM council should agree on the results before they are submitted for national reporting.

Learning Collaboratives under development

The SSHW Unit has contracted Diana MacDonald from Dynamic Leadership Limited to work with the Unit to develop and implement a series of CCDM Learning Collaborative workshop. The Learning Collaboratives will provide intensive knowledge transfer and support change, bringing together DHB’s and union partners. Together they will problem solve, share solutions, collaborate and plan for ongoing implementation of the CCDM programme. This initiative will also contribute to reducing some of the duplication of effort that is inevitable in executing a programme of this size across 20 DHBs.

The one-day workshops will bring together expertise from DHB’s and the SSHW Unit Programme Consultants into one place, so learning and proficiency can be accelerated. The learning collaboration also provides a place to network and further develop professional relationships in relation to the CCDM programme.

The workshops are currently being co-designed with several DHB’s as end users. The workshops will be co-produced as we mobilise sector expertise to present and support each other across the sector. The first Learning Collaborative is being planned for February 2020. This is an exciting development for the CCDM programme and there is a lot of enthusiasm in the sector to participate.
 

New SSHW Unit appointment

We welcome a new Programme Consultant to the SSHW team – Rosalie Wright. Rosalie comes from Southern DHB where she was the TrendCare coordinator. Rosalie is a registered nurse with extensive DHB experience and several years in TrendCare and CCDM. Rosalie will  provide valuable expertise, particularly with regards to the acuity tool and will be an asset to our growing and busy professional team.

For more information about any of the above, contact the SSHW Unit Director or Programme Consultant.

Allied health CCDM update




The CCDM programme is about achieving an appropriate match of care capacity (available staffing hours) to clinical demand, and then managing any variance that occurs each day. Determining the capacity required to meet service demand is a core feature of an allied health staffing model and is fundamental to the attainment of clinical outcomes and staff wellbeing.

The ability to identify and fluidly respond to changes in capacity and demand, is the basis for Variance Response Management (VRM).

There are now four allied health resources that have been recently added to the CCDM website on the Variance Response Management page. These resources have been developed specifically for allied health. They support allied health services to develop processes and systems that achieve consistency, transparency and visibility.

The resources are:
  1. Allied health variance response management overview (7.9.5)
  2. Allied health capacity and demand (7.9.6)
  3. Allied health variance indicator scoring guideline (7.16.5)
  4. Allied health standard operating procedure (7.17.5)
The resources are available on the CCDM website www.ccdm.health.nz.  For advice or support on the resources don’t hesitate to contact your allied health programme consultant.  

CCDM website: Your one-stop-shop for resources

The CCDM website is your one-stop-shop for all CCDM programme resources. Follow this link: www.ccdm.health.nz

If you have any questions feel free to get in touch. Email us at: ccdminfo@tas.health.nz

Would you like to feature something in the next edition of CCDM Connect, or do you have some feedback?  
Please contact: ccdminfo@tas.health.nz
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Phone 04 801 2430  Address: TAS, 69 Tory Street, Te Aro Wellington 6011
Email: ccdminfo@tas.health.nz  Web address: https://tas.health.nz

Care Capacity Demand Management is managed by the Safe Staffing, Healthy Workplaces Unit at TAS.

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