Glasgow Clinical Workforce Redesign

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Glasgow Clinical Workforce Redesign

• Hospital At Night

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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.

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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

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Clinical Workforce Redesign

• The status quo is not an option
• Change is unavoidable by design or default

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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.

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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

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Hospital At Night

• NHS Modernisation Agency
• British Medical Association
• Academy of Royal Colleges
• Royal College of Nursing

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Workload Falls After Midnight
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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

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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

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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

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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 (gt30mins)

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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