Using The Calderdale Framework to Assure Quality

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Using The Calderdale Framework to Assure Quality

• Prepared by Rachael Smith Jayne Duffy
• Calderdale Huddersfield Foundation Trust
• July 2008

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WHY BOTHER ! ?
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National Context

• Leitch Report - The skills agenda
• Our NHS,Our Future Darzi review
• Skills for Health
• Health Social care Bill 2007

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Reasons for delegation and skill sharing

• Improves patient experience right person at
  the right time with the right skills
• Increasing demand on services
• Maintain service quality whilst controlling costs

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Delegation carries potential risk!

• Assistant responsible for the task
• Delegator remains accountable

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Risks in delegation (professional)

• Variation in what is delegated
• Variation in how task is to be delivered
• Variation in documentation

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Risks in Delegation (assistants)

• Lack of skill/training to fulfil task (unknown
  competence)
• Unable to read/follow written plan
• Unsure when to seek help/abort task
• Boundary not clear

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Advantages of Competency Approach

• Organisations
• Consistency safety
• Efficient effective
• Improved productivity
• Competitive edge
• Employer of choice
• Mobile flexible staff
• Improved patient satisfaction
• Reduction in risk
• Better assessment on quality

• Teams Individuals
• Core team objectives
• Clear roles
• Clear responsibilities
• Better understanding
• Cross boundary working
• Enjoyment
• Personal team development needs
• Portable passport
• (Chris Mullens NWP Conference 2007)

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In The Beginning..!!
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The Functional Model of Delegation (
Saunders 1996, 1997 )
Systematically addresses factors in delegation
Manages risks inherent in delegation
Known standard of care Ensures quality of care
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The Functional Framework for Competency

• Developed by Rachael Smith Jayne Duffy (2007)
• Based on Functional Model of Delegation (Saunders
  1996).
• Provides framework to manage delegation blurred
  boundary working.

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Evolution .. !!
1996 FMD to manage delegation in early discharge
team
2000 FMD in Multi-Disciplinary Community Teams
blurring boundaries
2006 FFC across therapies. Core and service
specific competences
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Voilà The Calderdale Framework
emerges !!
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The Calderdale Framework

• CF is the result of evaluation further
  development of Saunders original Functional Model
  of Delegation.
• (R Smith J Duffy 2007)

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The Calderdale Framework 7 Stages to Successful
Implementation
Raise awareness and engage key staff
Identify Service Functions And Tasks
Decision table Saunders
(1996) Smith Duffy
(2007)
Assess suitability of tasks for delegation
www.skillsforhealth.org.uk
Map tasks to Skills for Health/- write
local competences
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Implementing The Calderdale Framework
Set up supporting systems

• Professional
• Assistants

Training
Sustaining
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So, How do You do it?
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Service Analysis

• What does the service do
• When and Where is the service delivered
• What tasks are carried out
• How do you deliver these tasks

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Orthopaedic Early Discharge 7 day (9am-9pm)
service for elective cases. staffed by Physio,OT
Assistants.

• Tasks to
  Run Service
• Subtasks

Triage,assess,plan,treat,delegate, Evaluate,liase,
document,discharge
Treatment
Equipment
Mobilise
Exercise
stretches
e.g. Quads SQ, SLR, TRQ..
Function
Strength
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TASK ANALYSIS
KNOWLEDGE BASED
SKILL BASED
RULE BASED
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Skill Mix Review
Qualified staff Blurring professional boundaries
Tasks mainly Knowledge Skill based
Delegate to support staff.
Tasks mainly Skill Rule based
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Competences from tasks

• Tasks analysed for suitability to delegate using
  decision tables.
• Consensus gained from peers.
• Map to SfH competences.
• Accepted tasks not on SfH written as local
  competences.
• Comprehensive training package for qualified
  support staff developed.

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Risks Managed Through

• Competences
• Reduce variation in WHAT tasks are
• delegated HOW they are delivered.
• Documentation
• Standardised
• Communication
• Clarity re when to seek help/stop.
• Feedback supervision.

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So What.??
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Benefits of Calderdale Framework

• Delegation risks managed Competent staff
• Fast track to NVQ 3 with staff fit for
  purpose
• Effective skill sharing cross professions
• Quality assurance for patients
• Improved documentation
• Skill mix reviewed

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Benefits of CF across CT R Directorate

• Skill Mix Pre 15.7
  Post 14.8
  (Shift to non
  qualified staff)
• Activity Pre 372803
  Post 421284
  (Increased
  activity)
• Hours lost to sickness Pre 10552
  Post 4900
  
  (Sickness halved)
• Risk Score Pre risk score
  9
  Post risk score 2
• Patient Satisfaction Complaints down from 79
  - 34

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In summary

• The Calderdale Framework provides a framework to
  manage delegation.
• The Calderdale Framework leads to the
  identification of competences which link to NVQ
• The Calderdale Framework is transferable to any
  setting (as it is based on patient service
  needs).
• The Calderdale Framework is transferable to
  blurred boundary working can lead to protocol
  development