The School Nursing Service Planner - Benson Wintere
The Benson Model Safe Staffing for District Nursing Introductory Resource Pack Q4 2017 Benson Community Planning Models Benson Model: Health Visiting Childrens Centres Benson Model: School Nursing Benson Model: Social Care Benson Model: District Nursing Benson Model: Mental Health Benson Model: TIMELINE 2010 Launch of BM Health Visiting 2012 Launch of BM for School Nursing 2013 Launch of ASC model 2014 National DN Consultation w/ QNI 2015 DN Report to QNI Initial DN Model specification Benchmarking reporting commences 2016 Launch of BM Social Care & MH models 2016 Q1 DN Pilot selection 2016 Q2 DN Pilot begins 2017 Q3 Launch of Benson DN model Benson UK Network
Cumbria We have implemented Benson model/s with 40+ sites in England (+ 1 in Scotland) and continue to work with several of these providers Lancs Blackburn w/Darwen Bury Salford Stockport Liverpool & Sefton A, L & Wigan 4 DN Pilot Sites: Warrington Halt. St Helens Somerset Plymouth Liverpool Luton Derbyshire Leic & Rutland Derby City Lincolnshire* Northants Coventry Birmingham
Cambs Beds Norfolk Luton Herts Essex More than half of our clients use more than one service model North Somerset Ealing Medway Somerset Bristol Kent Oxfdshire Surrey Cornwall & IoS Plymouth Dorset Torbay W Sussex E Sussex Key Benefits Allocate Staff & resources objectively using a live, evidence Based
methodolog y Match skills with caseload complexity by profiling local demographic s Forecast and Cost future service incorporatin g future development s and ageing Identify Risk, Efficiencies and potential to improve outcomes Link with other systems including PAS, EScheduling & ERostering Bid team Organisational function Org anis atio nal app roa
ch Health Intel Costing Information flows Patie nt Syste m 3rd party software Strategic devpmt Planning Operations E-Sched. & ERostering Benson Service analytics Staff & caseloads Fin. syste m Commissioning HR Syste m Benchmarking
Forecasting HR Commissioners Financial DN: What are the challenges? Informal / subjective allocation & decision making Rigid standardisation not accounting for complexity Decentralised planning / mixed practice models Failure to adequately address & allow for complexity Not leveraging / learning off data / intelligence / systems Incentivising quantity over quality Failure to deliver or focus on outcomes Commissioners want greater accountability and transparency Tighter budgets / incentive to reduce inefficiencies DN caseloads / funding not necessarily proportionate with populate size, geographic or demographic challenges DN: What are the challenges? So what? We are unable to convey the situation & challenges within an objective, robust and transparent approach Lack of objective, informed or up to date data leading to unfair staff allocation, creating gaps & risk of unsafe practice Unhappy workforce Too much pressure / Good work unnoticed / Gaming Lack of outcomes focus may lead to: slow discharge / high re-referral / unhappy patients / avoidable visits / inefficient planning Inefficient or inconsistent practice - all hands on deck Not leveraging off performance data = missed opportunities Benson Outcomes
What have our clients used Benson models for? Outcome Details Contract support Supported commissioning / bid development Basis for co-working with commissioners Provided a common approach promoting focused interactions and enriched communications between providers & commissioners Rebalanced workforce/workloads Based on objective approach focused on complexity Scenario testing / simulation Modelled future workforce and funding strategies, evaluation of financial and service impact Service reconfiguration / integration Assessing workforce & resource requirements of changing team or functional structure e.g. Night, Rapid Response, change to geographic caseloads Better reporting Clients generate live reporting packs based on latest caseloads, including benchmarking, demand forecasting, budgeting & costing, and variance reporting actual vs budget Establish fair, objective caseloads Customised approach assessing complexity to reflect challenges using local data and national statistics to develop local profiles Risk and opportunity evaluation
Identified areas of risk / shortfall (teams, workforce roles) Identified areas of non-conformity or variance Service improvement Encouraged discussion based on possible risks & opportunities Used to inform changes and reconfiguration in client organisations Integration / Link with other planning areas E-Scheduling, staff rostering, long term forecasting, HR The Benson Methodology Benson is a quantitative, demand led, live planning approach implemented with both commissioners and providers. But what does it do? Embraces innovation, reconfiguration, service improvement and integration Informs safe caseloads & workforce by applying dynamic, objective approach Encourages robust & dynamic planning leveraging off health intelligence Live system and workspaces inform planning & decision making in real time Applies a harmonised service approach reflecting safe/good practice Identifies & allows for complexity through analysis of patients & demographics Benchmarking to allow comparability & external validation Evidence base linked to national & local intelligence A shared system to improve and focus communication Focuses on improvement: Identification of areas of development / inefficiency Establishes consistent generic classifications to ensure comparability & objectivity The DN Pilot Programme Why? The Pilot What happened?
We carried out national consultation in 2014/5 with the Queens Nursing Institute This showed a lack of modelling catering specifically to community healthcare Demand from DN services to use better planning tools to assist planning, costing and case building The programme commenced in Q2 2016 resulting in selection of four sites representing range of issues geographics, deprivation, density, cultural etc The intensive programme allowed the model specification to be built and tested resulting in several iterations to ensure a model fit for purpose A significant amount of time was spent working with the wide range of provider datasets More than 60 iterations of the model building in improvements in line with feedback and to ensure sufficient flexibility 3 of the 4 pilot sites have now received full working version of the model and are now rolling out the models 1 site has taken the model live, and is using to allocate staff & report to commissioners Based on feedback we have decided to proceed with the
model and are in initial steps new providers regarding implementation 4 DN Pilot Sites: Somerset Plymouth Liverpool Luton Service Modules Beginning in the blue zone, Benson provides an opportunity to improve information, decision making and link with related organisational functions & initiatives Clinical data integration & developmen t Insight & Planning Budgeting & Reporting Forecasting Clinical data improvement Benson demand and workforce modelling Service Costing Multi-year forecasting & budgets
Demographic profiling Service Benchmarking Integration, mapping & analysis Service reconfiguration Performance: Actual v Budgeted Scenario development & sensitivity analysis Financial reporting & budgeting Workforce supply modelling Patient profiling & assumptions Identify Opportunities & efficiencies E-Scheduling, E-Rostering Finance Tender managemen t Commissioning
support Bid support Bid team Implementation Client resource Steering group Health intelligence Working group Steering group Management Model configuration Establish scope & objectives Data request/templates Data development Data analysis Validation Triangulation Mapping Strategic development Develop settings Benchmarking Validation
Workshops Reporting & Sharing Costing Roll-out Reporting pack Development & Collaboration Support from Benson Refresh & updates Refine & improve 2 weeks 2-4 weeks 4 weeks 2 weeks Typically 1012 weeks rollout time Complexity Complexity = key issue evolving from the QNI consultation in 2014 Multi-faceted not just about age or deprivation MUST be addressed & used to sensitise caseloads Benson objectively assesses complexity and
allocates complexity premium additional time to ensure practitioners with more complex caseloads can deliver outcomes This is achieved using a weighting mechanism resulting in patients being split into three levels of complexity Assessed quantitavely by reviewing data on the underlying patients & demographics, validated by the local working group Support environFrailty & ment & dementia informal care Complexity Patient environment (e.g. care home) Rurality, isolation, cultural, language Complexity premium Clinical Admin Travel Standard delivery allocation Planning in Community Healthcare Our approach Work undertaken PAS Baseline report last 12 months BENSON 1st year
Budget / Plan Demographic statistics Longer Term Forecast Data validation: - Check completeness & consistency - Mapping / alignment - Adjustments Modelling: - Extrapolate baseline - Reflect anticipated changes in service delivery - Alignment with strategic objectives - Balancing with funding & staffing constraints - Scenario planning - Comparing with actuals Key considerations Existing caseloads Existing staffing Service delivery Area & Patient profiling Benchmarking key metrics 1st year: Apply delivery targets Apply safe caseloads Optimise staff allocation Harmonise service delivery Targeted service improvement Forecasting: Impact of ageing population Changes in commissioning Targeted service improvement Workforce development & gaps Costing & budgeting
Benson Model (DN) Overview Demographics database Local demographics Staff Profiling Patient Profiling Patient complexity Complexity premium Referrals Care Pathways Reporting Benchmarking Patient Outcomes Venue & visit rates Staff duties & capacity Team Caseloads Clinical Interventions Staff requirements
Legend Existing capacity & risk Optimum (Benson) workforce Input Model process Output Local commissioning Local config. Activity time allowances and benchmarking Forecast & costing Complexity premium Activity grade Complex caseloads require more time to manage Complexity is multi-faceted and measuring it required facts about our patients and their environment Patients are graded into 3 levels of complexity depending on various critiera (see complexity) Activities time allowance are represented by a range, for instance wound care 20-50 minutes Research shows more complex patients are more acute, volatile and less compliant They therefore receive Patient complexity
a higher intensity of care taking longer Level 1 Level 2 Level 3 The scales use in Simple Benson reflect this Other inflators include Moderate language, cultural, Difficult rurality and travel Project workspace Intralinks is our online file sharing provider Secure & NHS friendly Each provider has their own folder Allows users to upload and download the model, reports & related documents Each user access by login/password Enables remote support, changes and updates to be made by Benson Wintere Updating the model The provider and/or commissioner develop a process to collaborate and oversee development The Working group & Benson Wintere as administrator access the live model on the project workspace Provider and commissioner may agree process to
release reporting pack e.g. quarterly The models are replenished with updated demographic data and benchmarking by Benson Wintere This process ensures the model is always live and secure Reports are shared with key stakeholders as a PDF pack Benson Wintere support development and reviews of the models either in person or remotely by webinar (shared screen teleconferences) The client will identify target areas in the model over time for development New developments: DN Benchmarking key metrics to help external validation Delivery time for each clinical intervention / other services Clinical admin & travel time Patient mix Staff clinical responsibilities Staff clinical capacity Caseloads Referral rates Patient longevity (days active) Patient intensity (rate of care interventions) Enhanced forecasting & costing reporting Development of commissioner support module Testing our new web platform later in 2017 Supplementary Material Modelling Clinical Demand External factors
Scope, GPs, Acute Referrals Local demogs Scope Caseloads & pathways Services & Activities Historic patterns Future modelling, changes Internal factors Complexity premium Time Allocation Best practice Benchmarks Clinical resps Staff required Consultation: Common Issues Key issues confronted raised by DN services in workshops during QNI Consultation:
What is going to happen in 5 years time? Will demand be higher? How will our service respond? Are we recording clinical activity completely and consistently? Is there any point? Are we accepting referrals that are outside the scope of our contract? What number and mix of staff do we actually need to meet the needs of our patients? What is driving our workload? Why do we keep getting busier? How do we allow for areas with greater caseload complexity? How do our referral/discharg
e rates and caseloads look like against other areas? Why are they different? Are we able to effectively use our own data to make objective, evidence based decisions? Our Community Care strategy Initiative Details Community focused Community care requires a different approach to acute & specialist services e.g. different constraints, more demand focus, unable to use waiting lists to regulate demand Safety An objective basis to determine safe caseloads and workforce structures, reflecting good practice and harmonised delivery Evidence based Incorporate national demographic data, statistics & research, local activity data; refreshed regularly Objective & comparable Develop generic classifications for service user groups, staff and interventions to ensure comparability and allow benchmarking Support integration - across modules (e.g. joining services together; e.g. scheduling is linked to
workforce planning) Grow network organically A larger network offers benefits to users as it enhances benchmarking and increases credibility; all implementations instigated by NHS / Commissioners Ease of use Avoid complexity; ensure focus on key metrics to encourage sharing between providers and commissioners; use online shared workspaces; work towards transitioning to central web-based application Modular approach (see next page) Allow clients to pick and choose scope & support; including comprehensive planning tools & support across community healthcare and social care Ongoing assistance Continuous support both onsite and remote allowing clients to understand, operate and collaborate to maximise benefits
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