Trust introduces a system to enhance capacity and demand management of district nurses, improving allocation of patients and reducing missed visits

* Please describe the challenges or problems your solution set out to solve.

 There is a growing demand on our District Nursing Services and a diminishing number of qualified district nurses(1).

This has resulted in the following challenges:

• daily demand exceeding capacity

• patients’ appointments moved multiple times

• team leaders spending more time allocating visits than performing clinical duties

• staff not always having the appropriate skill-set for their patient’s needs

• long distances between allocated visits.

 In order to maintain safe, high quality care in the face of these challenges, it was felt imperative to focus on maximising efficiency through technology.

1. Understanding quality in district nursing services: Learning from patients, carers and staff, The King’s Fund, 2016

* Please describe the actions you took to achieve your result.

 The aims of the service development:

Improve capacity and demand management in district nursing, with all patients seen on time and a significant reduction in unallocated visits.

Identify and manage capacity peaks in advance by moving patients with appropriate needs to days with less demand and ensuring clinicians are used to their full competency

Allocate visits in advance to reduce delay in clinicians arriving at their first patients Reduce duplication of work and unnecessary administration.

Reduce the time team leaders take to allocate visits by locating all required information in one place (available staffing, competence and training, daily demand and acuity)

Continue progress towards paperless working

Release time to care Improve senior staff’s visibility and supervision, improving productivity

Free team managers’ time to care for more complex patients

Improve cost efficiency

Reduce staffing costs by 6.45 WTE / 310k through more efficient working derived from an improved IT solution

Reduce incidents

Through improved competency and skill matching

*Evidence of achievement of aims can be seen on attachment 1.

 Identifying the correct solution: Intelligence was triangulated from quality and performance indicators, staff feedback, complaints, incidents and patient feedback via staff. This allowed us to ascertain the challenges faced by the team and to identify a solution that met these issues.

Several clinicians within the team attended multiple conferences to find out what other community providers were using locally and evaluate their successes with various software.

The QES product; eCommunity was chosen through this process. The system had been developed for another DN provider in the Midlands, but in order to meet the needs identified by our district nurses, the clinical team felt that the product would ne ed to be customised.

In addition to all of the clinical benefits addressed above, the business case also identified clear cost savings through efficiencies gained as a result of having a robust clinical solution. The first year running costs including our system changes were £69,400 with a recurrent running cost of £40,000 per annum. Releasing time to care through improved allocation of patients based on skill mix and locality, reduced time spent on unnecessary duplication of work and administration, and optimum route planning has led to an annual productivity saving of £310k the equivalent of 6.45WTE.

The business case was signed off in summer 2016 and the system live by 1st June 2017.

 * Please list the most significant results

 The new technology system made an obvious impact within one month of the software being operational and the project did surpass expectations. Service quality indicators revealed a massive reduction in unallocated visits. In May 2017 there were approximately 2000 DN unallocated units (15 minutes each) rapidly falling to approximately 200 by the end of June 2017.

There has also been a reduction in missed visits and a significant improvement of skill mix allocation. These combined factors have led to an improved service for our patients. It has also been of value to the DN service which has seen a decrease in WTE and budget expenditure from 2016/17 to 2017/18

 * Describe how your project has spread to other teams, departments or organisations

 We are currently demonstrating the system to three community providers who are looking to implement this system. To meet all our identified challenges an initial SMART allocations system was designed to manage the capacity and demand in district nursing.

However, as the role of district nursing continues to evolve with more and more patients are being treated outside of a traditional hospital setting, we are keen to further innovate and develop our workforce deployment. Our original software was purchased by Allocate and we are continuing to work with them to further enhance and modify the system and our service to continue providing continuity of care and the correct skill of staff visiting