Determining consumer demand measures and nursing workforce requirements for mental health services

Transcription

1 Determining consumer demand measures and nursing workforce requirements for mental health services Kate Veach Assistant Director of Nursing, Nursing and Midwifery Office Queensland Wendy Hoey Nursing Director, Central Queensland Hospital and Health Service

2 Session Aim To share how the application of a standardised business planning framework assisted nursing services to determine core mental health consumer demand considerations and measures.

3 Session Overview Determine and manage the unique healthcare requirement of mental health consumers. Develop, deliver and evaluate quality mental health care to diverse populations. Articulate what constitutes productive consumerfocused care. Incorporate evidence-based practice and emerging trends into service planning. Determine consumer activity and acuity trends to improve consumer outcomes and quality of mental health services.

4 Business Planning Framework (BPF) Queensland Health s (QH) tool for managing nursing workload/workforce requirements. Industrially mandated tool since Supports nurses to determine consumer demands, staffing numbers, skill mix and key performance indicators (KPIs). Utilises both quantitative and qualitative measurers.

5 3 Stages of the QH BPF Cycle 3. Evaluate Performance Routine monitoring of performance against the plan Balanced scorecard/reports Service Demand Resource Allocation (Supply) Balance of Service Demand and Resource Allocation Aims Objectives Environmental Analysis SWOT Analysis 1. Develop a Service Profile (Demand) 2. Resource Allocation (Supply) Match of: Service Demand Activity Acuity/Complexity Other factors To Resource Allocation (Supply)

6 Service Profiles (starting point) 1. What is the aim of the service? 2. What are the objectives of the service? 3. Description of present service. 4. Analysis of the internal environment. 5. Analysis of the external environment. 6. Completing a SWOT analysis.

7 Mental Health Services Addendum Developed in 2012 to improve the application of the BPF in mental health services. Clinical experts, nursing leaders, professional/ industrial nursing bodies and finance officers worked together to determine the core demands for mental health services.

8 Mental Health Context Articulating consumer complexity in mental health services can be complicated. Literature supports the use of standardised factors to indentify consumer complexity for workforce/service planning [1-9]. Agreeing on how to identify and weight complexity indicators in nursing mental health environments is difficult due to diverse environments, varying consumer groups and differing contexts of practice [1, 4, 7]. More empirical research is needed.

9 Mental Health Context continued Health of the Nation Outcome Scale (HoNOS) and Consumer Integrated Mental Health Application (CIMHA) are two data collection systems capable of providing specific consumer information relevant for mental health service planning. Casemix data currently lacks capacity to accurately represent the acuity of mental health consumers.

10 Mental Health Core Demand Considerations Categorises specific demands on productive (direct and indirect) nursing hours in mental health services. Categories are based on the most common and frequent demands placed on nursing hours within mental health services. Demand categories should not be considered in isolation.

11 Mental Health Core Demand Considerations Consumer and service outcomes Population demographics Context of practice Health policy, clinical guidelines, strategic plans and legislation Research and evidencedbased practice Consumer complexity Service activity Models of care/service delivery Leadership and management Quality and safety Education and service capacity developers Community interface

12 Mental Health Core Demands Diagram Context of practice Consumer/community Population/demographic/ epidemiology Consumer complexity Quality and safety Model of care/service delivery Education and service capacity development Community interface Leadership and management Service activity Primary health care Private sector Community Mental Health Services Acute Inpatient and Extended Inpatient Services Community residential Specialised Statewide Mental Health Services Research and evidenced based practice Meeting service demand and health outcomes Health Care Staff Health policy/national clinical guidelines/qh strategic plan/legislation

13 Meeting service demands and health outcomes Service objectives, strategies and goals to balance supply and demand Articulate core demands on the service which influence workforce numbers, skill mix and material resources Informs productive hours required and KPIs

14 Population and Demographics Analysing catchment population provides insights into the types and levels of mental health care required within the community. Demographics (e.g. growth rate, age, socioeconomic status) Cultural considerations (e.g. diversity of population) Morbidity/mortality (e.g. disease trends) Birth rates (e.g. present and forecasted) Transient trends (e.g. fly in/fly out populations) Community expectations (e.g. realistic and deliverable)

15 Context of Practice All essential elements of your service and determines the framework of nursing practice. Services offered Catchment area Location of direct care delivery (e.g. home, community centre, telehealth facilities, hospital) Resources available internally and externally

16 Health Policy, Clinical Guidelines, Strategic Plans and Legislation This demand can directly influence a number of services areas such as staffing, quality standards, clinical protocols and education/training requirements.

17 Research and Evidence-based Practice Essential for improving the standards of care and providing better health outcomes for consumers. Influences the number of indirect nursing hours required for service delivery

18 Consumer Complexity A combined approach using both quantitative information to monitor changes in service trends and complexity and qualitative information based on professional experience Caseload Identifiers Contact frequency Expected time allocation Intervention type/s Skill mix level required Caseload maturity Location of consumers/customers Mental Health Act status Response difficulty Staff competence/seniority required General Identifiers Diagnosis Stage of illness Co-morbidities No. of consumer/population risk factors Socioeconomic status Support networks Level of intervention Type of care package Weighted Activity Units (WAUs) Carer Engagement

19 Service Activity Most methods involve counting the number of session delivered and/or the number of consumers accessing or admitted to the service. Informs: Nursing Hours per Patient Day (NHPPD) Nursing Hours per Occasion of Services Nursing Hours per Activity Unit Occasions of Service Occupied Bed Days Weighted Activity Units No. Separations No. Consumers (group session) No. Referrals No. Home Visits Activity targets Waiting lists Scheduling

20 Model of Care/Service Delivery Directly influences nursing hours required. Changes to models of care or service delivery requires an impact assessment on nursing hours Example: Healthcare setting Internal health providers (e.g. multidisciplinary teams) External providers (e.g. Disability Services)

21 Leadership and Management Leadership and management roles are closely linked with local service delivery models and organisational strategic direction. Skill required of leaders/managers Service accountability and responsibility HR management (e.g. recruitment, succession planning) Organisational involvement (e.g. committees, networking) Organisational culture Staffing profile (e.g. training/skills) Interactions with multidisciplinary team

22 Quality and Safety Primarily governed by organisational policy and legislation and directly influences productive nursing hours. Examples: Consumer safety Staff safety Requisite training requirements Policy development and review Staff portfolios Incident and near miss reporting/management Mental Health Act

23 Education and Service Capacity Developers Organisational policy, health registration boards and legislation provide guidelines on the level of influence these demands have on a service Example: Undergraduate, graduate, post-graduate training requirements and credentialing.

24 Community Interface Variety of integrated models of care exist across the continuum of mental health services. Models inter-relate and generate demands on productive hours in connecting services Primary health care Private sector Community mental health services Acute inpatient/extended inpatient services Community residential Specialised statewide mental health services Correction/forensic services

25 Evaluating Performance Consumer Indicators Staff Indicators Service/Organisation Access Absenteeism Activity/occupancy Complaints/compliments Education hours Budget integrity Incidents Re-deployment Cost per WAU Seclusion/restraint episode (including length) Novice - experienced staff ratio Leave usage/accumulation Waiting times Satisfaction survey NHPPD/NHPOS/HPAU Readmission rates (time framed) Turnover rates Policy compliance Average length of stay Workcover claims Quality and safety initiatives/audits Consumer follow ups (time framed) Workload grievances Skill mix profile Completed discharge summaries (time framed) Competency compliance Workforce data - vacancy

26 Further Research In collaboration with Central Queensland University (CQU) and QH the decision was made to progress this work with further analysis of clinical data to enhance the understanding of nursing workloads in mental health nursing community settings. Why? Literature identifies the need for significant developments in instruments to measure nursing workloads in community health settings.

27 Outcomes to date Accepted for publication in Australian Health Review The activities that nurses working in community mental health perform: a geographical comparison (Professional Brenda Happel, Cadeyrn Gaskin, Wendy Hoey, Drebra Nizette and Kate Veach)

28 References 1. King, R., G. Meadows, and J.L. Bas, Compiling a caseload index for mental health case management. Australian and New Zealand Journal of Psychiatry : p Twigg, D. and C. Duffield, A review of workload measures: a context for a new staffing methodology in Western Australian. International Journal of Nursing Studies, : p Meldrum, L. and P. Yellowlees, The Measurement of a case manager's workload burden. Australian and New Zealand Journal of Psychiatry, : p Pollock, J.I., et al., Health and social factors for health visitor caseload weighting: reliability, accuracy and current and potential use. Health and Social Care in the Community, (2): p South Australia Department of Health, Development of a staffing methodology equalisation tool for community mental health and community health nurses: final report, Department of Health, Editor. 2007, Government of South Australia. 6. Hershbein, B. Nurse to patient ratios: research and reality. in New England Public Policy Center and the Massachusetts Health Policy Forum Massachusetts: Federal Reserve Bank of Boston. 7. Henderson, J., et al., Measuring the workload of community health nurses: a review of the literature. Contemporary Nurse, : p Ridley, C., Relating nursing workload to quality of care in child and adolescent mental health inpatient services. International Journal of Health Care, (5): p Bhaskara, S., Setting benchmarks and determining psychiatric workloads in community mental health programs. Psychiatric Services, (5): p

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