01 / 03 / 2013
Several years ago the Royal Free microbiology department was experiencing high staffing costs and found it difficult to deliver timely patient diagnostic services.
There were two voluntary on call services which were not compliant with the European Working Time Directive and very difficult to manage. The department was also operating an additional rota for blood cultures, C diff & MRSA screening at weekends and during bank holidays which again required additional staffing and was very costly.
Previous staffing arrangements were complicated and some services did not have the right balance of trained staff to deliver elements of the service. Microbiology regularly had to rely on increased use of long term locum staff and were not able to fill long term vacancies due to the hospitals location.
What we did and why
Microbiology services were reduced at weekends which didn't meet the needs of patients. For example, between 100-150 patient urine and sputum samples were typically discarded after the weekend as they were too old to process, resulting in patients having to be re-tested. This increased patient diagnosis times and resulted in delays starting their treatment.
It was decided that in order to improve patient care, changes in service delivery were required and the trust focussed on key areas to transform delivery of this; changing and expanding staff roles, altering staff job descriptions and introducing more automation and molecular systems staff.
How we did it
Microbiology looked at the skill mix of the existing workforce and decided it required a change in staff structure including new associate practitioner roles. This required changing job descriptions and person specifications.
When speaking with the workforce, microbiology focussed on the positive aspects of the total reward package including flexible working, self-rostering and education and development. It took time to negotiate effectively with staff but was necessary to deliver the ultimate goals of the project.
Communicating with such a large group of staff was sometimes a challenge so an effective communication strategy was implemented. Key members of staff who expressed an interest from the outset, helped to change culture, engage colleagues and help achieve the changes needed.
Time was crucial to negotiate change and allow for staff to retrain and gain necessary experience and competency, meaning benefits would be realised in the longer term. It was important to maintain sight of the long term goal in implementing the new system.
Results and next steps
The impact on patients has been extremely positive. Samples are now processed within necessary timeframes, resulting in the non-repeat of testing. Blood cultures are processed more quickly and doctors are now contacted with results sooner enabling them to make timely treatment decisions. Improved MRSA screening services are in place with two runs of testing taking place each day which has helped to reduce delays in treatment of 24 to 36 hours and to achieve effective treatment planning and bed management.
24 hour staffing has enabled better access to the high security pathology unit preventing the need for patient transfers to other European centres, avoiding costs between £1,000 and £10,000 per patient transfer.
The service now operates using an early, main, late and night shift. Staff are competent across all microbiology services and access to the high security pathology unit is always guaranteed. Activity has increased more than 100% and has been managed within the same staffing budget, demonstrating improved productivity.
The new service is:
- Providing a flexible and well trained workforce who can deliver 24 hour services, seven days a week resulting in high quality patient services.
- Improving work-life balance for staff who can now self-roster.
- Improving productivity and work flow.
Tips for other organisations
- Have clear and measurable goals with realistic timeframes when planning change.
- Engage staff early and gain as much agreement with the project goals as possible, ensuring meetings are noted and shared with staff.
- Engage staff of all grades in the design of the system.
- Ensure negotiations with staff are reasonable and managed well with accurate minutes.
- Consider skill changes as they provide positive training and development opportunities for all staff and enable flexibilities when rostering.
- Develop key baseline measures, track them and provide feedback to all involved (audit and re audit then communicate to staff).
- Be prepared to modify original plans, taking on board staff suggestions and use these as part of the decision making process.
The Royal Free London NHS Foundation Trust leads improvements in healthcare from cancer therapies to new types of surgery. It has a regional centre for kidney and liver diseases and a major transplantation centre, treating over 700,000 patients a year from all over the world.
Simon Rattenbury, Head of Laboratory Service