The Calderdale Framework

A Facilitation Tool for a Flexible and Competent Workforce

Developed by:Rachael Smith & Jayne Duffy

The right person,

doing the right thing

at the right time,

RIGHT!

The Calderdale Framework:

“a transformational tool for a competent & flexible workforce”

• CF is the result of evaluation & further development of Saunders original Functional Model of Delegation.

• Developing a competent & flexible workforce using the Calderdale Framework

R Smith & J Duffy, IJTR 2010; 17(5):254-262

• www.calderdaleframework.com

• (Please refer to reading/reference list for further articles)

Why Bother ….! ? The National Challenges

Demographic challenges –workforce and patients

Fiscal challenges

Safety and quality challenges –Francis, Keogh, Berwick, Cavendish

Modernising medical careers = early specialisation- GAPS in less ‘sexy’ areas

Five Year Forward Plan -INTEGRATION

Why Bother….! ? Local Challenges:

Longstanding medical and non medical staffing recruitment difficulties

Reduction in numbers of junior doctors Changing demands of the service Ability to offer career development

opportunities Regular rotation of junior doctors impacts

on continuity of care

What does this mean to us?

INCREASING DEMANDS ON OUR SERVICES

PATIENT DRIVEN SERVICE PROVISION

MAINTAIN QUALITY & PRODUCTIVITY WHILST CONTROLLING OR REDUCING COST

ENSURE REGISTERED PRACTITIONERS ARE FREE TO UNDERTAKE TASKS ONLY THEY MUST DO

IMPROVE SKILLS BASE OF THE WORKFORCE TO PROVIDE FLEXIBILITY & CONTINUITY

HEYH response: Development of both Assistant

Practitioners and Advanced Practitioners is a regional priority.

Regional steering group being formed to ensure consistency and rigour.

Investment in Calderdale Framework methodology to support this.

So how can we do this?

Service Improvement Initiatives

Workforce development and new ways of working using The Calderdale Framework.

Calderdale Framework: 7 stages Focus on

EngagementFocus on Potential

to Change

Focus on Risk

Focus on Best

PracticeFocus on Governance

Focus on Staff

Development

Focus on Embedding

2Service Analysi

s What is the service?

When & where delivered?

Staffing

What functions and tasks are carried out?

Who does what now?

How well are patients needs met ?

What could be different?

Captures ‘as is’ in detailCaptures ideas to improve

KNOWLEDGE BASED

SKILL BASED

RULE BASED

3Task

Analysis

RISK ANALYSIS

FREQUENCY

TRAINING IMPLICATIONS

Tasks mainly knowledge &rule based

Tasks mainly skill & rule based

Tasks rule & knowledge based with protocols

available

Delegate to support worker

Allocate to Assistant Practitioner

Tasks mainly knowledge &rule based & highly specialist

Registered Practitioners considerSkill Sharing/Advanced Practice

Remain with current profession

Stages 2 & 3 - ‘New Ways of Working’

Assistant Practitioner Definition:

‘An assistant practitioner is a worker who competently delivers health & social care to & for people. They have a required level of knowledge & skill beyond that of a traditional healthcare assistant or support worker. The Assistant Practitioner would be able to deliver elements of care and undertake clinical work in domains that have previously only been within the remit of registered professionals. They may transcend professional boundaries. They are accountable to themselves, their employer and more importantly the people they serve’.Skills for Health 2009

Advanced Practitioner definition :

‘An Advanced Clinical Practitioner is a professional who has acquired the expert knowledge base, complex decision making skills and clinical competencies for expanded practice the characteristics of which are shaped by the context and/or country in which s/he is accredited to practice.’

(HEYH Advancing Clinical Practice task & Finish Group 2014)

Benefits of The Calderdale Framework

For Organisations

Consistency & Safety Reduction in Risk Efficient & Effective Improved Productivity Flexible Competent Workforce Improved Patient Experience Employer of Choice Provider of Choice

For Teams & Individuals

• Builds Effective Teams around the Patient

• Personal & Team development needs- Links to KSF (in UK) and PDP

• Clear Roles & Responsibilities

• Safe Skill Sharing

• Transferable Skills

• Job Satisfaction

Hybrid Support Worker

Jack’s wife , Margaret said, “ Under the direction of the

therapists, Cath the rehab assistant undertook speech and language therapy exercises and movement exercises. To the relief of both of us Jack’s speech returned and his walking has improved, giving him more independence.

Thank you to all.” Margaret

Assistant Practitioner (New type of worker)

Nicky Byrne, team leader (MacMillan Rehab) said:

“ Michelle is now competent to take her own non complex caseload, including elements of assessment (to protocol) previously done by Health Professionals. This means patients are seen quickly by one person and complex cases have access to the specialist skills they need”

Health Professional Skill Sharing (level7)

Nicky Hill, Emergency Department Occupational Therapist said

“ Competency training was completed around tasks that are traditionally uni-professional, to allow Health Professionals to share skills in order to complete all aspects of the assessment & treatment. This enhances the patient experience and journey by reducing the number of disciplines involved, subsequently speeding up the assessment & discharge planning process”

OT News May 2010; 18(5):25

Health Professional Advanced Practice (level 8)

Physiotherapy led outpatient orthopaedic clinic:

First assess

Order X rays and scans & tests –read & interpret these.

Prescribe

Inject

List for surgery,

Refer on

Give advice

Review & monitor.

NEW WAYS of WORKING:STAFF VIEWS

”

”“Still ensuring quality

services”

“ Confidence and skills

increased”

“Allay fears

of role erosion”

“Enables health professionals to focus on more complex

interventions”

“ Increase knowledge of wider initiatives and

policies”

“ Able to apply new knowledge

and skills with real benefit to patients”

“ Beneficial for patients- they don’t have to wait for another assessment”

The Combinations are Limitless ……

‘alternative approaches are needed to develop a sustainable workforce that is flexible enough in its work practices to manage the complex changes facing the NHS’.Gita Milhora, Kings Fund UK