#IGNursing17

Tracy Selsby-Orlandi

Head of Occupational Health

Derby Hospitals NHS

Foundation Trust

Inside Government

The Importance of Promoting the Health and Wellbeing of the

Nursing Workforce

Presented By:

Tracy Selsby-Orlandi – Head of Occupational Health

Derby Teaching Hospitals NHS Foundation

Trust

Over 8000 staff

30% (2452) of our workforce are nurses

Based across two sites

Serving a population of over 600,000

people in and around Southern

Derbyshire

6,000 babies are born in its maternity unit

annually

72,000 elective operations take place

every year

320 patients seen in the Emergency

department every day

1,100 beds

Recognising the positive impact of staff health and wellbeing

on patient experience, benefitting from increased patient

satisfaction and staff engagement and retention

Staff

Health

Absence

Presenteeism

Productivity

Efficiency

Customer/Patient

Care

Recruitment/

Retention

Clinical

•Chronic Disease

•Genetic

Lifestyle

•Exercise

•Diet

•Smoking/Alcohol

Socio-economic

•Carer

•Commute

•Debt

Em

plo

ye

r ca

n in

dire

ctly

influ

ence

Work Related

•Employment Security

•Relationships

•Job design

(autonomy, control,

interest and

challenge)

•Reward/Recognition

•Environment

•Work/Life Balance

•Development

Em

plo

ye

r ca

n d

irectly

influ

ence

•Health Improvement•Counselling•Training

ManagementPractice

Individual

•Improved

Health and

Wellbeing

•Enhanced

Motivation and

Engagement

Organisation

•Attendance

•Performance

•Patient Care

•Retention of

staff

Local Needs Influences on Health and

Wellbeing

Interventions Outcomes

Strategic Approach to Health

and Wellbeing

5 Year Strategic Summary on a Page

Our Vision – Taking Pride in Caring: To be a beacon for all that is best in the NHS delivering 21st

Century healthcare. We will be part of a flourishing network of health and social care partners to integrate care for our patients, deliver clinically excellent results and be financially sustainable

Putting Patients First

Right First Time

Investing Our Resources

Wisely

Developing our People

Ensuring value through

Partnerships

P R I D E

Our Pride Objectives

Our CARE Values

Compassion Attitude Respect Equality

Our ambition for the next 5 years

The most patient centred, harm free and caring

teaching hospital in England

To deliver effective,

sustainable services with no avoidable delays

To attain a level of financial

independence by reaching and

maintaining a sustainable

surplus

To be the top NHS employer

and educator in England

To improve care and efficiency

across the system through

purposeful partnerships

Delivery - Integrated Performance Report (IPR)

GOLDEN THREAD

Putting Patients First Right First Time

Investing Our Resources Wisely

Developing our People

Ensuring value through

Partnerships

R • Clinical Service

Strategy• Transformation

Strategy

I• 5 Year Financial

Model• 5 Year Capital

Plan (incl. Estate, IT and Equipment)

D• People Strategy

(including workforce plan and OD & Leadership)

E• Partnerships

including STP, Burton and others

Our ambition for the next 5 years

The most patient centred, harm free and caring teaching hospital in England

To deliver effective, sustainable services with no avoidable

delays

To attain a level of financial

independence by reaching and

maintaining a sustainable surplus

To be the top NHS employer and educator in

England

To improve care and efficiency across the

system through purposeful

partnerships

Enabling Strategies

P • Quality Strategy

Divisional Plans

Divisional Plans

Divisional Plans

BOARD

EXEC

DIVISIONS

Ass

ura

nce

–Su

bco

mm

itte

es

(Qu

alit

y, P

eop

le, F

inan

ce a

nd

Per

form

ance

RIS

K (

BA

F an

d H

LRR

)

DEVELOPING OUR PEOPLE

Education and Innovation

Workforce Transformation

Recruitment and Retention

Health and Wellbeing

Engagement

Our ambition for the next 5 years

Apprentice Development

Centre for E&T Delivery

MSC Programmes

Nursing Associates

International Workforce

Development

New Career Structures

Team Development

Workforce Plans –including new roles

linked to STP / Collaborative working

Embedding new roles

Place based development

Corporate Function Collaboration

Embedding Service Transformation

Further develop concept of new roles

International Recruitment

Optimised Transactional

Process supporting business needs

Identification and Intervention on Retention Issues

Employer Brand

Culture of Health and Wellbeing Development

Delivering Attendance Targets

Mental Health Support including

culture

Rapid Access for Staff

Enabling Opportunities

Top rated for organisational engagement

Staff able to contribute to

improvements at work

HSJ top 100

Staff FFT

LEA

DER

SHIP

AN

D O

RG

AN

ISAT

ION

DEV

ELO

PM

ENT

Patient Outcomes

Divisional Plans

INC

LUSI

ON

Recognising the Importance of

Nursing Workforce Health and

Wellbeing

Absence

Reduced Sickness absence reduced from 4.49% to 3.8%

Reduction in days lost from stress from 43,218 to 30,364

Reduced average length of absence for stress from 28 days to 15 days

Reduction of absence in ED from 12% to 3%

Health and Wellbeing

Increased engagement of wellbeing services by 30% (13,615 unique contacts)

Access to Mental Health and Physiotherapy services

Wellbeing App

Feedback/Survey

Patient – (6575 surveyed) 94% of our patients would recommend us

Staff – Staff morale 71 to 92, nursing vacancy 8.1% (bridged by internal bank)

Compliance

NICE Guidelines for Workplace Health from 55.7 (National Median 59.2) to 87 (National Median 67.2)

Finance

Delivered on a cost neutral basis

Commercial income of over 1 million (40% profit margin)

Regional savings of over £200,000 for partner organisations

Reduction of agency spend

Engaging with staff to identify key areas of importance

including managing stress and focusing on mental health

Engaging with Nursing Staff – ED case study

High sickness absence (12% - in the main stress-related down to 3%

after the work done)

Vacancy rates (3%) posed a real challenge to service continuity, staff

morale and performance.

Overall 5% increase in attendances, continuing increases in

attendances, higher patient acuity (11% increase in patients requiring

the resus room and an 11% increase in over 80 year olds)

Failure of the ED 4hr target

“ED team felt they were at breaking point”

Engaging with Staff

8 staff focus groups were held

75 staff attended equating to approximately 30% of the ED workforce.

Staff who could not attend were provided with the opportunity to

feedback individually

Intended Outcomes

To ensure that the ED Teams are aware that the Trust has considered

their feedback and are looking into creative solutions into some of the

key areas of concern.

To engage with staff to find out what their views are and what the

potential solutions are.

Gather information to help inform the departments risk assessment,

which in turn will inform the action plan.

The Good, the bad, the ugly

The Good The Bad

The Ugly Solutions

We deliver the best patient care we can

The team we work with are great (well most of them)

The hospitals is nice

The shifts are good

Equipment is often broken and no one puts it away to

be fixed

You need a huge bunch of keys to get into restricted

areas

Car parking is awful

IT is can be a problem

111 and dentist actively tell people to come to us!

The four hour target is stressful

Patient pathways can be an issue in some areas

Standard of management is variable

We only see managers when it is going wrong

We are short staffed and no one wants to stay

We cant recruit into the department

Can we get key pads instead of keys

Can we do a communication to make sure people don’t

put broken equipment back in the store

Can we contact dentists and 111 to educate them

Can we have more visible leadership

Can we look at a better recruitment package

Can we promote why ED is actually a really rewarding

place to work

Stress Risk Assessment

Demands

- Increase in patient activity and type of activity

- Reduced Staffing levels

Control

- Frustrations with external factors reducing control

Relationships

- Identified issues with patient pathways (internal)

- Identified issues with external stakeholders

Support

- Training

- Equipment

Change

- Internal and external

Role

- Lack of clarity of roles (managers)

- Clear on my role but get pulled in to cover other aspects when short staffed

Actions Taken

Leadership training – Band 6 and above

Proactive and reactive attendance management

- Case review of 4 occasions or more

- Attendance and Stress Management training

- 4 occasions of absence invitation to wellbeing check

Business case for investment in staffing levels and resources

Engaging with internal stakeholders to improve patient flow

Engaging with external stakeholders to reduce attendance to ED

Structured health and wellbeing programme, focussed around the 6

c’s

Outcomes

Commended by the National Emergency Care Intensive Support Team (ECIST) for driving up

performance and achieving real engagement and cultural change within the Department.

Jennifer Walker (ECIST) said: "The changes you've made to the health and wellbeing of your staff

has made the department fit for future years to come. This has led to the sustained delivery of the

4hr target and positive staff and patient feedback.

Exploring the next steps following the ‘Get Healthy, Stay Healthy’ campaign

Reducing sickness absence and improving productivity through investing in staff health and

wellbeing

Health and Wellbeing Services

Health and Wellbeing CQUIN

In March 2016 NHS England announced a health and wellbeing CQUIN,

linking 0.75 per cent of provider income to improving staff health and

wellbeing.

Introduction of health

and wellbeing

initiatives

Healthy food for NHS

staff, visitors and

patients

Improving uptake of

flu vaccinations

• Introducing improved mental health initiatives using NICE

guidance.

• Introducing physical activity schemes.

• Improving access to physiotherapy for those with MSK

issues.

• Submitting data on food suppliers operating on NHS

premises.

• Banning price promotions on foods high in fat sugar and

salt (HFSS).

• Banning advertising on HFSS foods.

• Stopping the sale of HFSS foods at checkouts.

• Ensuring healthier meals are available out of hours.

• Achieving an uptake of flu vaccinations by frontline

healthcare workers of 75 per cent by December 2016.

Promoting Positive Mental Health

Policy and Process

Stress Policy

Mental Health

Guidance

Health and

Wellbeing Strategy

Attendance

Management Policy

Support and Advice

EAP

Self referral to Occ

Health

Clinical

Psychologist

Specialist Mental

Health Nurse

Bespoke sessions

for departments

Lifestyle Checks

Mediation Training

Communication

and Engagement

Focus Groups

Staff Survey

Brand

recognition

Road shows

and events

Annual Plan

Training, Education and

Development

Stress Awareness

Stress Management

Coaching

Leadership

Programme

Positive Assertiveness

Coping with Change

Evaluation and

Reporting

Wellbeing

Dashboard

Clinical

Outcomes

Routine

Evaluation

¼ reports with

hotspots and

trends

Business Unit

Reports

Project Managed Approach

Musculoskeletal

Physiotherapy Outpatients Occupational Health Occupational Therapy

Rapid Access

Single source of data collection

Streamlined Evaluation

Business Continuity

Physical Activity

Flu Jab Dashboard

75.24% of Trust Frontline Healthcare Staff Vaccinated

Staff Group Percentage

Doctors 68.61%

Qualified Nurses/Midwifes 63.66%

Other Professionally Qualified 74.90%

Support to Clinical Staff 95.65%

Total 75.24%

Burning Question

How do we ensure that we continue to achieve sustainable results in relation to staff health and

wellbeing and measure the impact on patient care?

How do we increase engagement in our Nursing workforce?

- Strategic Plan

- Exec support

- Engagement with staff

- Accessible services and support

- Good management practice

- Eat, sleep, rave repeat!!!

Questions