SHuRePlan

What options exist for changing workforce demand through new service models or ways of working?

In step 5 we will compare the planned demand with forecast supply. If they do not match we need to find ways of increasing supply or reducing demand. If there is no way of increasing supply sufficiently the only other option is to try to reduce demand. The main ways in which this can be done are:

• Reduced planned activity or the quality of service
• Improve productivity so that more can be done with the same workforce
• Introduce skill mix changes or new ways of working
• Make changes to the service model

Clearly the first option is likely to be a last resort but the potential for workforce capacity to limit service delivery needs to be acknowledged.

The other three options are discussed separately below but, in practice, are inter-linked since the required changes are likely to involve all three.

Productivity

Productivity improvement is about achieving more service activity for a given level of workforce input. Increasing productivity is commonly misunderstood as trying to make people work harder. While improved motivation will, no doubt, produce some productivity improvements, the significant gains come through using a scarce workforce resource more effectively. The main ways in which this can be achieved are:

• Technology
  The introduction of new technology is one of the prime drivers for improving productivity. It does this by enabling tasks to be eliminated or completed in a shorter time. While some simple technologies may be introduced without major changes, most will require a rethink of ways of working and the service delivery process.  Medical advances such as minimally invasive surgery and new drug treatments have been one of the major drivers of increased productivity.
  
  
• Patterns of working
  The second way to improve productivity is to try to eliminate dead time or duplication of effort. Dead time can be eliminated by better deployment of staff to ensure that staffing matches predictable peaks and troughs in activity. A variety of tools exist to support better deployment and rostering of staff.
  
  
• Service models
  A prime driver of increased productivity is change in the service model.  For example the main driver of increased nursing productivity in acute trusts has been reduction in length of stay and the shift to day case surgery.
  
  
• Increasing skills
  Research shows that more highly skilled workforces are more productive. This results both from the fact that individuals are able to perform tasks more effectively and also have less need to refer decisions to more highly skilled individuals.  Reducing turnover, effective appraisal and personal development plans, clear training plans based on organisational objectives are all tools for increasing productivity.

New ways of working

An alternative to increasing the productivity a specific staff group, is to use the skills of that group more effectively by transferring tasks to other groups of workers.  Staff at any level typically spend a large part of their time undertaking tasks that do not require their level of training or skill.  These tasks can often be successfully transferred to other workers.  Where these are existing types of staff this is often referred to as changing the skill mix, in other cases the transfer may require the development of new roles.  The main driver of these changes is likely to be where the supply is limited for the professional group that has traditionally carried out the tasks.

A lot of work has been carried out in recent years on new ways of working.  The Changing Workforce Programme has tested a range of new roles and details are available from their website.  We are also adding to the knowledge base a collection of case studies and 'how to' guides.

New ways of working do not always increase productivity or reduce costs, however.  There are a number of reasons for this:

• People are likely to find a job stressful if they are being asked to work at their maximum skill level continuously, so there is a limit to how far easier tasks should be transferred to others.
  
  
• Delegating tasks can lead to problems in terms of communications and duplication of effort. In many cases it is more efficient for one person to undertake a complete set of activities.
  
  
• While productivity may be increased for the staff group from whom tasks are transferred, overall productivity may fall because those brought in to carry out the delegated tasks take longer, are less effective or are not qualified to make key decisions.

New service models

Process improvement can have a double effect on workforce demand.  By making the process more efficient it can often increase productivity.  It also allows the design of more effective roles e.g. a single person dealing with a patient rather than the inefficiencies of multiple hand-offs.  However, many early 're-engineering' projects failed because of the adverse effects on the staff involved.  This has lead many organisations to move on from 're-engineering' to embracing the ideas of Knowledge Management and Human Capital where recognition is given to the need to design work around the skills and knowledge possessed by the workforce and not just around the physical process.

There is wealth of material on process improvement that has been generated by the Modernisation Agency and the various service collaboratives and links are provided within the toolkit to some of this material.