Pathology reprofiling confidential draft findings from the early adopters

3. The exam question Support a sub-set of MSC early adopters to profile the work done in Pathology who does what and for how long? Validate the findings and model the effort to the lowest grade observed lowest grade as advised by MSC professional advisors �median� grade observed Consider productivity improvements Write it up!

4. The scope Nine of the early adopters took part To maintain confidentiality, none of the participants is named here and individual workforce costs are not shown Data were collected for comparison of 1,516 whole time equivalent (WTE) employees in five main Pathology disciplines

5. The population

6. Processes, activities and tasks A pathology department can (as can any organisation) be described as a set of interlinked processes. Each process is, in turn, characterised by the activities that define it And each activity will comprise discrete tasks that make up the activity So tasks define activities, which define processes, which define the service In this study, the time spent by the staff at each Agenda for Change (AfC) pay band in pathology was set against a list of processes, activities and tasks (or PAT list)

7. The �PAT� list

8. Validation

9. Findings The �spread� of time is represented on the left hand side in 'blocks of blue': the deeper the colour, the more concentrated the effort for that task as a proportion of the total effort reported. The numbers to the right are the total effort set out as 'whole time equivalents' (WTE) for all the early adopters that took part.

10. Findings (2)

11. Reprofiling � scenario one To re-profile the same amount of effort to the lowest AfC Band recorded for each task This provides an theoretical indication of the maximum potential saving solely from re-profiling, but is impractical no account at individual task level is taken of the need to ensure adequate and safe supervision

12. Reprofiling � scenario two To re-profile the same amount of effort to the AfC band that corresponds to the midpoint of the effort recorded for each task or kept below the midpoint for any effort that has already been recorded at a lower grade This provides an indication of a realistic potential saving solely from re-profiling, based on current practice at NHS Pathology services.

13. Reprofiling � scenario three To re-profile selected tasks (up or down) to the AfC Band suggested by MSC professional advisers involved in pathology These suggestions are set out on the next slide This provides an alternative (and hopefully consistent!) view of the minimum potential likely from re-profiling

14. MSC professional advice

15. Benchmark profiles To create benchmark profiles, a combination of scenario two and three was used: if the expert advisor has suggested the best AfC band for a particular task, the effort was concentrated at this band �up� and �down� if no expert suggestion was available, the workload was re-profiled down to (or kept below) the AfC band that corresponds to the midpoint of the early adopter's staff

16. A word of caution Reprofiling � with the inference that staff who currently 'do' tasks and activities are to be 'downgraded' � is a complex message to communicate Highly qualified scientists with many years of experience can reasonably claim that to reduce their leadership role, professional training and contribution to Pathology to a sequence of related tasks and activities is an oversimplification of their contribution to the NHS But in creating the reprofiling tool, we have had to be mindful of the burden of collecting meaningful data by simplifying the categorisation of the work done by individuals in Pathology

17. So what did we find?

20. Biochemistry � before and after

21. Possible savings - Biochemistry

24. Haematology � before and after

25. Possible savings - Haematology

26. Microbiology � before and after

27. Possible savings - Microbiology

28. Histopathology � before and after

29. Possible savings - Histopathology

30. Summary

31. Work in progress Measures of productivity the ratio of outputs to inputs defines productivity. match the upper-quartile performance of 'tests per WTE of direct effort (the work done to complete the core function of the Pathology service) Rebalancing of core (direct) and support (overhead) effort match the upper-quartile performance in 'the ratio of direct to support effort' Early (conservative) estimates suggest that an additional 8 � 12% of savings are possible over time

32. Yes, but� In certain circumstances, there may be good reasons why the profile for each task is not optimised. For instance: The use of higher band people may be a necessity out of hours, if there is only one person on duty, for instance There may be degrees of complexity in a task. In other words, some parts of the task can be done by people at lower bands, whereas others have to be done by people with more experience More experienced people might do some tasks more efficiently than those at lower bands, because they are more skilled. In other words, it could be a false economy to use the lower bands all the time Shortages in one band might be �pushing� work onto other bands, at busy times of the day, for instance

33. How to� A guide to �reprofiling the Healthcare Science workforce� is in preparation But in the meantime have a vision of the �shape� of your future workforce communicate informally about ideas emerging brief people regularly, in small groups so that questions can be asked - and answered! keep personal data confidential and restricted � check the policies of your organisation carefully Keep an open mind � reprofiling is an iterative process

34. How to� (2) Consider the continuing need to train the �next generation� possible variations in workload how to provide an �out-of-normal hours� service European Working Time Directive on-call arrangements supply of appropriate skills risks associated unauthorised absence and vacancies age profile by AfC band

35. How to� (3) Plan how to engage and communicate with the workforce minimise the need for redundancies manage performance during and after the transition obtain relevant skills introduce new ways of working and technologies Know when to ask for advice from experts � often! Always act as a �leader� even if, occasionally, you don�t feel like one!

36. And finally� Benchmarking indicates a relative position By definition, some organisations must be above and some below the average However, there can be a tendency for organisations with above-average performance to rest on their laurels It is the job of management to improve processes and efficiency continually Reprofiling is �a marathon, not a sprint� � and there is always scope for further improvement!