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Managing the realities of skill mix and role substitution

From CWP to QIPP: Going in the right direction?. If skill mix is the answer, what's the question? (Buchan et al, 2001)Efficiency aims: lost in translation?Who's ?counting' the cost of saving resources?. If skill mix is the answer, what's the question?. Enhancement; substitution; delegation; inn

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Managing the realities of skill mix and role substitution

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    1. Managing the realities of skill mix and role substitution Dr Anne McBride Manchester Business School University of Manchester

    2. From CWP to QIPP: Going in the right direction? If skill mix is the answer, what’s the question? (Buchan et al, 2001) Efficiency aims: lost in translation? Who’s ‘counting’ the cost of saving resources?

    3. If skill mix is the answer, what’s the question? Enhancement; substitution; delegation; innovation; transfer; relocation; liaison ..in the later years, the workforce implications of increased activity …. demonstrate the need for skill mix changes and other means of improving productivity; .. (Wanless 2002: 75) Lack of good evidence on the scope, effectiveness and efficiency of most types of skill mix change. “To be successful, the NHS in five years’ time will have more services closer to home and therefore less investment and activity in the acute sector. (QIPP for Clinicians, p11)”

    4. Efficiency Aims: lost in translation? Changing Workforce Programme: improving patient care Skills Escalator: personal development or productivity? 3 Quality domains: Patient Safety, Patient Experience and Effectiveness of Care (High Quality Care for all) “We need to ensure that the NHS focuses on delivering quality and efficiency gains together.  The key to identifying these is innovation.” http://www.ournhs.nhs.uk/?page_id=1638 Competing logics of consumer orientation/ rationality Alternative scenarios: The ‘Low Road’ approach to skill mix (Thornley’s work on HCAs in 80/90s) “..locally, trusts are making deep and dangerous cuts to staff numbers now, with further cuts planned for the future.” (Peter Carter, RCN, 2010)

    5. Who’s ‘counting’ the cost of saving resources? Financial disconnectedness How do payment systems reward (or penalise) organisations making the desired changes to working practices? ..pay modernisation…. should result in a more flexible workforce with greater scope for team working and fewer barriers between different staff groups. This should allow the skill mix in the service to change. (Wanless 2004: 90) What education and training investment is required to extend roles and at what level? If regulatory boundaries are changed do organisations, roles and practices change as anticipated? What ‘old’ ways of working need to be discontinued? “This was made possible due to change in the prophylaxis policy; resulting in the cessation of pre operative prophylaxis” http://www.institute.nhs.uk/images/documents/Quality_and_value/RIE/Orthopaedic%20Special%20Newsletter%20Oct%2009.pdf

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