2015-16 Disclosure Log

747 Pages·2016·18.4 MB·English

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Information
DOH-DL 15/16-032RTI Document 1
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Business Planning
Framework
th
5 Edition
November 2015
DOH-DL 15/16-032RTI Document 2
RTI Release
th
Business Planning Framework – 5 Edition
Published by the State of Queensland (Queensland Health), November 2015
This document is licensed under a Creative Commons Attribution 3.0 Australia licence.
To view a copy of this licence, visit creativecommons.org/licenses/by/3.0/au
© State of Queensland (Queensland Health) 2015
You are free to copy, communicate and adapt the work, as long as you attribute the
State of Queensland (Queensland Health).
For more information contact:
Office of the Chief Nursing and Midwifery Officer, Department of Health, GPO Box 48,
Brisbane QLD 4001, email
Contents
Introduction .........................................................................................................4
Key benefits of the Business Planning Framework ............................................... 5
Governance and process influences .................................................................... 6
Service profile ...................................................................................................... 7
Resource Allocation .................................................................................... 9
Guide to completing a Service Profile ............................................................... 13
Service overview ....................................................................................... 13
Internal environmental analysis ................................................................. 14
Information technology management ........................................................ 16
External environmental analysis................................................................ 17
SWOT analysis ......................................................................................... 18
Comparative analysis ........................................................................................2 0
ACTUALS .......................................................................................................... 20
Performance ............................................................................................. 22
Resource Allocation .................................................................................. 24
Priorities for next 12 months ..............................................................................2 4
FORECAST (PLANNED/PROJECTIONS) ......................................................... 25
Forecast Activity or Estimated Future (Health Service) Activity (EFA)
Methodology ............................................................................................. 25
FORECAST ....................................................................................................... 26
Nursing Resource Determination .............................................................. 26
Converting total hours into full-time equivalent (FTE) staffing resources ............ 32
Step Approach for Determining Required Nursing FTE..................................... 33
Calculate Productive Hours ................................................................................ 33
How to calculate HPPD / HPOS: ............................................................... 33
Calculate Productive Hours ................................................................................ 34
Determine Skill Mix ............................................................................................ 34
Convert Productive Hours to FTE ...................................................................... 35
Calculate Non-Productive FTE ........................................................................... 35
Add Productive FTE with Non-Productive FTE to Determine Resource Estimates
required to meet activity ..................................................................................... 36
Determine Seasonal Demand ............................................................................ 36
Additional Examples for Determining HPPD/HPOS within Specialty Areas ........ 37
Residential Aged Care (Utilise residential classification scale) .................. 37
Short Stay ................................................................................................. 37
Community / Mental Health / Child Health ................................................. 38
Hospital In The Home (HITH) .................................................................... 38
Day Surgery .............................................................................................. 38
CSSD ....................................................................................................... 38
Theatre ..................................................................................................... 38
Recovery .................................................................................................. 39
Mental Health............................................................................................ 39
Emergency Department ............................................................................ 40
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Chapter 3 - Reaching a balance ........................................................................4 2
Exercising professional judgement ............................................................ 42
Data Analysis ............................................................................................ 43
Strategies to evaluate and address an imbalance of supply and demand . 43
Finalising the service profile ...................................................................... 46
Chapter 5 – Performance Metrics ...................................................................... lii
Why performance management matters ........................................................... liv
Principles of Nursing Metrics ...................................................................... lv
Patient Experience ..................................................................................... lv
Nurse Sensitive Indicator Tool and Reports ............................................... lvi
Setting tolerances and targets ...................................................................l ix
Benchmarking ........................................................................................... 60
Conclusions .............................................................................................. 61
ACTUALS ............................................................................................................ ii
Forecast .............................................................................................................. iv
Nursing Resource Determination 2016-2017 ............................................. iv
TEMPLATE Service Profile & Budget Negotiation Formal Agreement (optional)vii
Annexure 1: BACKGROUND - Understanding the funding environment ........... ix
Glossary ........................................................................................................... xvi
References ........................................................................................................ xx
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Introduction
The Business Planning Framework: the tool for nursing and midwifery workload
management (BPF) will imminently transition to a Standard, to support safe ratios and
workplace provisions. As part of the Nursing Guarantee – putting patient safety first, the
Government has committed to legislate for safe nurse-to-patient ratios and workload
provisions in Queensland’s public Hospital and Health Services (HHS).
The complementary objective for this initiative is to transition the BPF into a Standard, to
provide a clear message that the number of nurses on a shift is an important aspect to
improving patient safety and quality of care. Integral to the Standard, is the emphasis on
increasing transparency on health system performance, monitoring and public reporting on
compliance with ratios and the BPF.
The BPF provides nurses and midwives with a business planning process to assist in
determining appropriate staffing levels to meet patient requirements and evaluate the
ongoing performance of the nursing service.
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The BPF provides nurses and midwives with a simple, standardised business planning
process, which assists to:
x determine appropriate nursing staff levels and skill mix to meet service requirements
x identify strategies for managing workloads; and
x guide the development of transparent processes to evaluate the efficiency and
effectiveness of the service.
Each clinical unit is required to determine its nursing / midwifery requirements to ensure
safe, high quality patient care through shift-by-shift assessment of patient demand.
Individual patient needs must be met by the appropriate nursing and midwifery resource
allocation over the twenty four (24) hour cycle.
The BPF also determines the process for monitoring and acting to ensure these
requirements for nursing and midwifery staff are met and most importantly, to ensure
patients are receiving the nursing and midwifery care and contact time they need on the
shift. These procedures are outlined in the BPF to demonstrate effective responses to
unplanned variations to predicted patients’ needs or the availability of nursing staff at any
time during the day or night, including prompt action to enable an increase or decrease in
nursing staff.
Key benefits of the Business Planning Framework
The BPF improves health service delivery by:
x assisting nurses / midwives to plan
x defining goals and objectives
x identifying priorities determining the required human resources (e.g. nursing / midwifery
hours, skill mix) and determining other required resources (e.g. technology, equipment
etc)
x guiding monitoring and evaluation; and
x promoting the alignment of frontline services with the strategic directions of Queensland
Health and Hospital and Health Services.
Principles of the Business Planning Framework
Business planning is a systematic process for examining a ward / unit / service and its
environment in order to allocate nursing and midwifery resources to meet the demand in the
most appropriate way. The underlying principles in the BPF process promote transparency in
consultation, collaboration and negotiation with the nursing and midwifery leadership team
and the Hospital and Health Services (HHS) executive team to ensure that current demand
for service / activity is matched with the supply of resources.
These principles fall into three key categories aligned with the key stakeholders of a health
service: patients, staff and the wider organisation. The principles are:
1. Patient / client focussed
í applies evidence based models of care and clinical practice
í meets agreed outcomes and health improvement targets
í promotes the premises as underpinning delivery of safe, quality health care
(accessible, responsive, safe, efficient, sustainable, effective and appropriate).
2. Staff focussed
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í ensures active participation in the planning and management of resources by nursing
and midwifery staff to ensure a balanced approach to resource management
í aligns staff numbers and skill mix with service demand to effectively manage
workloads
í integrates workforce planning, workforce flexibility, evidence-based practice,
competency, requirements and training
í embeds systems for delivering safe, equitable workloads
í clinical environment.
3. Organisation focussed
í ensures alignment and consistency between individual service-based business plans
and Hospital and Health Services’ strategic direction
í promotes optimal use of resources
í integrates systems to assist staff in decision making
í provides access to timely, accurate and reliable data.
The BPF supports nursing and midwifery service managers to match the supply of nursing /
midwifery resources with patient demand to deliver services that provide quality patient care
outcomes.
Governance and process influences
Individual nursing and midwifery services within Hospital and Health Services have
individual, agreed processes for the planning and reviewing of nursing and midwifery
resource requirements. These processes align with the current BPF methodology and
National Standards for Safety and Quality, and also promote budget integrity.
The people responsible and accountable for nursing and midwifery staffing follow agreed
governance principles to identify and support appropriate staff resources at an organisational
and at a ward / unit / service level to ensure safe patient care. These processes are
delivered within an overarching governance structure to ensure an integrated, consistent and
supported approach to workplace and workforce management, and are influenced by:
x Patient Safety and Quality
x Clinical/Performance Outcomes
x Defensible Business/Workforce Plans
x Accountability Structure
x Approval/Negotiation Processes
x Workload Management o service profiles o strategic / analytical monitoring o
determining skill mix
x Consistency and Transparency
x Staf Colaboration
This approach requires ‘service profiles’ that detail the nature of the demand, including
population health profiles and internal, external analyses with comparative analysis and
performance metrics. These steps reveal any gaps that indicated service growth or
reduction, and what the impacts of these variances maybe on the nursing and midwifery
workforce.
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Contemporary BPF
•Historial Data
Actuals
•YTD
•Planned
Projections •Budgeted
•Do they equate?
BPF
•Growth?
Variance / •Reduction?
Gap •Maintenance / Staus
Quo?
•Workforce - nursing
and midwifery
Impacts workload
•Technology
•Equipment, Beds
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Gap Analysis will indicate that estimates of human resourcing, capital, technology are
required. The gap will need to be managed up through the governance structure of the
organisation, supported by data wherever possible. This leads to the negotiation process
between what the service has planned and should guide the budget negotiations. Optimally,
budgeted activity (actuals) equal planned (forecast) activity.
Service profile
Health care services exist in a complex and changing environment and a robust plan assists
to meet these challenges. Therefore, the ability to balance service demand and staff supply
is essential when planning the long-term viability and sustainability of these services.
Frequent monitoring and evaluation of demand indicators such as client acuity and activity is
necessary to ensure nursing and midwifery workloads are matching service (patient)
demand.
A service profile will identify the nature of the demand, the clinical capability of each facility,
service and unit, the resource allocation used to meet current demand and the amount of
resources required to meet activity projections for future year/s. The relevant corporate and
HHS priorities / strategies need to be reflected in the service profile to align with the HHS
service level agreement and the National Safety and Quality Health Service (NSQHS)
Standards.
When developing the service profile, it is important to document the core demands on the
service and consider all influences and variables, particularly in relation to workforce
numbers, skill mix profiles and material resources.
A completed service profile:
x describes the demand placed on nursing and midwifery resources
x assists in the planning of service delivery
x identifies the service’s purpose, direction, tasks and priorities
x determines the resources utilised to deliver the current services and estimates of
resources required to deliver future activity
x provides guidance with monitoring and evaluating service performance.
A service profile is developed annually, based on the financial year, acknowledging
adjustments to the profile may be required throughout this time if key factors such as patient
/ client activity and nursing supply change during this time. The proposed service profile
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determines the current / future state of demand and provides a plan for matching this with
resource supply through the collation of relevant data collected from the following analyses:
The external environment includes the following factors:
x Policy/Legal
x Economic
x Social
x Technology
x Research and EBP
The internal environment:
x Structural
x Human Resource Management (HRM)
x Information and Communication Technology (ICT)
x Comparative Analysis
The SWOT reviews:
x Service Strengths
x Service Weaknesses
x Service Opportunities
x Service Threats
Using the initial service profile as a guide, the service area’s budget for the financial year is
clearly identified and can be readily discussed and negotiated. Once the budget and the
level of service is agreed upon and finalised, the initial service profile is recognised as the
‘agreed service profile’ (keeping in mind the profile may need to be reviewed and amended
periodically in line with the budget allocation).
It is important to remember the service profile includes both demand and supply data, and
performance metrics of how these can be measured for monitoring and evaluation.
Resource Allocation
Chapter 2 discusses the importance of a BPF approach to resource allocation, and the
calculation tools. The calculations to estimate the resources required to meet planned /
forecast activity for the following financial year will become simplified as automation replaces
the current calculations. Chapter 2 contains the manual calculations, however the
corporate/IT systems current recommendation will be updated and linked to the Office of the
Chief Nursing and Midwifery Officer’s website.
Methods for allocating resources in response to demand are explained and response
strategies are provided where the allocation of funds does not balance with identified service
requirements in Chapter 3, Reaching a Balance
Reaching a Balance
This third and final stage of business planning analyses the differences between the demand
for resources and the actual resources allocated. It allows service area managers, staff and
senior management to identify gaps and agree on a resolution. That solution is likely to be
one of three potential outcomes:
x change the demand for resources
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