Using specialist nurses as a solution to quality and efficiency issues in healthcare
What is workforce modelling?
Healthcare and workforce modelling has become vital in recent years and LSBU leads the way. Healthcare has traditionally looked at workforce supply, but a team at LSBU is building models around demand from organisations in acute care, the community and the third sector.
“One area in which LSBU excels is working with organisations to understand the issues they face and then modelling demand on services including workload. This allows organisations to make the most of their talent and release the potential of the specialist advanced practice workforce to help meet demand,” explains Professor Alison Leary, Chair of Healthcare and Workforce Modelling.
The importance of specialist nurses
“Specialist nurses who manage the care for patients with specific conditions are usually experts in the field and practice at an advanced level. They can play a major role in not only delivering care but also in enabling patients to manage their own. In England and Wales, however, there is concern that patients may not have equal access to specialist nursing. Employers are not always aware of the good return on investment this level of practice provides, and instead see them as a potential cost. The postcode lottery looms large.”
Specialist nurses who manage the care for patients with specific conditions are usually experts in the field and practice at an advanced level. They can play a major role in not only delivering care but also in enabling patients to manage their own.
Improving quality and efficiency using specialist nurses
Professor Leary has established herself as a leader in using data modelling approaches in nursing to understand the complexity of caring. She has applied this to research in staffing levels, workload and patient outcomes, and used these approaches and other information to contribute to a robust evidence base for utilising the potential of groups such as specialist nurses as a solution to quality and efficiency issues in healthcare.
Gathering the data
“I have worked with numerous collaborators over the last 10 years to establish this area of research, which has led to the building of evidence-based models for employers and funders to maximise the potential of the workforce. Recent research work has included analysis with colleagues at the University of Nottingham and the National Lung Cancer Audit funded by Dimbleby Cancer Care,” adds Professor Leary.
“We analysed the national lung cancer data set for England, which revealed specialist nursing provision inequalities, and investigated the value of using specialist nurses to provide equal access to treatment. We have also modelled the workforce for many specialist groups using an understanding of complex work and its benefits to organisations. This has included specialisms such as cancer, sickle cell and multiple sclerosis. We are currently working with the Crohn’s & Colitis UK to model the inflammatory bowel disease workforce.”
As Professor Leary’s work is international, she has contributed expertise to models of specialist advanced practice around the world in countries as diverse as Norway, the USA and Saudi Arabia. She is currently working on routinely collected data in the acute and community sectors looking at the relationship between aspects of care and other factors such as staffing and safety.
The research on specialist lung cancer nursing uncovered a number of critical findings:
There is a clear association between the age of patients and the likelihood of receiving an assessment by a lung cancer specialist nurse, with those over the age of 75 significantly less likely to be assessed than those aged 65 and under.
Patients were twice as likely to have been assessed in trusts where the majority of work is done by (more senior) band 8 nurses, compared to bands 6 and 7.
Patients referred by an emergency route were 57 per cent less likely to receive an assessment, compared to those referred by a GP.
Patients with advanced cancer are less likely to have access to specialist services.
Patients first seen in trusts with an annual lung cancer caseload of _ > 265 were less likely to be assessed compared with smaller trusts.
Our work with cancer specialist nurses has shown that specialist nursing provision is not equal across England, despite the fact that they improve outcomes, producing numerous pieces of work on the contribution and cost effectiveness of this group of healthcare professionals.
Working with NHS trusts Professor Leary has helped remodel cost effective workforce solutions that maintain quality and safe practice by understanding demand and releasing talent.
On the strength of her research into the value of and need for specialist advanced nurses, Professor Leary has received many prestigious appointments and commendations, including: invitations to advise the all-party parliamentary groups on topics such as patient safety; the International Council of Nurses; Health Service Journal roundtable on Workforce and Rostering; the Department of Health, Directors of Nursing Group; and the NHS Improvement Safer Staffing group (community).