Healthcare Workforce Modelling Drives Improved Patient Care

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06/08/2021
4 Mins

High quality patient care depends on effective healthcare workforce planning, making sure the right nursing skills and experience are there at the right time. Workforce modelling identifies exactly who and how many the “right” staff are. Professor Alison Leary’s sophisticated mathematical modelling led to:

  • The decision to increase the target ratio of specialist nurses for bowel cancer care by 67%
  • Evidence that increasing the number of registered nurses in high-risk acute hospitals improves patient outcomes and reduces falls
  • Validation of the model of medical support services for football matches

Professor Alison Leary, Chair of Healthcare & Workforce Modelling takes an evidence-based approach to healthcare staffing, analysing large data historic data sets to understand how healthcare workforce staffing levels affect patient outcomes.

Incident reduction

Nursing is a safety-critical activity but its complexity means impact is not easily quantified.   Leary analysed incident logs and patient records from an NHS acute trust to see how staffing levels of registered and non-registered nurses were linked to incidents, falls and overall patient outcomes.   Leary’s analysis identified 40 correlations between safety factors, physiological data and nurse staffing levels.  Increasing registered nurse staffing led to step changes in positive clinical outcomes and patient safety including a reduced number of falls.

300,000 people in the UK have IBD

Specialist nurse numbers impact on bowel disease care

National Standards for the Healthcare of People Who Have Inflammatory Bowel Disease (IBD) (2013) defined the number of nurse specialists needed as 1.5 full-time equivalent (FTE) per 250,000 population.  Leary’s research found 63% of nurse specialist respondents had a higher caseload than the recommended standard and 84% regularly did unpaid overtime.  Leary’s research demonstrated the patient care improvements achievable from higher staffing.  This was needed to cope with the increasing complexity of the role and care demands and compensate for the fact that IBD specialist nurses are typically less experienced than other specialist nurses.  New national standards for IBD care were launched in 2019.  Specialist nurse requirements were increased to 2.5 FTE per 250,000 and every acute Trust in the UK is now benchmarking and action planning against these new standards.

63% of nurse specialist respondents had a higher caseload than the recommended standard and 84% regularly did unpaid overtime

“As Professor Alison Leary puts it: The compassion and caring are really important, but it isn’t generally compassion that will save somebody’s life. If we can help society to understand that nursing is a “knowledge intensive occupation”, she believes it would help nursing to be more valued and attract more men and women into the profession. I wholeheartedly agree with her.”  Matt Hancock 2019

Specialist nurse roles and careers

There are over 50,000 specialist nurses in the UK, experts in caring for patients with complex and diverse clinical needs. But are they cost-effective? Leary’s analysis revealed a large number of different job titles, 595 in the 17,960 specialist posts analysed.  The job title had little correlation with education level so any performance measurement by public employers and commissioners was extremely difficult.    

Even in a primarily female-oriented profession there is still a bias towards men in higher paid nursing roles. Leary’s analysis of specialist advanced practice clinical nurses showed men were over-represented at senior levels with advantages in both pay and progression.  

These research projects led to reflection and policy change across the profession.

“This [study] has raised a lot of discussion within the profession and from those commenting on the profession… our preferred position is that only a [registered nurse] should have the word ‘nurse’ in their job title or in their job description.” Chief Nursing Officer for England writing to directors of nursing at NHS Trusts  

Evidencing the value of nurses

“The Apollo Nursing Resource website is a practical and valuable tool. It captures the very essence of what we do and allows us to turn this into a meaningful dialogue which will assist with service provision and development” (Colorectal Nurse Specialist, University Hospitals Birmingham NHS Foundation Trust)

Workforce planning and modelling inevitably includes an assessment of financial value.  This is potentially a challenge for nurses to communicate their value in a way the managers who pay for their services will understand.  In response to requests for help from the profession Leary developed Apollo Nursing Resource in partnership with a major global medical devices manufacturer and a UK university School of Nursing. This widely used free resource, launched in February 2014 helps nurses articulate their value in terms of quality and efficiency for employers and commissioners of services.