To develop the environment and culture that enables people to redesign the way they work that delivers sustainable benefits for both the patients and staff. 

• Reducing delays in the patient’s journey
• Improving the quality
• Reducing the waste in the system
• Reducing lost hours
• Improving staff experience

We have continued to challenge the myths and blocks that delay the development and sustainability of new roles and changes to the design of the workforce.  Working nationally with professional, regulatory and educational bodies, we have developed new ways of working which improve services for patients and staff that have changed:

• The attitude of many staff 
• Increased the retention of staff
• The range of career opportunities for staff
• Reduced patient waits

Improving the way in which people in health care can introduce sustainable changes for a redesigned workforce requires approaches which simultaneously tackle issues at both the macro and micro levels.  This involves working with real people in the practical realities of health and social care delivery to identify the blocks that hinder the implementation and sustainability of new ways of working.  Many of these blocks are difficult to influence at the micro level, but it is the evidence from the practical situation that enables these issues to be overcome at the macro level.  This includes the necessary changes to legislation and statutory rules that are required to support a new modernised and flexible workforce within health and social care.

It is the fusion of service and workforce redesign that is fundamental to improving the whole system and achieving the sustainability of a new way of working.  Graph one (above) illustrates how by revising patient flows and changing the way in which people work, an overall benefit was achieved with an increase in the number of patients being treated within four hours from admission into emergency care departments within an acute hospital. 

The use of the wider health care team (skilled but not registered part of the National Health Service workforce) is demonstrated in graph 2 (above). Three skilled but not registered non-medical members of the team developed competence in simple endoscopic procedures, so the other members of the team could use their skills in more complex cases.  The overall benefit was improved access for patients for sigmoidoscopies.

Alice O'Neill
Deputy Director
Changing Workforce Programme
Alice.o’neill@doh.gsi.gov.uk

[Storyboard presentation at IHI's National Forum, December 2004]