| Case Study 2 Knowsley Metropolitan Borough Council & Primary Care Trust Overview Knowsley has been recognised at the highest level as 'pioneers of partnership working - where the PCT and Council work hand-in-hand'.1 One of the areas where this success has been founded is the provision of Reablement Services which comprises of care, support and input from a variety of professions including approximately 70 Reablement Assistants. In November 2008 the In-House service was redesigned as a Reablement service and has enjoyed considerable success in enabling Service Users to continue living at home with no, or reduced, care needs. The team is involved for a period of up to 6 weeks, although in some exceptional circumstances this can continue for longer. At the conclusion of this period, any continuing care needs would be commissioned and delivered by external Home Care providers. As the service approached its 1st anniversary, managers were keen to assess its impact and address concerns that performance was adversely affected by the Reablement Assistant rota. Two specific areas were identified as problematic: • Continuity of care; The number of different Reablement Assistants required to maintain a care package during the course of a week was considered unacceptably high, unfavourably affecting Service Users’ experience. • Unproductive time; It was thought that the time Reablement Assistants were available to provide care was not being satisfactorily utilised, mainly due to the peaks and troughs in demand not corresponding with levels of supply. OptiCare Systems Ltd was commissioned to analyse the situation and develop an alternative rota which more successfully met the demands of the service. A proposal was produced setting out 3 clear stages in which the work would be organised: • An initial analysis of the current rota and specification for alternatives. • The production of alternative rotas. • The use of optimisation to produce schedules, ensuring like for like comparison. Analysis of existing rota
A sample area and retrospective period was identified which represented approximately 1/3 of the service, over one week. Data about visit times, staff availability and all of the relevant business rules was collected and converted into CSV data sets. Using this information Gantt charts were produced for each day, providing a clear pictorial analysis of the differences between supply and demand, (visits and carer availability). It showed that visits were reasonably equally distributed across the week, with similar levels of care required regardless of the day of the week, including weekends, (see table 1). It also showed that the fluctuation in demand throughout the day was dramatic (see table 2), although virtually identical on each day.
In contrast the existing rota had significantly less staff available at the weekend, high levels of staff during periods of comparative slack and each day was staffed differently, leading to planning difficulties for managers. Production of alternative rotas
Using this information, 3 alternative rotas were produced in consultation with key managers of the service, to ensure that they would be feasible and took into account crucial service requirements. Rota 2 - focussing on addressing some of the shortcomings of the Current Rota, particularly fluctuation in availability on different days, but with minimal changes to the working patterns of Reablement Assistants. Rota 3 – introducing a longer shift of 7 hours, consistent levels of staffing both a.m. and p.m. with a reduction on weekend evenings and staff working over a 6 week pattern. Rota 4 – again 7 hour shifts but over an 8 week pattern with 1/3 of staff available during weekday evenings but consistent deployment throughout the weekend. Once these rotas had been produced managers considered their appropriateness, eventually deciding that the more radical solutions were necessary to satisfactorily resolve the problems and equip the service for the foreseeable future, consequently discarding Rota 2 as an option. The sample
The period when service demand data was measured covered Monday 10th August to Sunday 16th August 2009 in respect of North and South Huyton. 35 people received a service during this sample week, provided by 30 Reablement Assistants. This information was then translated into data sets, digitally describing the detail of both visits and staff availability, together with all of the complexity surrounding employment rules. The use of optimisation to ensure fair comparison
The task of comparing Rota 3 and 4 with the Current Rota so that improvements could be accurately assessed then remained. This could only be achieved by applying OptiCare's unique optimisation process, to ensure that the best possible application of Reablement Assistant time was achieved for each of the different rota options. 25,000 iterations for each of the rotas were applied, resulting in the production of the optimum solution for each planning problem. Once completed, analysis of the results showed that improvements could be made of between 5.9% - 8.5% of the weekly establishment costs by introducing one of the alternative rotas. That continuity of care could be improved by a factor of 0.12 and contact time could be increased by as much as 13.4%, (see table 3).
Conclusion
• All services functioning over an extended day must use rotas as a way of deploying staff. Analysing the effectiveness of these rotas against the service objectives can be an illuminating and beneficial process. • In this case, OptiCare have produced rotas which deliver significant improvements in staffing costs, contact time and continuity of care. • To assess whether the existing rota meets service objectives as effectively as possible alternatives, it is necessary to utilise optimisation to ensure that the comparison is scientific. Anything less would be comparing apples with pears! 1 Andy Burnham MP (Secretary of State for Health),11th June 2009 http://www.dh.gov.uk/en/News/Speeches/DH_100754 |
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