SERVICE IMPROVEMENT FEATURE be made , resulting in more time for care . A time and motion study was completed over an eight-week period , with time to care defined as time spent with a service user or carer open to the clinician , either face to face or on the telephone . It did not include travel or clinical administration associated with the contact .
Following completion of a time and motion study , it was found that face-to-face contact time with service users averaged at 13 per cent of their working week .
Embarking on the project A small project team was set up with support from the trust ’ s Continuous Quality Improvement team and included the occupational therapy professional lead and data quality lead .
Following the feedback from the time and motion study , the Buckinghamshire learning disability occupational therapy team recognised the need to release more time for care and were keen to participate in the project .
An ideas generating session was held with staff to involve them with the initial planning . The team identified issues that were affecting their working practices and completed an impact grid that showed which issues they felt would have most impact on their effectiveness .
This gave the team ownership of the project and they were able to influence the path that it took . A driver diagram was then completed and highlighted caseload management and clarity of their role as primary drivers to success .
Developing a caseload weighting tool A caseload weighting tool was developed by the project team , which provided a weighting score based on the ongoing risk management of the service user and the occupational therapy process ( from assessment to review ).
This enabled staff to score their caseload and better understand the demands and workload . This was piloted with the team .
Using several rounds of PDSA ( plan , do , study , act ) cycles , amendments were made to the weighting tool to ensure it was both user-friendly and produced the relevant information . In particular , the tool was enhanced to become a valuable clinical supervision document and quickly became an essential part of the allocations meetings .
The tool enables staff to see at a glance the level of complexity of each team member ’ s caseload and the overall team caseload , allowing them to forward plan their workload and the team allocation list .
It also enabled the staff to better identify service users nearing discharge to ensure that reports and recommendations were written in a timely manner according delays to discharge .
Other aspects to the design included using Lean techniques to streamline the team processes , including administration staff to support , reviewing the paperwork to reduce duplications , and planning diaries in advance and ring fencing time to complete clinical administration tasks .
Following the guidance on allied health professional job planning issued by NHS Improvement in 2017 , individual job plans were completed for the team that linked the percentage of direct faceto-face contact time to a face-to-face contact calculator on the caseload weighting too , making the job plan and the weighting tool a live reflection of their time for care .
The general feeling in the team was that while the journey itself was often challenging and uncomfortable , the result was worth it .
Lizzie Druce , specialist occupational therapist in the team , describes the value of the caseload weighting tool as ‘ helping you to keep on track with your caseload and ensure you support service-users through the occupational therapy process ’. She adds : ‘ It enables you to identify when you have capacity to take on more work .’
The review period for the project ended in July 2019 , by which point the team had fully adopted the weighting tool into their allocations meeting and clinical supervision .
Results from a follow up wellbeing survey showed that staff felt they were better able to be effective in their role than before the project started and felt more valued in the team .
The result of a number of small , targeted changes led to an increase in time for care to 26 per cent in July 2019 . The allocations waiting list had reduced by half and the longest wait on the allocations waiting list had reduced from 57 weeks to 15 weeks – resulting in the service consistently achieving the 18-week waiting target .
The allocations process was also improved by the caseload weighting tool . The team was able to use the weighting tool to make more informed decisions about who was best able to manage a new complex case .
The project team has now switched focus to job planning and has incorporated the caseload weighting information to benchmark expectations . Job plans are currently being rolled out and we expect a significant increase in time for care over the next six months .
A number of services are looking at replicating the caseload weighting tool and work has started with a number of projects to implement tools across three areas .
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