What is it?
Establishment Genie is an online tool that supports senior nurses and midwives, in partnership with their non-clinical colleagues, to review, compare, remodel and report their establishments.
From working with 30 hospitals in the UK, Australia and New Zealand on nursing workforce reviews, we saw an opportunity to create something to help providers take stock of care levels, plan and remodel for safe staffing, and articulate the budget required to deliver this. The challenges that these organisations shared with us included:
- Ward-level workforce analysis available to senior nurses and midwives to enable and justify decision making was of variable scope and quality. This disadvantaged the professional voice in trustwide planning and debates.
- Different providers used different staffing metrics when reviewing their establishment – and the same metric could be calculated differently from trust to trust. This compromised comparison and reporting accuracy.
- A push-and-pull relationship between safe staffing and budgeting, and a lack of common ground from which to approach this as a shared, corporate issue.
- Guidance on how and what to report in order to demonstrate ‘safe staffing’ and meet the monthly and six-monthly reporting requirement was regarded by many as light. There is significant variation in what trusts publish and considerable time is spent by senior staff on producing the outputs.
- Certain workforce cost reduction approaches risked false economies and placed hidden pressure on safety, budgetary control and the ability to cover 24/7 services.
There are a number of tools to help trusts roster their staff and respond to staffing issues on-the-day, but we believe there is a gap in detailed, integrated planning and budgeting at the very beginning of the staffing continuum. We designed Establishment Genie with this in mind, and consulted with experts and piloted with providers over 12 months to develop our approach.
What do providers use Establishment Genie for?
- Taking stock of establishments and remodelling to improve safety or cost
- Delivering cost reduction safely and articulating the relationship between budgets and care levels
- Identifying the exact WTE requirement and uplift for each ward and comparing this to the budget
- Preparing for, or responding to, inspections by the CQC and other regulators
- Overlaying staffing levels with quality indicators to explore trends between staffing and outcomes
- Exploring better, cheaper ways of meeting fluctuations in demand, bed numbers and patient mix
- Saving time and improving the quality of monthly and six-monthly safe staffing reports
- Demonstrating compliance with recommendations from the Francis inquiry, Carter review and the NQB
- Modelling the workforce for new roles (e.g. Band 4 Nursing Associates), mergers or reconfiguration of services
What does Establishment Genie mean to me?
The Establishment Genie is for use by senior nurses and midwives in collaboration with their non-clinical colleagues, but we envisage benefits for other stakeholders and audiences:
Researchers and Policy Makers
We hope the reports that trusts publish, and the bank of ward-level data that will build over time from data being collected and analysed in a uniform way will be of benefit to the profession. Our clients frequently ask what is a ‘good’ score for staffing metrics like Care Hours per Bed Day – we hope that the cumulative use of the system, and the ability to compare, will help hospitals to decide what ‘good’ means to them. See our page on Clients & Case Studies, or contact us to discuss your policy-related interests or questions.
Regarding the other workforce and rostering tools available, we have designed the Establishment Genie to be complementary to these, to address what we perceive as a gap in the workforce planning continuum. We actively recommend that our clients triangulate the outputs from the Genie with outputs from other tools, and we provide a list of examples on our Policy & Practice page.
We would like to partner with individuals or organisations to research and appraise the impact that the Genie may have over time on the organisations that use it. Please contact us if you are able to help.
As a key audience of the monthly and six-monthly safe staffing report that all trusts must publish, the Genie can improve the clarity and scope of the information you receive. You have the assurance of knowing the outputs have been calculated in a consistent way, which aids comparison across all trusts that you commission or benchmark against.
The metrics integrate safety and cost, and offer a value for money perspective on the workforce. If you have a special interest in a particular performance issue or patient outcome, you can request that your partner trust(s) include show this outcome against their staffing data. Consistent formats and metrics from one report to the next allow you to track progress over time. The facility to remodel for different scenarios (e.g. winter beds, changes in activity, reconfigurations, etc) enables balanced discussions around workforce costs and capacity.
Providers may use Establishment Genie reports to demonstrate the approach taken to assure nursing and midwifery planned staffing levels. By applying local or national staffing guidelines (e.g. nurse to bed ratios in paediatrics, etc), any times in the week where desired standards are not met will be highlighted.
Trusts may also use the Genie to react to action points raised in inspection reports. If staffing levels or skillmix are revised in response to CQC findings, the Current and Proposed reporting feature can articulate this transition, and overlaying outcome data against staffing metrics may help to demonstrate the improvements in patient care that result.
We’re always happy to receive feedback, explain our approach in more detail and discuss how the Genie could be of value to your interests. Please contact us to find out more.