Learn how Surrey Heartlands’ Continuing Healthcare service (CHC) has restructured its service delivery and staff models to meet varying population needs.
Surrey Heartlands’ Continuing Healthcare service is delivered by circa.100 staff, 51% of whom are clinicians working in multi-disciplinary teams (MDTs). The area population is 1.2 million, including 20% more people aged 80+ than the rest of England; meaning a large frail population with greater needs and complexity.
What was the problem you were trying to solve?
Feedback and complaints from staff, service users and integrated delivery partners as well as a jump in vacancies led the team to start to consider whether service changes were needed to improve the experience of staff, partners and service users alike. At the time the CHC team’s service model was organised in a way that it was delivering mirrored services across Surrey Heartlands’ four localities. However, the team were aware that the demand for their services was not evenly distributed across the localities, resulting in an inequity of service across the system. The combination of these factors acted as the drivers for novel solutions.
What did you do?
The team used a collaborative and participative leadership approach to gain the insights of staff regarding what could be done. The following changes were made:
A redefined service model which included the restructuring of responsibilities into clinical and pathway specialist leads and caseload and assessment delivery teams. The model moved away from being locality-based. In line with the new model, staff roles were redesigned based on a competency model where staff self-identified their areas of strength and preference. Each CHC-eligible patient has a named case manager and a single point of contact (SPOC) was created where the duty team receives all queries and then directs them to the appropriate person/team.
A redesigned approach to staff recruitment, induction, and competency framework. All of these are anchored into the National Framework for NHS CHC and decision support tool (DST).
The new values-based approach to recruitment included a refresh of adverts which highlighted the benefits for clinicians in working for CHC, in particular the flexibility that is afforded to them, as well as a centralisation of recruitment for the whole of Surrey Heartlands CHC – bringing in resource efficiencies and consistency of candidate assessment. New interview questions were created which reflect the job description and allow the candidate to share their strengths and development opportunities within the context of the revised competency framework. Interviews are also now seen as a space to clarify and set expectations relating to service delivery requirements so that candidates are fully informed about the CHC context prior to joining the service.
Individualised induction plans, derived from interview discussions, are now created for the 16-week probationary period for new starters and all new starters are initially line-managed by the professional development lead for the first month. This ensures that induction plans and in place for competency development areas. New starters are also assigned a peer buddy to help navigate their orientation of the organisation and build supportive relationships with colleagues.
What did these changes cost?
The activity was cost-neutral and was covered within the existing clinical staff budget/s.
What are the benefits have you seen from these changes?
The team have noted many benefits including:
- Improved equity of service provision due to ensuring the right people are in the right place to be able to offer the right support.
- Reduced complaints from partners and service users as a named case worker is now in place, so there is no chasing for updates or responses from the service.
- Reduced agency spend through the improved recruitment and induction processes leading to the filling of vacant clinical posts.
- Improved staff retention through undertaking meaningful recruitment and induction processes which ensure that expectations are set and met.
- Increased staff engagement as people are in roles that play to their strengths, optimise their impact and improve confidence.
- Greater sense of staff belonging as the workforce felt that their voice was reflected in all changes made.
What are you working on next as a team?
The team will be continuing to improve service delivery by moving Discharge to Assess (D2A) into a business-as-usual activity; surveying all staff recruited in the last six months to gain feedback about how recruitment and induction processes can be continually improved and also exploring how the use of technology can help to improve our pathways and ways of working.
What are the leadership top tips you’d like to share with others, based on your learning from this work?
Values-based vision and behaviours are key. Leaders need to have a shared vision and behaviours that are grounded in the values of honesty, inclusivity, and transparency in order to create a learning culture.
Collaborate and co-develop with your staff. They understand the context better than anyone and create spaces for meaningful discussion, debate, and decision-making.
Lead by example. Use a values-based competency framework to assess and develop your leadership skills.
Understand your local population, demand, and demographics. Being congruent with your surroundings is vital in improving equity of care.
Be brave. Don't be afraid to make big changes to meet service needs.
Remember people own what they help to create. The way to get adoption of change is to involve those who will be delivering it in the design of it.
Have a plan and make sure you have protected time to lead and deliver change.
Keep a continuous improvement mindset. Use feedback loops to check in regularly and make changes as necessary. Incorporate regular review, monitoring, and audit into your service governance so you can always see areas of opportunity.
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