Skill Mix: The essentials you need to know

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Skill Mix The essentials you need to know
Maggie Fisher Chair, Health Visitor Forum NPC
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Skill Mix The Essentials You Need To Know

• UNITE/CPHVA CONFERENCE
• SOUTHPORT October 2009
• Maggie Fisher Health Visitor Netmums Chair
  Unite/CPHVA Health Visitors Forum

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RATIONALE FOR SKILL MIX

• There are two main driving forces behind the
  reasons for the introduction of skill mix.
• The workforce issues and spiralling staff costs.
• The increasing complexity of health care needs.

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WHAT IS SKILL MIX?

• Gibbs et al (1991) defined grade mix as a mix of
  differing grades of staff in a particular working
  environment, their costs and activities. Grade
  mix does not reflect the skills of the staff
  concerned or the needs of their clients.

• Skill mix refers to the skills and experience of
  staff, their continuing education and
  professional development, years of experience and
  how they bring these together to influence their
  professional judgement. Skill mix connects
  needs with skills available and outcomes in a
  particular working environment with a specific
  client group.

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THE DIFFERENCES BETWEEN GRADE MIX AND SKILL MIX
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LINES OF ACCOUNTABILITY (Andrews, A. 1995 Pg.
26)
Public
Employer
Client
Profession
INCIDENT
Professional Conduct Hearing
Criminal Prosecution
Civil Claim
Disciplinary Action
Professional Misconduct
Breach of Contract
Criminal Offence
Claim for Compensation
o
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DELEGATION AND SKILL MIX

• Delegation defined
• The NMC (2008) define delegation as the transfer
  to a competent individual, the authority to
  perform a specific task in a specified situation
  that can be carried out in the absence of that
  nurse or midwife and without direct supervision.

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FACTORS AFFECTING DELEGATION IN SKILL MIX

• Carr and Pearsons study (2005) identified four
  facets to delegation in relation to skill mix and
  the care environment
• Decision making
• The delegator-delegatee relationship
• Patient/client need
• Structural and contextual facets

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DELEGATE EFFECTIVELY

• You must establish that anyone you delegate to is
  able to carry out your instructions
• You must confirm that the outcome of any
  delegated task meets required standards
• You must make sure that everyone you are
  responsible for is supervised and supported
• The Code NMC (2008) page 4

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MANAGE RISK

• You must act without delay if you believe that
  you, a colleague or anyone else may be putting
  someone at risk
• You must inform someone in authority if you
  experience problems that prevent you working
  within this Code or other nationally agreed
  standards
• You must report your concerns in writing if
  problems in the environment of care are putting
  people at risk
• The Code NMC (2008) page 4

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SKILL MIX IMPLICATIONS FOR PRACTICE

• When community practitioners delegate tasks that
  are normally within their normal practice they
  usually retain accountability for that persons
  care, and must therefore continue to ensure the
  delegated duties are carried out properly and
  delegation remains appropriate. This presents a
  greater management and supervision challenge in a
  community setting than it does in the more
  controlled environment of a hospital or clinic.
  Accountability for professional decisions and
  conduct relates directly to the authority that a
  practitioner has. Every practitioner has full
  responsibility for her/his actions or omissions.

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SKILL MIX IMPLICATIONS FOR PRACTICE

• A robust local policy framework needs to be
• in place to support staff to ensure
• The work is at an appropriate level
• The person has the knowledge and skills to be
  able to do the work
• The scope and parameters of the work to be
  carried out is clearly understood.

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FACTORS FOR SUCCESSFUL SKILL MIX INTRODUCTION

• A bottom up approach
• Excellent leadership
• Clear lines of communication and accountability
• Clearly thought through planning and
  implementation
• Regular planned supervision
• Through induction training and programme for all
  new staff

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FACTORS FOR SUCCESSFUL SKILL MIX INTRODUCTION

• Clear and established links with clinical
  governance to produce protocols
• Regular appraisal and training to ensure
  professional development
• Maintaince of core competencies
• Adequate resources for the team
• Regular review of the skill mix team

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THE LOW MORALE CYCLE. (MCKENNA, 1995 ADAPTED
FROM OVRETVEIT, 1992)
1. Staff cuts cost control
2. More work for remaining staff
6. More cuts More controls
5. Cost up Quality down
3. Staff/clients dissatisfied
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WHAT ARE THE ISSUES FOR YOU?
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REFERENCES

• Carr, S. and Pearson, P. (2005) Delegation
  perception and practice in community nursing.
  Primary Health Care Research and Development. 6
  pp72-81
• Charlton, B.G. Calvert, N. White, M et al. (1994)
  Health promotion priorities for general practice
  constructing and using indicative prevalences
  British Medical Journal. 308 pp.1019-22
• Cowley, S. and Andrews, A. (2001) A
  scenario-based analysis of health visiting
  dilemmas. Community Practitioner. Vol 74. No 4
  April 20
• Cowley S. A funding model for health visiting
  Part 2 Impact and implementation Community
  Practitioner 2007. 80 12, 24-31

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REFERENCES

• Family Parenting Institute (2009) Health
  Visitors A Progress Report. FPI
  www.familyandparenting.org/healthVisitors
• Gimson, S. (2007) Health Visitors- an endangered
  species. Family and Parenting Institute.
• Gibbs, I. McCaughan, D. Griffiths, M. (1991)
  Skill mix in nursing a selective review of the
  literature. Journal of Advanced Nursing. Feb 16
  16 (2) pp. 242-9
• Griffiths, P. Jones, S. Maben. J. Murrells. T
  (2008) State of the art metrics for nursing a
  rapid appraisal. National Nursing Research Unit.
  Kings College London. Accessed October 21st 2008

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REFERENCES

• McKenna, H. (1995) Skill mix substitution and
  quality of care an exploration of assumptions
  from the research literature. Journal of Advanced
  Nursing. 21, pp.452-59
• Newland, R. (2007) Record Keeping and
  Documentation Principles into Practice
  Unite/CPHVA
• Russell, S. (2008) Left Fending for Ourselves A
  report on the health visitor service as
  experienced by mums. Netmums. http//www.netmums.c
  om/files/FendingforOurselves_withappendix.pdf
  (Accessed January 30th 2009)

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