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Key definitions used by Safe Staffing Healthy Workplaces Unit

Note: There is a plethora of terminology in common use in health literature and in many instances a term may have a range of meanings.  The purpose of this glossary is to provide clear definitions for the terminology in current usage in the work of the SSHW Unit.

Safe Staffing & Healthy Workplaces – is achieved when we balance the triad of quality patient care, with a quality work environment for staff, and best use of the health resource

Quality Patient Care, Quality Work Environment, Best Use of Health Resources

Base staffing: A term used to describe the planned number, mix and scheduling of staff in a service based the forecast demand and predictable variance.

Bed Occupancy (as a measure of capacity): Is established by taking a census of patients physically present at a point in time (can be done more than once per 24 hours and averaged).

Buffer: Is the provision of resources in the base resourcing that accounts for predictable variation between care capacity and demand. 

Care Capacity: Is the resource (people, place and tools) needed to meet the patient requirement for care. Care capacity can relate to a single practitioner or be seen as widely as the whole organisation. Care Capacity is a product of the total financial capacity, resource capacity, workforce capacity, scheduling, and work organisation

Care Capacity deficit: Refers to any circumstance when any resource that has been assessed as needed to meet the patients care need is not available or not present in the quantity required.

Care Capacity surplus: Refers to any circumstance where the non re-investable resources available exceed the current demand.  For example the cost of theatre staff who are already present when the list is cancelled or the cost of having a scanner idle cannot be reinvested at a future point; the potential productivity has been lost.

Care Capacity Demand Management: A whole of organisation approach to identifying the requirement for care, matching care capacity to the demand for care, generating data to monitor and measure variance, and responding to variance.

Care Rationing: Is defined as any time that a patient does not receive an aspect of care that professional consensus judged to be in their interests. Care may be delayed, performed to a sub-optimal level, omitted or inappropriately delegated.

Churn: Relates to the amount of patient turnover in relation to base occupancy.  A ‘churn factor’ is currently being developed.  For the interim, churn should be calculated as the number of patient movements (in/out/moved internally) during a shift.

Core HPPD: Is the time required to complete activity directly related to the well-being of the patient (i.e. is not restricted to ‘hands-on’ care)

Co-morbidities: Refers to the total range of disease and/or debility associated with a patient during an episode of care (i.e. may be in addition to the primary presenting complaint)

Core (key) data sets: Refers to a named collection of data collected by the organisation to provide a specifically targeted information picture of whether the service is functioning within the boundaries of quality patient care, provision of a  quality work environment, and making productive use of the health resource.

Demand Forecasting: The process used by organisations to determine as accurately as possible the future demand that will be placed on the organisation. Forecasting is informed by prospective modelling of future need and retrospective review of past performance.

Discretionary work effort: Is defined as time spent working that is outside of the contracted hours of work. For example missed or shortened breaks or working past the end of the normal work day.

Environmental complexity: Includes features of the environment that impact on the ability to deliver patient care and/or care to a group of patients within a service. This involves many features including  tools, scheduling of the work, the way work is organised, team models, levels of authority, physical layout, efficacy of the supply chain etc.

‘Essential care’: Is a term used to define an agreed process of care rationing (see definition) that is implemented when demand exceeds capacity.

Healthy Workplace: One in which people work in a positive environment in which they are valued, and that supports them to work in an effective manner (HWAC, 2006).

Mix & Match: Is a resource developed by the SSHW Unit that enables a service to determine the most productive match between demand and base staff resourcing.  This includes the determination of skill mix, numbers and scheduling and also produces a cost estimate for the service.

Model of Care: Refers to the team matrix (including skill mix, role mix, and numbers of staff) that is established to provide the care capacity required for a ward or service.

Minimum staffing level: The minimum staffing level for a service is the base number of staff that will be supplied irrespective of patient numbers.  For example a SCBU may have a minimum staffing level of 1 regardless of whether there are any babies in the service or not on the basis that the capacity has to be available at all times.

Non Core HPPD (or other Productive): Is the time required to undertake activity not directly related to the well-being of a particular patient but necessary to effect the safe and efficient functioning of the environment of care.

Non productive time: Time spent outside of the clinical environment which is neither directly related to patient care nor related to the environment of care. Examples would be professional development, planned leave and unplanned leave.

Nursing care intensity: The amount of care required by each patient and the level of nursing skills required to deliver that care (often used interchangeably with ‘patient acuity’)

Organisational design: Refers to all activities that relate to preparing the organisation to safely and effectively deliver planned services and to manage variance. This includes for example; forecasting, planning, budgeting matching resources, establishing resources and structures, scheduling, training, IT etc.

Partnership: In this context ‘partnership’ refers to workplace partnership between DHBs and health unions that is being used as a modern approach to managing employment and industrial relations. It is about building an employment relationship based on mutual gain, with the underlying idea that there is something in it for all parties (PRC definition).

Patient acuity: (Sometimes used interchangeably with the terms ‘patient complexity’ or ‘nursing intensity’). Is an amalgamated assessment of the care required by an individual patient based on factors such as dependency, intensity, time critical factors, co-morbidities, and social and spiritual needs.

Patient dependency: The level to which the patient is dependent on nursing care to attain, retain, or maintain health and function

Productive time: The time spent providing direct care to patients and/or the time spent undertaking activity not directly related to the well-being of a particular patient but necessary to effect the safe and efficient functioning of the environment of care.

Productivity: Is defined as the quality of the outcome for the amount of resource required to achieve this. 

Safe Staffing: Is achieved when an appropriate number of staff, with a suitable mix of skill levels, is available at all times to ensure patient care needs are met and that hazard free working conditions are maintained. (AFT, n.d.)

Safe Staffing Healthy Workplaces Unit (SSHW Unit): A Unit established as a collaborative between DHBs and health unions to facilitate change within DHBs relating to the provision of safe staffing and healthy workplaces.

Service Delivery: Describes the part of organisational functioning that involves the application of resources and the provision of care

Service Utilisation: Is established by counting the number of patients who utilised a service over a given period of time; (utilisation can be calculated as an average or as an ‘on the day’ marker of service requirement)

Supply chain: Refers to the movement of materials as they flow from their source to the end customer

Staffing configuration: Refers to the mix of staff type and the accompanying work schedule (roster)

Time critical factors: Refers to specific time-related care interventions that are required to secure an optimal patient outcome

Total hours per patient day (HPPD): Is a process of establishing the hours of core clinical care and non core activity required in a 24 hour period to meet the patient requirement for care and maintain a functioning environment.  HPPD does not account for all indirect or non-productive work that takes place; for example in-service education and quality activities may be included in the daily total HPPD, but out of ward education may be calculated separately.

Variance: Is the term used to describe situations where the service demand and/or available care capacity differs from what was forecasted and resourced in the base establishment

Variance Management: Is a structured approach used by organisations to minimise causes of mismatch between demand and care capacity and to respond effectively to residual variance.

Variance response management (VRM): Is a planned intervention that is invoked when there is a mismatch between demand and care capacity.

Variance response testing (VRT): Is a process that is used to test how well the hours of care supplied by a roster met the actual hours of care required.

Variance smoothing: Refers to the identification and reduction of any potential gap between care capacity and demand before the day of service delivery.

‘Whole of organisation’ approach: A whole of organisation approach recognises that an organisation and those within it represent a functioning entity that has inbuilt strengths, capability and relationships. A whole of organisation approach seeks to strengthen both the system’s capability to produce the right outcomes and the relationships that support sound action and good decision making.

Work analysis: Is a process used within the Mix & Match methodology to identify what work is being undertaken in a service and what work is unable to be completed.

Workload management: Is the normal process that individuals and teams use to schedule patient care over a defined period. 

 “Workload issues”: Is a term often used by clinical nurses and midwives to describe episodes of care capacity deficit; that is the requirement for care exceeds the capacity to provide it. “Workload issues” should be interpreted more broadly than simply working hard (work intensity)

Workload complexity: Includes all of the factors relating to patient complexity but also includes environmental complexity. (The overall care capacity is influenced by both patient complexity and environmental complexity)

Workload tolerance: Is a term used to refer to an allowance above or below the base hours of care supplied.  The allowance recognises that the team will generally be able to compensate for a degree of workload variation within current capacity. For example the hours of care available for the service on the morning shift is 28.  The workload tolerance is 12.5%. 12.5% of 28 is 3.5.  Therefore as long as the care hours required are between 24.5 and 31.5 this service would be considered to be operating within the agreed workload tolerance.  There is however a MAXIMUM workload tolerance of four hours.  Therefore if a ward had a base requirement of 48 hours, 12.5% of this would be 6 hours.  Because 4 hours is the maximum workload tolerance, workload tolerance in this instance would be exceeded when the deficit exceeds 4 hours not 6 hours.   

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