Staffing

Citation

Gourlay, R. (2004), "Staffing", International Journal of Health Care Quality Assurance, Vol. 17 No. 1. https://doi.org/10.1108/ijhcqa.2004.06217aaa.001

Staffing

Staffing

A key determinant of providing a quality service is that of staff, their numbers, competencies and deployment. The aim in managing and planning staff numbers is to achieve maximum productivity commensurate with quality and minimum risk.

The UK's National Health Service is one of those experiencing a staffing "crisis". For many types of staff, it is proving very difficult and expensive to recruit. This includes medical staff as well as manual staff such as porters, caterers and cleaners. And, of course, there has been for many years a shortage of nursing staff.

What is being done about such shortages? And how can a quality service be provided when a key resource is in short supply? The first place to turn to is the terms and conditions of service. Do the remuneration packages attract, retain and motivate staff? The answer always begins with "it all depends on what groups of staff are being considered".

In the NHS recruitment packages have been, and probably still are, sufficient to attract staff from developing countries; this is especially the case for nursing staff. However, the policy is often criticised for "pinching" staff from underdeveloped countries where the need is greater. Another issue is that of language and customs where the newcomer is not familiar with the host country's procedures and processes. Despite these issues, there is no doubt that this policy of employing foreign nationals works not only for manual staff but also for medical and nursing staff. Whether this is a long term solution is open to debate. It must surely be in the interest of the NHS to grow its own. One only needs to note the current costs of agency staff who are employed to fill the gaps to realise that recruiting abroad will not solve all the problems. What therefore inhibits local recruitment?

There are many possible answers to this question – is it the image of the "professional"? For example, are potential recruits inhibited by the hours of work of nurses and other professions; or is it something more basic such as not being able to find somewhere to live at a price they can afford. In London three is an emerging strategy of providing low cost accommodation for the city's key workers.

Other approaches to recruiting and retaining staff include the offer of a career to those in the very local labour market. This means that the hospital offers a full blown training and development programme covering both the theoretical and practical aspects of the job leading to a qualification that enhances their market value. The costs of such a strategy can easily be met by the savings on agency staff. Another value to the hospital is that they can ensure that the balance between theory and practice is correct and that the hospital's own processes and procedures are taught.

Another approach to maximising productivity is that of breaking down professional boundaries. Such boundaries are sometimes enshrined in the law which was formulated a number of years ago. Providing a professional who has the competency to do a task normally reserved to another professional discipline, there should be no reason why, say, a physiotherapist in an ITU could not also take X-rays, a task normally reserved for a radiographer.

Perhaps even more significantly, could not nurses undertake some medical procedures. Being able to deploy staff more flexibly can improve the patient's experience and save costs.

If one couples this "boundary breakdown" process with "growing your own" it is possible to foresee that a number of tasks currently done by a professional could be done by an assistant who does not have the full range of competencies possessed by the qualified professional.

Such an approach obviously depends on the clear definitions of the competencies required to do specified tasks. Although this would be a significant piece of work, it can be done and in fact is being done in the NHS under the rubric of "Agenda for change".

Another potent source of productivity improvement is that of process innovation and redesign. This approach often and quite properly focuses on improvements for the patient. But it is equally powerful in highlighting high cost areas when staff time is used rather extravagantly.

Again in the NHS, the modernisation agency is doing good work using this approach. There is probably a need to extend the operation more widely so that staff are constantly examining how they do their job and in what ways improvements can be made, especially in the area of staff costs.

Although staff shortages cause significant management problems in both costs and quality, there are a range of approaches that can and are being made to enhance the productivity of staff.

These approaches are not stand alone; they could and should include approaches not only to productivity but also to quality. By being developed in-house, the architects and designers of the strategies can ensure that the appropriate messages are included about the management of quality and the facilitation of continuing quality improvements.

Robin Gourlay