This London-based NHS Foundation Trust formed in 2000 provides mental health care and delivers a range of specialist and community based health services across the City of London, and surrounding areas.
The School Health Service team that Meridian worked with are within the Children & Young People Community Health division, who work to tackle health inequalities, facilitate children with special needs into inclusive education and aim to promote health of school children.
A week’s study was conducted within the North & South school nursing teams, where Day in the Life of, capacity studies, diary and activity analysis took place to gain an understanding of the productivity as it stood, i.e. of school nurses time, how much was spent in contact with children and parents and how much was spent doing other activities. From the analysis:
- the actual observations showed that 24% of time was spent on school premises, i.e. in contact with children/ parents, Face to Face (FTF)
- the majority of nurses’ days were spent in lengthy case conferences, as well as safeguarding and care planning meetings
- nurses planned their own days, however, their activity was not managed by specific targets
The objectives over the 8 week project included:
- Developing and agreeing school contact frequencies, based on size & need, and modelling the resulting resource options;
- Ensuring that immunisation commitments, and all other monitoring, health promotion and education requirements were built into the way of working;
- Developing the methodology as a business development tool for winning and maintaining school nursing contracts, particularly with regard to investing in education of school staff, and health promotion within the pupil base.
In order to meet these objectives, Meridian worked with the management team and held 3 workshops and multiple one-to-one sessions to agree the new working model.
Various management tools were devised during the project, including an Activity List which reclassified multiple activities, resulting in a division of work into school and non-school based activities with defined expectations in relation to frequency and norms, which in turn fed the Resource Activity Modelling Tool, allowing management to quantify demand and match it with resources and ensure a more equitable allocation of schools between nurses. The activities/‘ways of working’ were repackaged to enhance the true value of the new service and this fed into the production of a booklet in preparation for presentation to head teachers in schools and also for the school nursing bid process.
The new model was supplemented with a robust Reporting and Review Process Flow and management report that ensured constant communication from school nurses to senior management, enabling the monitoring and identification of any areas of concern and good practice to be highlighted.
Through the implementation of the new model, the Trust was able to establish and define service Client Facing, 24% Non Client Facing, 76% Pre-project face to face time 2 delivery with corresponding requirements for different stakeholders.
The project has shown that at current capacity, the school nurses are able to spend on average one day per school per week on school premises, which would equate to 82%, an increase in time of almost 60%, dedicated to activities based in schools. The remaining 18% can be used for nurse development activities.
Utilising the Resource Activity Modelling Tool, it allows for senior management to develop a structured approach to the activity expectation per school to be conducted by school nurses on a daily/ weekly basis. It has also improved the clarity for nurses through the commitment of a scheduled weekly service provision, allowing and enabling them to provide their respective schools with a list of dates they will be based at the school, increasing transparency and nurse visibility and availability to teachers and children.
The new way of working has enabled the nurses to concentrate on health promotion and education, which was lacking in the previous model.
This work has not only improved the level of nurses’ presence within schools, which has received very positive feedback from head teachers and commissioners but can also be used to set an example for other health organisations on how a School Health Service should run more effectively. This work has also enabled the organisation to position itself competitively for future contract bidding.
In addition, Meridian proposed the development of a skills and flexibility matrix to identify training needs and highlight constraints in staff flexibility, providing an overview of the skill level of the team.
This was not part of the original project schedule, but proved very useful.
The implementation of a management control system particularly planning, assigning and reporting has ensured that Management are now equipped to continually improve the service provision within schools.