Modelling the Impact of Workforce Change in Social Services
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Modelling the Impact of Workforce Change in Social
Services
Sally Brailsford1, Pei Shan Ang1 and Peter Knight 2
1 School of Management, University of Southampton, UK2 Hampshire Social Services, UK
ORAHS 32, Wrocław, Poland, 23-28 July 2006
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Basingstoke
Portsmouth
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Hampshire Social Services• One of the biggest Departments in England: over
5,000 staff, annual turnover over £300M• Serves population of over 1.2 million people• Divided into 7 regions • Proportion of people over 85 is higher than the
national average and is continuing to grow• Nationally, people over 65 use around 40% of the
NHS budget and 50% of the Social Services budget
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Equipment services• HCC SSD provides services to enable elderly
and disabled people to maintain independence and autonomy in their daily lives
• Professional assessment service and the loaning of special equipment
• Equipment provision service run by the Integrated Community Equipment Service
• Two centres in the Hampshire region:– Hampshire Joint Equipment Store (JES) in
Basingstoke– Portsmouth Community JES
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Current process
• Client’s needs assessed by Occupational Therapist (OT)
• OT orders equipment from JES or substore• Equipment delivered by van• OT makes second visit to demonstrate
equipment and train client in its use: may involve some reassessment
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Yes
No
Yes
No
Yes
No
No
Start
Client phones OT Direct
Self assessment?
Staff arranges for OT visit
OT assesses and orders equipment
More than 3 items selected?
OT Direct (trained staff) processes order
JES receives order(via fax, e-form, post, hand)
Self collection?
Yes
Drivers receive tickets in the afternoon
Normal delivery: Within 7-10 working daysUrgent delivery : Within 3 working daysCollection : Within 2 weeks
Client collects items
Sub-store has inadequate stock
Sub-store makes order/ System shows that certain stocks are below standard
level
JES allocate equipment
Delivery and collection tickets being printed
Assessment through OT Direct/ Equipment collection?
OT visit clients and demonstrate equipment
End
Client waits
OT (or district nurse) visit client
OT (or district nurse) assesses client and orders equipment
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Current Problems
• Shortage of OTs• Even the most basic equipment currently has
to be demonstrated by an OT • Long waiting times between assessment by
an OT and receiving the equipment and being able to use it
• Inappropriate use of the OTs’ expert skills• Problem likely to get worse in future
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Potential Solution
• Train van drivers to install and demonstrate equipment
• Implications: costs of training and temporary cover for van drivers; need to recruit additional drivers; possible resistance from OT’s
• Key question: which specific equipment (of the 900 – 1000 types held in the JES) would it be safe for drivers to demonstrate?
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Study Objectives
• To determine the optimum number of additional drivers that need to be recruited to maintain the current level of performance and to take on these additional duties
• To obtain the overall cash value of the time saving to OT’s from adopting this approach which enables them to focus their time and skills more appropriately
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Modelling approach• Discrete-event simulation
– Need to allow for variability of input variables.– Allows users to forecast the impact of different
scenarios by asking ‘what if’ questions.– Graphical interface as a better communication tool .– Determine number of drivers needed after
implementing the proposal.
• Spreadsheet model– Convenient “front end” for user to experiment with
Simul8 model– To carry out the cost benefit analysis of this proposal.
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Data Requirements
– Equipment groups– Demand (order arrival rate)– Client numbers– Travel time – Demonstration time – Proportion of clients with special conditions– Maximum hours drivers available for delivery/
collection– Sub-stores replenishment– Costs
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Equipment Groups
• Different categories for each JES
• Categorized, after discussions with OTs, by the following criteria:– Equipment in the same group should have
similar demonstration time – Desirable to have equipment of a similar
function in the same group
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Equipment Groups - Clients’ Deliveries
A Standard Equipment (OT)
B Standard Equipment_5mins (Driver)
C Standard Equipment_10mins (Driver)
D Standard Equipment_15mins (Driver)
E Standard Equipment_15-20mins (Driver)
F Standard Equipment_15-30mins (Driver)
G Standard Equipment_20-30mins (Driver)
H Standard Equipment_30-45mins (Driver)
I Hoists (OT)
J Motor (OT)
K Pressure Relieving (OT)
L Pressure Relieving (Driver)
M Sling (OT)
N Special Equipment (OT)
O Special Equipment_15-30mins (Driver)
P Special Equipment_15-20mins (Driver)
Q Walking & Mobility (OT)
R Walking & Mobility (Driver)
* (OT): Still requires OT demonstration (Driver): Driver can demonstrate * _xx-yy mins: Estimated demonstration time for equipment in the corresponding group
Equipment Groups - Clients’ Collection & Sub-stores’ Deliveries
AA Standard Equipment
BB Hoists
CC Motor
DD Pressure Relieving
EE Sling
FF Special Equipment
GG Walking & Mobility
Equipment Groups –
Portsmouth JES
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Demand and Travel Time
• Demand data – obtained from the Primary Care Trust Group
Reports and Store Activity Reports– analysed based on each group– distributions fitted using BestFit
• Travel time from work place to client or from client to client limits the maximum number of clients that a driver or OT can reach in a day
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Demonstration time
• Vital in deciding the additional task time required from drivers and time saved in OTs
• Drivers will be up to 25% quicker than OTs (on average) in demonstration time, as they will not be reassessing the clients
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Other data
• Clients with special conditions– Drivers might be less suitable to demonstrate to
certain clients, e.g. amputees, or clients with terminal conditions, Parkinsons disease etc
• Maximum hours drivers available for delivery/ collection– A main determinant of the total duties that can be
performed by a driver.
• Training and staffing costs
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The Simul8 model
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Three scenarios
• Permanent drivers do not cross-task (swap jobs with other drivers); No agency drivers
• Permanent drivers do not cross-task; Agency drivers will be employed when needed
• Permanent drivers cross-task; No agency drivers
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Results – Basingstoke JES
Costs Permanent Agency Driver
Scenario Value (£) Driver Lower Limit Average Upper Limit
i 10968.75 13 - 0 -
ii 10720.76 12 62.73 66.20 69.66
iii 10968.75 13 - 0 -
Best combination 10720.76 12 62.73 66.20 69.66
OTs' time saved 677.66 695.45 713.25
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Results – Portsmouth JES
Costs Permanent Agency Driver
Scenario Value (£) DriverLower Limit Average Upper Limit
i 6750.00 8 - 0.00 -
ii 6209.85 7 29.16 33.73 38.31
iii 6750.00 8 - 0.00 -
Best combination 6209.85 7 29.16 33.73 38.31
OTs' time saved 299.93 320.47 341.00
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Costs involved after Implementation
Short-term
Total training cost 987.19
Total agency driver cost while training (B) 1458.00
Total agency driver cost while training (P) 583.20
Short-termed extra costs 3028.39
Long term
Total permanent driver costs/ month (B) 15000.00
Total agency driver cost/ month (B) 595.76
less Current Cost (B) 12500.00
Total permanent driver costs/ month (P) 8750.00
Total agency driver cost/ month (P) 303.60
less Current Cost (P) 5000.00
Long-term extra costs 7149.36
Costs saved after implementation
less Total OT time saved (cash value) 9191.66
986.09
Cost Benefit Analysis
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Payback Period
Time Net Cash Cumulative Payback Month
(Month) Flow Cash Flow
0 Costs spent -3028.39 -3028.39
1 Costs spent 2042.30 -986.09
2 Costs saved 2042.30 1056.21 Payback Month
3 Costs saved 2042.30 3098.51
4 Costs saved 2042.30 5140.81
5 Costs saved 2042.30 7183.11
6 Costs saved 2042.30 9225.41
7 Costs saved 2042.30 11267.71
8 Costs saved 2042.30 13310.01
9 Costs saved 2042.30 15352.31
10 Costs saved 2042.30 17394.61
11 Costs saved 2042.30 19436.91
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Conclusions
• Both JES need additional drivers if drivers are taking over part of the demonstration tasks from OTs
• This proposal will save OT time equating to a cash value of approx £9200 per month
• The payback period is less than two months
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Thanks are due to
• Frances Farrar, Kevan Dyne and Richard Jarczyk from the Portsmouth JES
• Dr. Maxwell Chipulu and Korina Katsaliaki from the University of Southampton
• Many other HSS staff (OTs and drivers) who were involved directly or indirectly in this project