Integrated working in community health and care promises benefits for people receiving care and workers as well as operational savings from better use of precious workforce capacity.
Delegating healthcare tasks reduces demand on nursing staff
Task sharing in integrated teams is often thought of as going in one direction by delegating healthcare activities from healthcare professionals, such as nurses, to trained homecare workers. This reduces demand on nurses, enabling them to work at the ‘top of their license’.
Part of the logic is that shifting tasks from higher paid workers (nurses) to lower paid workers (homecare workers) is expected to reduce overall cost.
This sounds reasonable but does it make best use of the team as a whole?
Sharing a small number of tasks in both directions can benefit the whole team
Many of AI Dimension’s international customers operate integrated teams and use our optimisation both to design the operating model and for daily operational planning. Here’s a real-world example showing the benefits of sharing tasks in both directions.
The image below shows the morning schedules from an integrated team with 4 registered nurses and 13 homecare assistants. In this integrated team, homecare assistants undertake delegated healthcare tasks, reducing demand on nurses.
However, during the morning peak, before 10am, nurses also carry out a small number of homecare tasks, mostly for people they’re already visiting – these tasks are circled in red.
The morning period, before 10am, tends to be the busiest in homecare, and this peak determines how many workers are needed. Sharing a small number of tasks during this period can have a surprisingly large impact on staffing requirements across the whole shift.
In this example this results in:
7% reduction in the number of homecare assistants needed No additional nurses required No increase in travel for nurses Nursing capacity still reserved for urgent, unplanned care
In this example, homecare assistants are paid for full shifts, so needing 7% fewer workers represents a meaningful reduction in staff cost. Even where workers are only paid with reference to contact time, such as in the UK, this would translate into being able to give workers better filled schedules and more paid hours.
This ties into the wider concept of managing homecare staffing requirements by managing and shaping peak demand periods – I’ll write a separate blog post about this.
Using Optimisation to break down silos, test assumptions and co-design services
Before implementing these types of change, AI Dimension Optimisation is used to model different operating models and explore their impact.
In this example, it enables:
Homecare workers and nurses to understand each other’s current work by visualising their routes, schedules and interactions.
Those same homecare workers and nurses to understand how sharing tasks in different ways would affect their daily work by modelling the changes to routes, schedules and interactions.
Managers to compare the options, including workforce requirements, travel, quality of care and cost.
This gives integrated teams a practical way to test assumptions about who should do what, understand the effect on the whole service and agree changes together.
Optimisation then supports daily planning within the agreed operating model.
Optimisation at all levels
Making the best use of an integrated workforce means looking at how the whole team works together. Using Optimisation to model different options helps identify opportunities which would be missed when each profession’s workload is planned separately.
Putting these changes into practice adds complexity to daily planning. Tasks need to be allocated across the team, taking account of skills, timing and travel, while maintaining stability, responding to changes and allowing for urgent, unplanned work.
AI Dimension Optimisation supports all planning stages: helping teams explore and agree how they will work together, then creating workable daily schedules that put those decisions into action.
If you’re developing integrated teams or reviewing how your community services operate, I’d welcome a conversation to compare notes and hear how you’re approaching it. I’d also be happy to share how optimisation is used to explore different ways of working and put them into practice.
