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Role Redesign


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Role Design
 


What is it and how can it help me?

Role redesign is a workforce improvement tool which can help you improve patient services, tackle staff shortages and increase job satisfaction through the development of new and amended roles. It can benefit the entire healthcare team, from support workers to the medical workforce, by challenging the set patterns of working to make life better and easier for patients and staff. There are many examples of role redesign improving the quality and flow of the patient journey and experience of the NHS.

When does it work best?

The NHS needs to continue to develop in a more innovative way. Process redesign is a key factor in this, including the redesign of job roles and responsibilities.

Role redesign is the subject of the tenth High Impact Change. The ‘10 High Impact Changes' document proposes that optimising roles along an agreed pathway of care leads to significant improvements for staff and patients in key areas, including reducing delays and waits for procedures.

How to use it

Do I need role redesign?
If you answer no to any of the following questions, role redesign may be able to help you. Do you feel that:

  • You fully use all your training and skills?
  • You give enough time to patient care?
  • There are enough staff to provide safe, timely and effective care?
  • Your roles are designed around patient needs?
  • You and your colleagues use all the technology available?

What does role redesign involve?

When you implement role redesign, it may not be necessary to create entirely new roles. Instead, you might extend an existing role so it has the capability to undertake an identified task. Sometimes the task moves between different levels of skill, sometimes the individual moves to take on new duties. A task in this context is an element of the workload that an individual undertakes, however complex.

Where to focus?
You can apply role redesign to a variety of service problems, for example, where there is variation in capacity caused by skills shortages, or problems with implementing the Working Time Directive (WTD). Examples from emergency services, primary care, intermediate care, mental health, and acute services demonstrate that role redesign helps place staff with the right skills, in the right place, at the right time.

There are three categories of role redesign which make a significant difference for patients and staff. 

  • Administrative and clerical roles - extending these roles releases caregivers from administrative duties and improves communication between providers and patients.
  • Assistant practitioners - healthcare workers with a level of knowledge and skill beyond that of the traditional healthcare assistant or support worker. They deliver care and undertake tasks that were previously within the remit of registered professional staff. 
  • Advanced practitioners - experienced clinical professionals who have developed their theoretical knowledge and skill to a very high standard. They can make some decisions and often have their own caseload. They carry out tasks that would previously have been performed by another professional. For example, nurses and allied health professionals (AHPs) undertaking tasks previously assigned to doctors.

What do I need to consider before starting?

Significant role redesign is a long term activity. It takes time to fully implement roles which require training or re-training (i.e. before you see the benefit in your service delivery), so don 't assume that you will immediately achieve like for like capacity from someone taking on a new role. You will need the support of your human resources team, so make sure you engage them early in the process. There are many tools and materials to help you with role redesign; the rest of this section is designed to help you work through the challenges.

So where do I start?
An action plan for redesigning and extending roles would include the following steps, in order:

1. Identify and define the service problem or constraint that can be solved by new or amended roles.

2. Assess the workforce: identify who does what in the current process.

3. Agree opportunities for new or redesigned roles with additional skills or training.

4. Define protocols and guidelines which will allow a wider range of professionals with the appropriate skills to provide care for patients.

5. Agree a training and development plan.

6. Write a business case for sustainability.

7. Agree an action plan for testing and/or implementation.

8. Undertake recruitment process into the new role.

Where can I get help?
The NHS Institute Improvement Leaders' Guide is a generic guide to role redesign, which includes:

  • Introduction to role redesign
  • Think about your own team
  • How are redesigned roles different?
  • Getting started
  • Important considerations when redesigning roles
  • Role profile and person specification
  • Preparing a business case
  • Case studies
  • Activities
  • Frequently asked questions.

What are the most common tools used?

The table below lists the most common tools used within role redesign, accessible from the Large Scale Workforce Change team at NHS Employers.

Problem analysis - advanced thoughts work card

This activity gives staff an opportunity to reflect on the service that they are working in and delivering to patients. It consists of a card that can be easily carried around in either a bag or pocket. Each member of the staff group working on solving a problem keeps the work card with them in the workplace for two weeks. During this time they consider and note the following:

  • What works well within the service?
  • Why does it work well?
  • What troubles them at night?
  • What are the things they would like to put it right?
  • What do they think is the problem?
  • What has been tried in the past? Did it work? If not, why not?
  • What ideas do they have for improvement?

This provides excellent material for discussion and deciding where to take action for improving flow through the patient journey.

Problem analysis
The root of the problem is not always obvious, especially where current working practices are based on local custom, tradition or simply habit. This tool helps you to analyse service issues to identify the root of the issue and look for possible workforce solutions. It takes you through a process to identify how changes to an existing role, or the development of a new role may solve the problem.

Time plotting patient journeys activity record
The tool provides a picture of time spent by staff undertaking patient related activities. It facilitates the removal of inappropriate tasks and the appropriate reallocation of tasks from one worker to another. This tool consists of time plotting activity cards and composite profile sheets.

  • It can be used by individuals or by groups.
  • It helps identify opportunities for task reallocation, removal of unnecessary steps, promoting team working, skills escalator and development of new roles.  
In pursuit of our workforce
This tool is an activity designed for healthcare staff to stimulate thoughts and discussion within a group, as well as pointing out some of the key issues that may be overlooked when creating new or amended roles.  It should be used during the final stages of role redesign.  The reponses in this activity further inform the development and implementation of a new or amended role.  It helps tackle management aspects of the new or amended ways of working.  It is useful when working with a large group.


Writing a job description person specification.
This tool guides you in writing a clear competence based job description and associated person specification. It should be used once a role has been developed and the tasks of the post holder clearly identified. The tool consists of a template for a role profile, which helps to develop an explicit description of what the post holder would do. The template helps you consider the purpose, responsibilities, physical and social environment of the role, training and education required and development opportunities. The role profile clarifies desired level of knowledge, skills, qualifications, previous experience and personal attributes.

 
Education and training plan
This tool should be used by groups of staff or individuals to identify the necessary skills for the role, plus the associated education and training necessary to achieve competence in each skill. It encourages you to:

  • Consider how easily the plan can be transferred to other roles or organisations
  • Seek external education, assessment and validation to increase the transferability of the plan
  • Work with neighbouring organisations to develop common education and training plans.

Managing practical issues
This tool can be used early in the role redesign process to refine roles that have been developed. You can approach it as a role play activity or use it to guide your thinking. It consists of a job interview scenario where the candidate asks the panel a series of practical questions relating to the new role or new way of working that they are being interviewed for. The tool contains a question card for the candidate to use and a worksheet for the interview panel to complete, listing the issues they need to take action on before the role can be implemented.

Developing a business case
This tool outlines how to write a persuasive, robust business case for role redesign to outline the changes you are proposing. It tells you what you need to do, how to prepare a business case and how to get it approved. Although it is a generic tool, the guidance is a useful checklist that you can amend to fit your internal processes.

Adventure enterprises
This tool takes participants away from the healthcare environment, puts them in a different context and helps them to consider role redesign without professional constraints. It is a small business scenario designed so that all participants are able to contribute to the discussion. The tool can be worked through as a table top exercise, where the group consider themselves to be the managing director and have to develop a new way of working, or as a role play, where the managing director has called a staff meeting to discuss the findings of the evaluations and work together to determine a way forward. The tool encourages participants to discuss issues relating to implementing a new role outside healthcare, thinking creatively to answer trigger questions. The responses can then be used to inspire and encourage new ways of working to address service issues.

Videos
There are a number of videos that are accessible from the Changing Workforce Programme resource. These provide an excellent method of learning, including the benefits of role redesign and the views of medical secretaries and  administrative staff who have first hand experience of role redesign.

Case study videos
There are a number of case study videos that are accessible from the Changing Workforce Programme resource. The videos cover physical health, mental health and children's services. They emphasise the need for role redesign in aspects of the NHS and encourage lateral thinking about patient and staff perspectives.

Additional resources

Workforce Matters publications introduce role redesign, explain how to assess service needs, how to write a new role definition and develop a business case. They outline service and workforce redesign initiatives that were happening nationally as the report was written, give examples of innovative practice, sources of support and provide references and further reading.

The documents give an overview of good practice and workforce redesign initiatives, highlighting the benefits of new ways of working. Examples are given of new and amended roles, focusing on a range of roles in different care  pathways, including guides to role redesign in:

  • Cancer services (January 2005)
  • Neonatal services (December 2004)
  • Staff caring for older people (September 2003)
  • Emergency care (August 2003)
  • Staff in the wider healthcare team (2002)
  • Diabetes care (2002)
    Primary care (2002)

Background

Role redesign tools for the NHS were developed by the Changing Workforce Programme at the NHS Modernisation Agency. A wide range of these tools are now available from the Large Scale Workforce Change team at NHS Employers .

© Copyright NHS Institute for Innovation and Improvement 2008