A Method for Work Functions and Competency Mapping - Health ...

=Workforce IssueWhich Functionsare required?WhichCompetencies?Which Role?Workforce ModelINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

CONTENTS/OVERVIEWSET THINGS UP FOR SUCCESS — PREPARE WELL 51. AGREE YOUR WORKFORCE ISSUE 72. AGREE ON BEST PRACTICE TO DELIVER CLIENT CENTRED CARE 113. DEFINE THE WORKFORCE NEEDED TO DELIVER THE SERVICE MODEL 154. SUPPORT YOUR AGREED FUNCTIONS & COMPETENCIES 21CONTENTS/OVERVIEW5. IDENTIFY THE ENABLERS AND BARRIERS 256. GIVE IT A GO: PLAN, DO, STUDY, ACT (PDSA) 297. TELL US HOW IT WENT: DOCUMENT AND FEEDBACK 31RESOURCES AND BLANK TEMPLATES 33INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping1

HOW TO USE THIS GUIDE2The objective of this guide is to provide the tools and guidance necessary to carry out thefollowing steps:1. Decide what your workforce problem is2. Identify your key stakeholders in the process3. Decide what changes are needed to the patient journey to solve this problem (via the process map)4. Identify evidence or best practice initiatives which will support or inform the development of your workforce solution5. Develop the functions of the proposed workforce role6. Identify and assess the applicability of relevant education and workforce competencies7. Identify workforce barriers and enablers for implementationWHO this resource is forProject officers involved in HWA Caring for Older People demonstration projects — it supports the preparation phase beforetrialling and testing your workforce redesign.Health services who wish to review their workforce in order to improve productivity (access to services or reduce waiting timesand improve efficiency).HOW TO USE THIS GUIDEWHY it is neededWe want you to be successful.This guide will help you work out what needs to be done in your workforce project to develop new workforce models, and inturn improve the patient’s journey.It will help ensure that you complete a process that is high quality and innovative, that all the projects are working at the samestandard across the program, and that it will stand up to scrutiny.Sometimes it is tempting to leap straight to a solution without adequately defining the issues; however this can be problematic,as ‘it is a bit like diagnosing a patient without taking a proper history or consulting with other experts. When you know what isreally required, you will understand who is best placed to do it. This may be more than one person or role and not apre-determined profession.INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

HOW to use itThis guide is one module in a learning series that Health Workforce Australia is developing to help you lead and manage yourworkforce innovation.Use it as a guide to assist you in the identification and development of your workforce solution. There are examples provided tohelp you to think about the functions and competencies required for your workforce and blank worksheets for each sectionat the back.This guide is a work in progress. Your feedback on what tools and activities helped you use this module is valued.Tell us what worked and what didn’t — how can this work become as simple, yet as rigorous as possible?HOW TO USE THIS GUIDEINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping3

DEFINITIONS USED IN THIS DOCUMENT4FunctionsThe roles, responsibilities, activities and interactions expected of a worker.CompetenciesThere are many definitions for competencies in education, professional and clinical settings. For the purpose of your project,think of the knowledge, skills and attitudes that are required of a workforce role. Competencies can be attained through acombination of clinical experience, education, training and team development.A competent workerAn individual’s capacity to function in a manner that is consistent with their role level and responsibilities within a continuum oflearning to maintain safe, quality and effective practiceTrainingTraining is a term which can be used in the context of the employer responsibilities to ensure that workers have the requisiteskills to perform effectively in their job. Training can be in the form of a program which may or may not lead to a partial orcomplete qualification or as in-service provided by the employer.EducationEducation is a broad term which enables an individual to build on knowledge, skills and values relevant to the individual’s lifelong learning requirements. It can occur in formal and informal circumstances and thus covers courses and programs as well aslife experiences.Continuing professional developmentContinuing learning is a concept which encompasses ongoing development of the worker throughout their career and is stronglylinked to continuity and maintenance of practice.DEFINITIONS USED IN THIS DOCUMENTINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

SET THINGS UP FOR SUCCESS — PREPARE WELLLeadership and effective team processes are critical to a project’s success.If your group for this exercise has previously worked successfully together, you may only need to skim this step. If not, we haveprovided some tips below to help create an effective collaborative environment in order to complete this process efficiently.Ineffective teams and meetings can, (and often do) de-rail projects!Ensure each member of the team clearly understands their role, and that of other members of the team.Set ground rules in collaboration with team members so that everyone is clear on what is expected of them.Clarify terms used within the group to prevent any misunderstanding.Carefully decide who should be at the team meetings — attendees should be the people who make the key decisions and/orexecute them.Circulate team meeting agendas in advance and clearly set out the objectives of the meeting to keep everything on track.Ensure meetings start and finish on time and engage all participants in the meetings and activities to encourage ‘ownership’of the project — don’t assume silence is agreement!Identify and agree how you will make decisions and how and when they will be reviewed.Make sure that decisions and required actions are accurately recorded and distributed promptly to attendees with the minutes.Follow up with team members who are unable to attend team meetings to ensure their feedback is incorporated into theproject activities.Leadership is about confidence, organisation and moving forward.Workforce reform is challenging, innovative, and hard work, however the rewards are worth it.Get More Info — Find more tips for managing projects @ http://www.projectsmart.co.ukSET THINGS UP FOR SUCCESS — PREPARE WELLINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping5

INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

1. AGREE YOUR WORKFORCE ISSUEIntroduction:Process:Time required:Resources:Actions:Work with your project team to identify and define the issue you will address, e.g. reduce waiting times orimprove access to allied health services for older people.Brainstorming workshopApprox 1 hr 45 minButchers’ paper or whiteboard and pensTo address your identified issue, your team will need to define the service(s) affected and what workforce changes are need todeliver that service optimally. Use these information gathering techniques in sequence to address the main issues affecting thisworkplace problem.1. The 5 “WHYs” (approx 10 minutes) – to clarify the issue2. Mind mapping (approx 30 minutes) – identify all the stakeholders affected by the issue and the proposed change3. Process mapping (approx 1 hour) – identify where the patient trajectory and service might be improvedSee following pages for worked examplesReflect & Record — The presenting issue identified for workforce reform is often not the fundamentalissue; presenting issues are often symptoms of a larger, more complex set of problems. Record yourthoughts about whether the presenting issue is the real issue in your journal.1. AGREE YOUR WORKFORCE ISSUEINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping7

8The ‘5-Whys’ ExampleThe “5 Whys” is a simple method used to explore the cause and effect relationships of an issue. It starts by stating a problemand continuing to ask ‘why’ until the root cause is uncovered.Use this method to describe the service and workforce issues and possible causes:WHY?WHY?WHY?WHY?WHY?Older people have a higher incidence of falls and functional decline. Allied health interventions can maintainstrength and functional independence, but this is currently not happening.In the current workforce model a physiotherapist is only available to visit the facility 1 day per week, as they alsoprovide services to several other medical facilities in the region. Therefore, minimal allied health therapy occurs.The physiotherapist prioritises assessments during her/his weekly visit, leaving little time to provide therapyinterventions to reduce functional decline in clients. This contributes to a longer length of stay or continued declinefor those requiring therapy.The current workforce model relies solely on the physiotherapist to provide the exercises to maintain or improveclient strength and reduce functional decline (physiotherapy) which prevents timely discharge of older peoplerequiring this service.The functions, competencies and/or training required to provide the therapy needed, has not been explored as towhether or not it could be done by someone else with appropriate training and supervision.What can be solved through workforce intervention? In order to deliver evidence based services to maintain a client’sstrength and independence as a key influence in falls prevention the workforce evidence is that interprofessional teams areeffective at improving service interventions for falls prevention.1. AGREE YOUR WORKFORCE ISSUEGet More Insight — Is the issue the length of time from admission to the physio assessment; or is it that the physio is too busy toprovide the interventions, or are there not enough physios to do the required work? Are there alternatives to the physio providing theinterventions? Who are the clinical decision makers and what decisions do they make or can they make? What are some workforcealternatives that might address this situation and improve the service outcomes? How and will an interprofessional team approach help?See Worksheet 1 in the Resources section (p40)INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

MIND MAPPING EXAMPLEThe Mind Mapping exercise in this example has 3 aims: to engage everyone and get them on the same page; to brainstorm thewidest possible stakeholder inclusions (systems thinking); and to identify and develop groupingsMind Map ExampleOther collaboratives &projectsOther projects from thesame collaborativeHealth WorkforceAustraliaGP teamsConsumersLegendGeriatriciansInpatient/Outpatientservices (referrers)Emergency DepartmentsAmbulances Servicesup-skilling Health Assistants toprovide more physical therapyStakeholders who will be involved in the decisionPeople who will be affected by the decisionIndustrial — UnionsAllied Health AssociationsAcreditation andRegulation bodiesSimilar sustaining healthycommunitiesprojects/AHA projects1. AGREE YOUR WORKFORCE ISSUELocal council/housing servicesAdmin staff/referralprocess staffAcute and CommunityHealth staffIntergrated assesmentframework projectRDNS/communitynursing serviceExecutive sponsorsHACC servicesOther clinical staffaffected by the changePrivate Physiotherapist(non-eligble HACC ptsacute & resicare)Rural Health teamINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping9

INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

2. AGREE ON WHAT NEEDS TO CHANGE TO SOLVE THE PROBLEM& DELIVER BETTER CAREDefine the clients’ needsGather your evidence to inform your functions and competenciesThe Caring for Older People demonstration projects represent a diverse group of service providers and workforce issues thatneed to be addressed. However, all projects focus on developing the right functions to respond to identified and aged carespecific needs.These care needs all include dimensions of biological, psychological and social ageing, which encompass the whole person notjust physical frailty.In general, older people tend to have a greater requirement for health, social, psychological and various other support services,including accommodation, recreation and leisure, mobility, finance, advocacy and family support (AIHW 2000). Some of thetypical needs that result from ageing are listed in Resource 2 at the back. For instance, in assessing the risk that an older personmay be admitted to residential aged care Aged Care Assessment Teams (ACAT), pay close attention to the impact of socialissues in ageing. As a person grows older, their social network may contract through death, inaccessibility of relatives andfriends, cognitive decline or other losses. The psychological effects of this reduced social participation can have a significantimpact on overall wellbeing. Psychosocial aspects of ageing have been found to be a key factor in admissions for low-levelresidential care (LGC 2002). 1The task for projects is to map the functions and competencies required to improve the patient trajectory of older peoplereceiving care at home, in residential aged care facilities and in hospital. Begin by identifying and describing client needs and theresponses or functions that may be performed by the aged care workforce to meet those needs. Resource 2 at the back may beused as a prompt to aid identification of the functions required in your new service delivery model to respond to yourclients’ needs.See Resources 2 in the Resources section (p35)2. AGREE ON WHAT NEEDS TO CHANGE TO SOLVETHE PROBLEM & DELIVER BETTER CARE1 Lincoln Gerontology Centre (LGC). (2002). Victorian aged care assessment program evaluation, 29th Progress Report. Melbourne: La Trobe University.INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping11

12Process Mapping GuideIn order to explore and identify what needs to happen to change the way things are done, you first need to describe thecurrent process and document the key functions in that process.Process mapping refers to the process of developing a diagram which defines exactly what your service does, who is responsiblefor doing what, and how the success of that process can be determined.e.g. If you have identified your workforce issue as having limited access to certain functions such as medical, nursing, or alliedhealth assessments or interventions, you will need to identify how current patients access those functions and how access mightchange to improve the service outcomes.The example below shows the four stages of the client journey of care from community to acute (AISR 2009) 2 which helps identifykey activities/functions along the patient journey from pre-admission to discharge.These steps can be used for any interface along the Caring for Older People journey. 23Get More Info — There are many ways to produce a process map. Some health care agenciesuse the “Lean” value stream mapping to do this 3 . For further information refer to the publicationslisted in the bibliography at the end of this document.If you know of, or use, a different method, please share your ideas with the HWA ChangeManagers and your team.2. AGREE ON WHAT NEEDS TO CHANGE TO SOLVETHE PROBLEM & DELIVER BETTER CARE2 Australian Institute for social research, Final report: A transition care education and training framework and implementation plan for the workforce at the acute-aged care interface, December 20093 Ben-Tovim,D, Dougherty,M, O’Connell,T & McGrath, K: Patient journeys: The process of clinical redesign, MJA, Vol 188, No 6, March 2008INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

Process Mapping ExampleThe following is an example of a process map for the issue of ‘Older people lack access to physiotherapy after a fall causingdelays in acute hospital discharge’.Process map of the patient journey Who? What? When?Stage 1 — Pre-Admission/entry planning activitiesClient has a fall at home and is referred to hospital byAged Care Assessment TeamStage 2 — Admission activitiesClient arrives in the unit via ambulance with letterfrom ACAT.Stage 3 — Restorative Care activitiesClient is an inpatientStage 4 — Discharge planning activitiesAdmin staffDiv 1/Nurse in chargeDiv 1/Nurse in chargeDiv 1/Nurse in chargePhysiotherapistOccupational TherapistDiv 1/Nurse incharge/AHCollates the paperworkfor admissionCompletes a comprehensiveassessment of the clientPlans and implementsindividualized care plan withthe clientRefers to MDT forfunctional assessmentCompletes a functionalmobility assessmentCompletes a functionalassessmentRefers to community AH teamfor therapy who use aboveassessment to make interventioncare planOn the day ofreferralOn arrivalOn day of arrivalOn day of arrivalUp to 6 daysafter arrivalUp to 6 daysafter arrivalOn day of Ax2. AGREE ON WHAT NEEDS TO CHANGE TO SOLVETHE PROBLEM & DELIVER BETTER CAREINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping13

14From this process map, you should be able to produce a snapshot of the current client journey:Day 1Comprehensiveassessment bythe nurseCurrent patient journeyDay 2No physio-therapy— waitingassessmentDay 3No physio-therapy— waitingassessmentDay 4No physio-therapy— waitingassessmentDay 5No physio-therapy— waitingassessmentDay 6PT providesassessment &community referralfor therapy2. AGREE ON WHAT NEEDS TO CHANGE TO SOLVETHE PROBLEM & DELIVER BETTER CAREINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

3. DEFINE THE WORKFORCE NEEDED TO DELIVER THE SERVICE MODELDevelop a vision for your Service & Workforce ModelIntroduction:Process:Time required:Resources:The next stage is to develop a vision of what your service & workforce model should be. Work with yourstakeholder group and draw on evidence from the literature, clinical guidelines and expert opinion to reacha group consensus of ‘best practice’.Brainstorming workshopApprox 1 hrButchers’ paper or whiteboard and pensWith your project group, map the workforce responses to achieve the desired future service model. This should be based onevidence and group consensus in order to define the new goals of the client journey and identify the functions required todeliver the new model. You may have to test this several times until everyone is satisfied that it is ‘fit-for-purpose’Example:Day 1Comprehensivemultidisciplinaryassessment bya trained workerDay 2Falls assessmentusing agreedprotocolDay 3Intervention fromtrained assistant/family memberDay 4Review from PT— using agreedprotocolDay 5Intervention fromtrained assistant/family memberDay 6Client discharged3. DEFINE THE WORKFORCE NEEDEDTO DELIVER THE SERVICE MODELProposed patient journeyQuestions your project team should explore include:1. What is the preferred workforce model and why? Write this as a hypothesis i.e. if we do this... then we will...See Resource 1 in the Resources section (p35)2. What are the key functions required that will deliver your optimal new workforce model?INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping15

16Developing work role functionsYou are encouraged to use the Workforce Role & Functions development worksheet (Blank Worksheet 2) to help you explore theknowledge, skills and attitudes required to undertake the proposed work role/s effectively.You will need to ensure that the functions are contextualised to your work environment to be ‘fit for purpose’. It will beimportant to identify the full scope of functions to include skills, working with others and responsiveness to workplace demands.Be very clear in the language and descriptions to ensure that roles are clearly explained.This will take you some time to complete and there will be a range of activities undertaken to make sure each of you fullyunderstand the work role/s functions required. These include:Review the “5 whys” exercise and clearly identify current and required work role(s)Review your process mapping and integrate findings into the work role functionsDiscussions and observations of clinical staff at point of careDiscussions with health workers who provide support for work roles you are reviewingDiscussions with organisational leadership groupsUse the acute-aged care interface matrix as a guide to identify different contexts of the patient or client journeyReview of professional and educational competencies which could inform or be embedded in the work role you are developing.This may require you to look at multiple competency standards and frameworksIdentification and review of relevant work role regulatory requirementsMake sure that you are informed by relevant evidence and best practice literature as you develop your functions.3. DEFINE THE WORKFORCE NEEDEDTO DELIVER THE SERVICE MODELSee Blank Worksheet 2 in the Resources section (p41)INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

Identify specific Functions & CompetenciesIntroduction:Process:Time required:Resources:Actions:Use these steps:Take your agreed future desired service process map and its functions (make sure it is evidence based), andidentify the staff competencies needed to undertake them. Who has these competencies (and/or who elsemight have them with extra training/support)?Roundtable discussion/small team workApprox 1 hrProcess map, paper and pens1. Identify the functions required (using the process map)2. Identify the competencies required to match the functions, as a group exercise3. Consolidate the competencies using the activity diary, working relationships /external contacts activity4. Validate and benchmark the competencies with your project team5. Consider how to make the most of the current workforce6. Agree on opportunities for extending, re-designing or creating new roles. What additional skills, training, or supervision needto be provided to ensure safety/quality standards are maintained.3. DEFINE THE WORKFORCE NEEDEDTO DELIVER THE SERVICE MODELINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping17

18Match the functions and competencies to the needs based on the evidence gathered.e.g. The Community Services & Health Industry Skills Council develops nationally applicable vocational education and trainingand has a list of competencies required to complete the training for roles in health and community services. These may helpyou identify the competencies required and support your workforce implementation and development, including trainingpackages. (https://www.cshisc.com.au) (You will receive more information on how to navigate this website).e.g. The “skills for health” program in the UK (NHS) also have a database of competencies for the health workforce(http://www.skillsforhealth.org.uk) Caveat: we are including this one to illustrate a range of skills, in some instancethere may not be existing opportunities for education and training within the Australian system. 4Get More Info — Hint: To help you identify the competencies required:See the example below of a matrix of the core competencies mapped against the client journeyof care developed by the Australian Institute for Social Research (ASRI) 4 in 2009. Identify where these competencies may exist within team members — (see next section 5).If they currently do not exist, you may need to organise some additional training.Chart your current organisational opportunities for education and training and map thestrategies against the functions you have identified. It presents a clear picture of where existinggaps may be and the consistency of education and training initiatives within your organisation.We will provide you with more resources as you progress through the project.3. DEFINE THE WORKFORCE NEEDEDTO DELIVER THE SERVICE MODELIn the example provided, ASRI (2009) identified four stages of the client journey of care at the Acute-Aged care interface as:Pre-admission/entry planning Admission Restorative care Discharge planning/transition planningThey also identified and grouped the competencies into four domains:Case Management Management Cultural competence Care of older people4 Australian Institute for Social Research, Final report: A transition care education and training framework and implementation plan for the workforce at the acute-aged care interface, December 2009INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

Use Resource 3 in the resources section at the back to develop an outline of the competencies required for your interventionand the responsibilities of the position into a role specification. This will allow your project team to review and agree on theposition description including who will employ and supervise this person.We are aware of other competencies used both nationally and internationally and welcome your recommendations.See Resource 3 in the Resources section (p37)3. DEFINE THE WORKFORCE NEEDEDTO DELIVER THE SERVICE MODELINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping19

4. SUPPORT YOUR AGREED FUNCTIONS & COMPETENCIESAssess your current workforceIntroduction:Process:Time required:Tools:Actions:To assess if your current workforce has the capacity to meet the demands of the new service model, establisha baseline measure of who does what and when through an activity diary; from this establish the impacteach change is going to have on all the health professionals/support staff in the new workforce model –this is called a “knock on” effect.Due to the multidisciplinary nature of aged care, every role has an impact on other roles either in servicetype or workloadIndividuals to complete Activity DiariesEquivalent of 1 working weekActivity Diary templateAn activity diary is used to documents actual work performed by an individual, and should be completed over a working week toget an accurate picture of what is really happening, not just what was expected to happen. The key is to encourage each personto document as many of their activities as possible. The outcome is a clear picture of their workload, working relationships andexternal contacts. The activity diary also helps develop a picture of who else is involved in their tasks, giving an indication ofpotential knock-on effects of changes to the processes.Example:If you up-skill and supervise the support workers to take on some therapy interventions with clients, whatdifference is this going to make to other roles in terms of service type and workload volume?Will the physiotherapist do less exercise classes and more specialist treatment and supervision?Will the community nurse do less falls assessments and have time to do more specialised communitydiabetes management?Will the GP remember that he can now refer his clients to therapy instead of his admin officer ringingaround many organisations that don’t have the service?4. SUPPORT YOUR AGREED FUNCTIONS & COMPETENCIESINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping21

22Activity Diary ExampleActivity Diary/WorkingRelationshipsExamplesDeliver clinicalintervention e.g.assist with washing& dressingWound carePhysical therapyMedication roundStaff name i.e. Jane DoeTelephone dieticianfor AssessmentDocumentation ofadmission notesOrganisation ofthe team orother servicesMove patient fromadmission unit toGEM unitLocate mobility aidDeliver bloodsto labProvide equipmentWaiting for responseRole Title Nurse Unit ManagerRACFTeam leaderShift leaderGPPhysiotherapistAmbulance triageAmbulance officerProvide informationSeek informationGive adviceSeek adviceNegotiateConsult etc.Day 1Time Clinical Tasks Admin tasks Portering tasks Contact with Interaction with others Outcome7am8am9am10am11am12 noon1pm2pmAssess male patientwho may be sufferingform Urinary retentionComplete medicationroundAssist RN with Ptwho is now unable tomobilise to bathroomAttend handoverOrganise the teamRefer Patient to RMOfor geriatric Ax— 20 minsRing GP who is unableto attend todayRing EDRing an ambulance totransfer Pt – organisetransfer notes Order med stocks Refer to PhysioOrganise annual agedcare assessmentswith GPDocument aged carepaperwork linked toACFI fundingOrganise wheelchairWait for ambulanceRN x2 EN x2 PCA x2RMORNGPEDAmbulance triageAmbulance officerEN Staff & patients Physio GP surgeryProvide informationGive advice to teamProvide informationto RMOGive advice to RNSeek advice from GPNegotiate with EDProvide information toAmbulance triageNegotiate withambulance officerSend EN to hospitalwith patientProvide informationProvide informationHandover toshift change Geriatrician visit in 1week for Assessment Patient able to walk tobathroom with aid Dietician review in2 daysPatients & TasksassignedGeriatrician visitarranged in 1 weekUnable to arrange GPreview today advisedto send patient to EDSend patient in the EDfor catheterisation withEN escortDeliver medsPhysio assessmentbooked for tomorrowbut patient is immobileuntil thenGP visit booked for1 week4. SUPPORT YOUR AGREED FUNCTIONS & COMPETENCIESGet More Insight — Key questions: Who else does this now? Who else could do this?INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

See Blank Worksheet 3 in the Resources sectionFilling the gap(s) — training and/or development needsYou may need to organise some additional training and development. There are many part time training courses and in-housetraining programmes that allow people to learn new skills while still working.Consider:What are the training and education needs for the new role?Can the training and education be provided in-house or do you need external support?Would a neighbouring organisation have an in-house course that fits the bill?Can the training be accessed online?How will you tailor the training to take account of, and value, the individual’s existing skills?What further training and development can be provided to support continuing professional development?Hot Tip 1: Work with your change manager or other colleagues within your collaborative to explore all of the availableopportunities for training once you have determined your competency requirements — There may be options thatyou are not immediately aware of and education and training contacts you can be linked with.Hot Tip 2: As a recruitment and retention strategy you may want to ensure that your training selections (which meet yourfunctions and competency mapping requirements) are able to articulate into a qualification pathway.Reflect & Record — The ‘Interaction with others’ column will help you identify who are thedecision makers, which decisions they make, what the impact on other team members are, andpotential role realignment. e.g. Could the nurse extend their scope of practice to include malecatheterisation and reduce avoidable hospitalisations or could somebody else complete themobility assessment to prevent functional decline?4. SUPPORT YOUR AGREED FUNCTIONS & COMPETENCIESINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping23

5. IDENTIFY THE WORKFORCE ENABLERS AND BARRIERSIntroduction:Process:Time required:Tools:Actions and examples:Determine whether you can easily make the changes your group wants — identify the drivers andconstraints to the changes through a force field analysis.Team discussion and documentation of ideasapproximately 30 minutesForce field analysis sheetForce Field Analysis is a technique for looking at what will help or hinder your decision. In effect, it is a specialized methodof weighing the pros and cons. The outcome should be a list of all the forces that can support the change and a list of all thebarriers that may hinder the project. By completing the Force Field analysis, you can plan to strengthen the forces supporting adecision, and reduce the impact of opposition to it (i.e. your risk management plan).To complete a force field analysis, follow these steps:1. Enter your plan or proposal for change on the top of the chart on the next page.2. List all forces for change in the column on the left, and all forces against change in the column on the right.3. Agree on the actions required to reduce the impact of opposition.An alternative way to review the action plan and identify risk and success factors is to perform a SWOT Analysis.A SWOT analysis starts with defining a desired objective, and moves on to identify subsequent steps required in planning toaddress the constraints, weaknesses and threats. This is important for the change to be successfully integrated into your serviceand workforce systems. Strengths: your internal attributes helpful to achieving the objective Weaknesses: your internal attributes harmful to achieving the objectiveOpportunities: external conditions helpful to achieving the objective Threats: external conditions which could do damage to the objective5. IDENTIFY THE WORKFORCE ENABLERS AND BARRIERSINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping25

26FORCE FIELD ANALYSIS ExampleList desired change:e.g. Expand the role of Personal Care workers and Div 2 nurses to include allied health interventions increasing sustainable allied healththerapy services that reduce functional decline in older people.Driving Forces (+) Restraining Forces (-)We have staff who are interested in expanding their scopeof practiceWe have identified the current practice gapsWe have identified a registered training facility to provide atertiary qualificationWe have management support for this projectWe will have more staff able to provide restorative therapy toreduce functional declineWe will have continuity of care for clients.Actions:The staff may want a higher salary once they have completedthe trainingThe cost of training may be too highThere may be staff who do not want to or are unable to completethe trainingSome allied health professionals may not support the initiative orprovide clinical support/supervision.1. Project manager will engage all stakeholders to be involved in the steering committee and provide information.2. Ensure clear service arrangements are agreed with the training organisation after negotiating a price.3. Ensure clinical governance strategies are agreed at all levels.4. Work with HR and peak bodies to confirm salary rates.5. IDENTIFY THE WORKFORCE ENABLERS AND BARRIERSINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

SWOT Analysis ExampleState what you are assessing e.g. The use of an agreed falls risk protocol while training & supervising a health assistant to provide physicaltherapy interventions to improve access to services and reduce unnecessary hospital stayCriteria examples Strengths Weaknesses Criteria examplesResourcesAssetsPeopleExperienceKnowledgeDataStaff who are interested inextending their scopeof practiceWe have successfullyimplemented other projectsThe cost of trainingNo clinical supervisionFinancials Management cover Succession planningCriteria examples Opportunities Threats Criteria examplesTechnology developmentInnovationGeographicalPartnershipsAgenciesDistributionThis project could be rolledout to other facilities ordisciplinesWe could develop arelationship with an agencywho is similarKey staff may leaveAccreditation/registrationbodies may not supportthe projectPolitical effects?Legislative effects?New technologies,services, ideas?Reflect & Record — This information is also useful for contributing to risk management assessment.5. IDENTIFY THE WORKFORCE ENABLERS AND BARRIERSINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping27

6. GIVE IT A GO — PLAN, DO, STUDY, ACT (PDSA)ImplementationYou need to write the action plan for change.1. Collect all the pieces of information and use them to make a decision about managing the change2. Decide on the changes needed to the current workforce3. Decide how education and governance strategies support the plan4. Engage your champions5. Write the action plan and agree testing with your stakeholder groupGive it a go — plan, do, study, act (PDSA)You need to:Implement the plan, now that you have spent so much time planning, measure progress using the agreed indicators and reviewthe plan as required.Build your indicators into the usual quality improvement cycles and reports. Consider who you need to report to and who youneed to keep informed.In order to end up with:Reflect & Record — Congratulations! You now have all the elements to write an action plan as a groupto prioritise your way forward.A process for reviewing the efficacy of your workforce at regular intervals and a system for providing a response to changes6. GIVE IT A GO — PLAN, DO, STUDY, ACT (PDSA)INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping29

7. TELL US HOW IT WENT (DOCUMENT AND FEEDBACK)Feedback Date: / /Tell us what have you learned from this resource/experience?Which parts would you recommend?Which parts would you change or delete?Would you use this module again?Any other resources you found useful in doing this task?7. TELL US HOW IT WENT (DOCUMENT AND FEEDBACK)INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping31

ADDITONAL RESOURCESResource 1: Guidelines to develop a working hypothesisResource 2: Needs common to ageingResource 3: Acute aged care interface (Competencies list)Resource 4: Reviewing Professional RolesWorksheet 1: The 5 WhysWorksheet 2: The roles and functionsADDITONAL RESOURCESWorksheet 3:Activity DiaryINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping33

DEVELOP WORKING HYPOTHESES (RESOURCE 1)Your objectives and methods are a series of working hypotheses — assumptions, themes and ideas — about a workforce issueand how to address it.Working hypotheses are NOT intended as conclusive proof of ‘the answer’ but an estimate of reality and the workings of thebroader health ‘system’.The purpose of writing your aims as hypotheses is to:Clarify your assumptions about your workforce innovation and how you planned and created changeCreate a basis for continuous innovation & improvement (through PDSA cycles)Build your capacity to develop and build working hypotheses for project and collaborative workWork collaboratively with others to create an account as it is being put togetherWrite your key workforce aims as hypotheses in this format — IF we… THEN we will…Check that your hypothesis:Is written as a statement, not a questionIs based on observations, experience and knowledgePredicts the results in a clear formIs measurable — demonstrates how you will know and assess the results34ADDITONAL RESOURCESINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

NEEDS COMMON TO AGEING (RESOURCE 2)Table 1: Needs common to the general ageing populationResult of ageingBiological AgeingAssistance potentially required1. Signs of ageing 1 Assistance with grooming and personal care such as podiatry,hairdressing and skin care.2. Sensory deficits (for example, vision, hearing) 2.1 Access to regular assessments, medical services.2.2 Augmentative devices (for example, glasses, hearing aids).2.3 Adapted environments (for example, placement of furnishings)and large-print materials.3. Reduced fitness, muscle tone and strength 3 Need for continued opportunities for exercise and recreation,and rehabilitation services.4. Reduced mobility 4.1 Ambulatory aids (for example, sticks, wheelchairs).4.2 Assistance with learning to use aids.4.3 Adapted environments (for example, handrails, ramps andbathroom grip rails).4.4 Safety monitors.4.5 Transportation.4.6 Rehabilitation services.ADDITONAL RESOURCES5. Dietary risk 5.1 Adequate diet and nutrition assistance.5.2 Assistance with food shopping and meal preparation.5.3 Delivered meal services.6. Increased risk of physical illness and chronic disease 6.1 Access to health care and monitoring services.6.2 Medical assistance including dental services.6.3 Education about the signs of impending illness and disease.7. Increased risk of dementia 7.1 Medical services.7.2 Increasing levels of supervision.7.3 Support to carers.8. Increased risk of some other mental disorders(for example, depression)8.1 Access to health care and monitoring services.8.2 Awareness of causes of stress and stress-reduction strategies.INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping35

36Acute –Aged Care Interface matrix (resource 3) continued...Table 1: Needs common to the general ageing populationResult of ageingPsychological ageingAssistance potentially required9. Personality change 9. Opportunities for reminiscence and life review.10. Motivational change 10. Stimulation in personally valued experiences.10.1 A variety of activity options, and10.2 Opportunities for new experiences.11. Changes in cognition and intelligence 11 Need for continued practice to maintain/learn skillsand interest areas.12. Change or perceived change in personal control and choice 12 Opportunities to have input into decisions affecting theindividual and a range of options.Social ageing13. Transition from work to retirement (changes in financial status,social roles, social network)13.1 Pre-retirement planning/advice.13.2 Opportunities for part-time or voluntary work.13.3 Assistance in leisure time preparation.14. Social network and role change 14.1 Opportunities for social contacts and inter-generation contacts.14.2 Continuing links with the community and valued role at homeand in the community.15. Social effects of biological ageing (for example, increased loss ofsocial contacts due to reduced mobility, health problems andsensory loss)Source: Adapted from AIHW 2000:44–5.15.1 Transportation and mobility assistance to maintain communitycontact, and15.2 Support in facilitating contacts.ADDITONAL RESOURCESINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

ACUTE — AGED CARE INTERFACE MATRIX (RESOURCE 3)Acute – Aged Care Interface CONTEXTClient Journey of CareADDITONAL RESOURCESHealth workerCompetencyDomainDischargePlanning/ExitPlanningRestorativecareAdmissionPre-admission/entry planningKnowledge of aged care systems & available servicesKnowledge of individual roles in different sectors & the scope of those rolesCare ofOlder PeopleNational Planof ActionCategoriesof healthworkerSpecificprofessionalcompetencyrequirementsHealthdeliverysectorsEducation& TrainingprovidersCaseManagementKnowledge &SkillsCase management, achieving individualised person centred care skillsCase coordination, including case conferencing skillsKnowledge of informal supports available to the person in careAdvocacy skills, for person in care, across & within systemsReferral skills (informed by knowledge of different service systems)Comprehensive assessment of the personComprehensive assessment of the home environmentSearch skills using different information technologies & in relation to communitycare services & to medical recordsTeam work within and across health worker disciplinesKnowledge of aged care policiesManagement skills to provide appropriate leadership, prioritising demands, rolemodelling and delegation of workManagementKnowledge &SkillsTime & resource management skillsCommunication skills a) verbal b) written c) documentation & reporting d) conflictresolution & negotiationInterpretive skills (consistently able to use & interpret data & information supplied)Knowledge of additional needs of CALD background peopleKnowledge of additional needs of people from Indigenous backgroundsCultureInclusiveKnowledge &SkillsCross cultural awareness and cultural competence skillsAwareness of Indigenous culture & how to ensure these issues are addressed whenworking with Indigenous clientsKnowledge of ageing process and age-related conditions and illnessesKnowledge of dementia & related conditions & their managementCare of OlderPeopleKnowledge &SkillsManagement of challenging behaviours skillsKnowledge of complex and chronic conditions & their managementKnowledge of legal issuesKnowledge of end of life issuesKnowledge of healthy ageing including preventative carePalliative care skills & end of life decision making skillsPalliative care skills & end of life decision making skillsKnowledge of ethical issuesRestorative (basic to advanced) skills a) nursing & medical b) personal care c) specificallied health skills, as requiredAbility to balance safety issues with dignity of independenceReflective practice skills — learning from your own interventionsFirst aid and emergency procedure skillsSmooth handover skills – ability to interpret, provide clear documentation,communication, reporting & observationTransfer equipment skillsTransfer pharmacology skillsCounselling skills to support the older person and their family or carerProblem solving skills related to care of older people transitioning from acute health toaged or community care sectorUnderpinningAttitudesCommitment to individualised identification of client needCommitment to cultural diversityCommitment to client empowermentEmpathy with the older personRespect for the older personPositive view of ageingCommitment to healthy ageingINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping37

REVIEWING PROFESSIONAL ROLES (RESOURCE 4)38Figure 1: Schematic overview of factors governing revision of professional rolesFactors driving change(wider healthcare environment)population ageingNew technologies andtreatmentsMedical workforce shortages(female, part-time, rural areas)Patient demands andexpectationsRising healthcare costsEtc.Healthy policy responseRevision of professional rolesADDITONAL RESOURCESBarriers and facilitators for implementationProfessional andpatient attitudesAcceptanceSpecialisationTeamwork/collaborationPayment systemsFinancial incentiveseg. Fee for service,capitationProfessionalregulationand trainingEducationalprogrammesLegistlation eg.prescription rightsFrom : (QQUIP) Miranda Laurant, Mirjam Harmsen, Marjan Faber, Hub Wollersheim, Bonnie Sibbald and Richard Grol 2010 : Revision of professional roles and quality improvement : A review of the evidenceINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

BLANK WORKSHEET 1: THE ‘5-WHYS’ WORKSHEETWorkplace issue to be discussed:WHY?WHY?ADDITONAL RESOURCESWHY?WHY?WHY?INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping39

BLANK WORKSHEET 2: ROLE & FUNCTIONS TEMPLATERequired Function & Description Describe current role Identify the gapsWhat is required of the proposed workrole? Explain the key elements of the roleWhat is the current role or situation?What are the key gaps in functionsbetween the proposed work roleand the current role?40ADDITONAL RESOURCESINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

BLANK WORKSHEET 3: ACTIVITY DIARYActivity Diary/Working RelationshipsActivitiesStaff name i.e. Jane DoeRole Title Nurse UnitManager RACFTime Clinical Tasks Admin tasks Portering tasks Contact withInteractionwith othersDay 1OutcomeADDITONAL RESOURCESKey questions: Who else does this now? Who else could do this?INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping41

NOTESNOTESINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping

NOTESNOTESINNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping43

INNOVATION AND REFORMCaring for Older People Program — Learning Module 1A Method for Work Functions and Competency Mapping