Department of Health - Planning the workforce in pathology

Background

In 2007 Collinson Grant Healthcare (CGH) acted as lead consultants on Lord Carter’s Independent Review of NHS Pathology. The Pathology Services employ over 25,000 clinicians, scientists and technologists, and interpret more than 700 million pathology tests in over 160 different organisations at 400 locations. We collected information about 4,000 NHS employees and 39 million tests. Lord Carter concluded 'We now have a strong evidence base for pathology – better than has existed before. It has enabled us to move on to the modelling of future options.'

After this review, we were asked us to design, test and implement a tool to help workforce planners and managers of Pathology business units and departments to plan and reprofile the workforce in Pathology.

It became clear that robust data were needed on who did the work, for how long, and at what grade. Otherwise, local decisions about how to plan, structure and organise effort to use the available resources would be below par. And it would be difficult to describe and plan confidently how the local workforce needed to develop.

Approach

The objectives were to create a tool:

• to understand better the work being done – how much, and by whom
• to consider how work might be designed in the future, and what competences would be required
• to design good, lean organisational structures that conform to employment legislation
• to plan recruitment and training, and set medium-term priorities.

Our main tasks were:

• to design a reliable mechanism for collecting and interrogating information on pathology work. This depended, first, on preparing a three-tiered, nested list of Processes, Activities and Tasks; and secondly on creating a robust model for collecting and analysing data – we designed an electronic questionnaire and an Excel-based computer model
• to pilot the tool – to make sure that it worked properly in ‘field’ conditions. The staffs from six NHS Trusts contributed to this stage
• to produce guidance documents, so that the tool could be rolled out fully to the wider NHS without significant support.

A long time was spent talking to the managers on the pilot to ensure that the outcomes would meet their needs. We set up a secure web space (using Documentum eRoom) to encourage collaboration and communication. It acted as a forum for the exchange of ideas.

Results

The workforce planning tool was refined and improved as the pilot stage progressed. The final version helps managers:

• to understand in some detail what their people do, and how much of their time they spend doing it
• to concentrate on activities that add value and to reduce waste
• to re-profile their workforces to do jobs at the limit of their competence
• to understand how changes in test volumes will translate into demand on and for the workforce.

We prepared a forty-page manual called “Planning the Pathology Workforce: A guide for pathology managers”. It was published by the Department of Health under the auspices of Professor Sue Hill, the Chief Scientific Officer. The methodologies are also available on-line.

After this project was completed, we were asked to assist in the national dissemination of the methodology. We helped to organise a national conference at Congress House and provided two key speakers. We have since described the tool at a number of other Pathology events.

Transfer of skills

To most managers who contributed to the pilot, the approach to analysing jobs and measuring efficiency was novel. Therefore we prepared particularly detailed written guidelines and offered telephone support whenever it was necessary. This helped them to acquire new skills much faster than might have been expected.

Lessons learned and relationships

When dealing with a complex and changing scientific service, it was essential to insist on accuracy in the description of activities and tasks. We adapted a methodology that we have used in other parts of the public (and private) sector to ensure that this was the case. Process Activity Analysis provided the foundation for consistent comparisons and well-founded arguments for change. The response has been good.