District nurses in Barnsley, UK, have for many years used a patient classification system based on ‘Criteria for Care’, whose value in practical management terms has established itself into the routine of the information system used. This is a descendant of FIP, now known as TCCS (Total Care Community System). ‘Criteria for Care’ was, however, hospital based and an independent validity check was required for community use. This was carried out in Belfast, Northern Ireland, where research produced a system for patient classification, workload analysis and skillmix analysis which was generated by nurses and acted both as a validity check and further development of the system used in Barnsley.
The management information matrix, which is the outcome of this paper, is generated from practitioners using guidelines agreed by them, and yields management information of a directly practical value.
The system presented is now implemented and uses data updated daily, if required, to produce a spreadsheet covering team workload index, a workload profile, and measures of pressure of work on each nurse, patient acuity [1], and a quality of care index. From this it is possible to adjust skillmix and staffing levels to create equity of pressure across teams and to match nursing skillmix to patient classification in the light of a quality index from each team.
From a GP attachment and a team perspective this information can be utilized in conjunction with contract monitoring data in order to review district nursing activity. This will enable workloads to be reviewed and could facilitate integrated team working within the practice.
The Patients Progress: towards a better service NHS Executive, London, HMSO1994
3.
Using information in Managing the Nursing Resource: Workload. Greenhalgh and CO, Macclessfield and Mersey Regional Health Authority, (1991) [The Rainbow Pack]
4.
Carr-Hill R A, Jenkins-Clarke S.Measurement systems in principle and practice: the example of nursing workload. Journal of Advanced Nursing1995;22: 221-225.
5.
Ball J A, Hunt K, Booth M R, Franklin F.‘…But who will make the beds?’: A research-based strategy for ward nursing skills and resources for the 1990s. Nuffield Institute for Health, University of Leeds and Mersey Regional Health Authority, 1989.
6.
Ball J A, Goldstone L A, Collier M M.Criteria for Care. University of Northumbria, Newcastle: Unique Business Services Press, 1984.
7.
DHSS study of night nursing services. A report by NHS Management Consultancy Services, 1987.
8.
DHSS service quality: A report on the activities of nursing staff, 1988.
9.
Goldstone L A, Ball J A, Collier M M.Monitor: An index of the quality of nursing care. University of Northumbria, Newcastle: Unique Business Services Press, 1983.
10.
Illsley V, Goldstone L A, Ruxton N.District Nursing Monitor II. University of Northumbria, Newcastle: Unique Business Services Press, 1992.
