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Case Management as a tool to Improve the Health and Wellbeing of the Organisation. Gerard Marsden Occupational Health and Wellbeing (OHW) Head of Service Jacquie Scott Case Manager. Buckinghamshire Healthcare NHS Trust. Integrated (acute / community) Trust:>5,000 - PowerPoint PPT Presentation
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Case Management as a tool to Improve the Health and Wellbeing of the Organisation
Gerard MarsdenOccupational Health and Wellbeing (OHW)Head of Service
Jacquie ScottCase Manager
Buckinghamshire Healthcare NHS TrustIntegrated (acute / community) Trust:>5,000
staff serving population of 550,000 Two acute hospitals: Wycombe and Stoke Mandeville includes National Spinal Injuries Centre Five community hospitals One Occupational Health & Wellbeing Department
Financial cost to the organisationFinancial cost to the organisation
Increased pressure on the wider team, the `domino effect`Increased pressure on the wider team, the `domino effect`
Detrimental effects on the health and wellbeing of the individual
Detrimental effects on the health and wellbeing of the individual
Processes going round in circlesProcesses going round in circles
Lack of ownership and fragmented approachLack of ownership and fragmented approach
Persistently high levels of Sickness Absence resistant to existing management practice
Persistently high levels of Sickness Absence resistant to existing management practice
Rationale for change
QIPP agendaQIPP agenda
The Financial Implications...
The Business Case & Role
Bid submitted to Charitable Funds June 2010
Improvements in Health and Wellbeing of the staff.Benefits to patient care and recovery
Potential for large financial savings
Underpin the Trust’s Patient Promises
Fundamental to success is the recognition that this is a Trust-wide role which requires significant skills
Effective communicatorDetailed understanding of how the organisation works Confidence in deliveryAble to drive the agenda in a supportive wayCompetent – able to hit the ground running
Commenced in role November 2010
Information/Data
Case Managementaction plans
Policy refresh
Training sessions 1:1 & group across Divisions
Pro
ject
wo
rk s
trea
ms
Bradford score information shared monthly
Identify individuals score > 300 > 1000
Templates & flowcharts distributed
Health summit meetings monthly
Manage change effectively
Training & support
Communication
Stress Workshops156 managers Sickness Absence
WorkshopsOne to one coaching
Home visits Return to work interviews
Group seminarsHealth Summits
(divisional)Health Summits
(divisional)Round table discussionRound table discussion
HR / OHW liaison
Sickness absence tracker (OHW/HR)
Sickness Absence Activity
Fast track to Physiotherapy -
76 clients 2011/12
Fast track to Counselling - 211 clients
2011/12
Specialist referral clinics
Realistic and informed actions
Quick response
Case Management ActivityCase Management Activity2011/20122011/2012
Case Management Activity TotalEmployee meeting 143Sickness policy staff trained 455Coaching 1:1 with manager 157Case Conference meetings 36Home visits 4Health summit 51Long term over 12 months returned 37Panel pending 7Panel dismissal 6Ill Health Retirement 11Redeployed 20Resigned due to illness 18
OHW Totals 2009 / 2010 2010 / 2011 2011 / 2012
Counselling Referrals 126 139 211
Counselling Appointments 470 434 845
Physio Referrals 142 52 76
Management Referrals 582 764 781
Phone Calls To Service (All Clients) 19819
Emails To Service Mailbox 2256
Needlestick Injuries 211 221
Musculoskeletal Audits 69
Reported Stress To OHW 90 86 134
Activity in Occupational Health and Wellbeing
Progress by Case Manager
DivisionJune 2009 –May 2010
March 2011 – Feb 2012
Top 20 individuals with highest Bradford score
No of Episodes
Calendar Days lost
No of Episodes
Calendar Days lost
W& C 136 2547 64 1210Medicine 151 2199 50 1302Surgery 193 2233 109 1091
W & C Division– Bradford FactorW & C Division– Bradford Factor
Area Employee No of Episodes
Calendar Days lost
Bradford Factor
No of Episodes
Calendar Days lost
Bradford Factor
Chiltern Team L8 A 12 130 18720 7 125 6125 Paeds - Nursing - SCBU SH L8 B 9 127 10287 5 65 1625 Speech Therapy - Child Community L8 C 9 110 8910 1 1 1 Ward 3 - Paediatrics SH L8 D 7 144 7056 4 116 1856 Ward 3 - Paediatrics SH L8 E 7 128 6272 1 305 305 Ward 3 - Paediatrics SH L8 F 12 39 5616 Resigned Ward 4 Gynae/Gen Surgery (Was Wd 9 Gynae) SH L8G 7 104 5096 5 138 3450 Ward 3 - Paediatrics SH L8 H 9 61 4941 4 15 240 W&C Administration SH L8 I 6 118 4248 8 27 1728 O&G - Nursing - Maternity Unit SH L8 J 8 57 3648 5 19 475 Wycombe Team L8 K 7 68 3332 2 23 92 Continuing Care for Children L8 L 6 79 2844 6 90 2420 Ward 4 Gynae/Gen Surgery (Was Wd 9 Gynae) SH L8M 3 312 2808 Retired Wycombe Team L8 N 3 310 2790 1 157 157 O&G - Nursing - Maternity Unit SH L8 O 3 308 2772 3 18 162 Ward 4 Gynae/Gen Surgery (Was Wd 9 Gynae) SH L8P 6 74 2664 1 13 13 Speech Therapy - Child Community L8 Q 5 103 2575 Resigned -
Health Ridgeway Team L8 R 4 160 2560 0 0 0 Paeds - Nursing - SCBU SH L8 S 7 49 2401 7 34 1666 Paeds - Nursing - SCBU SH L8 T 6 66 2376 4 64 1104
Totals 136 2547 64 1210
August 10 - July 11 August 11 - July 12
Medicine Division – Bradford FactorMedicine Division – Bradford Factor
Area Employee No of Episodes
Calendar Days lost
Bradford Factor
No of Episodes
Calendar Days lost
Bradford Factor
Ward 8 Stroke Rehab (W12/6) SH L8 A 9 193 15633 7 169 8281 EMC Nursing WH L8 B 8 197 12608 1 126 126 Medical Division - Secretarial Support L8 C 6 228 8208 4 273 4368 Ward 8 Stroke Rehab (W12/6) SH L8 D 6 189 6804 4 9 144 A&E - Nursing SH L8 E 10 60 6000 2 9 36 Ward 5b WH L8 F 6 160 5760 3 20 180 Pharmacy WH L8 G 10 49 4900 1 33 33 Ward 4a (Was Ward 6a) WH L8 H 10 45 4500 Resigned
Pharmacy SH L8 I 6 124 4464 Dismissal Bucks Neuro Rehab Unit L8 J 10 41 4100 Retired Ward 8 Stroke Rehab (W12/6) SH L8 K 6 105 3780 Dismisses Ward 9 (was Wd 4b) WH L8 L 4 229 3664 2 21 84 Bucks Neuro Rehab Unit L8 M 7 74 3626 3 8 72 A&E - Nursing SH L8 N 6 92 3312 3 4 36 Trustwide Diabetes Services WH L8 O 5 124 3100 1 366 366 Bucks Neuro Rehab Unit L8 P 13 18 3042 3 2 12 Ward 9 MOP (was Wds 1 & 2) SH L8 Q 5 118 2950 4 131 2096 Ward 9 (was Wd 4b) WH L8 R 10 29 2900 Resigned Bucks Neuro Rehab Unit L8 S 8 45 2880 6 41 1476 Chlamydia Screening Programme L8 T 6 79 2844 6 90 3240
Totals 151 2199 50 1302
August 10 - July 11 August 11 - July 12
Surgery Division – Bradford FactorSurgery Division – Bradford Factor
Area Employee No of Episodes
Calendar Days lost
Bradford Factor
No of Episodes
Calendar Days lost
Bradford Factor
Theatre WH L8 A 19 87 31407 8 22 2408 Theatre WH L8 B 20 63 25200 11 45 5445 Theatres SH L8 C 11 117 14157 12 27 3888 ITU SH L8 D 8 189 12096 4 26 416 Theatres SH L8 E 9 147 11907 4 12 192 Theatre WH L8 F 9 143 11583 2 296 1184 Theatre WH L8 G 12 63 9072 8 44 2816 Ward 7 (prev Wards 5/6/21) SH L8 H 9 110 8910 2 47 188
Ward 12b WH L8 I 15 36 8100 5 186 4650 Theatres SH L8 J 8 119 7616 7 27 1323 Theatres SH L8 K 6 181 6516 7 69 3381 Theatres SH L8 L 9 77 6237 2 20 80 Theatres SH L8 M 7 119 5831 2 94 376 Theatres SH L8 N 9 62 5022 10 41 4100 Theatre WH L8 O 7 101 4949 9 14 1134 Wards 1/2 Trauma (was Wd 4) SH L8 P 10 46 4600 1 15 15 Theatre WH L8 Q 4 264 4224 1 42 42 Trustwide CSSD Service SH L8 R 5 164 4100 2 13 52 Wards 1/2 Trauma (was Wd 4) SH L8 S 10 41 4100 11 44 5324 Ward 6 (PFI) was 21 (22) SH L8 T 6 104 3744 1 7 7
Totals 193 2233 109 1091
August 10 - July 11 August 11 - July 12
Based on: Mid point band 6 1.00wte23% on-costs5 day week
Financial Savings to the TrustFinancial Savings to the Trust
1068
1056
1279
NSIC
Medicine
Surgery
Three Divisions having reduced lost days over the specified period
3403TOTAL Days saved
TRUST SAVING£473,039.00 2011 - 2012
Based on: Mid point band 6 1.00wte23% on-costs5 day week
Financial Savings to the TrustFinancial Savings to the Trust
897897
11421142
MedicineMedicine
SurgerySurgery
Seven Divisions having reduced lost days over the specified periodSeven Divisions having reduced lost days over the specified period
17411741
TOTALTOTAL
Days savedDays saved
TRUST SAVINGTRUST SAVING£950,353£950,353
2011 - 20122011 - 2012
93419341
13371337W&CW&C
CorporateCorporate
Other Divisions Other Divisions (Est)(Est)
34963496
CHALLENGESCHALLENGES
Engaging staffEngaging staff
Making paperwork Making paperwork accessibleaccessible
Showing the Showing the benefitsbenefits
Gaining trustGaining trust
Changing Changing habitshabits
• Continue to engage• Build resilience• Share learning• Refine processes• Embed feedback and
data collection
SustainabilitySustainability
The Future
• Demonstrable benefits from investment in Case Manager
Valued by Managers and Staff
• Endorsed by IIP Assessment for Health and Wellbeing Award:– “There is impressive and extensive support through good Health
and Wellbeing practice, e.g. The Case Manager Absence/Sickness”
• Sharing Best Practices– NICE Conference, London, March 2012– SE England Health & Wellbeing Conference, May 2012
HPMA Winner 2012
HSJ Efficiency Award Finalist 2012
ConclusionsConclusions
