Health and social care workforce planning and development – an overview

Purpose - The purpose of this paper is to discuss the issues relating to getting the right health and social care staff with the right skills in the right place at the right time and at the right price. Design/methodology/approach - Key points arising from several master-classes with health and social care managers, supported by a literature review, generated remarkable insights into health and social care workforce planning and development (WP & D). Findings - Flawed methods and overwhelming data are major barriers to health and social care WP & D. Inefficient and ineffective WP & D policy and practice, therefore, may lead to inappropriate care teams, which in turn lead to sub-optimal and costly health and social care. Increasing health and social care demand and service re-design, as the population grows and ages, and services move from hospital to community, means that workforce planners face several challenges. Issues that drive and restrain their health and social care WP & D efforts are lucid and compelling, which leave planners in no doubt what is expected if they are to succeed and health and social care is to develop. One main barrier they face is that although WP & D definitions and models in the literature are logical, clear and effective, they are imperfect, so planners do not always have comprehensive tools or data to help them determine the ideal workforce. They face other barriers. First, WP & D can be fragmented and uni-disciplinary when modern health and social care is integrating. Second, recruitment and retention problems can easily stymie planners' best endeavours because the people that services need (i.e. staff with the right skills), even if they exist, are not evenly distributed throughout the country. Practical implications - This paper underlines triangulated workforce demand and supply methods (described in the paper), which help planners to equalise workloads among disparate groups and isolated practitioners - an important job satisfaction and staff retention issue. Regular and systematic workforce reviews help planners to justify their staffing establishments; it seems vital, therefore, that they have robust methods and supporting data at their fingertips

Shape correction of thin mirrors in a reconfigurable modular space telescope

In order to facilitate the construction of future large space telescopes, the development of low cost, low mass mirrors is necessary. However, such mirrors suffer from a lack of structural stability, stiffness, and shape accuracy. Active materials and actuators can be used to alleviate this deficiency. For observations in the visible wavelengths, the mirror surface must be controlled to an accuracy on the order of tens of nanometers. This paper presents an exploration of several mirror design concepts and compares their effectiveness at providing accurate shape control. The comparison test is the adjustment of a generic mirror from its manufactured spherical shape to the shape required by various off-axis mirrors in a segmented primary mirror array. A study of thermal effects is also presented and, from these results, a recommended design is chosen

Shape Correction of Thin Mirrors

Future large space observatories will require large apertures to provide better resolution and greater light gathering power; thin mirror technologies provide one possible route for addressing this need. This paper presents a study of a 10 m diameter sparse aperture based on a collection of thin, active mirror segments with identical initial shapes. A preliminary design for a 1 m diameter mirror segment is proposed and an investigation into the performance of this design is carried out utilizing finite element modeling tools. The results indicate that it is possible to adapt the generic segment shapes to fit the local mirror shape, and achieve near diffraction-limited performance through the use of lightweight, surface-parallel actuators. These actuators may also be used for thermal compensation. Additionally, a design for a scaled 10 cm diameter prototype mirror to test and validate the envisioned scheme is presented

A Medieval tale: Saxons, Normans and the telscombe ring

Title from PDF of title page, viewed on March 19, 2014Thesis advisor: Burton DunbarVitaIncludes bibliographical references (pages 85-86)Thesis (M. A.)--Dept. of Art and Art History. University of Missouri--Kansas City, 2013A medieval silver-gilt finger ring was found in July, 2010 using a metal detector near the village of Telscombe, in the Lewes District of East Sussex, England. The object, hereto referred to as the Telscombe Ring, was reported and documented per the Treasure Act (1996). In 2012, it was disclaimed as treasure, returned to the finder and sold to a private collector. The object is unusual, combining multiple motifs on the same ring: first, clasped hands, traditionally symbolic of a love token and belonging to a classification of rings known as the fede; second, a series of crosses or saltires that runs down each side of the hoop; third, forming a second bezel opposite the clasped hands, an arcing arrangement representative of stirrup rings; fourth, the heads of two distinctly different beasts positioned at each shoulder of the stirrup bezel. The objective of this research is twofold: first, complete detailed visual and metallurgical analysis to shed light on its use, composition and construction and to identify the makers design intent and production method; second, a comparative stylistic review within a compendium of medieval rings found in England and an array of other objects discovered near the find location to establish the ring's likely geographic origin and approximate creation date. The complexity of the Telscombe Ring provides the additional chance to offer thoughts about the ring's meaning. Since its stylistic variety necessitates the review and discussion of so many other examples featuring one or more of its characteristics, it also presents the more ambitious opportunity to expand upon the broader art history of medieval rings in England.College of Arts and SciencesAbstract -- List of illustrations -- Acknowledgements -- Introduction -- Contextual overview -- Technical evaluations -- Stylistic evaluation -- The Telscombe tales -- Conclusions -- Illustrations -- Bibliographymonographi

Optimized actuators for ultrathin deformable primary mirrors

A novel design and selection scheme for surface-parallel actuators for ultrathin, lightweight mirrors is presented. The actuation system consists of electrodes printed on a continuous layer of piezoelectric material bonded to an optical-quality substrate. The electrodes provide almost full coverage of the piezoelectric layer, in order to maximize the amount of active material that is available for actuation, and their shape is optimized to maximize the correctability and stroke of the mirror for a chosen number of independent actuators and for a dominant imperfection mode. The starting point for the design of the electrodes is the observation that the correction of a figure error that has at least two planes of mirror symmetry is optimally done with twin actuators that have the same optimized shape but are rotated through a suitable angle. Additional sets of optimized twin actuators are defined by considering the intersection between the twin actuators, and hence an arbitrarily fine actuation pattern can be generated. It is shown that this approach leads to actuator systems with better performance than simple, geometrically based actuators. Several actuator patterns to correct third-order astigmatism aberrations are presented, and an experimental demonstration of a 41-actuator mirror is also presented

Developing a workload benchmarking tool for community (public health) nursing

Objectives: To outline the development of a safer staffing tool for use in community (public health) nursing. In 2013, funding was secured to convert selected variables and outputs from the UK Nursing Database to: (i) create community staffing formulae; and (ii) generate organisational profiles. A workload-quality driven workforce planning and development model was built and tested to enable community nursing teams to calculate their workloads and benchmark staffing levels and skill mix against high performing teams. This complements similar models built for inpatient areas (the Hurst Tools). Population: 430 community teams have entered data into the English Safer Staffing community workforce model since 2013 (Scotland and Northern Ireland have similar databases, appropriate to their context). Data are derived from more than 13,000 patient care days during which 3,700 community staff contacted, on average, eight patients a day. Methods: Staff (all grades) keep a diary, spanning 24hrs, Monday to Sunday, and record nursing interventions and patient dependency/acuity. An empirically derived workload index shows whether each full time equivalent staff member (FTE) is under- or over-occupied. This index is calculated from patient numbers, case mix, direct care time and an ‘overhead’ (e.g., desk time). Only data from teams achieving acceptable service quality is admitted to the model. Benchmarking information for overall staffing levels, skill mix and activity (contact time) is available Findings: Although clinic time is logged, patients are counted in the daily contact rate. Typical patient dependency is 13% Level 1 (simple case); 36% Level 2 (requiring intermediate interventions); 37% Level 3 (requiring complex interventions) and 14% Level 4 (most complex cases); suggesting highly dependent/acute patients aren’t being hospitalised, thereby relieving pressure on hospital beds. Sixty-seven percent of the workforce are registered practitioners, generally higher than inpatient specialties. Sixty-three percent of all activity is patient focussed; i.e., direct (face-to-face) care or indirect (patient-related) care. This is markedly higher than inpatient contact time. Twenty-nine% of staff time is spent on activities not directly connected with patient care (e.g. general meetings and administration). Unproductive time is negligible (less than 1%) in comparison with inpatient areas (10%). The concurrent service quality audit (166,000 questions answered by patients, carers and staff) indicates that patients and carers highly value the service they receive from community staff, but community staff report stressful workloads, which require significant unpaid overtime (i.e., completed at home outside work time). Conclusion: This community staffing model complements inpatient staffing models and enables comparisons across teams and localities. The tool has proved popular with senior staff as it provides valuable best-practice data to support service delivery. Results highlight that community care is efficient and effective, and is likely to reduce inpatient workload and costs significantly. However, community care appears to be the Cinderella service, which desperately needs additional resources. Front-line staff report challenges with objective assessment of patient dependency and have, at times, been resistant to data capture. The approach has been rolled out for community mental health and learning disability workforces and results will be shared at the conferenc

Emergency department attendances and GP patient satisfaction

Background: Despite invaluable national data, reasons for the relentless rise in England’s emergency department (ED) attendances remain elusive. Setting: All EDs and general practices in England. Question: Are rising ED attendances related to general practice patient satisfaction, i.e. if patients are unable to get a convenient appointment with their general practitioner (GP), then do they attend their local ED for diagnosis, treatment and care instead? Method: GP patient satisfaction and ED attendance data were extracted from national data warehouses and organised into two groups: (i) England clinical commissioning group (CCG) areas and (ii) a London CCG subset. Data from London CCGs were compared with CCGs outside London. Results: ED attendances were strongly correlated with GP patient satisfaction data in non-London CCGs, e.g. if patients said they had difficulty obtaining a convenient appointment at their general practice, then local ED attendances increased. Associations were repeated when other GP perception data were explored, e.g. if patients were satisfied with GPs and practice nurses, then they were less likely to attend their local EDs. However, these associations were not found in the London CCG subset despite lower satisfaction with London GP services. Discussion and Conclusions: Although our study generates valuable insights into ED attendances, the reasons why London general practice patient and ED attendance data don’t show the same associations found outside London warrants further study. Diverting patients from EDs to primary care services may not be straight forward as many would like to believe

Whole system quality: local benchmarking to improve workforce planning

As a team of workforce analysts and academics with an interest in workforce planning, we are aware that the data available to support primary care workforce planning are disorganised and overwhelming. This makes it difficult for General Practice to extract meaningful and relevant information. We deliver workforce planning workshops across England. Participants at our workshops regularly express their frustration with the quantity of information they are required to produce and the quality of information they receive from other parts of the system. We are dismayed at what we sense to be growing cynicism with data generation and information analysis and are interested in stimulating a conversation about what data matter and how primary care teams can extract data that are usefu