The Estates team at Derbyshire Community Health Service NHS Foundation Trust (DCHS) was a finalist in the HEFMA Team of the Year Award category this year in recognition of the transition of its Estates maintenance function from a workshop-based model to a commercial, mobile delivery and 'agile working' service model.
DCHS is a large Community Trust that provides a comprehensive maintenance service to community hospitals and primary care premises in the large geographical area of Derbyshire (over 1,000 square miles).
DCHS Estates employs around 60 members of staff and is registered to BS ISO 9001:2015 & 14001:2004 Quality Assurance Standards, which provide a totally integrated quality management system to control and monitor Estates business processes. The team identified the need to redesign its maintenance function to improve service efficiency through improved work planning and to deliver its business in a more commercial and responsive way. This initiative has enabled Estates to tender for new business opportunities in Derbyshire as well as neighbouring counties and provide assurance to the board that the service is open and responsive to change.
After reviewing public and private sector operations across a large geographical area, Estates identified what it considered to be best practice and set out to operate a similar model. The strategy it selected supported the wider clinical aim of providing patient care in the home - or as near to home as possible - as well as supporting the Trust in rolling out the agile working initiative for eligible staff. The model also contributed to the Trust's carbon reduction programme as improved work planning reduced the amount of travelling time for Estates staff by issuing work based on the geographical area where operatives live.
Staff engagement was crucial to ensure a department-wide buy-in. A service delivery group was formed, comprising representatives from trade staff, supervisors, managers, help desk staff and IT support to monitor progress against the action plan. A wider consultation took place with all maintenance and staff side representatives.
Mobile systems and technology were researched to ensure mobile communication, improved logistics and work planning was achievable. This involved visiting private sector and public sector organisations to look at their systems and gain insight - particularly over lessons learned.
Deliverables achieved
• A generic job description was produced for a Multi-skilled Technician which addressed the issue of having a divided workforce with differing pay bands.
• Technicians work from home each day and have been empowered with greater autonomy and responsibility over their day-to-day activities. They have the flexibility to arrange work outside their core hours to meet the needs of the service user. This has allowed workshops to be closed reducing capital charges/revenue cost or even allowing the building to be refurbished for another service.
• This business model, along with the ongoing Estates multi-skilling initiative and the fact that technicians take ownership for their own quality of work has resulted in trade staff obtaining an increase from band 4 to band 5. This also allowed for the removal of RRP.
• Technicians have designated managers available for technical support if needed and to ensure wellbeing meetings and annual appraisals take place.
• The work requests are received via intranet, telephone or email. The work is issued direct to technicians by the help desk/resource planners, removing the need for a supervisor to allocate the work.
• Estates vans are fitted with tracking devices to improve work planning and allow improved responses to planned maintenance, day-to-day repairs and emergencies. This also improves lone worker controls to improve staff safety, particularly when attending out-of-hours emergencies.
• Reduced carbon emissions by wherever possible allocating work to staff that live local to the sites being maintained.
• The use of mobile technology to transmit and receive work information, reducing the risk of lost paperwork and allowing real time data. Work not budgeted for is recharged in a much timelier manner. Health and Safety and all necessary technical information are available on the android tablets.
• The use of purchase cards to allow trade staff to source materials locally and wherever possible aim to fix the repair on the first visit.
• The introduction of a new corporate uniform to create a professional image along with awareness training for staff which clearly defined expectations, making staff aware of the impact they have on clinical staff and the patient experience.
• The new Estates model of working allows for increased business opportunities which generate income for the Trust, such as GP practices and other healthcare providers.
• Improved response times and completion of maintenance requests with fewer staff.
• Revenue savings on staffing by not replacing posts lost through natural wastage.
• Reduced effect of negative peer pressure on individual performance.
• Technicians report improved job satisfaction and morale by having control over their day-to-day activities.
• Improved customer satisfaction as evidenced through feedback from service level review meetings with in-house and external users.
• Reduced disruption and downtime by adopting a flexible approach to working patterns ensuring minimal disruption to clinical services delivering patient care.
• Reduced administrative work for technicians allows for greater productivity. Technicians use paperless technology to improve information flow and reduce the likelihood of lost paperwork.
• Improved technology and improved reporting systems to give board assurance on Estates services including statutory compliance.
• Reduced likelihood of peer pressure on operatives allowing them to work flexibly and more commercially.
• Reduced impact on service delivery when staff are absent from work by other staff taking on additional activities outside their core trade.
• Apprentices complete a multi-skilled apprenticeship i.e NVQ level 3 in electrical & NVQ level 2 in plumbing or vice versa.
• Peer to peer teaching by technicians of their core trade.
Key Challenges
• Reluctance to change - 'that’s how we have always done it attitude'.
• Resistance to multi-skilling.
• Fear of technology from the more mature operatives.
• Selling the vision of where the service needs to be.
• Staff involvement and continuous engagement.
• Identifying best practice.
The team engaged with all staff to create a shared vision of where the service needs to be and the many benefits of operating this model. These benefits are to the service and the individual, for instance, being able to take a vehicle home and greater autonomy in the day-to-day activities. Training was provided to allow operatives to see change in a positive way and involve them in key decisions.
A combination of internal and external courses supported by knowledge sharing amongst technicians, clearly articulated what multi-skilling means.
Technicians were involved in the decision over which devices to purchase and were involved in the trial. Peer to peer training resulted in younger members of staff who adapt well to technology sharing their knowledge with the less confident technicians.
Although the Estates senior managers had a clear idea of where the service needed to be positioned so it would be able to meet the demands of future service provision, all operatives were encouraged to put forward their own suggestions. Managers engage with staff on a regular basis and continue to encourage suggestions for service improvements from all members of staff. Regular team meetings take place between management and staff.
Estates actively seek out best practice and participate in benchmarking activities as members of The National Performance Advisory Group (NPAG).
Outcome
By ensuring excellent staff engagement and involving staff at every stage of this project, DCHS has an Estates service delivery model that all staff are proud of. Staff and management work well together with a common objective: to be the best Estates Department in the NHS.
The improvement is evident across a number of KPIs, one of the greatest achievements being the ability to demonstrate the significant change that can be made when there is an honest and open dialogue, as well as trust, between all levels of staff.
DCHS Estates has hosted visits from a number of Trusts who are keen to look at adopting the model and feels it could be rolled-out nationally to every mental health and community Trust.
Furthermore, the Estates team is now exploring a model that is output driven as opposed to time spent on the job. If introduced correctly with the appropriate safeguards in place this model has the potential to further improve productivity whilst improving staff health and wellbeing.
