Exploring delegation a workshop for registered staff Louise Williams Healthcare Support Worker Development Coordinator, Powys Teaching Health Board

What is delegation? to give a task to somebody else with responsibility to act on your behalf to entrust (a task or responsibility) to another person In the NHS… …..the process by which a registered practitioner can allocate work to a support worker who is deemed competent to undertake the task.

Why delegate? So the patient gets the care they need when they need it – right person, right skills, right place, right time etc To provide good quality care at the best cost Best use of resources /best use of the team To meet increasing demand/need

to: the patient your employer the public your profession (HPC, NMC) yourself? As a registered healthcare professional, you are personally accountable for your practice

Accountability ……..being responsible for the outcome of one’s actions (or omissions) And …….being able to justify decisions made

As a registered healthcare professional, you are responsible and accountable for: The appropriateness of the delegation Ensuring adequate supervision or support is given

What are the key factors in delegation? It must be in the best interests of the patient the way the task is carried out must meet standards: policy protocol National Service Framework National Occupational Standard job description/post outline

What do you need to consider before delegating a task to a support worker? The task The person whom you are delegating to – the support worker The patient/s The situation

The Task – is it suitable for delegation? Is information gathering and/or decision making involved? Is clinical reasoning involved? Is there a protocol to follow? Is it carried out frequently? Is a high level of manual skills required Is the procedure complex? What would the consequences of error be? What is the probability of error occurring? Is it in the support workers job description?

The person to whom the task might be delegated Are they competent? How do you know they are? Have you seen them carry out this task competently? Do they have credits/a qualification in this task? Do they feel competent? Do they understand what is being asked of them? Do they know the limits of their competence? Have you checked their understanding of the task to be done / your request? Do they know how to contact you or someone else who is competent in this area, if they have a query or concern about the task? Do they know who to report any unexpected occurrences / outcomes to? Do they know where and how to document the task done and any outcomes?

The Patient /s Is the patient able to participate as expected? Is the patient's condition stable? Is the presentation of the patient’s condition complex? Is the patient’s condition common? Is the patient anxious? Is the patient’s situation likely to be unpredictable?

The situation Is the patient’s situation likely to be unpredictable? Does the situation pose any increased risk?

What about you?.. the person who is delegating? Do you know what the standards are? Are you competent yourself? (Do you always need to be?) How do you know the support worker is competent? Have you seen them carry out this task competently? Do they understand what is being asked of them? I.e., is your request clear?

SMART – a simple delegation rule Specific – be clear about the task you are delegating. What must be achieved? Clarify understanding by getting feedback from the other person. Measurable - How will the task be measured? Make sure they know how you intend to decide that the job is being successfully done. Agreed - people cannot be held responsible for something to which they've not agreed. People are more committed to delivering a responsibility if they've been through the process of agreeing to do it. You must give the other person the opportunity to discuss, question and suggest issues concerning expectations attached to a delegated task. Realistic – Consider the task, person, patient and the situation. Time-bound - When must the job be finished?

Ensuring adequate supervision and support is given Support and communicate – Make sure that the support worker knows how to recognise if and when they need to ask for help. Make sure they can contact you or some one else appropriate, if need be. Do you need to inform anyone else that you have delegated this task to the support worker? Involve the support worker in considering this. Do not leave them to inform your own colleagues of their responsibility.

The importance of feedback Feedback on results - It is essential to let the person know how they are doing, and whether they have achieved their aims or not. You must review with them why things did not go to plan if this is the case, and deal with the problems. You can help them reflect and learn from the experience, and make sure you pass on the credit for success.

The support worker is responsible for: Accepting the delegated task Carrying out the task to the standards they have been trained to meet Following policy and protocol as they have been trained Duty of care to the patient and others Maintaining patient records as they have been trained to do so

WORKSHOP What is…….. Competence? Accountability? Responsibility? Vicarious liability? Duty of Care? Indemnity insurance? A National Occupational Standard?

Further info and resources… Health care assistants and assistant practitioners, Delegation and accountability. Essential guide. RCN, Nursing Standard. December Publication code Supervision, accountability and delegation of activities to support workers: A guide for registered practitioners and support workers. CSP, RCSLT, BDA, RCN. January 2006 Effective delegation Information sheet. Sally Brockway, Library and Information Services, RCN Wales. 11 th March Accountability for HCAs and assistant practitioners. Chris Mulryan. British Journal of HCAs April.3(4). p Delegation in practice. Ann Shuttleworth. NT April.104(17). p10-11 Core standards for Assistant Practitioners. Skills for Health. November Allocate and check work in your team. National Occupation Standard M&L D5

Acknowledgments With thanks to: The RCN The CSP The Calderdale Framework