Title of the Change Project Student ID. MSc in Healthcare Management, Institute of Leadership, Royal College of Surgeons in Ireland Header line 1 Header line 2 Header line 3 Workload Management in Primary Care Occupational Therapy Mary O’Kelly MSc Leadership Abstract Aim: This dissertation describes a project that aimed to introduce a workload management system in a primary care occupational therapy service. Rationale: The project was completed in the context of a changing healthcare climate where primary care was expanding and becoming increasingly diverse. A workload management system was required to facilitate the effective use of limited staff resources to meet this dynamic agenda and to provide evidence to support strategic workforce planning. Change process: The health service executive organisational development model was used to guide change because it enabled staff to work together using a consistent organisational learning approach to improve the experience of service users. This was central to the success of the project. Development of the workload measurement tool concentrated on four key elements; direct intervention time, indirect intervention time, travel time and role tasks. Implementation of the system was augmented by revision of an existing workload weighting tool to include time in addition to professional judgement as a measure of complexity. It also included a caseload monitoring tool that enabled clinicians to reflect on their caseload profile and their caseload management behaviours. Evaluation: The project was evaluated using the Structure Process Outcome conceptual model as a framework. It facilitated use of the Context Input Process Product model and Kirkpatrick training evaluation model. Results and conclusion: The successful introduction of the workload management system resulted in the team gaining increased knowledge, understanding and ability to manage their workload leading to a significant cultural change towards ownership of their response to the demand for the service.  

Workload Management in Primary Care Occupational Therapy Mary O’ Kelly MSc Leadership mary.okelly@hse.ie Introduction & Background Methodology Evaluation Maintaining a well structured and engaged workforce of an appropriate size which is able to meet needs in a cost effective manner is necessary for the delivery of quality occupational therapy (OT) services. Figure 1: SPO model1 Primary care OT required a workload measurement and management system that facilitated the effective use of limited resources to meet increased and diverse demands to ensure a safe, quality service while facilitating strategic workforce planning. The HSE change model2 was used to guide the project(figure2). Initiation The project commenced with a critical review of literature, current practices and information gained from environmental scanning to determine the need, urgency and readiness for change. Key stakeholders and the project team were identified. Planning A vision, strategy and gap analysis supported the development of a workload measurement workbook that focused on the key elements of; frequency and duration of direct and indirect intervention. travel time. role tasks. Implementation Onsite training and mentoring was provided by the project group to ensure colleagues became proficient in use of the workbook. Ratio allocations for direct, indirect and role tasks were established. Mainstreaming The adoption of the system was enhanced by; revision of the workload weighting tool to include time in addition to professional judgement as a measure of complexity. a caseload monitor. Figure 3: CIPP model3 Figure 4: Workload awareness (post) Structure OT team Primary Care Administrative Processes Time Process Assessment Goal setting Planning Intervention Outcome Service user occupational performance goals met in a timely manner Organisational Impact Figure 2: HSE Change Model 2 Aim & Objectives Invisible workload became visible. Increased ability to efficiently and effectively manage workload. Reduction of risk factors associated with unmanageable workloads that negatively impact on service users. Greater understanding of risks associated with setting service targets without criteria. Aim To introduce a workload management system that will provide evidence to facilitate workforce planning in a HSE primary care occupational therapy service. Objectives To develop and pilot a primary care OT workload measurement tool that provides evidence on which to base individual and service workload management. To implement a policy, protocol, guideline (PPG) for workload management in a primary care OT service. To establish individualised workload metrics for all OTs.  To develop a workload weighting tool that includes a turnover and time on caseload monitor. Conclusion The acquisition of new skills, attitudes and behaviours regarding workload measurement and weighting resulted in adoption of workload management into the service culture. References 1. Donabedian, A. (2005). Evaluating the quality of medical care. 1966. The Milbank Quarterly, 83(4). 2. HSE. (2008). Improving our Services: A Users’ Guide to Managing Change in the Health Service Executive. Dublin. 3..Stufflebeam, D. L., & Coryn, C. (2014). Evaluation theory, models, and applications. San Francisco: Jossey- Bass.