Effective use of ESR in Workforce Management and Service Transformation

A Case Study by East & North Hertfordshire NHS Trust

Background

The East and North Hertfordshire NHS Trust has circa 5,000 dedicated staff who proudly provide a range of general and specialist services across its 4 sites.

The Trust was formed in April 2000 with responsibility for managing Hertford County Hospital in Hertford, the Lister Hospital in Stevenage and the QEII Hospital in Welwyn Garden City (since renamed as the New QEII). In April 2005 we also gained responsibility for managing the Mount Vernon Cancer Centre, in Northwood. We provide a wide range of emergency and inpatient services at the Lister, with outpatient and diagnostic care provided at Hertford County, the Lister and the New QEII. Our maternity service at the Lister offers co-located midwife and consultant-led units, as well as a range of other services – including a dedicated early pregnancy unit.

In 2014, the Trust delivered an extensive and large scale acute services reconfiguration.  The project ‘Our Changing Hospitals’ (OCH) resulted in reconfiguration of acute services and required extensive workforce consultation.  The mitigations put in place enabled us to deliver one of the largest CIP programmes -  £26.2m - in the NHS during 2014/15.

In order to achieve the deliverables of OCH it was imperative there was a coherent ESR strategy, clearly linked back to service improvements and performance targets for the business.  The strategy focused on the use of the ESR solution as the core employee management system in the Trust and the linkages with other workforce systems.

The strategy was underpinned by the following objectives:

  • Development of ESR as a ‘single source of truth’ for workforce information
  • Accurate tracking of the head count reduction required for the consolidation of services.
  • Establishment controlled through the ESR system with clearly defined linkages with the Finance department and systems
  • Standard Trust-wide processes for accurate and timely data input
  • Robust recording of key employee information (i.e. professional registration and pre-employment checks)
  • Accurate, timely and credible Workforce information reporting, accessible to all from a trusted source.

The review and subsequent development of our use of ESR was separated into a number of main projects and PRINCE 2 methodology was used:

  1. OCH project to manage the acute reconfiguration of services; 5000 staff were consulted, 3500 staff were under part of reconfiguration plans, 2500 staff moved during the reconfiguration;
  2. A full review of OLM; this involved the reassessment of all roles and competencies to ensure safety and consistency across the Trust. We used a training needs analysis; this is the basis now for increment award approval and progression and is now embedded within the Trust;
  3. Establishment Control Project; Alignment of ESR against the ledger, recruitment and e-roster systems. This ensured an up to date staffing profile, with the ability to forecast vacancy levels and bank and agency usage and spend, based on the recruitment pipeline and turnover;
  4. The full introduction of e-forms and self-service to ensure that ESR information is as real-time as possible.

ESR workforce data and its integrity was essential to the delivery of the project; the HR team were in charge of the workforce transformation.

The staff consultation exercise was extensive and throughout the programme almost the entire Trust workforce of c.5000 colleagues were consulted. The consultation was complex and involved changes to location, terms and conditions, shift patterns, skill mix and the introduction of new care pathways to improve outcomes. The Trust took all measures available to engage with the workforce to design new services and pathways of care and also to mitigate the financial consequences of the change programme.

The table below details the number of staff involved at each stage of the change process:

Key Transformation DataNumber of Staff
Staff directly consulted withc. 5000
Staff that had 1:1/group mtg994
Staff that slotted in1478
Competitive slotting in202
Staff that went through expression of interest349
Staff interviewed 149
Redeployed32
Redundancies8
Team training engagement 327
Interview skills401

Our Changing Hospitals Workforce Transformation Programme Board was established with strong executive leadership and membership. This oversaw the work of the project, which in turn reviewed over 50 separate consultations, ensuring that interdependences were addressed and coordinated. ESR provided a master database which was essential to the management and integrity of the process.

Thomas Simons, ESR Executive Sponsor for the Trust said: ‘Having real time access to accurate data and business intelligence is crucial for any organisation or manager to assess how their business is performing and where they are going. For us, having accurate data from ESR BI was critical to ensuring our success’.

Workforce Transformation and Redundancy Cost position - The Trust delivered a 360 wte workforce reduction in 2014/15. Against the anticipated original redundancy risk of £8m mainly through vacancy control, redeployment and the use of attrition, the actual redundancy cost was mitigated to £400k. A clear outline of the workforce movements and their various consultation stages helped to provide a process map which made it easy to track affected staff throughout the transformation period (see above table).

Accountability and monitoring – monthly PMO meetings were chaired by an executive director, holding the divisions to account and monitoring the development of workforce plans

In 2015 the Trust introduced an effective establishment control process. This process matches the information from both the ledger and ESR ensuring that information in both systems is accurate at any point in time. This has allowed production of vacancy rate modelling, taking account of the recruitment pipeline data and turnover rates to produce a vacancy rate look forward. This is an essential tool for managers to assess their current and future staffing profile and align the need for temporary staffing. In turn, this has enabled us to reduce the costs of bank and agency staff, improve forecasting to help produce better pay spend and budget alignment and is helping to drive workforce performance management and increase productivity.

Robust and comprehensive Vacancy Control and Re-deployment programmes were implemented to mitigate the impact of the changes for staff and the Trust.  The development of a five step gateway process provided a clear and highly visible route for organisational change, the ‘to be’ staffing models and the subsequent consultation with staff.  The gateway process set out the key decisions to be made at each step and who was responsible for approving the plans.

The introduction of competences led to a simpler and accurate way of managing statutory training compliance which enables the control and monitoring of pay increment approval and progression.

The introduction of self service will help to not only empower staff to take ownership of their personal information, but increase efficiency reducing administrative manual paper-based inputs. Used in conjunction with the locally designed e-forms, self service functionality helps to speed up the recruitment process, triggering actions and starting the recruitment process as soon as an e-Leaver action has been initiated.

The Performance, Information & Planning team developed heat maps to assess the overall performance of wards and divisions and directorates against a number of key workforce performance indicators. This gave us a single temperature rating for each area based on an algorithm encompassing vacancy rate, bank usage, agency usage, appraisal rate and training compliance. This helped to develop coordinated action plans to assist the areas that were not meeting the level required.

Below is an example of the workforce metrics on which an algorithm is applied to convert the figures into a temperature heat map chart identifying areas that require support: 

Trust Summary

Vacancy rate %

Sickness %

Agency usage %

Bank usage %

Staff Appraised % (rolling 12 months)

Statutory Training Overall Coverage %

Surgery Division Ward 1

6.65%

3.66%

2.54%

1.38%

86.29%

88.34%

Surgery Division Ward 2

9.54%

4.61%

4.22%

2.88%

88.43%

91.30%

Cancer Division Ward 1

11.28%

3.60%

11.16%

2.95%

81.29%

87.44%

Medicine Division Ward 2

21.62%

3.87%

20.51%

7.43%

66.26%

85.52%

Medicine Division Ward 2

15.26%

1.33%

0.00%

1.26%

65.52%

90.68%

W&C Ward 1

12.72%

3.85%

7.84%

3.19%

77.52%

86.19%

W&C Ward 2

7.08%

4.88%

7.89%

5.95%

85.30%

90.16%

Stakeholder engagement was essential prior to and during the implementation and rollout of additional ESR functionality. From Board level to frontline engagement- we established a robust approach to involve and engage our staff.

With Establishment Control and Self Service, it is important to ensure that data cleanse is completed to help increase confidence and the resultant ESR BI reports which form the basis for effective Workforce intelligence.

Evaluating and reviewing after implementation remains a critical component for the success of any such projects. The ESR support desk remains key in exploring and providing solutions to some of the challenges we have come across using ESR and therefore we would encourage ESR users to raise SRs for help.

Most importantly ‘You can never start too early’