Context Task mapping exercises have a valuable part in shaping future workforces. Our project examined the tasks undertaken by a multi-professional, non-consultant workforce in a large, busy general paediatric department, which provides secondary level paediatric care and also assists in the care of tertiary subspecialty patients, providing a total of 12000 inpatient episodes of care per year.
Problem Uncertainties around numbers of doctors in training allocated to the department in the future and the anticipated contraction of the junior medical workforce had led to new models of care provision. Introduction of international fellows and non-medical practitioners such as advanced nurse practitioners and physician associates into the team are seen as a way of developing a resilient and future-proof workforce.
Assessment of problem and analysis of its causes There was a perception of mismatched distribution of competencies within our team, with an assumed deficiency in middle grade level skills. Therefore, we embarked on a task mapping project to examine the spectrum of everyday tasks undertaken by the team in order to ensure that the non-consultant workforce had the right competencies to deliver safe and timely patient care.
Intervention A series of initial stakeholder meetings were held, and a task mapping sheet developed which coded all clinical and non clinical tasks that could be anticipated to be performed over the working day. Each team member was required to enter a code at 15 min intervals, as well as a code for any pending tasks, daily for 3 weeks. A pilot was run with senior trainees in the department following which amendments were made. Champions for the project were identified, and educational sessions with power point presentations were given prior to commencing the project.
Study design The study used a Plan-Do-Study-Act model as a framework. The data collection sheet was partially anonymised, requiring the individual to complete only their clinical grade and location of work.
Strategy for change Data analysed shows the amount of time each team-member group spent on each coded task. There is a reliance on middle grade staff for practical procedures – 66% of lumbar punctures are first attempted by registrars, and 40% of intravenous access. Attendance rates at educational sessions are highest by FY trainees, with lowest rates by registrars. There needs to be a cultural change, with reallocation of tasks from registrars to allow the non-medical professionals to gain necessary experience and competence.
Measurement of improvement The non-medical professionals needs training to be able to manage the required tasks autonomously, before the mapping process can be repeated.
Effects of changes We anticipate that training of the non-medical workforce to perform more advanced clinical tasks will result in more efficient patient care, with better provision of training and education for those existing trainees.
Lessons learnt A post-task debrief identified a degree of anxiety that the process was being used as a performance assessment tool. This suggests discordance between participants’ performance and their declarative knowledge of the task. Another challenge was “mapping fatigue” that became particularly evident as the project progressed. Social acceptability determinants of self reporting affects the validity of data and to ensure the integrity of the data, data collection by independent observers may be a more effective method.
Message for others Diversifying the workforce is inevitable for paediatric departments in the future. The multi professional task analysis we undertook is a pathfinder for other organisations who will need to undergo similar change. While multi professional workforce use is well developed in other areas, there has to be recognition of the time required for non-medical professionals to develop the breadth of knowledge and skills required to function autonomously at middle grade level in general paediatrics. Targeted training would speed up the development process.
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