Transforming the Hire to Retire process across NHS Wales

A case study by NHS Wales Shared Services Partnership                         

NHS Wales Shared Services Partnership is a dedicated shared services organisation sharing common operating standards and systems. The use of one workforce system – the Electronic Staff Record (ESR), across NHS Wales provides significant opportunities for standardising processes, providing more efficient services and lowering costs. However an audit of recruitment and on-boarding processes for new employees across NHS Wales revealed unnecessary delays and duplication of processes.

The delay in Occupational Health (OH) clearance along with the manually dependant process of notifying Recruitment of eligibility to commence work lead to significant delays within the recruitment chain, resulting in a higher dependency on agency and locum staff, often adversely impacting the variable pay bill.

More than ever, the necessity to maximise efficiencies, reduce the variable pay bill and maximise digital resources is critical if NHS Wales is to provide safe, effective, world class health services to its patients.

Coupled with this was significant variation in the use of OH systems and processes, duplication of data entry, inconsistencies in processes, no standardisation of data sets and processes were manual and paper driven. These issues combined and resulted in lengthy delays in OH clearance and delays to appointing new employees into posts.

The Project

With evidence of waste, including duplication and delays in the on-boarding process, a scoping exercise was undertaken to benchmark existing processes against a world class solution.  With the automation, standardisation, portability and workflows that ESR provides, full deployment of ESR was defined as our world class standard across NHS Wales.

An ESR ‘world class Hire to Retire’ vision was developed that defined the process from confirmation of preferred applicant to Occupational Health clearance and readiness to commence in post. This became the blueprint for the project.

We initially undertook a process mapping exercise with key stakeholders including the NHS ESR Team, Occupational Health and Recruitment staff and an OH supplier to determine the degree of variation that existed. This exercise provided us with robust evidence around the differing processes, duplication of data entry, dependency on manual and paper based processes and lack of standard operating procedures across the various organisations. We established a stakeholder group to identify how the ESR OH module and use of ESR Interfacing technology could be used to streamline and automate the processes, and three pilot organisations were identified to test and implement the solution.

Some of the required functionality was already available within the ESR solution, but additional functionality was identified that would enable a bidirectional exchange of information between ESR and the OH system. This required co-production and partnership working. We developed a specification outlining the data exchange required and how the process could work.  For us as a team this was not without challenges; implementing this innovative solution within a live environment introduced high risks because we didn’t have a testing environment, so agile project management was required to ensure services would not be adversely impacted for any length of time.  The Recruitment and OH staff required significant training, support and IT support as infrastructure varied significantly between the three pilot organisations - with different solutions often required. 

This was not a straightforward ESR implementation project to deploy existing capability.  This project was bold and transformational, taking the existing ESR solution and enhancing it to achieve greater efficiencies.  One of the keys to the success of the project was the resilience and commitment of all the project stakeholders which included the three large NHS Wales organisations, Medgate, the Occupational Health provider and the NHS ESR Systems Integration Team to implement a cost effective solution with no additional resource or expenditure.

Benefits

There has been a wide range of benefits identified as part of this project;

• Standardisation and embedding of robust operating processes between Occupational Health and Recruitment resulting in time savings of 23,835 hours per annum within both processes, which equates to efficiencies of approximately £40K per annum across the pilot organisations.
• An 80% reduction in duplication of data entry for Occupational Health administration teams.
• A 20% reduction in the Occupational Health process steps.
• Establishment of standard data sets, significantly reducing variation.
• Portability has resulted in pre-employment data being available to Occupational Health at an earlier stage in the recruitment process, speeding up on-boarding for new employees.
• ESR workflow notifications removed approximately 3,000 clearance emails per annum from the process.
• The project has significantly raised the profile of Occupational Health services.
• The deployment of ESR Self Service has been progressed by organisations to ensure the data in ESR is current and correct.
• Improved visibility about the OH interventions and immunisations required for staff groups.

Potential learning and advice for other Organisations

This project will act as a blueprint for the deployment of the ESR/OH bi-directional interface across all remaining Wales NHS organisations. Lessons learned have been meticulously documented with standard operating procedures created and process maps developed, improved and refined.

Tips for other Organisations:

• Ensure you understand the ‘as is’ process before developing new processes to maximise capabilities.
• Engagement with key stakeholders from the outset – particularly IT - is critical. Many of the issues we encountered resulted from local IT infrastructure, security settings, fire wall settings etc.
• Regular project meetings are very important so that you can manage issues and risks.
• Develop testing scripts and establish a robust testing process of the technical solution.
• Ensure that you provide training for your OH and Recruitment teams so that everyone across those teams understand the new processes, roles and the impact to each service.

The Next Steps

We now plan to fully deploy the ESR/OH bi-directional interface across NHS Wales and our business case has recently been approved by NHS Wales Shared Services Committee.  The next step is to get our project initiation document (PID) developed outlining the timeline and the sequence of on-boarding for the remaining five organisations. 

We are currently developing a specification that will enhance the interface between ESR and the recruitment software (TRAC) that we use to further remove duplication of OH clearance data entry by recruitment staff.

We are going to implement electronic pre-employment health questionnaires. This will require additional data portability from the interface to pre-populate position requirements, but it will reduce delays in pre-employment health information by approximately 50%, leading to quicker on-boarding of new employees and further removal of Recruitment and Occupational Health process steps.

For More Information

For more information about the project and associated benefits please contact Helen Thomas, NHS Wales ESR Hire to Retire Programme Manager at Helen.Thomas7@wales.nhs.uk, or Vanessa Davies, Head of Occupational Health, Hywel Dda UHB at Vanessa.davies2@wales.nhs.uk.