Steps to Describe Income Flow, Evaluate Skill Mix, Develop a System, and Audit Non-Staff Expenditure

Part 1 - Describing Income Flow in a Healthcare Organization

QUESTION 1: The question says ‘Describe’ the income flow into the organisation of your choice. You do not need to be overly critical here. Answering this question demonstrates your understanding of budget in healthcare (partially satisfying Learning outcome K3).  A flow chat may be used to describe the income flow in your organisation but it is not necessary (neither is it necessary to state the amounts).  Remember with income flow, you are not only discussing income from government but also income generated by the organisation.  QUESTION 2: The first part of the question as requires you ‘Critically evaluate the steps you would take when reviewing the skill mix’ Using a framework would help you systematically answer this question. For example, clinical governance- clinical effectiveness, risk assessment, learning effectiveness etc. You can evaluate the subject matter as a mix of posts within an organisation (Doctors, nurses, pharmacists etc.), but most specifically the mix of employees in nursing roles.  Also your review should be critical. It does not only require you state/describe your approach to mix the skills on the ward but discuss/evaluate the factors that you consider when doing so. For example, needs of the patient, competency levels, benchmarking, risk assessment and so on. These factors can then be reflected in your chosen approach to skill mix.  A good analogy would be: say you are building a house and someone asks you to review your plans for building the house. You would want to assess the distance of supplies to the building site, the cost of supplies and workers, the experience of workers in achieving the blueprint of the structures etc. As such, although you want the carpenters to make the doors and electricians to fix the wiring (which is obvious), in building that structure, your initial assessment would help you determine who does what, when and how.  Therefore, practically, depending on your care setting, the nurse patient ratio will vary (due to needs of patients), nurse healthcare assistant ration will vary (either due to benchmarks, cost/available spending or evidence).  This first part of the question gives you so much room to use theories to support your approach. For example, Benner (1984).  Remember the question is on two parts, the second part also requires you ‘Discuss how you might balance the financial implications of your actions’. This question challenges you in the sense that in reviewing your skill mix in a cost-controlled environment, you ensure and maintain quality care and also not compromise the quality of your staffing. Once again, you can use some of the pillars of clinical governance (especially strategic and audit effectiveness) to underpin your approach. Also remember to support your approach with current concepts in healthcare (for example, FYFV, leading change adding value (2014)- better use of resources).  Effectively answering this question helps you satisfy learning outcomes K3 and S3.  QUESTION 3:  This question clearly asks that you ‘Develop a system’, so please do so and offer detailed discussion on why you have designed or adopted that system.  You may or may not choose to use technology and go traditional approach of paper and pen for documentation and audit. However, remember with the FYFV, we are encouraged to maximise the use of technology in caring for our patients.  Your system should in general help you oversee every staffing expenditure monthly. Consider things like the needs of the ward, keep record of spending on individual staffs, their bands, leaves, days off etc.  Whatever system you adopt should reflect a systematic review of how to assess your staffing expenditures in your clinical setting. Basically, how would you keep an eye or be aware of how much you are spending on staffing your ward and provide reasons why you choose your approach. Remember you can support your approach or system with literature evidence, theories and or relevant health concepts.  Effectively answering this question helps you satisfy learning outcomes K3 and S4.  Remember to evaluate your system. Audit is important for reasons such as strategic effectiveness and even risk assessment (clinical governance).  QUESTION 4: You are clearly required to ‘detailed discussion how you would audit non-staff expenditure  Please focus on doing so.  Use managerial theories (K4 and S4) to do this. An example would be stock inventory system. Please do some research within the scope of healthcare.