Functional Mapping – a Guide for Commissioners and Participants Contents Why commission functional mapping? What is functional mapping? Functional Mapping within Health and Social Care When is functional mapping useful? How does functional mapping take place? What contributes to successful functional mapping? Why participate in functional mapping? Appendix 1: Functional mapping that has already taken place in the East Midlands Appendix 2: Example of functional mapping for one stage of the trauma pathway Why commission functional mapping? Functional mapping of a pathway or area of work produces a clear visual breakdown of what needs to happen to achieve a particular outcome, such as a patient pathway. It is developed by clinicians and practitioners with support from a skilled facilitator and an example of the first stage of the trauma pathway is available in Appendix 2. The benefits of functional mapping include: § designing services around a patient pathway identifies the most effective way of delivering services and what level of skill is needed for each function § defining tasks/functions by level of skill rather than staff group provides an opportunity to discuss how work is organised with staff in a less threatening way than by professional role or job description § this analysis will how if and where cost savings can be made, with engagement from staff § the participative process often leads to discussion within that particular community about what is good practice and promotes sharing of ideas and information across participants § functional mapping engages clinicians and practitioners in workforce issues and helps them to understand the value of workforce planning What is functional mapping? Functional mapping is a process to define the key purpose of an organisation or service with the functions or tasks needed to achieve that purpose. The major functions can be broken down into smaller and smaller functions until each sub-­‐
function represents a task that can be carried out by one individual. These smaller functions can then be used to analyse § what needs to be done along a particular patient pathway § whether an individual team or teams from different organisations are delivering the appropriate functions § whether tasks are duplicated or not carried out even though they have been identified as necessary for the patient This process is sometimes also described as systems analysis. The functions or tasks carried out by one individual can then be described as National Occupational Standards, NOS, or Competences. These can be used to develop § qualifications and learning packages to support them § job descriptions and tools for performance management Functional Mapping within Health and Social Care The functional map used within health care has been developed by Skills for Health and defines the overall purpose of health care to ‘promote, maintain and improve health’. The health functional map, shown below, serves as a tool to identify the detailed functions or tasks which need to be carried out to achieve this, regardless of setting and across all health employers – NHS, private and voluntary sector. The health functional map can also be used to navigate to more than 2300 individual NOS for both health and social care. Some of the functions identified within this map are not specific to health or social care, particularly within H. Management and Administration. For these functions there is usually a generic competence that has been developed by another sector skills council and imported for use in health and social care. For example: Within the sub-­‐function H2.6 Receive and pass on messages and information there is a NOS ICF:FS IT communication fundamentals, developed by e-­‐skills UK, the sector skills council for Information technology and telecommunications. When is functional mapping useful? Functional mapping provides units of activity and a framework for objectively discussing tasks, service specifications and job roles. By creating a standard currency for discussing activities it allows individuals and teams to consider what needs to be done without personalising issues. Consequently individuals are more open to new ways of working and are more likely to take a different approach to designing and delivering services. Functional mapping can be used to identify: § all the tasks that need to be carried out to support a patient pathway or achieve a particular goal § the level of skill needed to carry out any particular task § an analysis of how these tasks/functions can be allocated within a team § the competences that describe that skill § future workforce requirements or workforce requirements for a new service § a specification for learning outcomes Once functions have been identified they can be used to: § analyse tasks to develop job descriptions and person specifications by task/function rather than title, profession or pay band § develop career frameworks and education to support progression § support service or education specifications for commissioners How does functional mapping take place? Functional mapping is usually carried out in a series of workshops by a skilled facilitator in partnership with individuals who are involved in delivering a service. They may be qualified clinicians, unqualified support workers or service managers who are familiar with the day to day detail of service delivery. Over a period of time the group develops consensus about the tasks/functions necessary to achieve the particular outcome, and this is captured in a written document, signed off by the group. Depending on the complexity of the issue being mapped, it may take several meetings, but some simple mapping, such as the Review of Learning Disability Nursing (see Appendix) can be concluded in one session. Prior to the workshops the facilitator will work with the person commissioning the pathway to develop a patient pathway that can be recognised by participants and then suggest some functions for each point on the pathway that they think may be appropriate. At the workshop there are some initial introductions and a briefing about the process, after which participants work in small groups, ideally across organisational and professional boundaries, to § identify whether these are the correct functions § add other functions they see as necessary § provide additional information to contextualise the pathway This information is then collated and presented to the group at the next meeting for their confirmation. If there are a series of decisions to be made – different aspects of the pathway, level of skill etc – these should be made in series rather than in tandem. Part of the skill of the facilitator is to ensure that each issue is considered in an order that is clear to participants and supports the building of consensus. What contributes to successful functional mapping? Functional mapping is most successful when there are participants from different teams and organisations who are involved in working with the same or similar group of service-­‐users to achieve a goal that they can all buy into such as enabling a good end of life experience or enabling an individual to live as independently as possible following an accident or illness. It’s likely to be less successful when § all participants are from the same team or service, as they may find it harder to think about what the patient needs rather than what their service provides § the goal is very precise and it’s very clear what needs to be done § there are legislative requirements about who should carry out a particular task Why participate in functional mapping? If you’re invited to take part in this process it will involve attending 2 -­‐ 4 half day facilitated workshops to comment on a specific pathway where you have clinical or professional expertise. The workshops aim to develop consensus on what is good practice, using the skills and expertise of practitioners rather than imposing answers from the top. No preparation is required beforehand but you will be required to actively participate at the event. Most people who have taken part in these workshops have found them an informative and interesting process, and said they would recommend taking part to colleagues. Participants from previous functional mapping workshops saw the key benefits as § Considering the patient pathway and reviewing current practices § Clinical expertise, variety of views, links between services and practitioners § Having a strategic overview – learning from others § Get away from professional ‘role protection’ § Good communication with various professions and good lead into other work § Enjoyable process and good interaction with other professionals Further information Sheila Hawkins Functional Mapping Advisor for East Midlands LETB Hosted by Leicester, Leicestershire and Rutland LETC [email protected] Appendix 1: Functional mapping that has already taken place in the East Midlands Regional activities Long Term neurological Conditions patient pathway 2008-­‐9 End of Life Care in non acute settings autumn 2010 Contributed to developing a national tariff for end of life care by quantifying what kind of staff input was necessary for good end of life care in community settings Trauma pathway spring 2011 Developed an understanding of the workforce issues around a co-­‐ordinated approach to trauma across the region, where there would be one Major Trauma Centre and a number of regional Trauma Units, and patients would be swiftly moved from one to another according to clinical need. Career Framework for Ambulance Staff 2010 Support to EMAS in developing a career framework for ambulance staff East Midlands Children and Young People’s Cancer Network October 2010 Using pre-­‐existing functional mapping to identify best ways of delivering and co-­‐ordinating multi-­‐disciplinary services to children and young people with cancer Review of Learning Disability Nursing April 2011 This provided an analysis of the functions carried out by LD nurses in a variety of employment settings and whether the current LD nursing course prepared them for these roles. Rehabilitation Pathway June – Nov 2012 Identification of functions and skill levels to support rehabilitation in any context /for any condition Non-­‐Medical Solutions for Emergency Care ongoing Analysis of functions carried out by different practitioners in the context of emergency care Local activities Clinical Placement Facilitators in LLR summer 2010 Analysis of the role of Clinical Placement Facilitators and development of job description based on functions Modernising Scientific Careers: Northamptonshire January 2011 Analysis with medical scientists to clarify their roles and the skills they used. Developing the workforce to deliver LD services in LLR by pathway ongoing Developing the workforce to deliver MH services in LLR ongoing