The "Fit Approach"

Hauora Tairawhiti along with the New Zealand Nurses Organisation (NZNO) and the Public Service Association (PSA) have entered into a collaborative initiative to implement the Releasing Time to Care (RTC) – Productive Ward, and Care Capacity Demand Management (CCDM) programmes.

We call it the "Fit Approach".

Releasing Time to Care (RTC) – the Productive Ward. 

RTC is a structured modular self directed programme that was developed by the National Health Service in the United Kingdom. It is ward focused with the main aim of the programme being to free up time in the nurses’ day by reducing waste and inefficiency, so they can spend more time on direct patient care. Thereby improving the safety, reliability and efficiency of the care delivered to the patient. The programme is led by the ward’s nursing team, and empowers front line staff to make the changes on their ward that will improve patient outcomes. The programme uses a continuous quality improvement approach to look at the systems, processes and working environment within a ward. However it does not look at workforce or patient acuity factors whereas the Care Capacity Demand Management programme does.

Care Capacity Demand Management (CCDM)

In order to be an effective health care provider to their communities DHBs must reliably maintain the match between demand (patient need for care) and care capacity (ability to deliver safe care). The CCDM programme has been developed within New Zealand by the Safe Staffing Healthy Workplaces (SSHW) Unit in conjunction with DHBs NZNO and PSA to provide methodology and tools which enable DHBs to strengthen their ability to do this.

CCDM involves:

Improving the quality of the information that is generated from staff working in the wards and units so this can be used reliably in strategic and operational planning.

  • Improving systems and processes to ensure accurate forecasting of demand.
  • Reducing known or predictable variance (the mismatch between staff numbers and /or other resources and patient need).
  • Improving the ability of the organisation to respond effectively when variance occurs.

It is the measure of the staff and resources needed to provide an episode of care for a patient that is efficient, effective and provides a quality outcome.

CCDM ensures: 

  • The right number of staff
  • Who are appropriately skilled
  • In the right numbers and mix
  • In the right place
  • At  the right time
  • With the right tools

 to deliver safe care and meet the patients needs.

The twelve month SSHW Unit supported CCDM Programme provides tested and validated tools and processes to assist DHBs to work in partnership with their health unions to achieve sustained improvement in their ability to manage care capacity and demand. The CCDM Programme builds and strengthens the DHBs existing processes and relationships and delivers three main Programme interventions as follows:

  • Establishing a Critical Core Data Set

Providing tools and processes to assist the DHB to establish generate and review an agreed, accurate, trusted and visible set of data and indicators that informs how well in reality the DHBs planned activity is being achieved. This also includes establishing levels of tolerance for relevant indicators of dysfunction

  • Mix and Match

Providing tools and processes to assist the DHB to better match forecasted demand with the appropriate number of staff, the optimum skill mix and scheduling that matches trends in demand including efficient supply chain, policies and structures.

  • Variance Response Management

Assisting frontline DHB staff and the DHB collectively to effectively identify, quantify, alert and respond to variance that occurs both in the moment and overtime in the interest of improving quality of care for patients, the work environment for staff and organisational efficiency. The programme interventions, tool and processes are designed to strengthen DHB structures, processes and relationships towards improving and sustaining Care Capacity Demand Management in the interests of ensuring quality care for patients, quality work environments for staff while ensuring best use of health resource.

Why the two programmes work together: 

  • RTC  focuses on systems, processes and the environment within the wards
  • CCDM focuses on right staff in the right place - (numbers, skills and schedule) with an organisation wide approach.
  • Both focus on right care and right use of resources (productive & efficient)

Resources about the Fit Approach

Fit Approach Overview

The Well Organised Ward (WOW)

Patient Status At a Glance (PSAG)

CCDM Mix & Match Trendcare