33N Ltd, London, UK.
Research Dept. of Primary Care and Population Health, University College London, London, UK.
BMC Health Serv Res. 2022 Mar 19;22(1):366. doi: 10.1186/s12913-022-07757-1.
The NHS is facing substantial pressures to recover from the COVID-19 pandemic. Optimising workforce modelling is a fundamental component of the recovery plan. The Clinically Lead workforcE and Activity Redesign (CLEAR) programme is a unique methodology that trains clinicians to redesign services, building intrinsic capacity and capability, optimising patient care and minimising the need for costly external consultancy. This paper describes the CLEAR methodology and the evaluation of previous CLEAR projects, including the return on investment.
CLEAR is a work-based learning programme that combines qualitative techniques with data analytics to build innovations and new models of care. It has four unique stages: (1) Clinical engagement- used to gather rich insights from stakeholders and clinicians. (2) Data interrogation- utilising clinical and workforce data for cohort analysis. (3) Innovation- using structured innovation methods to develop new models of care. (4) Recommendations- report writing, impact assessment and presentation of key findings to executive boards. A mixed-methods formative evaluation was carried out on completed projects, which included semi-structured interviews and surveys with CLEAR associates and stakeholders, and a health economic logic model that was developed to link the inputs, processes, outputs and the outcome of CLEAR as well as the potential impacts of the changes identified from the projects.
CLEAR provides a more cost-effective delivery of complex change programmes than the alternatives - resulting in a cost saving of £1.90 for every £1 spent independent of implementation success. Results suggest that CLEAR recommendations are more likely to be implemented compared to other complex healthcare interventions because of the levels of clinical engagement and have a potential return on investment of up to £14 over 5 years for every £1 invested. CLEAR appears to have a positive impact on staff retention and wellbeing, the cost of a CLEAR project is covered if one medical consultant remains in post for a year.
The unique CLEAR methodology is a clinically effective and cost-effective complex healthcare innovation that optimises workforce and activity design, as well as improving staff retention. Embedding CLEAR methodology in the NHS could have substantial impact on patient care, staff well-being and service provision.
NHS 正面临着从 COVID-19 大流行中恢复的巨大压力。优化劳动力建模是恢复计划的一个基本组成部分。Clinically Lead workforcE and Activity Redesign (CLEAR) 计划是一种独特的方法，它培训临床医生重新设计服务，建立内在能力，优化患者护理，最大限度地减少对昂贵外部咨询的需求。本文描述了 CLEAR 方法以及以前 CLEAR 项目的评估，包括投资回报。
CLEAR 是一种基于工作的学习计划，结合了定性技术和数据分析，以构建创新和新的护理模式。它有四个独特的阶段：（1）临床参与-用于从利益相关者和临床医生那里收集丰富的见解。（2）数据询问-利用临床和劳动力数据进行队列分析。（3）创新-使用结构化创新方法开发新的护理模式。（4）建议-向执行委员会报告写作、影响评估和关键发现的演示。对已完成的项目进行了混合方法形成性评估，其中包括与 CLEAR 参与者和利益相关者的半结构化访谈和调查，以及开发的健康经济逻辑模型，用于将 CLEAR 的投入、过程、产出和结果以及从项目中确定的变化的潜在影响联系起来。
与替代方案相比，CLEAR 提供了更具成本效益的复杂变革计划交付-独立于实施成功，每花费 1 英镑可节省 1.90 英镑。结果表明，与其他复杂的医疗干预措施相比，CLEAR 建议更有可能得到实施，因为临床参与水平更高，每投资 1 英镑，在 5 年内的投资回报率最高可达 14 英镑。CLEAR 似乎对员工保留和幸福感产生了积极影响，如果一名医疗顾问留任一年，那么 CLEAR 项目的成本就可以收回。
独特的 CLEAR 方法是一种临床有效且具有成本效益的复杂医疗创新，可优化劳动力和活动设计，同时提高员工保留率。将 CLEAR 方法嵌入 NHS 中可能对患者护理、员工福祉和服务提供产生重大影响。
