For integrated teams to operate effectively and efficiently the mix of skills and share of responsibilities within the teams needs to be correctly balanced, and care plans need to be defined appropriately. When this is not done, the ‘integrated team’ will function more like a set of sub-teams with the work inefficiently fragmented between them. Many of the European community care providers we have worked with have operated integrated teams and we have enabled them to address these issues and increase their productivity and quality.

Changing employee’s working hours and patterns can lead to increased productivity or increased employee satisfaction – or both. We have seen that small changes to work patterns can significantly increase productivity. In other cases, we have worked with providers to eliminate short or long, fragmented work shifts which have been unpopular with employees; employees have been able to work the number of hours they want in a week but with a better work-life balance. It has also meant that fewer workers are needed on a day-to-day basis, giving providers greater flexibility to handle absences and take on additional business.

When delivering care to an increasing ageing population and with limited resources and budgets it becomes increasingly important to enable the care to be delivered in an efficient way which maximises the utilisation of the available resources. The way in which the care is commissioned can have a significant impact on potential efficiency. It is a commonly recognised principle in logistics that as the number of providers serving the same orders increases, the potential for efficiency decreases. When provision of community care is fragmented between different providers in the same area it can lead to increased travelling for the workers. Providers may also seek to avoid travelling by relying on excessive numbers of workers with very long, fragmented schedules with a lot of waiting time which brings about its own set of problems. We can model alternative ways of commissioning which could address the current challenges.

Team size and geographic coverage of the team or office can impact quality and efficiency. We can model the effects of changing team sizes and coverages areas, of merging teams, eliminating the use of teams or using fuzzy boundaries. We have seen that it is not necessary to use large teams to achieve good efficiency if the teams are defined appropriately.

Where integrated teams are used, or teams include different skills, the demands on different skills can be different. In these cases there can be a benefit to pooling certain skills and sharing certain workers between teams.

A common practice with traditional planning tools is to distribute all visits between the available workers. This inflates the number of workers needed and leads to a constant shortage. In addition, the morning and evening peaks can become artificially inflated as planners use common intuition or the automatic allocation functionality built into some software to schedule visits based on geographic proximity. We are able to calculate optimal scenarios to determine how many workers are actually needed, or what can be achieved with the available workers.

Care plans are often defined with a task and time approach, based on organisational habit and in isolation. This leads to care plans which don’t match care needs and are unachievable, so promises to service-users end up being broken. Peak demand periods also become inflated, exacerbating staff shortages.

Outcomes-based approaches offer a possible solution, but are difficult to implement. In Finland we have had success with approaches which involve the client, provider and funding body (comparable to commissioning group in the UK) to co-design care packages which meet care needs and client expectations, and are achievable.