Theory areas

Christopher R Burton; Jo Rycroft-Malone; Lynne Williams; Siân Davies; Anne McBride; Beth Hall; Anne-Marie Rowlands; Adrian Jones; Denise Fisher; Margaret Jones; Maria Caulfield

Operational definitions

The worldview on staffing deployment (meta-explanations)	Organisational influences, context and responses to staffing deployment and evaluation	Influences of clinical need	Technologies and tools for articulating predictive and real-time data on patient needs
Legislation, mandates, guidance: Compulsory requirements and evidence-based practice	Organisational culture and attitude to risk management: Is an element of risk accepted? Is risk avoidance a key driver?	Patient dependency and acuity: How this drives decision-making around staffing Whether or not the assessment is accurate	Data for risk management (red flags and staffing): Linked to staffing requirements and patient safety and outcomes
Patient safety and quality outcomes: How these drive the staffing agenda	Leadership and powerful others: Those who can drive or inhibit the systems around staffing	Quality care, patient safety: How this drives the use of technology and tools	Visibility of quality care and safety outcome data for evaluation and comparison: How this affects decision-making and when clinical understanding affects interpretation
Risk management-reduced risk of litigation: The drive to reduce errors/complaints and costs incurred	Organisational investment in the system and support for users: Education, training, IT support, facilitators – impact on implementation	Patient feedback and experience: The impact of this on staffing decisions	Standard approach to compilation of patient dependency and acuity data: Is there standardisation or variability? What are the reasons for standardisation or variability? (e.g. lack of education, support or experience)
Professional obligations for achievement of quality and safe patient care	Organisational feedback and evaluation: How does this affect the use of technology linked to staffing decisions?	Impact on carers: Staffing decision may be more important for carers in certain settings (e.g. community)
Corporate reputation – patient and public confidence	Organisational trial, adaptation and innovation of technologies and tools	Public perceptions: The impact on good public relations on staffing decisions How the public links staffing to patient safety and outcomes
Workforce well-being – staff recruitment and retention: Linked to organisation reputation
Budget restrictions – effective management of finance

Resource availability	Day-to-day management of resources (with/without technology)	Nurse managers’ values and use of professional judgement	Impact of managers’ day-to-day work in balancing resources and demand
Staff roles, skill mix, staff numbers	Standardised approach for establishment setting in accordance with budget	Leadership skills: How do these drive the use of technology?	Improved patient safety and quality outcomes
Staff experience, capacity, capability: The impact of the knowledge of these on decision-making	Rule-setting system (e.g. skill mix, staffing requests and adaptation for patient needs) Whether fulfilling rules is adhered to or flouted when necessary	Fairness; risk assessment: Balancing fairness for staff and patients Living with risk or making changes because of risk	Staff satisfaction, recruitment and retention: How important is the negotiation around staffing by managers? How do managers ensure staff satisfaction while balancing patient requirements?
Bed state, admissions, discharges: How data collection is dynamic	Integration and visibility of complex data for comparison of patient needs and staffing requirements in the light of real time resources: How visualising may help and in what formats are best	User perceptions of technologies and tools (complexity/simplicity/trustworthiness): Is the data provided deemed to be useful? Is the method of finding data user-friendly?
Bank/agency availability and costs: Strategies to avoid this expense	Data for evaluation: comparison of clinical areas’ actual staffing needs compared with predicted needs: How this may affect budget and staffing decisions (e.g. request for a larger establishment)	Local knowledge; staff capabilities and environment of care: How may local understanding affect decisions? (e.g. knowing that an experienced staff nurse can manage)	Cost reduction: How does this drive decisions?
Clinical environment and geography: How different ward set-ups or distance for community affects decision-making on staffing	Comparison between clinical areas: Benchmarking and how this may influence decisions	Professional values: How do these affect decisions with regard to safe staffing and expectations of professional staff?	Improved organisational reputation: Links to staff satisfaction and patient and public perceptions; how does this influence managers’ decisions?
Staff requirements (shift requests): How this links to staff satisfaction, recruitment/retention		Flexibility and adaptability
		Experience
		Confidence
		Clinical understanding of patient acuity/dependency – linked to experience

Copyright © Queen’s Printer and Controller of HMSO 2018. This work was produced by Burton et al. under the terms of a commissioning contract issued by the Secretary of State for Health and Social Care. This issue may be freely reproduced for the purposes of private research and study and extracts (or indeed, the full report) may be included in professional journals provided that suitable acknowledgement is made and the reproduction is not associated with any form of advertising. Applications for commercial reproduction should be addressed to: NIHR Journals Library, National Institute for Health Research, Evaluation, Trials and Studies Coordinating Centre, Alpha House, University of Southampton Science Park, Southampton SO16 7NS, UK.

Bookshelf ID: NBK533073

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NHS managers’ use of nursing workforce planning and deployment technologies: a realist synthesis.

Appendix 4Theory areas

Operational definitions

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