Calderdale Framework

About the Framework

The Calderdale Framework (CF) is an evidence-based workforce transformation tool.  

Led by clinicians  the framework provides a 7 step format to facilitate a ‘best for patient, best for system’ approach and can be implemented in both acute and community settings across varied teams and professions. It provides opportunities to optimise workforce capacity , supporting staff to work to top of scope, identifying opportunities to skill-share and delegate, standardise patient care and improve service efficiencies.

The below graphic provides an overview of the 7 stages

The CF methodology is a formal, risk managed and structured framework which creates quality, efficient, responsive, and clinically governed services by:

• Engaging staff by raising awareness of the drivers for change
• Undertaking an analysis of current service provision and identifying tasks carried out in teams
• Deciding which tasks can be delegated or skill-shared across professional boundaries
• Creating local clinical task instructions (CTIs) to standardise how tasks are carried out
• Providing structured training and competence assessment for professional skill-sharing and delegation practice
• Establishing governance processes to support clinicians
• Embedding systems to sustain the model of practice in the long term.

Te Waipounamu and the CF journey

The Calderdale Framework was first introduced into Aotearoa New Zealand in 2015 by the Te Waipounamu Executive Directors of Allied Health for the five Te Waipounamu District Health Boards. It was part of a strategic approach envisioned to expand the capacity and capability of an allied health assistant workforce and to support professional skill sharing within allied health services. Read their position statement on CF implementation.

In 2018 a Cultural position statement [1] was developed and recommendations integrated within the framework.

This document has been prepared for facilitators as a guide to cultural considerations in relation to implementation of the Calderdale Framework.

[1] Acknowledgement Hector Matthews, Executive Director, Māori and Pacific Health, Canterbury District Health Board and Te Waipounamu Workforce Development Hub Steering Group

Wider Implementation of CF

The implementation of the Calderdale Framework was initiated within the Allied Health workforce however, the methodology is applicable across health workforces and as a methodology for change has had recognition by the Te Waipounamu Directors of Nursing and has been used in nursing-specific workforce projects.

There is continuing and active use of the methodology across Health New Zealand Te Whatu Ora Te Waipounamu region. Opportunities to engage with scientific and technical services has also commenced in a number of districts.

The Te Waipounamu Calderdale Practitioner group has also supported the training and uptake of the Calderdale Framework in other areas of New Zealand, notably within the central North Island and also Northland.

Becoming a Calderdale facilitator

The Calderdale Framework is applied under licence and has defined steps and processes, with an extensive library of resources to support each of the process steps. The success of its application is dependent on the training of Facilitators in its use. The CF training programme is offered by Calderdale Framework Practitioners and supported by the Te Waipounamu DAHs.

The first step of the training pathway is the Foundation Workshop. Participants who have completed the Foundation Workshop can then elect to undertake the CF Facilitator training programme.

The Facilitator Workshop is offered over approximately 4 days – 3-day Stage 1 workshop and 1-day Stage 2 workshop. The workshops are scheduled about 6 months apart.  As part of the training , CF trainees are to

• attend all training days,
• commence implementation of CF in their service between the Stage 1 and 2 workshops, and report on this for peer review in an informal presentation
• present Foundation (1-day) CF workshops and support teams in their District to implement the CF.
• submit a written report and reflection on their CF implementation experience demonstrating understanding of the methodology, to be assessed by CF Practitioners.

Doing Something Different Together. Future proofing our Workforce: a Te Wai Pounamu South Island led approach.

What has the Calderdale Framework achieved since 2015

• Training of Practitioners (3 all in Te Waipounamu) who can provide Facilitator training, oversight and governance, national perspective and feedback to the wider Health New Zealand Te Whatu Ora sector via the Executive DAH network
• Presentations to numerous Health groups including radiology, Maternity and dental services. Focus on engagement to raise awareness of the Framework, the fundamental principles and the drivers for change.
• Foundation Day training – Regular sessions provided by the numerous Facilitators in the various Te Waipounamu districts, providing a more in-depth insight and knowledge in to the process and to identify champions to support utilising the framework within an area.
• Facilitator training – across Te Waipounamu there have been 70 facilitators trained and in Te Tai Tokerau another 20
• Regional and International collaboration (Northland, UK and Queensland) Sharing of resources and experiences through strong relationships. Support and opportunities to peer review
• Library of Clinical Task Instructions – identified and written to provide consistent and standardised training in the Aotearoa context
• CF Support network – supported by The CF Practitioners, Regional Calderdale Facilitator role and utilising HealthLearn which is used as a repository for all licensed resources
• Governance support by the Practitioners and Regional Facilitator to support quality and regional oversight
• Projects and new ways of working
  • Agreed regional core training for Allied Health Assistants on When to Stop, delegation and documentation
  • Delegating to Assistants working in acute orthopaedic settings
  • Delegating to Assistants working in community settings
  • Delegating to Assistants working within the dietetic services
  • Delegating to assistants working with Speech and language therapists
  • The role of the assistant in supporting the Social worker
  • Delegating to the Assistant supporting a client in their own home
  • Supporting Maternity Kaiāwhina workforce projects
  • Rural CF dental project – supervised toothbrushing in schools
  • Developing a skill sharing model in a Medical Assessment unit
  • Delegation to the assistant working on the rehab unit

Regional Clinical Task Instructions

CTIs that have recently been published for regional use in Te Wai Pounamu and Northland Te Tai Tokerau within Calderdale Framework projects are added in here  for an initial three month period for general feedback.

Project/Implementation Examples

PDF: Shaping our South Island Allied Health workforce – The Calderdale Framework in Action

• Living fully and free of falls
• Strengthening Allied Health Assistants clinical skills
• Rehabilitation in the Community
• Increasing access to Allied Health

Video: Scaling up Speed – accelerating workforce change through a regional approach

Click here to view interviews with the UK founders of the Calderdale framework Interview with the founders.

The UK founders of the Calderdale Framework, Jayne Duffy and Rachael Smith, visited Christchurch in November 2016. In the short videos below they answer five key questions for Anne Buckley, Allied Health Facilitator and Project Manager, South Island Workforce Development Hub.

Video: 1. About the Framework

Video: 2. Key factors for success

Video: 3. Lean for the workforce

Video: 4. Business as usual

Video: 5. The role of champions

To view the South Island Alliance’s Calderdale Framework channel, which contains all five videos, click here: https://vimeo.com/channels/calderdale.

Click here for Articles relating to the Calderdale framework

Kartner M, Murtagh D, Bennetts M, et al. Randomised controlled trial of a transprofessional healthcare role intervention in an acute medical setting. Journal of Interprofessional Care. 2017;31:190-198.

This small RCT looks at skill sharing using Calderdale Framework methodology in the acute medical setting. Key findings reported include:

‘Descriptive outcomes indicated that patients receiving the new model of care underwent more comprehensive and prompt assessments in the health domains included than those in standard care, and demonstrated more positive health and functional outcomes at 1-, 3-, and 6-month follow-up.’

Assessing the implementation process and outcomes of newly introduced assistant roles

Video abstract – Prof. Susan Nancarrow, published December 5, 2012.

A qualitative study to examine the utility of the Calderdale Framework as an appraisal tool.

Video: Assessing the implementation process and outcomes of newly introduced assistant roles

Contact us: Nicola.westend@cdhb.health.nz