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 then 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 and Diversity 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.

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 the Te Whatu Ora Te Waipounamu region in all 5 districts. Opportunities to engage with scientific and technical services has also commenced in a number of districts.

The workforce team for the Te Waipounamu region 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 license 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 workforce team for the Te Waipounamu region.

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,
• participate in local and regional CF Facilitator Network meetings,
• submit a written report and reflection on their CF implementation experience demonstrating understanding of the methodology, to be assessed by CF Practitioners, to complete the training programme, and
• present Foundation (1-day) CF workshops and support teams in their District to implement the CF.

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 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 into 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 New Zealand context.
• CF Support network – through the Te Waipounamu workforce team and 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 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

Clinical Task Instructions (CTIs) that have recently been developed and published for regional use in Te Waipounamu and Northland Te Tai Tokerau are placed on this website for an initial three-month period for general feedback.

Project/Implementation Examples

• Living fully and free of falls, Nelson Marlborough
• Strengthening Allied Health Assistants clinical skills, Canterbury (poster below)
• Rehabilitation in the Community, Canterbury
• Increasing access to Allied Health, Nelson Hospital
• Shaping our South Island Allied Health workforce – The Calderdale Framework in Action (pdf)

  Video: Scaling up at Speed – accelerating workforce change through a regional approach on Vimeo.

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. Read more here about their visit to Christchurch.

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

View the Te Waipounamu Calderdale Framework channel, with all five videos.

Further resources

Randomised controlled trial of a trans-professional healthcare role intervention in an acute medical setting.

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.’

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

Assessing the implementation process and outcomes of newly introduced assistant roles

A qualitative study to examine the utility of the Calderdale Framework as an appraisal tool. Video abstract – Prof. Susan Nancarrow, published December 2012.

For further information please contact:
Nicola Westend Nicola.Westend@siapo.health.nz
Te Wai Pounamu South Island Calderdale Framework Facilitator

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