3.1.1 It is important at the outset to distinguish between operational policies which formed part of the design brief and operational procedures. Operational policies are usually quite basic statements of intent about how a facility should operate and the interrelationships between different patient and staff areas. The policies inform the design process. These must be agreed and officially adopted before the commissioning procedures are compiled. Unless prior agreement is reached on common issues, matters such as finance, staffing and relationships with other departments will be unclear. It will therefore be impossible to formulate consistent, compatible procedures.
3.1.2 Operational procedures and principles appropriate to functions to be carried out within the facility must be established. They will draw on project brief which has informed the design of the facility. The role of Infection Control is critical within this process. Given the significant time from planning to commissioning large/ complex facilities proposed policies should be reviewed to encompass new legislation and/or service development. Responsibility for producing operational procedures will normally rest with the appropriate service manager.
3.1.3 Operational procedures (or systems) should have been developed in support of the Design Brief. These documents address the operation and staffing of a healthcare facility and how services that support direct patient services will be delivered in the new facility e.g. imaging; transport of specimens. The procedures should contain the following information:
• how staff are to be developed; this could be the Commissioning Manager's role but likely to be the Service Manager's role unless it relates to training on systems/ways of working in new facility;
• the numbers of staff required in each functional area of the facility, this is the Service Manager's responsibility. Commissioning Manager's responsibility is to ensure they can 'fit and function;
• managerial responsibilities where change from current management responsibilities will occur;
• how patients will be received and directed to the services they require;
• management of patient flows, staff, materials management, catering, waste disposal, transfer of deceased. Out of hours. Who has access to different departments;
• how departments interact with the operation of the facility;
• how services that support direct patient care will be delivered e.g. imaging, transport of specimens etc; and
• waste and environmental management strategy.
3.1.4 The procedures should provide full details of how a particular facility or element of that facility will function. A process of engagement involving key stakeholders is essential to check and test assumptions underpinning the procedures.
3.1.5 An important issue will be the relationship between the functions within the new facility and relationships with the rest of the NHSScotland Body or
partner organisations involved. In relation to the provision of health services there requires to be consistency with the overall policies of the NHSScotland Body.
3.1.6 These policies and procedures should provide the mechanism for staff training and orientation of the healthcare facility and should be carefully documented and disseminated via an agreed communication strategy before the transfer of the function to the new facility. Again the role of Infection Control is critical within this process.
3.1.7 The operational procedures, in restating the principles behind the design of the facility, should form a strong base for the evaluation of the facility once it has been brought into use. Procedures should be specified during the early stages of commissioning and should be constantly refined and honed during the overall commissioning period.
3.1.8 A general format for each procedure document should be defined at the outset of commissioning, in order to provide a consistent approach when they are being considered by each of the working groups. Subjects for inclusion are:
• services to be provided by that department;
• hours of operation, opening hours, or visiting hours;
• predicted workload - this should be taken from the projections in the Full Business Case at the outset, but should be modified by contracting targets;
• quality standards and how these will be achieved;
• how each room or activity space in the department will be utilised;
• arrangements for training of staff in the use of specialised pieces of equipment - it may be necessary to refer to the relevant technical manual for this equipment, which will be provided by its supplier;
• general / induction training will be required, normally coordinated by the commissioning team.
• patients who may be referred outside that department and arrangements for how they will be directed there or taken there if necessary;
• arrangements for delivery and collection of supplies, post, patient notes, etc.
• numbers and grades of staff;
• staff shift arrangements;
• management arrangements for each staff group;
• details of interrelationships with other departments and the effects on their staffing levels and budgets - this will require good co-ordination with the operational procedures for this departments;
• how information is collected for patient records, clinical audit and financial systems;
• requirements relating to COSHH (Control of Substances Hazardous to Health) and health and safety legislation; and
• requirements relating to local NHSScotland Body policies.
3.1.9 Whilst a significant amount of detail needs to be included, it may be helpful to have a summary sheet for quick reference. A sample procedure using the proposed format should be issued as a guide for working groups.