Trust boosts staff numbers and satisfaction after overhauling rota system
BMJ 2021; 375 doi: https://doi.org/10.1136/bmj.n2493 (Published 12 October 2021) Cite this as: BMJ 2021;375:n2493
An NHS trust has been able to hire 18 more doctors and improve scheduling for its trainees by carrying out a huge redesign of its rota system—going from siloed spreadsheets to a cross-functional e-rostering system.
The project team at Sherwood Forest Hospitals NHS Foundation Trust—made up of junior doctors and administrative staff—were frustrated with the previous system which involved each department having its own spreadsheet, with no ability to see doctors’ availability, why there might be a gap in the rota, or what changes had been made.
Daniel Smith, a respiratory specialist registrar and member of the rota redevelopment team, told The BMJ, “You had no understanding of how many junior doctors you had at each time of the day. If there was a gap, you couldn’t understand why because there was no history behind it, no auditing available. And the ‘on call’ rota was only for the on-calls, so it didn’t tell you what all the other junior doctors were doing when they were not on call. We had no idea if they were on leave, on a course, on a ward, or in the clinic.”
In 2016, the General Medical Council said that the trust was relying heavily on locums to fill staffing gaps, with trainees reporting high workloads and difficulty fitting learning opportunities around the rota.1
To solve this, the team started by modelling how many patients were coming into the hospital and at what times. They found patient numbers peaked between 4 pm and 10 pm and by using e-rostering software they were able to pin down where junior doctors were meeting that demand and where they weren’t.
“From that, we were able to work out how many more doctors we needed to employ to match that demand curve,” Smith said.
In early 2019, the team put a business case forward to the trust—including national guidance on safe staffing, data showing gaps in the system, and the money that was being spent on locums. The trust agreed to invest in extra staff, noting that this would benefit both patients and staff, and hired 18 more doctors (11 international fellows and foundation year 3 doctors, and seven middle grade doctors) mainly through international recruitment.
The e-rostering system also gave all junior doctors the ability to check and control their schedule from their phone. And it allowed administrators to plan and provide schedules at least three months in advance.
With extra staff and a more accessible system, the team said they have received positive feedback from junior doctors and now require fewer locums to fill gaps.
“You can do so much from your phone. You can book annual and study leave and we’re moving towards being able to swap shifts and book extra bank shifts on your phone as well,” said Smith. “On a Monday morning, while having your coffee, you can check who you’re working with today, rather than being surprised when you get there. And there’s a lot more speed behind having your annual leave accepted.”
Coping with covid-19
The initiative put the trust at a huge advantage when the first covid-19 wave started affecting hospitals in early 2020, as the team could quickly change rotas to meet demand. “We turned from the normal rota to a covid-19 rota—which involved more evenings, weekends, and nights—within a week. The second time we did it, it was within 48 hours and the doctors all knew where they were because they could see it on their phones,” said rostering services manager Kim Mattison.
The team decided that, with the warning that 40% of them could be off sick at any one time because of covid-19, allocating junior doctors to a ward would be counterproductive. Instead, they allocated staff by floor and set up a floor leader, who would work with the rota team to move people to where they were most needed, for each day.
Since the trust did not hit the 40% sickness rate, there were more staff than expected and many trainees said they benefited from working alongside a senior doctor every day and sometimes overnight.
The new system has allowed the rota team more efficiently to organise when foundation and internal medicine training doctors take their required self-development and clinic time.
Mattison said, “We mapped when they take leave. When new doctors start they don’t take much leave, so we pushed self-development and clinic time into that period.” She said this means trainees can get the annual leave they want because the system is not as stretched.
The new system is currently funded until July 2022, with a review and analysis set to take place with a view to implement it permanently.
Advice for other trusts
Mattison, who has been working on rotas for over a decade, said that a key factor for other trusts wanting to do something similar was not to underestimate how much work is needed to get the initial data and evidence. On top of this, she said it’s crucial that any project team includes experienced rota staff. Another key part of the project was involving junior doctors, including when making the case to the trust for funding and when building rotas.