Using e-rostering to improve staff wellbeing and retention

Background

Trusts have often reported emergency department doctors having low levels of satisfaction and high rates of burnout, leading to a high turnover.

In 2017, Brighton and Sussex University Hospitals (BSUH) and Western Sussex Hospitals merged to form University Hospitals Sussex NHS Foundation Trust.

In addition to the high pressure environment of the Emergency Department, University Hospitals Sussex NHS Foundation Trust found that the organisation of shifts at Royal Sussex County Hospital (RSCH) and Princess Royal Hospital (PRH) and lack of flexibility were adding to the strain.

Situation

In 2013, BSUH legacy trust had seven consultants and seven registrars for two sites and understood this was not acceptable for staff or patients especially as RSCH, Brighton was becoming a major trauma centre with a need for 24/7 shop floor consultant cover. It became clear that an alternative approach to rostering could be a solution.

Aiming for a better work-life balance for emergency department doctors, the trust sought a system to help improve rota design and flexible working.

It was hoped that a new improved system of this kind would help to retain and recruit staff, whilst saving locum costs and improving patient care.

Aspiration

Implementation of annnualised self-rostering system to give staff more control over their working pattern, whilst also covering the clinical needs of the service.

Solution and impact

University Hospitals Sussex NHS Foundation Trust (RSCH and PRH sites) identified two main solutions:

• Annualised self-rostering/self-preferencing rotas so staff had more control over their working hours.
• Introduction of a clinical fellow role with 25% non-clinical time to allow these staff to undertake other projects – for example, teaching medical students.

This was initially started for the A&E departments and then medical juniors whilst implementing the same systems but also allowing for continuity of ward care.

Deploying HeathRota, the trust implemented an annualised system for consultants (using a period-of-activity contract), middle grades (using a combination of period-of-activity and hours contract) and junior rotas (using hourly contracts), alongside self-rostering or self-selecting preferences, with staff choosing the amount of clinical work they wish to do.

Using HealthRota means:

• Junior doctors can ‘block out’ dates they do not wish to work up to a year in advance.
• The rota automatically maps the appropriate number of staff with the necessary skill mix onto the shifts that need to be covered - allowing for staff flexibility and efficient cover provision.
• Doctors know their shift patterns up to a year in advance and can plan accordingly.
• Rotas are emailed directly to staff and sync to their online calendars.
• Shifts can easily be swapped via the app, without needing to go through rota co-ordinators.
• Part-time staff have more flexibility, they can do their jobs over an entire year or have extended periods off, making up the hours by working more intensely for the rest of the year.

The implementation of HealthRota has had the following impact:

• The trust now benefits from 24/7 A&E consultant cover at Brighton, and cover between 8am and 10.30pm every day of the week at the Princess Royal Hospital.
• In five years, the trust went from seven consultants and seven registrars on A&E (for two sites) to 23.8 full-time equivalent consultants and 20 registrars.
• The costs of using locum doctors have been massively curtailed. For example, before the annualised rota system was introduced, in A&E alone £1.3M was spent on locums at RSCH and PRH. For 2022-23 the only locum need is for sickness.
• Admin time needed to run the rota was reduced.
• All rotas are completely annualised. All leave of all types, days off in lieu, non shop floor time is already included in the rotas and the only locum requirement is for sickness across A&E and all medical wards at RSCH and PRH and across all junior grades (F1 to reg).
• All available posts have been recruited for, with locum savings used to improve staffing levels.
• Flexibility through self-rostering/self preferencing of shifts has elevated recruitment and retention rates. For Aug 22-23 there were no unfilled jobs in A&E at Consultant to F1 level and Medicine at Reg to F1 level, including recruiting 78 full time equivalent non training fellows as well as recruiting to the unfilled Health Education jobs with fellows.
• Burnout is as well controlled as possible; doctor wellbeing has improved with a better work-life balance and the flexibility to work when preferable.
• The learning environment has been enriched with more support available for junior doctors such as dedicated simulation fellows.
• A&E and general medicine is consistently run with the staffing it needs. This has enhanced out of hours cover with a true 7 day a week ward doctor service. This has improved clinical safety, patient experience and outcomes. For example there has been a 68% reduction in emergency calls at the weekend since the new HealthRota rotas were introduced and more fellows employed, which had a 4x higher number of weekend doctors on the ward
• The system which was used to help recruit fellows who do 75% clinical time and 25% non-clinical has had a great impact non clinically as well. They now have 44 FTE educational fellows delivering over 16,000 hours of undergraduate education contributing to great student feedback. The team roster the educational fellows educational rota to ensure that there are fellows available when the students are on placement.
• They have also recruited 14 research fellows and many others in areas such as leadership and simulation.
• 73% were ‘very satisfied’ with the rostering aspects of their clinical work.
• 67% said the rota had been ‘very beneficial’ to their professional life and career.
• 73% said the rota had been ‘very beneficial’ to their overall quality of life and career.
• The trust was named as the Royal College of Emergency Medicine’s education team of the year as a result of its educational fellows.
• Brighton and Sussex Medical School was second nationally in feedback for all medical schools in 2020-21.

Functionality

The HeathRota system:

• Is a suite of online tools to support rostering, job planning and locum banks.
• Includes a mobile application for users, with a notification suite. The app can be configured to contact members by phone, email or WhatsApp.
• An i-Cal exporting feature allows rotas to be synced with users personal calendars.

Capabilities

The HealthRota system includes:

• A familiar spreadsheet format display, with dynamic editing to minimise administrative time and keep all data current and accurate.
• A daily view showing all staff working at any one time.
• A trust view showing who is available to cover a shift or when a major incident occurs.
• The ability for HealthRota users to view and manage their working schedule directly from the mobile application.
• A full notification suite that allows users to be notified of any shift changes, requests for exchanges, self-rostering availability and any locum jobs available when utilising the locum booking system.
• A way for staff to exchange shifts with other staff without involving rota admins, but with the real time contract and working time rules compliance.
• Functionality to automatically check there are no non compliant shifts rostered even after swaps.
• Ability for users to enter requests for annual and study leave, and record Supporting Professional Activities (SPA) and admin time.
• Ability for users to enter times and exception reports against their shifts.
• Details of the hospital, location and times, as well as a list of all colleagues working with them, that users can view for each shift.
• A calculation tool that shows the hours each doctor needs to do after all their leave and non clinical time has been taken off and then ensures that they work those hours.
• Easily adjustable templated rotas to ensure junior doctors get the flexibility they want at the same time as ensuring that the service is covered.
• All the functionalities recommended in the RCEM guide to good rostering.

Scope of capacity

This system can be widely used. The University Hospitals Sussex NHS Foundation Trust is considering expanding the annualised self-rostering/self-preferencing system into other specialties and other non-doctor professions.

Other trusts have also adopted this rota system:-

• Critical Care:
  • Cardiff and Vale University Health Board
  • East Kent Hospitals University NHS Foundation Trust
  • NHS Lothian
• General Medicine:
  • Belfast Health and Social Care
  • Buckinghamshire Healthcare NHS Trust
  • NHS Lothian
  • Royal Free NHS Foundation Trust
  • Whittington Health NHS Trust
• Helicopter Emergency Medical Service & Physician Response Unit:
  • London Air Ambulance / Barts Health NHS Trust
• Imaging:
  • Belfast Health and Social Care
• Paediatrics:
  • Guy's & St Thomas' NHS Foundation Trust
  • Cardiff and Vale University Health Board
  • University Hospitals Bristol NHS Foundation Trust

As well as across 39 Trusts for Emergency Medicine.

Key learning points

• It was vital to secure executive and managerial involvement from the outset.
• During implementation, complete commitment was needed from all staff required to cover all core shifts. This meant a change in job plans or having to work non-fixed days for some.
• It was important that we kept to the appropriate job planning principles. For example, ensuring a group agreement that no staff member does more than three nights in a row or any shift the day after a night shift. HealthRota automatically checks that there is no non compliant shifts rostered even after swaps.
• Learning how to run the rota appropriately was an iterative process. The implementation team had to be willing to learn from the different staff groups who all required slightly different processes.

Digital equalities

For staff who are not able or do not want to use the app, a process has been set up by the team so that they can still telephone or email across the same types of requests.

Key figures/ quotes

Alice Young ACCS ST1(Acute Care Common Stem Specialty Trainee)

In an independent evaluation, users rated HealthRota 4/5 for improving doctor Wellbeing, and 3/5 for recommending a post to a colleague.

Find out more

BMA video - Medical rota gaps

Key contact

Professor Robert Galloway, ED Consultant
robert.galloway@nhs.net

Jim Barry, CEO, HealthRota
jimbarry@healthrota.co.uk

Give us feedback

Workforce Digital Playbook feedback survey

Page last updated: October 2022