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e-rostering to maximise staff resources and improve patient care

Mount Carmel Hospital in Dublin has recently replaced its traditional paper-based system for producing staff rosters with SMART workforce management solutions from Kronos. 
It has deployed SMART’s e-Rostering system across all four floors – starting with the busier wards on the ground floor and finishing with the operating theatres and out-patients department – to manage complex shifts and produce efficient rosters.  In a very short space of time, the hospital has noticed considerable benefits in the utilisation of nursing staff..  It also has the ability to plan ahead and arrange cover for unplanned changes which results in consistently high standards of patient care.
Dr Nigel McCarley, Chief Operating Officer of Mount Carmel Hospital, said: “I’ve been involved in nurse computing for over 20 years and, whereas most systems promise a lot but don’t always deliver, SMART always produces impressive results.  What attracted me first was the logical methodology the system applies to calculating staffing requirements.  The technology can track and identify roster trends over any given period of time, quickly and efficiently.  The beauty of SMART lies in its total transparency.  It is fair to everyone and is easily understood by nurses and non-clinicians alike. I consider it to be a vital part of our overall good governance framework.”
About Mount Carmel
Mount Carmel Hospital is set in five acres of mature landscaped grounds in Churchtown, in the suburbs of Dublin. Established in 1949, the hospital’s central philosophy is to create an excellent patient experience supported by excellent facilities and a dedicated medical, nursing and multidisciplinary team. 
Mount Carmel offers a wide range of medical and surgical services – from maternity care and specialist clinics to surgery and a dedicated orthopaedic unit. The hospital is also proud to be registered members of the Baby Friendly Hospital Initiative (BFHI) in Ireland which is a global campaign by the World Health Organisation and the United Nations Children’s Fund (UNICEF).
The challenges
The major challenge Mount Carmel faced was instigating a significant shift in culture by promoting the benefits of e-rostering.  As a well-established hospital, Mount Carmel has loyal and long-standing staff who are proud of their clinical excellence.  However, as times have changed, there has been far greater emphasis on helping ward sisters and nursing staff understand the importance of using automated technology to produce efficient rosters that tangibly support the smooth running of the organisation.
As a hospital reliant on a traditional paper-based system for many years, providing easy-to-understand, quality hands-on training whilst maintaining excellent patient care was an additional hurdle to be overcome. The hospital also has a higher proportion of part-time staff than is typically found within hospital organisations, many of whom hold (historic) restrictive contracts of employment – this presents further challenges for the SMART implementation team.
The solution – a change in culture
Mount Carmel has deployed SMART’s e-Rostering system across all four wards to support 210 nursing staff, manage complex shifts and produce efficient rosters that maximise the talents of highly skilled clinicians and provide fair rosters for everyone.  Staff can even access the system themselves (including remote accessing) to request changes to their shifts, book holidays or report sickness leave. 
At the same time, the SMART solution has been sensitively configured and installed to meet Ireland’s strict Trades Unions policy of consulting staff prior to changing shift patterns and rosters. 
In line with Dr McCarley’s own pioneering Timeframe Analysis methodology that maps a typical workload across the day and across the week and flags up what and how many staff are needed whenever there is a change in workload, SMART can be fine-tuned to Mount Carmel’s own schedule. 
For example, patient demand typically changes during the course of the day from lulls during night-time to intense bursts of post-operative activity. 
The successful implementation of SMART, giving hard evidence of positive results, has been the catalyst for cultural change at Mount Carmel.  From a strong resistance to change, staff at all levels are beginning to appreciate the benefits of e-rostering and look forward to utilising other features provided by SMART’s comprehensive suite of workforce management solutions.
Next on the agenda is installing SMART’s patient acuity solution, Real Time Hospital, to provide a 360 degree view of all staffing requirements to minimise risk and maximise safety.  It then plans to centralise all e-Rostering in the foreseeable future.
Putting patients first
SMART has enabled Mount Carmel to become more efficient in its use of key resources, meaning the most appropriate skills are allocated to the right wards at the right time.  In addition to properly identifying workforce requirements (expressed in whole time equivalents), SMART has allowed for the proper identification of the specific skills and expertise required within discreet service environments, based on the typical patient population. SMART has also improved the capacity for managers to redeploy nursing staff across service environments as activity/acuity changes leading to a reduction in the use of ‘Bank’ nursing staff.
SMART Real Time Hospital acuity solution provides a continual, comprehensive overview of the hospital rosters allowing managers to quickly identify periods of either overstaffing or understaffing, based on the predetermined minimum staffing requirements within each area. This also improves management decision-making
In short, SMART helps the hospital provide a truly patient-based service where the patient’s well-being lies at the heart of everything it does. 
Time and cost savings
Mount Carmel has been able to prove the benefits of e-rostering in real terms. Already, the hospital has saved significant amounts of time through the more effective management of rosters, reducing considerably the ‘overstaffing’ within many rosters. The time saved has released clinical skills back into patient care, where it matters most and where senior nurses excel. 
SMART has improved the equity in allocating staff to shifts that attract a premium pay.  The SMART scoring system automatically allocates the ‘premium’ shifts to staff that have the lowest score ie staff that have had fewer premium shifts.
The automated link to the hospital payroll has removed the requirement for managers to calculate premium payments for nursing staff, eliminates the potential for errors and further reduce the time required to manage the rostering process.
Management Information aids better forward planning
The accurate, real-time information provided by the SMART system has enabled Mount Carmel to analyse their use and deployment of staff.  Rather than look through paper or spreadsheet records, managers can quickly generate reports to identify the busiest times of day or year and track holiday or sickness absence and plan future rosters accordingly. SMART has also eliminated the requirement for storage of paper records of ward rosters.
Over time, Mount Carmel expects to yield the following additional benefits:
  • A greater focus on workforce planning and deployment, minimising the requirement for reactive staff adjustment
  • Improved capacity to deliver coordinated experimental learning for nursing staff
  • Enhanced ability to monitor hours worked against contracted time leading to a reduction in the requirement for Time Off in Lieu (TOIL)
  • More effective control of expenditure both on permanent staff and in the use of bank nursing
Move towards centralised rostering is fair to everyone
Mount Carmel has plans to move towards centralised rostering in the near future meaning it will be the sole responsibility of several people who are expert in the use of the SMART system to improve the cost-effectiveness of rosters and enhance the deployment of staff across all areas rather than a traditional one-ward perspective.
SMART will enable staff working on all four floors to have a clear view of rostering across the whole organisation, allowing them to fully utilise specific skills or address potential shortages on certain wards quickly and efficiently.  It will eradicate the duplication in ward management time, facilitate annual leave planning and support the integration of time sheets and absences into one system. 
A centralised approach to e-rostering will depersonalise the process for managers who have often built up a strong sense of camaraderie with their staff.  This will bring greater transparency to the process and dictate greater equity in allocation of premium working hours, fair for everyone.