Electronic rostering: a case study in the West Midlands

Rachel A Barton
Systems Manager for Internal Staff Bank and Electronic Rostering, Dudley Group of Hospitals Foundation Trust (DGOH), Dudley, UK

The Dudley Group of Hospitals Foundation Trust (DGOH) is an acute hospital, based within the heart of the Black Country, providing a wide range of medical, surgical and rehabilitation services to the people of Dudley and surrounding areas.  

With an inpatient hospital (Russells Hall Hospital) in the centre of Dudley, and two hospital outpatient centres at the Guest and Corbett sites (based in Dudley and Stourbridge), the trust provides care and treatment for approximately 400,000 people.  

Russells Hall Hospital has more than 700 inpatient beds, 75 day-case beds and 46 cots, and employs about 2,600 nursing staff and clinical support workers.    

Why have electronic rosters?
Rosters for nurses are the only way to ensure that wards are staffed with the appropriate numbers of nurses that have the correct mix of skills to ensure patient safety. Historically, the rosters have always been completed by either lead nurses or shift leads within the clinical areas. This is a time-consuming exercise, as a nursing roster can take up to six hours to complete manually.  

In addition, at the end of each month, the lead nurses would have to submit a paper turnaround document, detailing all the shift enhancements such as night and weekend shifts and those covering unsocial hours. As a manual exercise, this could take some hours to complete, taking the lead nurses away from their clinical duties. This paper-based exercise was open to human error from source and during processing.  

There was no standard approach to constructing nursing rosters and it was found that each clinical area had its own way of working. Some clinical areas allowed staff to self-roster and indicate the shifts they wished to work, whereas other areas did not have any kind of request system in place.  

The storage of these paper rosters was becoming a problem due to the lack of space and an organised filing system. In the event of any of these documents being needed, it would be difficult to both locate and extract the information required within a timely manner.

Electronic rostering requirements
The trust was seeking an intelligent system that supports management in providing effective shift rosters for staff working on wards and in departments, ensuring that there is adequate cover at all times to provide clinical and care activities, and that matches staff resources and experience to specific tasks.

DGOH drew up the following list of benefits it expected to result from the new system:

• 
Increased flexibility – giving better work-life balance and helping to reduce absence. The aim is to provide staff with greater control to request their working shifts, offering a better balance between work and outside commitments. Self-rostering provides opportunities for negotiation on shifts and achieves higher levels of autonomy resulting in a happier workforce. It has also been shown to reduce sickness absence
• 
Improved delivery of patient care – self-
rostering supports and facilitates safe working practices and improves the skill mix to deliver a high quality of care. In turn, this results in a more motivated workforce, which will positively impact on the patient journey
• 
Easier recruitment and better staff retention – a more flexible way of requesting shifts and leave encourages greater commitment from staff and is an incentive that attracts higher-quality personnel
• 
Return on investment and financial savings – efficiently utilising existing staff cuts costs through less reliance on overtime, bank and agency staff
• 
Simpler administration saves time and reduces errors – Replacing the turnaround document and using the generic inbound and outbound interfaces to feed attendance information into the electronic staff record (ESR) payroll system reduce manual returns and eliminates payroll input errors
• 
Compliance and management information – the ability to produce reports with regards to EU Working Time Regulations and absences.

The SMART system was chosen, as it was able to deliver the trust’s requirements. It had also proven credentials, having been adopted by a neighbouring trust.

SMART Workforce Management system
The SMART eRostering system is split into three different parts:

1. 
SMART eEmployee: Self-rostering: This is where staff can request shifts and absence either at home or work. Staff also have access to view what salary payments they will be paid at the end of the month and access to their annual leave and any time off in lieu balances. This part of the system provides access to the Team Roster at all times, once published
2. 
SMART Rostering (eHL): This part of the system builds, publishes and maintains the rosters, includes extra payment enhancements and authorises annual leave. It also provides system interfaces to ESR for payroll and attendance information  
3. 
SMART Auto-rostering: Rostering lead personnel use this part of the system to produce an automatic roster with instant work schedules.

Table 1 illustrates the process of the SMART eRostering system.

Implementation
eEmployee and eHL was implemented into all clinical wards and departments during 2008.  This was carried out in waves:
Pilot area – 4 wards/departments
Wave 1 –    6 wards/departments
Wave 2 –    17 wards/departments
Wave 3 –    27 wards/departments
The implementation of auto-rostering commenced in 2009.

Benefits after implementation
Staff gave positive feedback about the access to information relating to annual leave and also the transparency of the system. Staff are now able to check that their shifts have been agreed and overtime payments have been authorised. Any errors in relation to salaries can be rectified immediately, whereas previously payment would have been delayed until the following month. This has improved morale.

The system holds a wide range of information that can be collated within minutes into reports.  Such as:

• 
Working Time Regulations (WTR) – detailing staff
 who are breaching WTR
• 
Annual leave – an ongoing report to ensure staff are regularly booking holidays
• 
Sickness absence monitoring – detailing either individual staff absences or by clinical area, it records the absence taken and the reasons.

Accessing the electronic rosters can be configured to allow matrons to view activity in different clinical areas. The SMART eRostering system allows transparency of skill mix within clinical areas by displaying it in a simple tabular format. This gives the matrons on duty the ability to deploy staff to other clinical areas where staffing levels are below the service requirements. Auto-rostering is configured to create an individual tailored roster to consider the shift requests made by staff and to suit the specific needs of that clinical area. The benefits of auto-rostering include:  

• 
Saving time – the system produces a workable roster without the input from the rostering lead  
• 
Efficient resourcing of staff – the system works out the best way in which to utilise staff
• 
Fairly rostered shifts – the system ensures all shifts are equally distributed between 
the staff.

Standardisation of shifts
During the implementation of the SMART system, it was discovered that although clinical areas were open 24/7, the shift patterns varied within different clinical areas. The shifts started and ended at different times and breaks were non-standard. To address this, DGOH undertook a process to standardise shifts whereby selected wards and departments all worked the same agreed shift pattern.  

It was also noted that there were a large number of special shifts (family-friendly working shifts) being utilised on the wards, but not being reviewed on a regular basis. To rectify this, a database of all special shifts is now retained and monitored by the eRostering team and a controlled process is in place for these to be reviewed every 12 months.

The benefits of using the SMART Workforce Management e-Rostering system is that it is continually being developed towards the needs of the NHS and has enabled the DGOH to establish an internal staff bank to reduce agency spend.

We have rationalised our shifts, introduced a system that provides transparency for staff so that workers know that they are being treated fairly, payroll errors and delayed overtime payments have been minimised and staff can now maintain a better work-life balance.

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