Ineffective rostering is at the heart of the NHS's problems

Ineffective rostering lies at the heart of some of the most significant challenges facing the NHS.

A failure to maintain the balance between increasing pressure on the system and the supply of labour has led to care quality issues, reliance on expensive agency resourcing and profound problems with recruitment and retention.

Over the past few months we’ve heard the prime minister, Monitor and Lord Carter talk of new shift patterns, flexible resourcing and e-rostering as being key to a new, efficient 24/7 NHS.

‘There’s a danger that political pressure leads to “quick fix” approaches’

This however, has been backed up with scant detail on how the current workforce is expected to provide the additional cover needed without adding to the eyewatering £3.3bn agency bill we saw last year.

There’s a real danger that political pressure leads to the adoption of expensive “quick fix” approaches that manage the problem rather than tackling root causes and finding a sustainable solution.

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Demand mapping

Fundamental changes to local workforce planning and management are required to sweep away inflexible, institutionalised approaches and put in place a demand led approach to rostering.

This is not the next IT white elephant. It’s a proven resourcing methodology that has helped countless organisations successfully improve efficiency, productivity, service quality and employee work-life balance.

In many large and complex organisations the supply of labour is often controlled by rosters that are hamstrung by legacy employment contracts and shaped more by guesswork than rigorous analysis.

These shift patterns fail to anticipate and respond to volatility in service demand, leaving gaps in provision and a reliance on the goodwill of workers to provide flexibility.

‘Accurate demand mapping unlocks the potential for new rosters and ways of working’

In most cases this leads to spiralling spend on expensive overtime and agency staff, poor service, employee stress or sickness, and potential breaches of working time or health and safety legislation.

Demand led rostering helps tackle these issues by identifying patterns in data to build an accurate understanding of short, medium and long term variables. By building a data validated demand model like this, the NHS could more accurately forecast hourly resourcing requirements each day across every week of the year.

Predictive analytics is beginning to influence many areas of healthcare with statistical academics from the Cumberland Initiative currently demonstrating the power of data modelling in accident and emergency units in South Wales.

Only when trusts have built a detailed picture of their “true demand” across departments will they be able to deliver strategic and tactical workforce optimisation and ensure precisely the right amount of resource is available at exactly the time it is needed. Accurate demand mapping unlocks the potential for a wide variety of new rosters and ways of working.

The best fit

To emphasise the huge numbers of pattern options, it’s worth bearing in mind that for a team of just two individuals there are 441 ways to allocate five day shifts per week. This degree of flexibility will enable NHS planning teams to design and efficiently manage rosters where hour to hour staffing levels are optimised.

Understanding peaks, such as the one experienced by A&E departments every winter, enables contingency to be more effectively built in to working time agreements through the creation of solutions such as “standby” shift patterns. This allows the same core workforce to efficiently flex up to meet high demand using contracted hours that have been “saved” during quieter periods.

‘Rosters can be designed to lock in working time regulations and waiting targets’

As well as eliminating under or overprovision, rosters can also be designed to lock in key compliance and performance metrics such as working time regulations, nurse to patient ratios, waiting targets and optimal utilisation of capital assets.

The transparency and flexibility afforded by demand led rostering allows scope for shift patterns to be created that meet the needs of both staff and the organisation for which they work.

As long as rosters match the parameters dictated by demand, individuals’ shifts can be tailored to:

• minimise unpredictability around days off;
• ensure a fair distribution of pattern types; and
• meet changing personal situations.

It’s imperative the NHS supports a better work-life balance to tackle overworking, lower workplace stress and help limit the physical and mental impact of challenging roles. Ultimately, by making working patterns more predictable and appealing, it could address high attrition rates and the perceived unattractiveness of full time roles that have created its biggest structural resourcing threat.

Change ready

While the need is pressing and the benefits are clear, adopting demand led rostering may require fundamental changes to employment contracts, new working practices and cultures.

‘It’s imperative the NHS supports a better work-life balance to tackle overworking and lower workplace stress’

The NHS would need to take a careful, considered approach to employee engagement and participation in the process if it is to be successful and the benefits are to be maximised.

This approach to resourcing has the potential to put the NHS in a strong position to better anticipate and react to change in the long term. This could make all the difference to its ultimate survival but it will only be achieved if there is buy-in and commitment at all levels of the organisation.

Kevin White is managing director of Working Time Solutions, a workforce planning and management specialist