Realising the Paperless Revolution: How rostering in the NHS went digital
A decade ago, if you worked in an NHS hospital, you commonly had to wait for a ward roster to be pinned to a board before you knew what shifts you were working the following month. How to influence the roster was a mystery and staff often frustrated that others seemed to get all the best shifts and holidays. You were aware that sometimes there were too many people rostered on and sometimes not enough.
The NHS has seen a massive increase in the use of technology to support workforce deployment on the front-line. Whereas ten years ago few organisations (8 percent) used this technology, today its use is widespread, with 80 percent of all trusts using it for one or more aspects of rostering.
ZPB has worked with an independent expert group of healthcare workforce experts, to produce a workforce optimisation technology report, Realising the paperless revolution: How rostering in the NHS went digital. The expert group was chaired by Danny Mortimer, chief executive of NHS Employers, and supported by workforce technology specialist Allocate Software.
The report examines in detail the effect e-rostering is playing in the day-to-day management of the workforce. Currently, over 620,000 employees are managed via a technology solution. Temporary staff also rely heavily on technology to fulfil shifts, with over a million shifts managed every month via technology.
In trusts across the UK, staff are able to take control of their working time, select their own shifts (self-roster), put in for their holidays and work through shared banks across organisations – most which can be done through an app. Best practice rostering encourages advance rosters of six weeks, which increases transparency, improves fairness as well as flexibility and predictability – all making working life a little easier for healthcare professionals.
Efficiencies for the NHS
Technology has smoothed out the quirks inherent in manual rostering, for example, the shifts that weren’t always allocated every month adding up to millions of pounds worth of unused time across the system. Finding and allocating the extra resource can reduce agency spend significantly. In North and East Hertfordshire NHS Trust, e-rostering helped them to reduce the spend on agency staff for enhanced nursing care by £141,859 in one quarter.
However, the use of such technology remains inconsistent across trusts. At the NHS Providers conference in November 2017, Secretary of State for Health Jeremy Hunt announced that NHS Improvement believes there is a £1.4 billion efficiency saving per year by 2020/21 to be made if all trusts follow best practice in e-rostering and job planning.
E-rostering and the wealth of data it provides are also being used to plan care more innovatively and around the needs of patients. This is particularly evident at East and North Hertfordshire with the establishment of its enhanced nursing care team, which has resulted in improvements in agency staff spending, staff engagement and patient care.
The report also examines the use of e-rostering internationally, through expert opinions from Scandinavia, Germany, and Australia. While there is sometimes a belief the NHS lags behind other countries when it comes to healthcare technology, the international experience of the expert group suggests the opposite.
Danny Mortimer, chair of the expert group said: “Our use of technology is a good news story for the NHS. The UK uses e-rostering not just to schedule staff but also innovate new ways of working.”
The opportunity for the NHS
The expert group sought to answer the question: ‘Do we make the best use of workforce deployment technology?’, but this is difficult for trusts to assess because there is such a variance in how trusts use e-rostering.
Of real significance is the difference between which staff groups have embraced the approach. For example, over 600,000 NHS nurses are rostered electronically, while only 13,734 doctors make use of technology (based on a sample of 163 trusts, which use Allocate Software systems).
To help trusts understand their own position the group has developed a workforce optimisation opportunity map. From a starting point of electronic rostering linked to payroll through to operationally real-time rosters using live patient information, each staff group is assessed against the functions of workforce optimisation software.
Through this exploration of workforce optimisation, the group has developed five key recommendations of how to enhance the deployment and planning of the NHS workforce for trusts in the UK. They are:
Operational workforce and rostering process data should be shared within and across trusts, alongside clinical performance, activity and finance data. This should be centrally facilitated, through systems like the NHS Improvement Model Hospital Dashboard. This local use of national data will enable meaningful comparisons and drive improvement.
Trust boards should assess themselves against the workforce optimisation opportunity map to determine any areas where they currently are not leveraging technology, but other trusts have successfully deployed.
Human resources directors working closely with nursing and medical directors should continue to digitise key aspects of workforce planning.
Trust boards should develop a robust roster policy that has clearly defined roles and responsibilities for managing rosters from board to frontline staff and will help ensure a dynamic, demand-based approach to rostering.
Those responsible for the workforce need to embrace workforce optimisation, in the context of the Five Year Forward View, by having systems that are able to support working across health and social care, through sustainability and transformation partnerships, integrated care systems and accountable care organisations. Thus, ensuring the workforce is more flexible to the needs of the population it serves, through better identification of who to deploy.
At a time when the NHS is under pressure to do more with the same or less, it is heartening to see how technology can support calls for efficiency as well as improving patient care and empowering staff.