CASE STUDY: Centralised rostering at Buckinghamshire Healthcare NHS Trust leads to reduction in staff sickness

About the trust

Buckinghamshire Healthcare NHS Trust is a major provider of community and hospital services in South East England, providing care to more than half a million patients every year.

The trust has a workforce of around 6,000 doctors, nurses, midwives, health visitors, therapists and other support staff, caring for the full spectrum of patients from newborn babies to elderly people needing help to maintain living independently at home.

The challenge

Variations of shift patterns both between and within wards were leading to multiple handovers, fixed working patterns, and an inability to roster in a way that was clinically and financially effective.

The project team found that often training needed to be repeated due to staff changes in the wards, resulting in many staff not appreciating the full benefits of using e-Rostering.

The solution

SMART e-Rostering provides a fair and transparent system to ensure that staff resources are optimised as efficiently as possible, ensuring patient care is maintained.

By ensuring that e-Rostering is implemented effectively, making best use of the staff we already have, we have seen a lower requirement for temporary staff, reduced absence, better management of leave, and reduced admin for other departments

The centralised bureau supports the nursing teams with efficient rosters, while ensuring they keep control at the point of delivery. They are able to run their wards or departments knowing that the skills mix is optimised and patient care supported.

Following the initial consultation with staff, standardised shift patterns were agreed to ensure that both the needs of the wards were met as well as individual requirements. This provided a good foundation for central rostering.

The trust is using SMART e-Rostering across its acute wards and operating theatres. The production of all rosters is undertaken by a central team who are expert in the use of the system, releasing clinical nurse time to care for patients, improving the cost-effectiveness of rosters, and enhancing the deployment of staff across other clinical areas rather than a traditional one-ward perspective.

The central bureau was fully supported by the trust management and involved HR and finance departments working closely with the wards to deploy staff as efficiently as possible.

The results

Lynne Swiatczak, chief nurse and director of patient care standards at the trust, said: “The introduction of a centralised bureau using e-Rostering brings significant benefits to the wards. Band 7 nursing staff are no longer spending time on the adminstration associated with building and managing rosters, releasing highly-qualified staff back to patient care.

“By ensuring that e-Rostering is implemented effectively, making best use of the staff we already have, we have seen a lower requirement for temporary staff, reduced absence, better management of leave, and reduced admin for other departments such as payroll and ESR, all of which save the trust money. The transparency that the centralised approach gives us means that we are able to apply best practice across the trust, which ultimately improves patient care.”

The transparency that the centralised approach gives us means that we are able to apply best practice across the trust, which ultimately improves patient care

The bureau produces rosters not less than six weeks in advance, enabling staff to plan social and family obligations for the weeks ahead. Previously rosters were often not published until the week before, making it difficult for staff to plan.

The new system also enables the sharing of best practice, for example two similar wards are compared and the best of each taken and applied to the benefit of all.

Greater transparency and more accurate financial controls means ward managers are now fully aware of all budget available to them, which has, in many cases, made resourcing easier. Closer working with finance and HR departments has identified budget for management days previously unused, a significant benefit to the resourcing of wards.

In addition, a link with ESR has led to more accurate payroll, which saves time for the payroll department and results in staff being paid in a timely manner and tighter management of sickness. Within the last six months payroll verification has improved dramatically from 19% to only 2.6% as unverified by payroll.

Ensuring all ward staff have access to, and are using, SMART’s e-Rostering means more accurate records of actual shifts worked. The rosters highlight where there are gaps in the rosters, allowing staff with the right skill levels to be deployed across wards and reducing the need to use agency staff. Additional benefits that ensure compliance and also reduce costs include:

• Identifying over worked hours, which contravene the European Working Time Directive
• Holiday entitlement for leavers means the trust is now able to negotiate leave to be taken rather than paid
• Frequent spot checks eliminate staff claiming hours for bank shifts when on duty
• Since implementing the bureau approach, the trust has seen reductions in sickness of 0.8% for healthcare assistants and 1% for qualified nurses.

As well as ensuring that the wards have the right skills mix to deliver patient care, staff are still able to request particular shift swaps, annual leave or apply for extra shifts. This ensures that flexibility is maintained for staff, which is proven to help with staff morale.