Maintaining a consistent and accessible database of clinician and doctor records and working hours has been one of the defining problems for modern medical healthcare. No one country or healthcare system maintaining a singular record-keeping system for staff and clinician data, working hours and requirements across all departments.

As a result, one of the main barriers to a fast and efficient healthcare system has been the lack of ability among modern healthcare systems to seamlessly manage the time of healthcare professionals. All whilst efficiently and safely whilst complying with a myriad personal information regulations, regional rules, and patient confidence. As a result, health authorities across the world, but notably within the UK have been driven to adopt new e-rostering systems in hopes of avoiding burnout and keeping medical staff content.

The UK’s National Health Service (NHS) in 2021 laid out plans to get 38 regional hospital trusts signed up to E-rostering platforms in a bid to save the body money and improve overall efficiency in the face of an ever-mounting backlog of unseen patients and scheduled surgeries. The initiative was backed by a £26m national fund, including £7m aimed at getting NHS staff signed up to an E-rostering system designed to manage staff.

Announcing the rollout amid the Covid-19 Pandemic, the UK government said that E-Rostering had become instrumental when redeploying staff, reporting absences, and managing working hours and pay information, notably for vaccination centres. It also added NHS trusts have reported an increased appetite across clinicians to implement e-rostering as a result.

However, in 2017, a study published by the US National Institute of Health (NIH), titled: Critical success factors in implementing an e-rostering system in a healthcare organisation, detailed how unless the rollout of such a system is well communicated and accompanied with training, the benefits of implementing an e-rostering system could be undercut.

The report reads: “Unless an organisation has an effective implementation of such a system, possible cost savings, efficiency, and benefits could be minimal.” The report reads: “Unless an organisation has an effective implementation of such a system, possible cost savings, efficiency, and benefits could be minimal.”

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North to south success

Two separate NHS integrated care trusts, on opposite sides of the UK, have both seen e-rostering systems recently implemented, through UK-based e-rostering firm Patchwork Health. Whilst both trusts needed to implement a new e-rostering system as part of the NHS’ previous initiative, both trusts had very different requirements and both needed the system implemented within a several-week period.

Now, both the Northern Cumbria Integrated Care Trust (NCIC) and the southern Maidstone and Tunbridge Wells NHS Trust have seen staff management and e-rostering platforms integrated into their care systems. CEO of Patchwork Health, Anas Nader, sat down with Hospital Management to discuss some of the difficulties and benefits of establishing such systems in rapidly ageing NHS infrastructure and how the patients can benefit from better-managed medical staff.

Joshua Silverwood: Can you tell me a bit about some of the direct benefits when implementing an e-rostering system like this?

Anas Nader:  So, a good rostering system is meant to enable hospital managers to plan and deploy the clinical workforce where they are needed most appropriately to the skills and comply with various regulations, whether that’s safe working hours or junior doctor contract rules. These kinds of rules are in place to make sure people are working the appropriate hours. It also ensures that they are also able to deliver clinical services to patients safely. This is because it will be the right clinicians doing the right work in the right space.

It also helps to ensure the best possible cost-for-money possible, because e-rostering is about managing your workforce and putting them in the best situation where they can have the biggest impact whilst working within your budgetary constraints. From a clinical perspective, a good rostering system is fundamentally about providing the best way of working flexibly and empowering staff to have better visibility over their work, and hopefully, some say over how they can work within the constraints of how much flexibility can be provided.

JS: What are some of the ways systems like these can prevent clinician burn-out?

AN: We’ve learned over the years that most NHS managers and leaders do want to provide more flexibility to clinicians. It’s just that to do it at scale when you have hundreds, sometimes thousands of clinicians, it’s almost impossible to achieve. With the right tools, you’re able to provide some of that flexibility and visibility for clinicians.

Both clinicians and managers, often working with either legacy rostering systems or even the absence of a rostering system, can result in really a lot of frustrations in how the work is planned and managed. There is a lot of back-and-forth communication over email or WhatsApp groups just to negotiate who’s doing what and trying to swap shifts to accommodate personal and professional needs which takes away a lot of time from both the clinician and the manager to do other, probably more important work. So, ensuring that the user experience means that clinicians are wasting a lot less time.

It’s often assumed that when employees talk about being burnt out, the conversations are about long hours. Whilst this is often true, sometimes clinicians have worked more than they have meant to in one shift or felt the need to work harder because the rotor has gaps that there are not enough clinicians to fill, and the result of this can be burnout. We lose our autonomy with rigid ways of rostering and scheduling workers where we feel like we’re numbers in the system.

JS: What were some of the roadblocks when instituting a system like this?

AN: It is often down to human behaviour. It can often be because some trusts have been burned in the past, either by bad tech or just bad implementation, so it’s left them with that kind of hesitation because they’ve seen it go wrong in the past. We all know there are stories in the NHS’ history, bad technology and IT implementations, so it could simply be just human nature resisting change.

Therefore it is our job to assure them and take them on a journey. To do as much explanation of the changes as possible, but also to show them why these changes are worth all the effort and why our system does it in a way that might be a bit different than systems they have used in the past. So that’s one reason why we often see delays or blockers in things like decision-making or going live. Potentially, some of their old experiences have created that frustration.

The second set of reasons why we sometimes see roadblocks that is even when an organisation and its stakeholders are excited about the change is that the NHS is often in the headspace of firefighting mode. Whether it is backlogged or catching up pre-cover during the Covid-19 pandemic, or whether it is the doctor’s and nurses’ strikes, or the pressures of winter. It is a matter of the urgent versus the important, and again that is fully understandable. But it is one of the reasons that the best of intentions can end up causing a delay in implementing such a system.