Producing sustainable rotas that ensure there is a better balance of staff available throughout the day, compliance with the European Working Time Directive (EWTD) 2009 and giving staff a better work/life balance are the main benefits of the North West Rostering (NWR) tool.
NWR is a web based resource that helps users produce rotas that take into account factors such as annual leave, shift swaps and unexpected absences.
The tool originated with and was funded by NHS North West in partnership with Skills for Health - Workforce Projects Team (WPT). Throughout the summer it has been developed and piloted with Central Manchester NHS Foundation Trust (CMFT), who provided feedback throughout the production process with Dr John Bright and medical staffing coordinator Anna Finbow.
Production for the tool began in spring 2009, before being completed in August and released in September. The tool generates and populates rotas for healthcare staff where shifts must be undertaken by well rested doctors working within the legal EWTD compliant hours and contractual rest requirement limits.
Jenny Harrop, deputy director, EWTD - medical workforce development team at NHS North West, said: "Traditionally rotas have been determined by designated rota masters who are not always clinicians and have relied upon inappropriate software not designed for the purpose, to primarily fill the needs of the service by populating a simple rota pattern.
"However, rotas can be complex, with various teams working to provide cover across different wards and clinics, and require the availability of the right mix of senior and junior doctors. Because of these interactions, cross covering teams and different numbers of doctors per rota, it is not uncommon for a consultant to arrive for ward round only to find his registrar on study leave, senior house officer on nights and foundation doctor on a zero day after an on call.
"Generating a rota over a long period that increases team availability can be beyond the scope of the rota master and their traditionally large complex spreadsheets especially in large multidisciplinary departments. To add to these difficulties, doctors leave requirements, expected or otherwise, mean swaps must be made to the on call rota, but with difficulty determining how this will effect the cover more than a few weeks in advance."
These issues were recognised by NHS North West and they began looking for a solution to ensure adequate daytime cover for consultant teams whilst preserving safe service at night. The organisation was well placed to produce the software having implemented EWTD a year early of the 1st August 2009 deadline.
Rota patterns are designed in Doctors Rostering System (DRS), the parent product to NWR. These rota patterns are used in NWR, and rules are set according to the needs of the department, defining the minimum cover required in the day, translating to the mix of doctors that are available at night which must also meet a set of rules.
Lastly doctors details are entered and the software runs through permutations of possible rotas according to the rules and identifies where there is a clash and potential risk to service. The software still requires the rota master to decide when and if a clash is acceptable; the consultant may be on holiday that week or a locum is being sourced. Therefore, the software does not negate the need for a traditional human rota master but it allows for much more effective management of shift working.
In addition, the software can be used to complement the training needs of doctors by adding levels of clinic availability that may not be catered for by traditional rostering methods.
Jenny Harrop went on to say: "To date, NWR is the only rostering tool that can populate a rota pattern with the name, grade and team membership of individual doctors and manage their rotas over an entire department collaboratively. In addition, whilst helping to ensure a safe service over long periods the rota can be used to flexibly manage the training experiences of individual doctors and ensure they are well rested and in receipt of the best range of training experiences available within a particular service."
With EWTD compliant working hours already introduced across the region, NHS North West asked CMFT to pilot the tool, as they have busy, multidisciplinary departments that could develop the software to define the most complex rostering needs or rules and find solutions.
Dr John Bright, consultant acute physician at CMFT said: "This process took three to four months and we introduced our optimised rota midway through 2009. We implemented a user group with the DRS team, we analysed our rota and its deficiencies, and identified areas where the software could help the rota master find better solutions.
"By working with the developers we were able to contribute to the design of a piece of software that would be beneficial both to doctors work/life balance and good quality patient care."
Anna Finbow medical staffing coordinator added: "It also provides for rota swaps so changes can be approved in real time for things like holidays and study leave, and the affect on staffing levels can be seen immediately. When problems arise, the software can send emails or texts to appropriate staff advising them of available locum shifts. This enables doctors to work more effectively as they can focus on patient care rather than covering for doctor shortages.
"We have spent a great deal of time demonstrating the software directly to junior doctors, giving them first hand experience of what goes into rota design. The feedback has been very positive, with juniors feeling they have better staffing levels on the ward, allowing them to work and learn more effectively.
"This software gives healthcare staff the opportunity to actively take part in the rota design process, whilst non medical staff can view the availability of doctors in real time and contact them for clinical care. Doctors can log on to the system and view their rosters from home. Also, each consultant can now take an active role in management of their own staff and unit as they will be able to see the impact of absences on service delivery."
Working Time Directive 2009 
