New roster system can solve doctor fatigue and improve patient safety

Cass academics have carried out an initial pilot of 17 junior doctors in a London emergency department

Academics at Cass Business School, City University London, have developed an Ergonomic Roster software system for hospital doctors to reduce overwork and improve job satisfaction.

Professor of Operational Research, Celia Glass, has spent the last seven years seeking to help those treating patients, following earlier highly-regarded work with workforce management expert Dr Roger Knight at call centres and with nurses. The academics have carried out an initial pilot of 17 junior doctors in a London emergency department, and the success of this initial trial now offers the opportunity for further research.

Most NHS doctors work to an old fashioned and inflexible rota system, which only takes into account the shifts that need to be covered for patients. Other factors - part-time working, annual leave choices and training are difficult to accommodate. In addition, staff shortages and increased patient demand add to the problem. Increasingly, doctors have fewer opportunities for time off and have to accommodate their increasing workload in a more ad hoc way or in non-work time.

The Ergonomic Roster was piloted on doctors working in Whittington Health NHS Trust’s Emergency Department in February this year. By removing the constraints of a rota system and incorporating the entire workload into this novel system, the team from Cass were able to get better coverage out of the existing doctors, allowing them to have a greater degree of flexibility in the work, and meet all their regulatory and training requirements.

This new roster has benefits for:

Doctors: this system takes account of fatigue, flexible working (particularly part-time), training needs and personalised annual and study leave, which the current system is too rigid to accommodate.

Patients: reducing doctor fatigue also reduces risks to patients. The system can also ensure that the coverage of doctors matches patient demand.

NHS Management: immediate benefits are better deployment of staff and hence reductions in locum spend. Longer-term it should improve doctors’ morale, and hence retention and recruitment, by giving them a better work-life balance as well as training incentives. In the medium-term it can be used to test out staffing policies and help in determining safe staffing numbers to meet future patient demands.

Professor Glass said: “Controlling doctors’ work patterns can significantly reduce their fatigue. This is done in the rail industry and has been recognised by the government. However, redesigning rotas by hand is fiendishly difficult, if not impossible. Given the difficulty of the problem, there is a real danger that attempts to redesign rotas will result in poor working practices and uneven staff cover. A sophisticated mathematical algorithm, like our own, is required.”

Professor Glass and colleagues have translated this powerful mathematical algorithm into an electronic rostering system that has taken ten years of research to develop.

Dr Duncan Carmichael, Consultant in Emergency Medicine at Whittington Health NHS Trust, has been working with Cass on this pilot. He said: “Professor Glass has built software that writes the roster for us, taking into account doctors requirements, such as annual and study leave, to produce an individualised roster for each doctor. This system takes into account European Working Time Directive, New Deal, and also best practice on reducing fatigue.”

“The fact that the system can write the roster itself is pretty powerful stuff. We have used this software to work around hundreds of different leave requests for our current 17 person rota, and it was able to write a roster for us to ensure that all of the doctors were working fairly (to within very strict control parameters) and we were getting the best out of them. The software was able to write the roster in a few minutes when it would have taken me days to do.”

Towards the end of the pilot qualitative data will be collected with a view to publishing the results of the study. It is hoped that this work will lead to a bigger piece of research, with wider-scale plans to optimise workforce capacity to patient demand.