Automated rostering helps Mount Carmel Hospital maximise staff resources

2 December 2013

Mount Carmel Hospital in Dublin has replaced its traditional paper-based system for producing staff rosters by implementing a computerised workforce management system.

Mount Carmel has deployed the SMART e-rostering system from Kronos across all four floors, starting on the busier wards on the ground floor and finishing with the operating theatres and outpatients department. The hospital has already noticed considerable benefits in the utilisation of nursing staff. It now has the ability to plan ahead and arrange cover for unplanned changes which results in consistently high standards of patient care.

The challenges

The major challenge Mount Carmel faced was instigating a significant shift in culture by promoting the benefits of e-rostering. The Hospital has loyal and long-standing staff who are proud of their clinical excellence. However, as times have changed, there has been far greater emphasis on helping ward sisters and nursing staff understand the importance of using automated technology to produce efficient rosters that tangibly support the smooth running of the organisation.

As a hospital reliant on a traditional paper-based system for many years, providing easy-to-understand, quality hands-on training whilst maintaining excellent patient care was an additional hurdle to be overcome. The hospital also has a higher proportion of part-time staff than is typically found within hospital organisations, many of whom hold (historic) restrictive contracts of employment, which presents further challenges for the implementation team.

The solution – a change in culture

Mount Carmel deployed the e-rostering system across all four wards to support 210 nursing staff, manage complex shifts and produce efficient rosters that maximise the talents of highly skilled clinicians and provide fair rosters for everyone. Staff can even access the system themselves (including remote accessing) to request changes to their shifts, book holidays or report sickness leave.

At the same time, the system has been sensitively configured and installed to meet Ireland’s strict Trades Union policy of consulting staff prior to changing shift patterns and rosters.

In line with Dr McCarley’s own pioneering Timeframe Analysis methodology that maps a typical workload across the day and across the week and flags up what and how many staff are needed whenever there is a change in workload, the system can be fine-tuned to Mount Carmel’s own schedule.

For example, patient demand typically changes during the course of the day from lulls during night-time to intense bursts of post-operative activity.

The successful implementation with hard evidence of positive results, has been the catalyst for cultural change at Mount Carmel. From a strong resistance to change, staff at all levels are beginning to appreciate the benefits of e-rostering and look forward to utilising other features provided by a suite of workforce management solutions.

Next on the agenda is installing a patient acuity solution, Real Time Hospital, to provide a 360 degree view of all staffing requirements to minimise risk and maximise safety. It then plans to centralise all e-rostering in the foreseeable future.

Benefits

Putting patients first

Mount Carmel has become more efficient in its use of key resources, meaning the most appropriate skills are allocated to the right wards at the right time. In addition to properly identifying workforce requirements (expressed in whole-time equivalents), it has allowed for the proper identification of the specific skills and expertise required within discreet service environments, based on the typical patient population. The e-rostering system has also improved the capacity for managers to redeploy nursing staff across service environments as activity/acuity changes leading to a reduction in the use of ‘bank’ nursing staff.

The Real Time Hospital acuity solution provides a continual, comprehensive overview of the hospital rosters allowing managers to quickly identify periods of either overstaffing or understaffing, based on the predetermined minimum staffing requirements within each area. This also improves management decision-making

In short, the system helps the hospital provide a truly patient-based service where the patient’s well-being lies at the heart of everything it does.

Time and cost savings

Mount Carmel has been able to prove the benefits of e-rostering in real terms. Already, the hospital has saved significant amounts of time through the more effective management of rosters, reducing considerably the ‘overstaffing’ within many rosters. The time saved has released clinical skills back into patient care, where it matters most and where senior nurses excel.

The hospital has improved the equity in allocating staff to shifts that attract a premium pay. The scoring system automatically allocates the ‘premium’ shifts to staff that have the lowest score ie staff that have had fewer premium shifts.

The automated link to the hospital payroll has removed the requirement for managers to calculate premium payments for nursing staff, eliminates the potential for errors and further reduced the time required to manage the rostering process.

Better forward planning through analytics

The availability of accurate, real-time information has enabled Mount Carmel to analyse their use and deployment of staff. Rather than look through paper or spreadsheet records, managers can quickly generate reports to identify the busiest times of day or year and track holiday or sickness absence and plan future rosters accordingly. They have also eliminated the requirement for storage of paper records of ward rosters.

Mount Carmel expects to yield the following additional benefits:

• a greater focus on workforce planning and deployment, minimising the requirement for reactive staff adjustment
• improved capacity to deliver coordinated experimental learning for nursing staff;
• enhanced ability to monitor hours worked against contracted time leading to a reduction in the requirement for time off in lieu;
• more effective control of expenditure both on permanent staff and in the use of bank nursing .

Centralised rostering

Mount Carmel has plans to move towards centralised rostering in the near future, so a core group of expert users will improve the cost-effectiveness of rosters and enhance the deployment of staff across all areas, rather than a traditional one-ward perspective.

This will give staff working on all four floors a clear view of rostering across the whole organisation, allowing them to fully utilise specific skills or address potential shortages on certain wards quickly and efficiently. It will also eradicate the duplication in ward management time, facilitate annual leave planning and support the integration of timesheets and absences into one system.

A centralised approach to e-rostering will depersonalise the process for managers who have often built up a strong sense of camaraderie with their staff. This will bring greater transparency to the process and dictate greater equity in allocation of premium working hours, making it fair for everyone.