Reducing staff fatigue within the NHS

In summary

Rostering is a complex scheduling problem that affects healthcare services across the world. Previously, most NHS doctors worked with old fashioned and inflexible rota systems, which failed to account for staff fatigue and autonomy.

Celia Glass, Professor of Management at City’s Business School (formerly Cass), has spent a large part of her career working with health professionals to implement stronger workforce management tools and designing scheduling algorithms.

In 2016, she trialled her e-rostering system at a major London NHS Hospital. Results revealed an improved use of resources, reduction in staff fatigue levels and marked improvement in their which is a prerequisite for staff retention.

What did we explore and how?

Following previous successful workforce management research within call centres, Professor Glass and her colleague Dr Roger Knight adapted their theories onto nurses’ and doctors’ rostering systems.

In 2016, Professor Glass piloted her Ergonomic Roster with doctors working within Whittington Health NHS Trust’s Emergency Department.

Professor Glass’ rostering model incorporated multiple influences that previous systems ignored, such as, staff wellbeing, month-on-month continuity, personalisation of leave and training and the undesirable effects of night shift patterns which affect both staff fatigue and workplace risk.

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 difficult. 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.

Benefits and influence of this research

The immediate benefits of the research are:

• Doctors: this system takes account of fatigue, flexible working (particularly part-time), training needs and personalised annual and study leave, which the previous system was too rigid to accommodate.
• Patients: the system reduces risk for patients through staffing levels matching patient demand and reduced doctor fatigue.

Unlike other NHS rostering system, there is no trade-off between patient coverage and flexibility of staff leave. The utilisation of the software also had substantial financial benefits since the hospital was able to reduce locum (temporary) shifts and staff time in managing the rotas– saving roughly £23,000 per annum for a single rota.

Professor Glass’ research into this area achieved significant media coverage and highlighted the problems of poor rostering systems during the 2015/16 junior doctors contract dispute.

She also provided written evidence to the Public Accounts Committee which launched ‘managing NHS clinical staff numbers inquiry,’ highlighting the pressures junior doctors face. Her evidence helped shape, in part, the committee’s recommendations which the government subsequently adopted.

As a result, Health Secretary Matt Hancock spoke about the need for improved staff rostering as a cost-effective method of boosting the performance of the NHS.

The importance for the NHS of taking account of staff well-being has become even more apparent during the Covid-19 pandemic.