Key note speaker, Danny mortimer, and main slides

1. WELCOME
Effective Management of the
Clinical Workforce 2017
#RosterOurNHS

2. Welcome to the National E-rostering Conference
Effective Management of the Clinical Workforce
2017
Sam Gallaher, Executive Director,
Skills for Health

3. Who are Skills for Health?
• Not for profit organisation
• Experts in Workforce for operational
improvement
• Government appointed remit for the
UK healthcare sector
• Solutions - that work, value for
money
• Leading provider of e-Rostering
Planning and
Design
Utilisation
and
Deployment
Improvement
Sustainability

4. Delivery of healthcare
Human Capital
Financial ConstraintService Demand
Medical Advancement
Day to day delivery
of healthcare

5. Our Journey
Our Journey – working closely with health professionals

6. Join the conversation on social media
Follow and tweet using hashtag #RosterOurNHS
@skillsforhealth
skillsforhealth1
Skills for Health
W: www.skillsforhealth.org.uk

7. Keynote

8. Skills for Health
09 May, 2017
Danny Mortimer
Chief Executive – NHS Employers

9. Context
• Economics
• Dependency
• Workforce Planning
• Supply/Retention

10. Use of flexible working options
Part time working 29%
Flexi time 19%
Home working 14%
Compressed Hours 3%
Career Breaks 3%
Mobile Working 7%
Job Shares 1%
Annualised Hours 1%
Term Time Working 1%
CIPD – Commuting and flexible working report – April 2016

11. % overall satisfaction within different types of NHS organisations
Flexible Working
NHS Staff Survey Results
Mental Health 58
Acute 51
Acute Specialist 53Community 57
All Trusts 52
Combined
Acute/community 51
Ambulance 35

12. Can flexible working save money?
• Need more than just a flexible working policy.
• Need to make it real for the organisation, front line
managers and staff.
• If supply is the biggest issue…

13. Flexible working plus
Reduce Agency
Spend
E-rostering
Flexible workingCollaboration
Workforce supply
= patient demand

14. Different approaches to reducing agency spend
• E-rostering for junior doctors, centralised support
• Savings of nearly £27m in 3 years
• Benefits to organisation, team and staff
Leeds THT
• Empowered front line managers to work with staff to maximise
opportunities for flexible working
• Family friendly employer
Chelsea &
Westminster
• Flexible nurse team to respond to flexible need for cover across the trust
• Improvements to clinical effectiveness and quality outcomes
• Financial savings
Derbyshire
Community

15. The roll out of e-rostering for junior doctors supported by a centralised team delivered organisational and
staff benefits including:
Organisation
Increased use of trust bank doctors. Moved from 80% of medical locum shifts filled by agency in 2014 to
70% filled by bank in 2017.
Central control improved access to real time information on temporary medical staffing spend and usage,
this helped the control of agency spend.
Estimated savings for medical and dental agency spend of nearly £27m in 3 years.
Staff
Shift availability can be checked via mobile devices using an online app.
Vacant shifts can be notified to staff via text and email.
Reduction in administrative burden.
Fair approach, accessible to all.
Good practice in e-rostering –
Leeds Teaching Hospitals NHS Trust

16. Good practice in flexible working –
Chelsea and Westminster Hospital
Objective
A desire to support effective workforce recruitment and retention through being employer of choice
How they achieved it
They developed all employees understanding of policy and practice by providing:
• training for staff about the discussion necessary to support effective flexible working
• guidance to assist staff in making a request
• guidance to assist manager’s confidence in handling requests
• case studies of good practice
• coaching for staff in considering business as well as personal need
• extra support to managers, 1-2-1 coaching
• guidance for carers
• lunch time drop in session to support sharing of experience/good practice
Outcome
• Winner and regularly recognised in top employers for Working Families Awards

17. Good practice in flexible working –
Derbyshire Community Healthcare
Issue
The trust understood that patient demand fluctuated at different times of years and across
different regions of the county. To respond the trust required flexibility within the system to
target those geographical areas where services were needed most.
Solution
They set up a responsive workforce team which could be deployed across the county on
different shifts, to work in services that were struggling to meet demand.
This approach brought a number of benefits:
• effective way of sharing good practice within the trust
• improvements to clinical effectiveness and quality outcomes
• achieved financial savings.

18. Key messages
Importance of Policy and Systems but…
• Strategy
• Brand
• Supply
• Balance Short and Long Term
• Culture & Line Managers
• Practice
• Judgment
• Team

19. Developing a strategy for clinical
workforce efficiency and productivity
Dr. Jen Harrop

20. Making informed decisions quickly
That everyone is aware of

21. Why am I here?
NHS enthusiast ex medic turned manager and transformational type

22. • I’ve been on the receiving end of rigid rostering and confused process
management
• I’ve worked with organisations to find the best patterns within the
limits of these processes and contractual requirements
• I now run a department myself and I would say daily encounter
challenges that either…
a) NEED NOT HAVE HAPPENED AT ALL
b) COULD HAVE BEEN RESOLVED WITH LESS EXPENSE IN
TERMS OF BOTH TIME AND MONEY
So what?

23. Start at the Beginning…
Your needed
in theatre
NOW!
Weekends are
impossible to
swap!
Didn’t you know the
consultants swapped
(so why didn’t you)?
I keep missing
training
opportunities!
Reg is sick, who is holding the ARREST bleep?

24. • Hours reduction and shift patterns
• Shortage specialties and whole professions
• Waiting list increases
• Winter pressures
• Costs spiralled, spend in real terms reducing
A perfect storm in clinical workforce design and management
We got worse before we got better

25. • We tried to devise rotas that would satisfy safety training and service
but these were too fixed and didn’t flex with change or allow leave
• We implemented Hospital at Night in part to address the hours and
workforce ‘stretch’
• We looked to MDT working and sharing skill sets – still an excellent
idea but how do you know who can do what and if they are here?
• We made the plan complex BUT we kept the same management
processes and expected more and more of those administering the
plan, the training and the service.
Baby steps

26. Then there are the gaps

27. • Contractual requirements
• Historical policies and procedures “we’ve always done it that way”
• Inflexibility of some colleagues (especially if it means THEY change)
• Old fashioned ‘preferred’ methods of communication
• Expectations
• Hierarchy
• Uncertain roles and responsibilities –
the finger(s) of blame
Nitty Gritty (Can’t be forgotten)

28. • The extent of challenges and the complexity of the problems
• We need to communicate the frustration and problems succinctly to
gain support for change given the benefits on offer
• We need to define our processes for efficiency and that might mean
unpopular change (centralisation)
• We need modern techniques to eliminate errors and to provide the
visibility, and therefore ultimately the flexibility, our workforce desires
and service needs
• We need a plan!
So what do we know?

29. WHAT MAKES A GOOD STRATEGY?

30. • Define the Problem List
• What’s the priority
• Who do I need to convince (and how)
• Create the vision/reason to change
• State of readiness – who currently does what
• How can I simplify
• Business Case?
Back to basics

31. Any strategy that gets you one or more of the following from your would
like to have list…
• Reduction in locum spend
• Correct pay every time for all
• Visibility and ability to respond in exception to your plan
• A longer term service delivery plan
• Equity and fairness for your staff
• Audit Trail of who did what where and when
• Demonstrable reduction in admin time
Start by deciding what/which of these is the most important to achieve
and everything else that comes will be a bonus….
Problem List

32. Identify Benefits

33. PROCESS CONTROL –
PREPAREDNESS FOR E-ROSTERING

34. Information in/out
Process Control?
Absence Management
Operational Deployment
Surveillance & Monitoring
Single access sickness reporting
A/L access and approval mechanisms
St/L dual access approval
Swaps approval process
All junior team/grade identities held centrally
Divisional access to pertinent workforce rotas
Division decision on local deployment to service areas
Monitoring of rotas according to contract and legal hrs limits
Overview of workforce levels and standards
Surveillance of performance against contract

35. Information in/out
Process Control?
Absence Management
Operational Deployment
Surveillance & Monitoring
Approve and communicate the leave – WHO?
Deploy the available staff according to rules and
requirements – WHO?
Monitoring and planning ahead – WHO?

36. Fit For Service
What are skill sets/grades needed
What specialties/professions can provide them
How many people minimum
How many hours
?

37. • Flexible working policy (inc. review dates)
• Sickness absence policy
• Swapping shift, clinical deployment policy/guidance
• Arbitration/special circumstances process
• Data Controller(s) remit and guidance
Process control is vital to making decisions against the pre-defined
‘rules’ for the service.
It’s easier to say Yes/No when the explanation for the decision is clear
Supporting policy/guidance

38. • Central repository of all the mission critical information for a service
no matter how big or small.
• Like a child it ‘needs input’ and to be maintained
• Can provide the Chess Move options not immediately obvious
• System won’t let you make mistakes by enforcing the rules
• Will remind you of what has been in seconds
• Not human, has no heart or compassion – it needs people!
Visibility – what is e-rostering

39. • The more flexibly we work the more accurate our count needs to be.
days/weeks/hours/premium vs normal time etc
• What about last week, last month, last year
Audit trail and calculator

40. PUT SIMPLY
WHAT ARE THE MUST DO’S TO MAKE
THE WORKFORCE
1) FLEXIBLE
2) FIT FOR THE SERVICE
3) VISIBLE
EVERY DAY

41. Summary
Visibility
Define
Processes
Decide the
BIG FIX

42. How to make it happen
• Accept it won’t happen overnight
• Uniform practice – centralised & equitable process (local rules can
differ)
• Overlaying e-rostering on a broken or disjointed process will have
limited success
• Judgement, what’s reasonable to expect of staff and managers
Nothing other than inflexible work patterns can
happen without total visibility and controlled access
with supporting processes

43. ?
Questions

44. Workshop 1 - Nursing Focus: Plenary room
Workshop 2 – Medical staffing Focus: Propel 2
Workshop 3 – Operational Focus: Proceed 2
Workshops

45. Thank you
Thank you for attending. Continue the conversation on
social media. Follow and join:
#RosterOurNHS
For any questions, please do not hesitate to contact us:
contactus@skillsforhealth.org.uk
skillsforhealth.org.uk