Why is self rostering better than rolling rotas?
Rolling rotas are inefficient because they have redundancy built in to allow people to book annual leave. You need more redundancy depending on your leave rules. If you want to allow people to have time off any possible shift permutation apart from nights, then essentially you need TWICE as many people to staff a rota than you actually need. You do not need this with self rostering.
Rolling rotas are designed to provide a baseline level of cover and the underlying assumption when they are written is that they are always full (they are never full). They also assume that doctors work full time (this is becoming less common). If a rolling rota isn’t full it means that the redundancy built in to allow leave falls apart, and that redundancy (which was never designed for departmental resilience) is used to plug gaps, which leads inevitably to people not being able to get leave, or attend educational opportunities. This damages morale, training, and leads to burnout.
The rolling rota is often thought of as the baseline or required level of staffing for a department, but actually this isn’t the case. The department needs staff to be allocated at a different time and frequency than the rolling rota does. Once you separate people’s work schedules from the departments schedules you can more efficiently allocate your staff, and at your level (ie middle grade), that will have a real impact on department function.
The other thing that people find hard to believe with self rostering systems is that they are better at allocating night shifts and weekends. Nearly everyone can remember stories of people being rostered for nights or a particular weekend, and them having very legitimate reasons for not being able to work (ie getting married, exams etc etc), now often these shifts if there was no swap available would either be left blank, or get swapped with an empty slot, and remain vacant. This doesn’t tend to happen with SR systems because everyone fits their OOH allocation to where they can actually provide it.
Isn’t it impossible to self roster junior doctors in training jobs?
There is nothing in the JD2016 T+C document that precludes self rostering providing that the safe rostering rules are met. There is also nothing in the T+C document to suggest that doctors on the same rota need to be paid the same. Medical staffing generally want everyone to work the same because it makes their payroll calculations easier, and they are even more woefully understaffed than we are.
Junior Doctor Contract 2016 gives quite specific rules about rotas and leave, but the key to allowing a SR system is in the paragraph that explains what a Generic Work Schedule is.
“…A standard full-time generic work schedule shall be for a minimum of 40 hours and a maximum of 48 hours per week, averaged over a reference period defined as being the length of the rota cycle, the length of the placement or 26 weeks, whichever is the shorter. A less than full time generic work schedule shall not exceed 40 hours, averaged over this same reference period…”
You can use a generic work schedule as a template for self rostering. As long as the doctor does the number of shifts in the work schedule, it doesn’t matter what order, or what combination they are done in.
If you pull the generic work schedule that HR have, and count the variety and type of shifts that can form your allocation. As long as every doctor works all of their allocation their pay will remain the same.
Now if you add up each type of shift available, and multiply it by the number of full time equivalents you have you will notice that you probably have far more day shifts than your department actually needs. This is because your work schedule is based on a rolling rota and it is assumed that some of those day shifts are going to be used for SL or AL.
How did you get people to get on side?
The rota administrator who works in HR, or for your department will handle the day to day bits of the rota. They need to be brought on board, I did it by incrementalism. People are a lot more willing to try things if they think it’s a pilot or trial.
ED consultants generally are skeptical at first, and there is always some push back about excusing everyone from shop floor duties for a few hours to arrange a rota, however the gains become apparent very quickly. That sacrifice allows for more consistent staffing, and fewer episodes where there are feasts or famines of trainees.
People on the rota might be skeptical at first, however I found that once people grasped what the system would allow them to do everyone came on board.
How does Annual Leave work?
Annual leave works differently in this system. If a doctor doesn’t want to work, they just don’t book a shift. If they want to take annual leave, they can use annual leave to reduce the number of day shifts they have to allocate, they do this prior to picking their shifts. So if you want two weeks AL away on holiday, you spend enough annual leave days to reduce the daytime allowance you have to allow you to schedule your shifts how you want. It works the same for study leave. Doctors just don’t book themselves down to work on the shop floor, and submit forms in the usual way.
One of the biggest issues I found with this system was that it allows so much flexibility that people don’t need to use much annual leave to take time off. This means you generally have a glut at the end that you cannot accommodate (a bit like an normal rolling rota). I generally tried to strongly encourage people to take a few days each cycle, but suggest that they are mindful of when they want their ‘big’ holiday.
What about maternity, paternity or adoption leave
Generally speaking this is even simpler than annual leave. If you have a hard stop date (like a due date) you can do a number of things
- Reduce that doctors allowance for the rota period that they are in (say if the baby is due half way through)
- Take them off the rota for when they are off
- You can also change people’s allocations if for example they are pregnant, don’t want to do nights past a certain point but still want to do other OOH work. Though my general feeling was that if people wanted to be off nights from 26 weeks they could be, and they shouldn’t have to make up the time.
Paternity leave is slightly trickier because its start time is less clear cut, what I generally did was ask people to put their OOH shifts far enough away from the due date that we wouldn’t be short on nights or weekends but would be able to manage any short term absence caused by an early arrival.
Problems with complexity
Some people’s rotas are very complex, and it can be difficult to fit the required number of shifts and type in any way other than done by the work schedule. I’d argue that a rota like that probably isn’t fit for purpose anyway, as swaps will be almost impossible, and if the work schedule is that close to breaking the actual JD2016 contract rules in reality, then it is certainly breaking them in spirit.
The system I have described works if you have a small number of different types of shifts. It makes the administration easier, and the allocation faster.
Can you Annualise?
So Annualisation would basically mean adding up everyone’s allocation for the period of placement, or a year, and allowing them to pick shifts over a greater period of time. Now I am not sure if you could annualize on a training contract, it depends on what people interpret the reference period to be. If your rota cycle is 8 weeks, it’s 8 weeks, if your rota is more complex (and I’d argue they shouldn’t be) then it might be longer. Longer periods for allocation throw up practical problems. People are less likely to know what they do and don’t want to work 4 months in advance. This means that you might have to arrange swaps, and fiddle things further down the line. Which brings me to the bad thing about self rostering:
How do swaps work?
Swaps are hard to arrange and fit in safely.
This is because often people have created bespoke working patterns for their own reasons, and they don’t like it when they are tampered with. There is less flex in a finalized self-rostering rota to account for last minute swaps. However the same rules as for a rolling rota apply so if you can find someone to do a like for like shift swap it generally doesn’t matter. It just might difficult to find people who can.
What do you do if people are difficult?
Now these could be people who are a little difficult to work with, or people who don’t grasp the need for compromise when it comes to shift patterns. This system can work (and I have direct experience of this) with people who are inflexible or difficult, but it does take more of the rota coordinators time. I made sure that all communications about the rota went through email, so there was a record of what had been said, however the system is usually flexible enough to accommodate them.
Having people’s shifts decided at a meeting is a good way of moderating unreasonable behavior, because people find it a lot harder to be difficult when surrounded by their peers.
Sometimes people seem difficult because they don’t know how the system works. This is particularly true of more senior doctors who are more used to working on rolling rotas. People found it hard to grasp how annual leave worked, and how other commitments can be scheduled around their shop floor work. Once they get it, it’s a beautiful thing, but especially around changeover periods things can be confusing for people.
What about changeover?
Changeover time is tricky, it’s difficult to get an accurate list of all of the doctors who are coming, and get them in a room in time for the rota meeting. I also had a hard time finding out from medical staffing, and the deanery who was coming. Here social media is your friend, and you can often find out through gossip about who is coming and reach out to them over twitter, whatsapp, or facebook to welcome them and give them a run down of their shifts.
How do you run a rota meeting?
You need a big screen, someone to chair and someone to run the spreadsheet. I provided print outs for everyone with a list of their allocation, for them to fill in, so they could keep up with what shifts they said they’d do. I also had a flip chart on the side with the safe rostering rules so people could remind themselves of shift patterns that they couldn’t work.
The rota meeting starts at the end of morning handover, night SPRs are expected to attend. When I was in charge I ran the meeting after I had done a night shift a few times, and this worked well. Doctors who can’t attend need to specify what they want, and I nominate a deputy to book shifts for them. Generally the nominated deputy does a good job.
We start by allocating the night shifts, then the mids, and then populate the days and lates. We start at the top of the rota and just run down, with people shouting up if they want to do a particular shift. If more than one person wants to do a shift, I ask them to come to an agreement amongst themselves and this has never failed to produce a solution. Over Christmas periods I allocate the 2 weeks over Christmas first. The meetings generally last for about 2 hours.