Using technology to support the deployment of the health workforce has many applications and practical uses in terms of identifying issues and simplifying challenges. Examples from hospitals and health systems in this report have shown remarkable improvements in efficiency, staff retention, and clinical outcomes by linking payroll with time and attendance, planning rosters in advance, and pooling temporary staff, among the various ways of using workforce management technology.
But it is clear from the research that there is variation in how the technology is being deployed, both nationally and internationally. While the huge data resource and planning tools are being utilised by organisations, many benefits are yet to be realised.
The Workforce Deployment Expert Group sought to develop a workforce optimisation maturity index to define what ‘good’ looks like and to assess how the technology is being used currently in the UK. In order to do this the group had to first identify the key stages of workforce optimisation, which are defined below.
Workforce optimisation maturity levels:
Paper based rostering
The very basic form of rostering; rosters are produced, recorded and monitored on paper. This can still provide staff with data about the workforce and identify changes that could be made. Over the last ten years, most healthcare providers have moved away from paper-based systems.
Time and attendance, with a link to payroll
Recording the amount and duration of worked staff shifts and paying staff based on that record, to streamline processes, remove administrative tasks and improve accuracy of payments. The London School of Economics in 2014 suggested that if all trusts in England implemented e-rostering for payroll the NHS would save £41million per year.
Templated demand-based rostering
Trusts agree their standard demand, in terms of the number of staff needed. This provides them with clear visibility of unfilled demand (which places staff under stress) and control of over-rostering (which can cause unnecessary temporary staff spend).
E-rostering is a fair and transparent way for leave to be managed and, when planned well in advance, enables managers to find cover staff from bank resources first, and agency resources only when alternatives cannot be found. One trust found e-rostering reduced unavailability by 3.3% over a year, which produced £2.1 million in efficiency savings.
Integrated temporary staffing
This enables trusts know all the staff assigned to rosters, including bank and agency staff. Therefore, they know when their under or over staffed periods are. Additionally, temporary staff bookings are more effective as they are linked to the unfilled demand, and whether they are safe alongside substantive work.
Shared staff banks across organisations
Cross-organisation staff banks have been developed to increase the pool of temporary staff trusts have to select from, with the aim to reduce the dependency on agency staff to cover unfilled shifts. Sustainability and transformation partnerships (STPs) and accountable care organisations are ideally placed to make it happen, as shown in the report by the example from South West London STP.
Real-time staff engagement in rostering
Temporary staff can see the gaps in the roster that match their availability, via their phone or computer, and book into them. This can create better fill rates, better experience for the staff as it can remove contacting busy bank offices, and better for bank office as it removes basic administrative tasks, meaning they can focus on the ‘hard to fill’ requests. Allowing staff to choose their preferred shifts – by using mobile or web apps - results in more flexibility, which enhances the staff experience and in East and North Hertfordshire NHS Hospital Trust, reduced temporary staffing usage by 14%, agency usage by 12%, and sickness decreased by 3%.
Clinical activity based rosters
Moving an entire workforce onto e-rostering enables efficiencies across all roles, as trusts can then roster staff to a particular activity. They can then view the roster by activity and if each is properly staffed, enabling better multidisciplinary team deployment. It also means trusts can deal with changes, for example, a clinic is cancelled, this means the managers know all the staff allocated to the clinic are now able to work on another activity. Trusts can also report on unfilled activity, contracted activity against actual activity.
Operationally live rosters using live patient and staff status
Live rosters enable managers to redeploy staff to different wards, as needs change, matching patient demand. Trusts can bring together on-the-day patient activity and the actual roster. Patient demand can differ to the templated demand-based roster, but this give managers a just-in-time way to align the roster to patient need. This must be combine with daily staffing meetings driven by this data.
Roster effectiveness committee and board reporting and review board
Reviewing workforce key performance indicators regularly at board level happens at many trusts in England and e-rostering systems provide the data to facilitate this. This way of working provides trusts with a greater visibility and a corporate perspective of their most valuable resource – the workforce – and how it is used.
Enhanced care rostering
Trust can establish a central pool of substantive staff, who are then deployed to different areas, based on patient need ensuring safe levels of staffing. This can result in a reduction in temporary staff use. For example, in East and North Hertfordshire NHS Hospital Trust, a specially trained team was deployed to care for people with dementia, frequently rotating staff to improve and increase the number of patients the trust could care for, while reducing stress for staff.