Image: Logo Realtime Rostering.DRS Realtime is the new online electronic rostering and programmed activity management system, which originated through a partnership between Skills for Health and the NHS North West Junior Doctor Advisory Team. It has been shown to reduce locum spend and achieve better use of clinical theatres and staff time. It achieves this through advanced planning of rosters and alerting the user to staffing issues long before they occur. Use of the ‘rules’ feature prevents too many staff members of a certain grade / speciality or skill-set from taking leave simultaneously – ensuring a stable year-round service. The system also incorporates Scheduled Events functionality, which was developed and piloted at East Lancashire Hospitals NHS Trust (East Lancs Trust). This allows scheduled events such as ward rounds to be planned in advanced.

Realtime is a web-based tool that works in conjunction with the existing Doctors’ Rostering System (DRS) package that many Trusts have used for over a decade to produce rotas and monitor junior doctors’ hours. Multi-level access allows clinicians using smart phones to see at-a-glance where they need to be and when, providing junior doctors with easier access to their consultant’s job plan and allowing them to take advantage of training opportunities that would have previously passed them by. Therefore it is good for service provision, and good for doctors!

Following initial pilots at a number of sites in the North West, DRS Realtime is now being rolled out to ten Trusts across the region. Access to the Realtime solution is based on an annual subscription which covers the costs of training, support, hardware, and further development. This case study will look at how Realtime has made a difference to those Trusts involved, particularly East Lancs Trust where the benefits of the system have been assessed.

Key Outcomes

  • Reduced spend on locums - early implementers of Realtime in Blackpool reduced medical locum spend by between 10% and 20%. “The tool has helped us reduce locum use and administration costs and as a result it has been adopted as one of our Trust’s Quality Innovation Productivity and Prevention (QIPP) projects.” (Andrea Padgeon, Medical Staffing Officer, Blackpool Teaching Hospitals NHS Foundation Trust)
  • Better access to training opportunities - training for junior doctors has improved through linkage of consultants’ job plans with their trainees’, allowing junior doctors to take advantage of training opportunities that would have passed them by. Now junior doctors better know when and where potential training events are going to occur.
  • Reduced Cancellations – since implementing the system there have been fewer theatre and clinic cancellations at East Lancashire Hospitals NHS Trust, as events can be coordinated centrally for both hospital sites. This means that rostering errors are easier to detect which helps prevents the double booking of clinicians “Scheduled Events has led to better use of theatres and staff time. Cancelled theatre lists are now very uncommon as are writing mistakes such as missed people and double booking.” (Dr Kerry Grady, Consultant Anaesthetist, East Lancs)
  • Right people in the right place - use of scheduled events functionality ensures that clinicians with the appropriate skills are assigned to specialist ‘events’, meaning that the right people with the right skills are in the right place at the right time. Doctors at East Lancs can now check where they need to be on their smart phone en route to work.
  • Reduced administrative burden - at East Lancs the ability to coordinate rosters across different hospital sites from one base means that Realtime has reduced the rostering workload of medical secretaries by 50%. Producing reports and running rosters was very time consuming, “stretching” two people. Now a single person performs the role fairly comfortably following the retirement of a colleague. “Producing reports and changing rosters were also very time consuming but these often take just a few seconds now.”
  • Releases Consultants Time – for one consultant rota planning now takes 75% less time “I used to spend up to eight hours per week planning the rosters. This task now takes around two hours and I now have the option of planning activities over a longer period as is the case when I go on holiday.” (Dr Kerry Grady, Consultant Anaesthetist, East Lancs)

Image: Rostering discussion.

Key Aims

  • Reduce the spend on locums
  • Support the delivery of efficient, high quality patient services
  • Provide junior doctors with better training opportunities.
  • Produce sustainable rosters that ensure the correct balance of staff throughout the day, allow pro-active management of programmed activities (sometimes months in advance), and give staff a better work-life balance and compliance with the Working Time Regulations.
  • Assess the benefits to implementing an electronic system of managing scheduled events such as surgical lists, clinics, ward rounds, locum shifts and any other programmed activities.

How it Works

Realtime has two main areas of functionality that complement the existing Doctors’ Rostering System (DRS):

1. REALTIME ROSTERING: Existing junior doctor rotas and consultant job plans can be entered into Realtime which allows users to produce rosters from existing rotas - taking into account ongoing variables such as annual leave, study leave, shift swaps and unexpected absences. Realtime also allows users to set ‘rules’ across departments and produces a report showing where problems due to staffing capacity are going to occur in the future. Thus the Trust can be proactive in finding solutions and organising cover. This prevents too many doctors of a certain grade / speciality / skill-set from taking leave simultaneously and ensure that the service can be maintained year-round.

2. SCHEDULED EVENTS: enables the detailed planning of ‘scheduled events’ such as surgical lists, clinics, ward rounds, locum shifts and any other programmed activities – ensuring that each event has the appropriate skill mix it requires, alerting the user to problems long before they would otherwise become apparent

Resources

Access to the DRS Realtime solution is based on an annual subscription which covers the costs of training, support, hardware, and further development.

The main resource required by each Trust which implements it is staff time to develop and pilot local use of the system.

Key Challenges

Overcoming initial reticence and gaining support from some staff was a challenge, but this was achieved by spending a lot of time preparing for implementation and getting the engagement of other staff to help with this. “There was some initial scepticism from colleagues until they saw the benefits of the system. It helped that they can check where and when they need to be on their smart phones and iPads. Also they can use the report function for their job Diaries and ARCP`s etc” (Dr Kerry Grady)

Sustainability

DRS Realtime has proven its worth to East Lancashire NHS Trust and following the development phase it is now established as way of organising scheduled events there.

Over the last couple of years a total of ten Trusts have come on board and have started using the system. Within the last three months this included Wrightington, Wigan and Leigh NHS Foundation Trust, North Cumbria University Hospitals NHS Trust and Warrington and Halton NHS Foundation Trust, each of which have signed up to use Realtime for three years. Realtime is also now being used in a number of healthcare organisations in London.

Next Steps

Further objective assessment of the benefits of DRS Realtime is underway in a variety of specialities, with results to be reported in due course. It is hoped that in the future all North West Hospitals will use this system.

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