This blog is all about things I have done in my Senior Clinical Fellow year, most likely to talk about the rostering side of things.
Currently I’m an ST5 on an OOPTE for 2 years at Leeds Emergency Departments, I do a lot of undergraduate teaching, mentoring, lecturing, examing and any other kind of educational activity that you can think of, but along the way I fell into being the rota co-ordinator.
It turns out that I really enjoy it. A combination of spreadsheets, having control over my life and being able to make other people happy really appeals to me. Along the way I have fallen into a self rostering rabbit hole and wondered if other people could learn from what I have learnt.
Always happy to answer questions about anything I have done this blog details the process I’ve been through over the last year and will hopefully show where I am trying to go from here!
For longer than the nine years that I have been a doctor,
the rolling rota has been the standard rostering method. Unfortunately, this
standard is a brute force technique which allows for minimal flexibility and
correspondingly results in unnecessarily negative morale.
Styles of working have changed over time. An increase in out
of hours demand and an uptake in less than full time working have put the
traditional rolling rota model under pressure.
It was never designed to be flexible and its continued existence seems
to punish those that want to work more flexibly.
Over the last few years people have begun to challenge the status quo. I first became aware of alternatives to the rolling rota when watching a video by EM consultant Dr Rob Galloway. His Risky Business lecture in 2017 talked about the benefits of a “self-rostering” rota, I was intrigued. A self rostering post from St Emlyns in March 2017 talked further about the benefits, it including pictures of clever spreadsheets and ways of making it come together for a large group of doctors. This, I thought, was something that I could make work for ED registrars.
Unfortunately, both these rota systems were designed to
allow consultants to work flexibly in an annualised fashion. The consultant contract is worked out really
quite differently to a junior doctor.
Junior doctors can probably work less flexibly than consultants, we need
to work a specific amount of in-hours time to constitute training. If we work more out of hours time than predicted
we should be paid more as stated in our contracts so our hours are fairly
Dr Tom Bircher published his “How to Self Roster for Registrars” blog post in February 2018 and summarised it in a poster on self rostering at EMTA ’18 in Cardiff. He showed that you can flexibly roster a group of registrars, meet their training and personal needs, provide better cover for a department and decrease your locum costs. While I use a different method in my rostering to Dr Bircher I certainly leaned heavily on his work in persuading various consultants that a different style of rostering can work.
I started in Leeds Emergency Department as a senior clinical
fellow in September 2018. While I do a
lot of undergrad education my other hat has been the rota coordinator. When I started, I altered the method by which
the senior clinical fellows (6 HSTs on a 60:40 split contract) were put on
their rota, from rolling with minimal flexibility to a self rostering system. We were able to better cover the gaps in the HST
rota, allow the fellows to meet their non-clinical commitments and make
everyone happier in the process.
In May, I got the go ahead to implement the same style of
rota to the entire registrar body. To
put this into context for Leeds, that is 34 registrar level doctors, a mix of
Senior Clinical fellows, HSTs, Staff grades and PEMHSTs. This is a mixture of full time and less than
full time trainees. Some of our staff
grades are on fairly bespoke contracts and a mixture of both the 2016 contract
and the pre-2016 contract. Leeds,
although it is one trust, runs 3 emergency departments (St James’, Leeds
general infirmary and Leeds Paediatric emergency department) which all have
specific staffing needs. If I can make
it work for this place there is no excuse why it can’t be rolled out
What follows is the “how to” guide of what I did. My plan is to write a brief summary that
anyone can skim over but then delve into some really quite fine points, because
the fine points are often what makes the difference to trainees.
A lot of the things I will describe will relate to healthrota. I’m not sponsored by them, they don’t give me anything nice to use or promote their product. I will praise its features where I think they are good, I will critique where I think there are problems. The team I get to chat to though are great and have been very receptive to feedback and everything I write will be true at the time of publication.
Simplify the rota – removed historical shifts, and made
everything as homogenous as possible as it will make hour calculations as easy
Acquired every doctor’s work schedule – obtained the work
pattern of every doctor. The majority of
trainees may work 100% and this will be easy but all the LTFT trainees should
have a pattern as well. This may be
thought of as unnecessary, however, work patterns may vary from trainee to
trainee and doctor to doctor. As such,
acquiring schedules should be done regardless of if you are doing self
rostering or not and should not represent any extra work for the department.
Declared that things are going to change – informed staff of
upcoming changes four months in advance.
Some people may need reassurance or the chance to discuss what these
changes will mean. Many trainees may be
moving in from another area of the country or moving trust and as such will
need informing on the upcoming changes in advance, especially the first time
this is done.
Set a date that people can begin self rostering and write
down a list of FAQs that people ask – as people invariably have the same
questions, a manual was created with a list of common questions, queries and
answers. The manual was sent out to all
trainees at the same time. It also included a list of all regional training
days so people could book these well in advance of their actual dates. The rota was planned for 16 weeks followed by
a review. This is because the rota
patterns runs for 16 weeks at a time.
There is no reason why it couldn’t be done for any other number, 26
weeks may be far more ergonomic.
Sent out access to healthrota – while other systems are
available, healthrota is the system at use in Leeds. Everyone’s rota slot was pre-populated with
nights and weekends. These were
pre-filled to reduce the amount of work
required. With an otherwise blank rota it is very easy to swap nights and
weekends around. We managed to easily
rearrange nights and weekends for everyone who needed it
Any trainee who doesn’t want to self rota was permitted to
opt out – should a trainee not want to
self rota, for instance, if they wanted their rota in advance as far as
possible, this isn’t a problem. If a few
trainees want fixed patterns, we simply populate their slot with the
appropriate rota they had agreed with medical staffing. If 3 or 4 trainees want to do this it isn’t a
problem but if there are too many the resulting lack of flexibility would
become an issue. Anecdotally, a few
trainees were concerned that a flexible rota might adversely affect LTFT
working but the opposite has been found to be true so far and requests have
been accommodated easily.
Arranged for drop-in rota clinics – Although Dr Bircher
advocates for meetings in his self-rostering guide to arrange the rota, for a 3
department trust with so many trainees this approach would be impractical. Rota clinics were found to be effective in
such an environment.
With nights and weekends rearranged, everyone was encouraged
to request annual leave and study leave.
My promise was that, if people requested it prior to me doing the rest
of the rota, they would get the time off.
If they didn’t and then they requested it after the rota was finished, I
would do my best to approve it but couldn’t guarantee their leave. People made all kinds of requests, 4 weeks
off to go to India for Diwali – sorted!
One of our less than full time trainees wanted to take all their days
off in one chunk so they could go do some remote medicine – easy. One of our trainees wanted to swap working
Fridays for Saturdays for childcare reasons – not a problem. Flexible working worked.
Late shifts were then distributed to cover the department as
evenly as possible. At Leeds we aren’t allowed
to take annual leave on late shifts so it’s quite easy to distribute these
shifts to get as much department cover as possible.
Once everyone had had
their late shifts allocated, people simply had the correct number of day shifts
and non clinical shifts populated into the rota. That was then it done. It was about a day’s work to write the rota,
some time was spent before and after answering e-mails and creating resources
but hopefully as people become better with the systems this time should decrease.
While a lot of the pleasure from a self rostering rota comes
from the idea that you can say yes to a lot of trainee requests, the work
behind the rota starts some time earlier.
Like many tasks the preparation beforehand is crucial and will make a
large difference to the implementation of the rota when it comes out.
Simplifying the Rota
Rotas changeover time and with change that comes many
evolving shift times and patterns. A
rota sometimes can represent a historical record of how a department used to
be. Some departments have different
start times depending upon days of the week.
Or odd shifts on certain days because there used to be teaching on that
day. The teaching has disappeared but
the 13:20 start time hasn’t.
I’m lucky in Leeds, we use a predominantly 3 shift system
for the registrars. A 4th
shift time has just been introduced (something I didn’t want) but for the most
part we have 3 shifts.
Day 8:00 – 17:00
Late 15:00 – 0:00
Night: 23:30 – 8:30
Mid 12:00 – 21:00
There are also 12 non clinical (NC) days in a 16 week period. We do 5 weekends – 2 nights, 2 days and 1 lates.
It’s a nice rota even before we add self rostering into the
mix. As there are so few shift types and
every shift is the same length, it certainly makes life easier when self
rostering. If you are considering going
self rostering I would recommend going one step further and redesigning your
rota template to something with 9 hour shifts and standard start and finish
times regardless of weekdays or weekends.
Why 9 hour shifts?
Well under the new JD contract a 9 hour shift gives you a 30 minute
break while a 10 hour shift gives you two 30 minute breaks and so therefore 9
hours is the most efficient use of staffing.
The midnight finish is also beneficial, 2 am finishes start to incur
extra rules from the junior doctor contract and the less of those we incur the
Changing From a Rota
Pattern to a Shift Allocation Quota
Once we have a standard template such as that shown above, we
can start to progress with the rota.
Instead of thinking of it as a set pattern, think of what we have now as
a certain number of shifts to allocate.
From the pattern above we know that we have every 16 weeks:
Weekday day shifts: 24
Weekday mid shifts: 8
Weekday late shifts: 11
Weekday night shifts: 8
Weekend days: 4
Weekend lates: 2
Weekend nights: 4
And non-clinical days: 12
Simple you say, and it kind of is, however not everyone
works full time so the LTFT trainees need their pattern agreeing first. Is a 60% trainee going to work 60% of all
kinds of shifts? 60% of weekends? Split weekends? This all needs to be discussed and decided
If doing this rota has taught me one thing it’s don’t assume
that what you like from a rota is what the next person does. Many LTFT trainees I’ve spoken to have been
happier to work OOH shifts or weekends because it fits in better with care
arrangements or social lives.
Dr Andy Webster has been amazing at providing the template for every trainee and has certainly saved me a lot of work. For example, here is the template for one of our 60% trainees:
So, the rota is now simplified into easier and more
consistent shift types, and all less than full time trainees have got a rota
that meets their holistic needs. Even if
no change was made from here on your trainees will still thank you for what you
Next, before you can build a rota you’ll need to know how
many people to allocate to each shift.
In smaller departments this might be simple: 2 day regs, 2 late regs and
1 night reg is your minimum staffing but it is worth considering how “future
proof” this model will be. For bigger
departments or cross sites it will become gradually more complicated. Again, simplicity is key. At Leeds we went for “4 days regs, 4 late
regs, 2 night regs” as our minimum staffing for week days with no special
rules. This provides a clear goal of
what the rota needs to provide.
When you have done your minimum staffing levels and have
your rota templates you should be able to see if what you are setting yourself
up to do is possible. For example, we
fall short of being able to cover all of our weekday lates by about 10% based
on everything I’ve worked out. Knowing
this before compiling the rota is important as a) some empty late slots can be
expected, b) expectations can be set that the rota, while improving staff
coverage won’t mean that there are surplus registrars on every shift and c) it
can help manage recruitment of extra members of staff to meet the requirement.
Give People an Opt
We are nearly at a point where we can start writing a rota! But before we do check with your trainees
this is what they want, before we went live we offered people the option to
stay on the old rolling rota. One
trainee did, this is absolutely fine, as I said before I’ve learnt not to
assume that what I want from a rota is what other people would want.
We added the one trainee’s rota in and away we went.
One trainee won’t stop us having a flexible rota, we could
probably accept 3 or 4 trainees not wanting to be flexible but any more than
that and you would rapidly lose the ability to deliver what you needed to.
The “we could probably accept 3 or 4” isn’t scientific it’s
a gut feel and a number reflecting our 34 person registrar rota. Smaller departments would need more a similar
percentage buy in from members.
So, we have our pallet of doctors’ shifts to allocate,
shifts needed each day and we know what we can and can’t achieve, it is time to
create our masterpiece.
Stage one – using healthrota we set up an account for
everyone and then pre-populated nights and weekends into the rota!
“What!?“, I hear you scream, “This is meant to be self
rostering and you told people what nights they were going to work? I’ve read nearly 3000 words of drivel to find
out nothing has changed.”
Fair point, but working from a completely blank canvas is
hard and we needed a starting point. If
people had no problems with the dates that their weekends and nights fell I
left them alone, if they needed moving I could move them anywhere in the 16
weeks that allowed as at this point there were no zero days to consider and no
swaps to negotiate. This bit was
Next people populated their annual leave and study leave
into the rota, no swaps were needed and everything was readily approved, people
started booking flights and I panicked a little on the inside, if this didn’t
work, then I was either going to ruin an ED department or lots of people’s
Breathe: I’ll admit
that this was a little bit nerve wracking and at one point I nearly handed it
back and went this is too much for one person, then I made myself a cup of
Yorkshire Tea had a jammy dodger and pulled myself together – “We can do
this!”, I thought.
Now we have a rota with nights, weekends, annual leave and
study leave in, adding lates is next.
Lates are relatively easy to add (in Leeds, at least) as you
can’t take leave on them and they are of a fixed amount. I slotted them in around everything people
had asked for and got a pretty good cover through the department. It’s always hard to know what people want, a
horrible week of 5 lates or lots of semi horrible weeks of 2 lates, I filled
the rota in as best I could and everything went well. My heart rate settled and the whole thing
actually started to come together.
In-Hours Shifts –
Harder Than You Think
So, you’ve now got a rota that should hopefully cover all
OOH working, all forms of leave and give everyone their leave requests: now the easy part, bosh in some day shifts
and we’re done!
Except how many day shifts do you give people?
On a rolling rota you would take annual leave or study leave
on either NC days, Mid shifts or Day shifts but that isn’t how the
self-rostering rota works. Instead, you request your annual leave in an empty
space not knowing what kind of shift you would have been working.
We’re going to have to figure out how many different types
of shifts there are left.
A little bit of maths was needed and so I built this
It proportionally removes in hours shifts for every day of
annual leave or study leave day taken.
Regional training days are slightly trickier as they should be taken on
non-clinical days but also should be taken using study leave so I factored that
in too (I think that this info is from the gold guide guidance)
Once you’ve got the number of days, mid and NCs for each
registrar figured out they go onto the rota and then it is all done.
Tweaks are made as you go along to make sure department
coverage is sufficient and then you should have a balanced rota, giving everyone
all the leave they wanted, all the weekends off they asked for and the
department as close to fully staffed as was possible!
Can people still take leave after the rota is published?
Absolutely, but we revert back to rolling roster rules, if
the department has enough staff you can have the day off, if not then you’ll
need to swap
Not really no. The prep work I did before starting, along
with having practised for a year on a smaller 6-person rota, really
helped. I wouldn’t want to start on a
30+ person rota, but it appears more than doable.
The different style was a shock for some people, I think,
despite all the information I tried to provide beforehand, but I think it is a
change for the better. Things like NC
days no longer needed to be on a Tuesday caught a few people out who had got
used to having these days pre-assigned as not being clinical at work. There was no reason why a NC day had to be on
a Tuesday, this is an example of historical obsolescence. West Yorkshire
regional training days fall on a Tuesday, now if you give everyone a Tuesday as
a NC day you increase the number of people who could definitely go. I found out all the teaching days in advance,
passed them on to people to apply for and gave them the day off. After this all NC days could be wherever we
Some people have counted up their NC days and told me they
hadn’t been given enough. Giving a very transparent method of calculating how I
adjust the NC days based on annual and study leave requests seems to have
helped with this.
Working face-to-face with people always seems to work
better. I like the idea of a rota
meeting however this rota took me a full day to write when everyone had submitted
their requests. I can only imagine that
trying to fit 30 registrars in a room for a day would not go down well and is
also a waste of people’s time and the department’s money.
Instead I organised rota clinics, times when I would be
available to talk and sort any problems out.
Lots of people came, some with just a question whilst with others we
wrote most of their rota out while we talked.
I also offered phone and skype calls for people not in Trust. This helped keep everything as fair as could be.
Can People “Game” the
I suppose technically
they can, in the same way they could game a rolling rota, this is why I have
spent so much effort in putting in processes that keep things fair. It also means that when I hand over this
system to the next person who wants to do it, people are used to a particular
This Rota Isn’t
Self-Rostering, You Are a Fraud and Have Sold Me a Lie!
That’s funny you sound just like my internal voice!
First off, what is self-rostering? Having kept a close eye on the #twittersphere
– it didn’t happen in EM unless you put it on twitter – there are quite a few
people trying different models of non-rolling rotas. Currently with a 30 person rota there is not
a solution that exists to allow people to truly self-roster.
True self-rostering to me means choosing your shifts and
hours, completely independently, without any external supervision and meeting
the department need. I think there are a
few reasons why this hasn’t happened yet.
Firstly, the rules governing rotas, what is and isn’t
allowed, are complicated. The amount of time it would take to develop a
technological solution that could cover all eventualities would be immense. Healthrota does very well at meeting this,
it certainly has kept me from rostering too many shifts close together or
breaking rules accidently. It also
allows a lot of the day to day stuff to be managed a lot better, people can swap
shifts without having to talk to anyone and request leave easily.
Secondly, people would have to be provided with the
information on how many shifts they have to work. This would need to be a
dynamic number based on annual leave, study leave etc and no technological
solution to this currently exists. In
fact the biggest current downside to healthrota is I need at least 1
spreadsheet open at the same time to plan the rota because the program doesn’t
give me all the information I need.
Thirdly, all departments work
differently. This means that while a rota software company might be able to
build a bespoke system for your department, a department down the road may have
completely different needs. This means
another bespoke system and bespoke systems cost money. Excel spreadsheets work well in creating
bespoke solutions for departments but they don’t create true self-rostering
systems as they need someone to data input – mainly a rota co-ordinator.
Moving away from rolling rotas, however you do it, is good and more than doable .
It helps not hinders trainees especially LTFT trainees.