We've all been in Lockdown and trying to puzzle out what Tier we're in for so long it's hard to remember just how stressful the first few weeks of the pandemic were for the NHS. But in March, Department of Health officials were warning hospitals that a ‘reasonable worst-case scenario' could mean a potentially overwhelming number of COVID patients that would require care in both their Emergency Departments but also their Intensive Care Units, too.
What was it like to be on the other end of that call? We spoke to one Trust that says it was able to cope-thanks to technology. Based on the south coast of England, University Hospitals Dorset serves a population of more than 800,000 people, reaching as far as Purbeck, the New Forest and South Wiltshire. Collectively employing more than 9,000 members of staff, the organisation is made up of three hospitals; the Royal Bournemouth Hospital, Poole Hospital and Christchurch Hospital.
As well as delivering general hospital services, a range of specialist services and facilities are also under its roof, including medical and clinical oncology services, a major trauma unit, a state-of-the-art cardiology unit and an award- winning orthopaedic service providing hip and knee replacements.
The Trust-up until the start of October known as The Royal Bournemouth and Christchurch Hospitals Trust -says that e-rostering software has proven critical to dealing with COVID-19, and is now helping properly manage staff time fairly and efficiently for the current ‘second wave' as well as winter (always a tough time for the NHS).
Dr Becky Jupp, Clinical Director Stroke and Older Persons Services and also Wessex Clinical Lead for Stroke Services at University Hospitals Dorset, has been leading both systems, she states:
Fundamentally, I'm a stroke consultant, so I work with and treat patients who've had strokes; that's my day job. But on top of that, I have responsibility and oversight for managing the Directorate of Older Persons Services and Stroke, sharing responsibility for staffing and day-to-day management of the service and service development.
For a couple of years we've been looking to merge and fix services in Bournemouth and Poole, which we have now successfully done with the merger. Obviously, staffing is a big part of coordinating and managing a big service like the Stroke service. Making sure that everybody's in the right place at the right time is really important.
A system for all
Jupp stresses that e-rostering was not new at Dorset: in fact, the Trust had been e-rostering for around 10 years. What was different in early 2020 was that she and her fellow managers had decided to extend its use beyond the nursing and junior doctor population to senior medics and consultants: something that the latter demographic had traditionally pretty successfully been able to resist.
COVID, though, really looked like a game-changer here. Dorset recognised, she says, that it would need to redeploy almost all clinicians to COVID care in order to manage acute patient demand. The crisis seemed to suggest all 200 medical colleagues and 60 consultants would need to be rostered in order to provide the cover required to ensure all potential patients would be assured of the best possible care, 24x7. Team members staff were going to have to do very long shifts, and all those 60 consultants would be needed, almost certainly overnight, too.
When we were planning for the first COVID surge, we didn't know what we're facing then and we didn't know how it was going to affect us. Like everyone else, we were just trying to go on the best advice that we had, but we wanted to prepare for the worst.
And in order to do that, we decided that we needed to make sure that the consultants, basically, stopped doing what they normally do and so we're all available to treat patients with COVID or suspected COVID.
Making things a little more complicated for Jupp and her colleagues was the fact that a number of clinical staff needed to shield at home from possible infection. A smaller number were reluctant to come to work at all due to concerns around SARS-CoV-2 and its possible impact on their loved ones. And while temp or even retired colleagues could be called on, practical issues on safety and employment terms effectively ruled out these options.
What Dorset had to get all this sorted out: Excel. Hence her pivot to work with end-to-end staff management based on a consolidated view of all staff groups and all staff types. A crucial benefit, she states, is that staff would always have complete visibility of both their and colleague designated shifts via an app or on another device:
This move was successful because everybody knew what they were doing; they all could look at it on their phones, it can all be linked to your calendar. The fact that you could see what hours everybody had worked and there's a running tally meant that we could make it really fair; there weren't people working more or less than anyone else.
Admin staff are now fully trained on the platform and can spot and fill any gaps in service provision if needed.
What did that ‘fairness' look like in practice? Working closely with the Dorset IT team, Jupp was able to make e-rostering deliver what the Trust, but also staff and patients, needed, she says. A new pattern of three 12-hour shifts was created for consultants, with four consultants working nights. Jupp then created four teams across the hospital in a special ‘house' system that included the nursing staff and junior doctors, so all team members had the same diary.
For sure, staff ended up working long shifts. But the fact that the system ran smoothly and transparently, with everyone having full visibility of all rotas, ensured it all worked, she confirms. Use of the app got everyone through a very busy April and May, with things relaxing by June when more ‘business as usual' measures were introduced across the Trust, while admin staff are now fully trained on the platform and can spot and fill any gaps in service provision if needed.
So Dorset coped with a tough Spring, and thankfully the massive case loads in that ‘reasonable worst case' scenario feared didn't happen, now, of course, the virus pressure is back on. But as Jupp has experience of designing rotas for multiple departments in just 48 hours, the Trust is in a great position to deal with not just renewed COVID rates, but can hopefully flex enough to deal with peak WInter NHS hospital pressure, should it come:
Because we've got the rostering tool, we know how to do things this second time round. We also know how to just bring all of those emergency rotas back should we need to.