At HTN Now, we welcomed the NHS England Blueprinting Team and Derbyshire Community Health Services NHS Foundation Trust, to talk about optimising their electronic roster and implementing electronic job planning. We were joined by Paul Charnley, digital lead at Healthy Wirral partners and chair of the Digital Blueprinting Programme; Greg Benson, e-rostering and e-job planning application manager; and Chris Hampson, operational transformation lead with Derbyshire Community Health Service.
Overview of the blueprinting programme
“The blueprints began with the Global Digital Exemplar programme,” Paul explained. “In return for the investment that we benefited from, we had to produce blueprints of the projects that were being developed as a result of the funding. That allowed us to record the benefits, costs, pitfalls and successes of the programme. We’re now beyond that – we have worked with various programmes of work to capture blueprints as the investment has gone into digital technologies and frontline digitisation, clinical diagnostics, cybersecurity, and so on. It’s a much broader set of blueprints now and we’re still growing all the time. The idea is that we learn from previous experience, and help people on their own journeys.”
Now, Paul said, the team is working across NHS England’s Transformation Programme and beyond, and ranging from softer change management challenges to more technical projects.
Paul also shared the objectives for the blueprinting team for 2023-2024, including spreading into social care and primary care; integrating blueprinting into other communication exercises; working on the EPR programme; and focusing on priorities such as bed management, patient flow, and waiting list recovery.
Optimising electronic rostering and implementing electronic job planning
Next, Greg took the lead on the discussion, focusing on the topics of e-rostering and e-job planning.
Greg started out by offering a quick introduction to the trust. “We have approximately 4,500 staff, split across 10 community hospitals, 28 health centres, and health visiting and district nursing teams,” he said. “We’ve also got a number of inpatient units and GP practices that we run. From a rostering perspective, we’ve been using Allocate Optima. We’ve been rostering since around 2013 with about 3,500 rostered individuals, who are both clinical and admin staff.”
Moving on to discuss the project itself, Greg said: “The project was initiated as a result of an external audit that was undertaken on the roster, which made it apparent that effective rostering was dropping. We’d seen a bit of a rise in bad habits such as late finalising, contracted hours not being used fully or being overused, and excessive bank usage. So, as part of the relaunch, we decided to take a back to basics approach. That involved reviewing the fundamentals of the roster and asking some key questions like whether it included the right staff, the right number of shifts, and the right type of shifts.”
Having taken this approach, Greg said the next step was to develop a training programme in order to reinforce best practice and ensure consistency across all of the units. He noted that this had the benefits of making sure new starters were not picking up bad habits.
“Initially, the roster team itself was a very small team trying to cover about 3,300 staff, over 200 individual rosters,” he commented. “We had just two members of staff, really struggling to roll out the new areas or support new technology and developments in the Allocate product. We’d seen a real decline in the use of auto roster or patterns so a lot of the benefits around automation were lost, as managers were reverting back to manual rostering.”
Other challenges, Greg added, included engagement with the roster. “It wasn’t really seen as an essential system in the same way that a clinical system would be, and that was reflected in limited use. Also, senior management didn’t really have a solid understanding of the system or what the reports meant. That meant they weren’t sure how to make those reports actionable to see the benefits. And coming back to the small team – the training that was provided was very ad-hoc. It just covered the basics of getting people up and running on the roster.”
Establishing a blueprint for best practice in e-rostering
Having taken a full review and refresh of the rosters, he explained that the team decided that the project needed to be led by an experienced clinician. “Often, rolling things out from a technical perspective isn’t always the best, so we thought it would be better to have someone who knew the language and what the clinical needs were, because fundamentally, that’s what we are here to support.”
He continued: “We took a team-by-team approach, grouping teams within a service, so that there would be a shared learning approach that we could tap into. We wanted individuals championing the roster to be able to feed that down. We took a standardised approach; we developed a methodology of reviewing, looking at staff shifts, cost centres, adjusting where necessary and trying to counter misunderstandings. Then we could put together a template that we could move from area to area, and we devised a really thorough training programme.”
With the relaunch, the team took a dedicated unit or area approach, so that they could tailor the approach to specific needs and issues. To support this, Greg and his team developed the intranet to be a library of different resources for training, with PowerPoints, PDFs, and Allocate training videos.
Some of the benefits observed by Greg and his team include a better view of the roster within units and the wider trust, and a realisation of how rostering can boost efficiency in staffing levels and staff usage. Greg also noted that the programme has brought about “a reduction in bank and agency usage”.
Plans for the future include bringing in capabilities for annual leave and sickness to “remove that burden on staff”. Greg commented that this benefit has already been seen by running automated pay directly from the roster, avoiding the need for the administrative burden of filling in online or paper time sheets.
Electronic job planning
Greg handed over to Chris to move the focus over to electronic job planning.
Chris started out with an overview, explaining that prior to the pandemic, the trust had several services with offline job plans – mostly within the planned care division and specialist services. “But we had no job plans within our integrated community services division,” she said. “We were about to start job planning when COVID broke out, and it delayed it.” The trust relaunched their job planning project in summer 2021, with Chris as the project lead.
“The biggest part of it at the beginning was the engaging with teams,” Chris said. “We were rolling out electronic job planning with the Allocate system with occupational therapists, physios and support workers across specific bands. A lot of time was spent on engagement, making sure that they understood what was going on and had a voice around the principles behind job planning. We also focused on making sure that we were following the best practice guide which was produced by NHSE.”
Chris commented that the pilot was “really useful”, and rollout of job planning followed on a wider scale. “Within the next three months, all of our teams had job plans for all staffing bands 3-6.”
Reflections on implementing electronic job planning
Chris highlighted some of her key takeaways from the implementation of electronic job planning. “It was a big piece of work, and it did take an awful lot of time, but I think the engaging and education part was absolutely crucial,” she said. “It helped to address the variation within the team’s workforce activity, the productivity, the skills mix, and the staffing levels.”
In terms of the configuring of the Allocate system to community therapy, she said, “It was a little challenging and we learned a lot throughout the process. Having the trust-wide advisory group made a huge improvement in how we are job planning across the trust, and I would highly recommend that that needs to be one of the priorities.”
In addition, she commented, she feels that the quality of patient care has been promoted as a result of giving protected time to develop clinical and leadership skills within teams.
Electronic job planning has also helped the team make better use of data to gain new insights into the trust’s capacity and capabilities, Chris noted. “We are using the data from the Allocate system to understand how much time people are spending on different activities within their job plans, to understand truly what our capacity is. We then tie that in to our data on demand, and we’re able to benchmark what the capacity is within different teams. That helps us to save money, because we’re able to focus on supporting and uplifting those areas.”
Ultimately, she said, the “feeling on the ground is that electronic job planning is helping the trust to use resources more effectively.”
Many thanks to Paul, Greg and Chris for joining us.