E-rostering systems are used around the world to manage and deploy the healthcare workforce. This report has investigated how other countries have implemented and developed their systems, and their future plans for them, through a series of interviews with international experts.

The view from Scandinavia

“The UK has good examples to learn from, but also a lot of variation in care.”

Tobias Bøggild-Damkvist, Chief Executive Officer at Nordic Healthcare Advisory, has experience of the Danish and Norwegian healthcare systems using different workforce management systems, working as director of human resources and as an independent consultant.

Bøggild-Damkvist says: “Previously the Danish regions used workforce management systems which were primarily the front end for the payroll function.”

However, they are now using them for analytics, compliance with regulations and meeting employee wishes, as well as payroll. Bøggild-Damkvist explains their ambition: “They are trying to go from a staff support and attendance-based system and move to a patient orientated and activity-based planning system.”

In Norway some healthcare systems have gone further, in that they are integrating patient activity as part of their planning and have established direct integrations between the clinical systems and the workforce management system.

In comparison to the UK, Bøggild-Damkvist says: “From what I have seen and read, Scandinavia has more ability to deal with local agreements and arrangements, as it is not as centrally structured as the UK. I also believe Scandinavia have a higher degree of focus on compliance to the working time directive and local laws, as there are of political interest, so the healthcare systems have to be transparent.”

The UK’s level of standardisation and focus on workforce coordination is very different to the likes of Denmark and Norway. Bøggild-Damkvist says: “One of the major challenges of staffing is that planning is done in silos, but the UK is working on planning staff across professions. Another challenge is people reusing existing roster plans, but the UK seems to be using activity-based information to change rosters. The UK also seems to be leading the way in planning along patient pathways and systems. Scandinavia is trying to do this now.

“Because of the scale of the NHS there are lots of good examples to learn from, but this also means there is a high level of variation in care compared to the Nordic systems.”

The view from Australia

“It’s not about technology, it’s change management.”

Farhoud Salimi is Director of Corporate IT, in the public hospitals in New South Wales, Australia, where they are over halfway through implementing an ambitious rostering programme for all 150,000 members of staff, which will be one of the larger deployments of staff on one system globally.

In New South Wales they had many different systems, with some hospitals having two or three. Over four years and across 20 organisations they have consolidated rostering to gain visibility of staffing patterns. Salimi says: “It’s about safety, quality – having the right people in the right place.”

The new system works differently. The way staff are deployed has changed and is now based on demand templates – and which members of staff are needed to ensure the right nurse hours per patient per day, as per standard guidelines.

Salimi says: “The biggest learning is it’s not just software, it’s about practice and change management and this has been the biggest challenge. The data gives you intelligence in the form of information. The challenge is getting people to use that information to plan future rosters and update the demand. The technology has enabled us to make the changes we want to ensure that we have an accurate roster and ensure we have the right people in the right place.”

The view from Germany

“We’re excited to use e-rostering to help transparency for all staff”

Nils Krog, chief executive officer of Ategris. The German hospital group has two hospitals, with 1,100 beds and 3,000 employees.

“We use e-rostering software at a central level to make a staffing plans in advance, in specific areas like surgery. But we are not using it the same way as it is used in the UK.

When we visited hospitals in the UK in October we were excited to see how it could be used as an instrument to help transparency for all team leaders and for staff to use it on their smartphones. In the UK team leaders use it to see the whole hospital in real time, seeing the system as a whole, allowing more collaboration.

We want to move towards this system, and reduce our use of agency nurses and gain efficiencies in the system.”

The view from USA

“Empowering employees is the main reason for e-rostering in the US”

Allister Charles is a technology consultant and healthcare workforce management systems expert with PwC USA and says the typical e-rostering process in the US is for the shift rosters to be open to nurses who are able to self-schedule based on their availability. The charge nurse will then manually assign the nurses to the relevant wards and specific patients, based on the nurses’ skill sets. Systems automatically alert non-assigned nurses to gaps in the roster that need cover, taking pressure off the charge nurse, enabling them to focus on clinical commitments.

Some of the more sophisticated systems automate the assignment of nurses to wards and patients and automatically process calls from members of staff informing the hospital if they cannot cover their shift, although this level of sophistication is not widespread.

Charles says: “The self- scheduling approach to rostering is where the US is more advanced than other countries, particularly in terms of being employee-centric and less manager driven.

“Empowering employees is the main reason for e-rostering use in the US. Healthcare providers in the US want to enable employees to have a good work-life balance, and rostering systems can facilitate this. Of course, there are patient care and business objective reasons for rostering, but taking employees into consideration is the principal reason. The importance placed on the nurse has been the most profitable aspect of e-rostering in the US healthcare system.”

Although no legislation compels e-rostering, each state has a staff-to-patient ratio mandate, which is easier to comply with using e-rostering systems, which also optimise the workforce resource with greater ease than older systems.

Charles also explains that US healthcare has realised increased productivity, through e-rostering, as nurses spend less time performing administrative tasks and more time with patients, leading to important clinical benefits. US hospitals are continuously looking at how they can become more efficient through effective real-time alterations throughout a day using data and trend analysis.