Issues A multidisciplinary team at a London Hospital is redesigning the medical rota to address numerous issues, including:

• Unsafe levels of night staffing – a single doctor covers all medical wards.

• Disjointed weekend working patterns – driven by short weekend shifts with staggered start times which: lower opportunities to communicate within the team, and cause inconsistent staffing levels.

• Increased cost – largely due to the increased expense of weekend cover* and a missing shift which is typically only offered to locums

• It is more expensive for junior doctors to work frequent short shifts at the weekend because they are paid an allowance that varies according to the frequency of weekends worked.

Intervention To address the above, our team created a new rota which:

• Reduces the frequency of weekend shifts (average weekend day shift lengths have been increased from 9.33 hours to 12.2 hours, meaning doctors will work fewer weekends without reducing the total number of weekend hours worked)

• Synchronises shift start and finish times at weekends

• Incorporates a locum shift into the rota to reduce cost

• Moves a doctor from the twilight shift onto nights

It was agreed the rota implementation date should coincide with the date of the junior doctors’ changeover. However unfortunately due to issues implementing the rota this deadline was missed so the rota will be implemented at the next changeover.

Impact The weekend and locum shift changes are projected to save £40,130.78 per annum. This saving will be used to pay another doctor to work at night, whilst maintaining an overall financial saving of £9,589.74 per annum. Doubling shift cover and halving the number of patients each doctor looks after at night should result in improved patient safety and better service delivery. It is hoped the new rota will also lead to consistent weekend cover and improved teamwork. Junior doctors will be surveyed to ascertain the impact of these changes.