#006 Wins in the Workplace: Challenging a badly designed rota - Dr Dervla Ireland

Grievance/initial motivation for starting the campaign

During the outbreak of the COVID pandemic, our hospital created a new ‘COVID rota’ for doctors. However there was short notice of changing work schedules/rotas, and it happened both without trainee input to either the rationale or the rota development. Subsequently, there was a mass discrepancy between the number of hours trainees worked in the same department for the same pay.

Research – what information did you have to find out to ensure that you had all the necessary facts and couldn’t be tripped up at any point? How did you go about finding this information?

Researched trust policy, used JDF and covid committee minutes.

Checked individual rotas for compliance and calculated discrepancies between hours and on calls worked (i.e. some trainees would work 7 night shifts, others 20 during the period).

Gained feedback via a survey from juniors of all grades in the acute general medicine department regarding the trust response and the current and future rotas.

Target – as a result of your research, which individual, group, committee or organization did you identify as having the power to enact the change you wanted to see?

Acute medicine directors, rota coordinator and medical education director.

Allies – who did you identify as potentially on your side?

Local Negotiating Committee (LNC) chair, Clinical and Educational supervisors, Medical Director for Acute General Internal Medicine (GIM).

Resources – what resources were available to help you win? This could include volunteers, online survey tools, social media skills, negotiation skills etc.

3 FY1s (2 LNC reps and FY1 rep), support from two medical consultants (one for case presentation and one for rota planning). IROs and LNC chair provided advice. Friend assisted in programming spreadsheet for free.

Barriers – what were the main things in your way? This could include apathy amongst your supporters, push-back from your target or anything else that you found challenging.

Gold command approach – ‘this is not a democratic process, this is a crisis’. This line was provided to us throughout the last few months to shut down communication and debate.

Strategy – Based on your research and an understanding of your target, allies, resources and barriers, what strategy did you then employ to win?

Using the evidence we had from rota discrepancies and junior doctors views (which covered >50% of trainees affected), we were able to pressure the directors into an urgent meeting. The meeting had relevant stakeholders and we used our pitch to introduce junior doctor representation in rota planning and were given the opportunity to overhaul the medical rota.

Outcome – what happened?

7 Junior doctors gathered views from the GIM cohort. Identified problem areas of rota and problems for transition. Collated annual leave requests prior to developing rota to ensure we could honour it.

3 FY1s developed a new FY1 rota with more even distribution of on calls and recognised those who had worked extra on calls on covid rota to ensure adequate rest. Accounted for all annual leave and ensured safe staffing levels maintained. Introduced a float weekend in response to calls for more support on weekend (9-6pm shift). Rota has successfully been implemented to unanimous support from FY1s. We are currently collecting feedback so that this rota can be adapted further for future FY1s (will likely take 1-2 rotations to get it to its most fair iteration). Subsequently this case is now being used at LNC negotiations as a guide on successful junior doctor consultation in rota planning which we will aim to be used in 1 in 2 weekend rotas.

Evaluation

1. What went well?

- New rota, resolved discrepancies in work done by juniors. Allowed for safe rest periods. Better staffing at weekends.

- Built relationship with medical directors whom are more willing to accept junior input as a result of the work.

2. What went not so well?

- Time taken to get junior doctor input, the gold command structure has effectively shut down negotiations.

- Time spent by ourselves to fix the situation. Rota planning is a difficult job and it took 3 trainees + a volunteer >60 hours to put together a solution.

3. What could be done differently next time?

Pre-empt changes. We should be prepared to both escalate to covid rota and stepdown at short notice. This should be escalated to directors to prepare for, so that trainees can have an idea of what they will be working if there is a change.

What could the BMA do to help support and replicate the success of this campaign in future in other locations?

Provide case studies of success. Share information, i.e. we have had success on annual leave policy and rotas as well as pay protection which colleagues in other regions have struggled with but have not seen the documents and resources we have produced which could assist them.

What advice would you give to other doctors wanting to do something similar?

Provide case studies of success. Share information, i.e. we have had success on annual leave policy and rotas as well as pay protection which colleagues in other regions have struggled with but have not seen the documents and resources we have produced which could assist them.

If you’d like to ask Dervla any questions or are considering running a similar campaign in your own workplace, you can email her on dervla.ireland@nhs.net