CLWRota good department checklist

March 2015

As part of our Rotamap event in March 2015 we put forward a checklist to outline some of the valuable measures a department could use to gauge its efficiency. The idea for creating a checklist came out of taking a closer look at five departments who have improved their service using different approaches and what they were doing differently to make their service more efficient. The proposed checklist incorporates measures that can be evaluated by looking at the data available from our CLWRota service and looks at the department's capacity and consistency of delivery.

Planning the rota:

Job plans accurately reflect demand
Rota is planned a consistent time ahead

Usage of staff:

A consistent number of trainee led and extra sessions
Consultants meeting their expected sessions target
Trainees receive suitable amount of training time

A lot of the focus in our checklist is about reducing variation within the eco-system of the department. Famous management theorist William Deming said: "If I had to reduce my message for management to just a few words, I’d say it all had to do with reducing variation." Whilst there is little about the individual patient that can be systematised, treating patients is not like manufacturing cars, on a more strategic level, the planning and delivery of activity, and the availability of sessions does follow the characteristics of a system and it is in these areas we can work on reducing variation. Our analysis of departments using CLWRota show that the best results come from those departments that are in control of their planning and delivery.

Planning

The first item on the checklist and a crucial aspect to have under control is to ensure that the department's job plans accurately reflect the demand for lists to be covered. There are different ways to be able to check the ability to deliver the service in CLWRota. To establish if the templates are setup to accurately the demand request a capacity report through the Rota Management Console (RotaMC). The capacity report, available as an Excel file, shows whether there are enough staff job planned to be able to work on each day.

Fig 1. Example of a capacity report.

As can be seen from the example capacity report above above, this department has an average cover of 96%. The capacity report allows for the adjustment of the percentage of department expected on leave as well as the percentage of sessions to plan to cover using trainees working solo and as extra sessions. In the example above we have set 20% of people to be away on leave, 5% of lists to be covered by trainees and for no lists to be covered as an extra session. The capacity report uses the templates to calculate the amount of work needed to be done, and compares it to the number of staff on templates as well as available to work flexibly. The availability of flexible staff is averaged over the number of sessions they are available to work. It is therefore important to check that the week availability figure in the flexible sessions configuration area is correct. A common mistake is to leave all sessions (including evening and nights) still selected.

Fig 2. Demand and supply chart showing expected activity against achieved activity.

Another way of evaluating whether the department's template is set up to provide good cover for the demand. Is to check the demand vs. achieved graph. The blue line in the upper chart represents the activity the department is planning to deliver based on the theatre templates. The purple line represents the number of sessions actually delivered. In the lower chart the blue again represents the planned activity based on templates and the red, yellow and green lines the actual activity completed stacked by their various types. Red for consultant covered lists, yellow for trainee covered lists and green for lists covered for extra payment. From these charts it is easy to determine the weekly cycle of activity for a department and where activity rises and falls most against plan across the year.

Setting up and publishing the rota at a consistent time ahead of the rota week again provides consistency and gives the department a better model by which to plan the week. We encourage departments to setup the rota at least six weeks ahead and to publish two weeks ahead, in line with The Productive Operating Theatre's (TPOT) 6-4-2 scheduling policy. Ensuring that the rota is published at a regular interval allows for use of the changes after publication figures available on the CLWRota reports highlighting areas of the rota worst hit by late changes. A consistent approach to setting up and publishing the rota can also help with communication to the department when dealing with increasing amounts of flexibility.

Fig 3. Graph to show the number of weeks out the rota was setup and published.

Usage

The other major facet of running an efficient department is to ensure that the usage of staff on the rota is consistent. Departments that show a consistency in their usage of trainee led (solo) lists and extra sessions also tend to show a consistency in their ability to meet demand. Using trainee led lists as part of service delivery can be tricky to plan because of the rotational nature of training grades and there is a valid argument to be made for using extra sessions only when needed. However, analysis of sessions achieved by week across a range of departments would suggest there is relatively little difference throughout the year in the amount of work being done. Therefore, a department that is in control of how many sessions are expected will be able to estimate the right levels of solos and extras required to deliver the most efficient service.

Fig 4. Department line chart showing use of different types of activity.

There are a variety of ways to monitor the usage of different types of cover for sessions. The KPI page in RotaMC shows as a stacking graph and as tabular data the number of sessions worked as normal (consultant and NCCG), solo, extra and locum on a weekly or monthly basis. As part of our bi-annual department reporting we produce p-charts for usage of solos and extras as a percentage of all activity over the last 24 months. P-charts are used to monitor the proportion of nonconforming units in a sample, so they can be used to see if certain types of activity are regular in a department or there is a lot of variation.

Fig 5. A p-chart of a department's extra session usage.

Another very important thing to look at with usage is whether everyone is hitting their expected sessions. RotaMC allows the department to define an annual session target for each consultant based on their job plan. Delivery of sessions worked against the expected figure pro rata can then be tracked. Making use of this sort of data is vital to ensuring departments are getting the best out of their team and helping to make sure that flexible workers are progressing at a steady rate and not using up their sessions too quickly or slowly.

Fig 6. Screenshot of RotaMC detailed report.

A final measure to consider is whether trainees are receiving a suitable amount of training. A variety of reports exist within CLWRota to track trainee's activity to see how many sessions they work supervised compared with solo. It is also possible to setup the training modules trainees are working on and report on how many of their lists fall into one of their active training modules.

Fig 7. Screenshot of trainee report taken from CLWRota.

Conclusions

There are a number of measures to look at help improve department efficiency. Making use of the data available can really aid department to help understand and improve their service.

Questions

If you have any questions about the above ideas or would like to know more about how to get reports from your system please contact the CLWRota support team at support@rotamap.net or 020 7631 1555.