Self-rostering to improve paediatric residents’ well-being in a tertiary hospital

Introduction

An ideal rota should facilitate world–class training and professional development of its staff, allow for a good work–life balance and ensure adequate and safe staffing levels as detailed in the British Medical Association good rostering guide.

Poor rotas are intrinsically linked with reduced work satisfaction, poor quality training, increased workplace stress and subsequently resident burnout and attrition.

Paediatrics is under the greatest pressure, with an estimated 65% of residents experiencing burn–out. Departments are facing unprecedented pressures with suboptimal staffing, further compounding the problem.

At Bristol Royal Hospital for Children, a tertiary paediatric centre serving the South- west of England and South Wales, three parallel rolling rotas provide middle–grade staffing across 16 specialties, covering 56 doctors – many of whom work less than full–time (LTFT). We aimed to improve resident well–being and training through a self-rostering approach.

Challenges

An initial survey was conducted of residents, which identified that seven of the top eight workplace stressors were related to poor rota design and training opportunities (see table 1).

Table 1: In order of mean ranks of stressors at work as per the registrar survey (1 as the most stressful rank)

#	Issue	Mean Rank
1	Working in an understaffed environment	3.59
2	Large volume of work	4.18
3	Issues with hospital systems – such as IT, equipment	5.36
4	Finishing late	5.59
5	Shift pattern	5.73
6	Annual and study leave requests and flexibility with this	5.95
7	Training and portfolio pressures	6.70
8	Admin and documentation	7.38
9	Managing acutely unwell patients	7.78
10	Other healthcare professionals impressions of you	8.19
11	Supporting juniors and managing a team	8.94
12	Other	9.00
13	Medicolegal aspect of work	9.50
14	Nature of senior support at work	9.56

Solution

A proposal was developed to implement self-rostering using the HealthRota platform. A 6-month pilot began in March 2022 involving 18 doctors (10 whole-time equivalents (WTE)) in one team.

Following positive feedback, the approach was expanded to all teams in September 2022. Residents input their shift preferences, which were then reviewed for compliance with contract regulations. The project was assessed through serial surveys, informal feedback and analysis of rota data and locum costs.

The main challenge to introducing the new rota system was stakeholder engagement, with doctors worried about the impact on their workload. These concerns were mostly based around misconceptions, and we overcame this with open communication and a desire for honest feedback.

That feedback led to process refinements, including reducing to a single self-rostering round and focusing on OOH and leave shifts, making the system more sustainable and reducing the rota team workload. Cost savings also allowed for rota team expansion.

Results

£143,900

in combined cost savings annually

+196%

improvement in work-life balance

100%

of annual and study leave requests accepted

Post-implementation surveys showed significant improvements in well-being, rest and work–life balance (see table 2 below). 100% of residents received all annual and study leave requests compared with 27% previously. All responders wanted to continue working in a department that self-rosters.

Table 2: Percentage of responders who agreed to the statements across the intervention period

Question	Agree prior (%)	Agree after pilot (%)	Agree after full implementation (%)
The rota allows a good work–life balance	45.46	88.5	96.15
I think self-rostering will significantly improve my well-being	n/a	75.00	92.31
There is enough flexibility in the rota to have my annual and study leave	27.27	87.50	100
I think self-rostering is a fairer way of allocating shifts	n/a	69.00	92.00
Rota allows you to space out your shifts with adequate rest between them	59.09	87.50	96.15
I would prefer to work in a department which self-rosters in future	n/a	75.00	100.00

The flexibility with self-rostering allowed the department to release extra hours from the out-of-hours (OOH) rota and to significantly increase the number of normal working days (between 24 and 38 days/registrar/year).

A combination of standardising working hours across different grades and clinical fellows, reducing wasted hours and increasing total working hours (from 46.3 to 47.6 hours) facilitated this change.

Residents were previously only spending 57.1% of their working hours in hours. With self-rostering, this increased to 67.1% for general paediatric residents and to 70.1% for subspecialty residents, meeting RCPCH targets.

Supporting Professional Activities (SPA) time – for crucial non-clinical duties like training, teaching and management – increased 83% from 9 hours to 16.5 hours per month per resident, meeting training charter targets.

There were substantial cost savings, too. Comparing work schedules and salaries before and after self-rostering (adjusted for pay scale changes) indicated an annual saving of £32,748. Further savings arose from reduced need for more expensive locum staff.

When extrapolated, combined savings (including software costs) reached an impressive £143,899 annually across 30 WTE registrars.

This is the largest and most complex rota group transitioned to self-rostering in the UK. The results demonstrate that self-rostering is a feasible and impactful solution, improving resident well-being and training while delivering significant financial savings. It demonstrates a replicable model for other departments to consider in addressing employee burnout and workforce challenges in paediatrics and beyond.

About BMJ Open

BMJ Open is an online, open access journal, dedicated to publishing medical research from all disciplines and therapeutic areas.

The journal publishes all research study types, from protocols through phase I trials to meta-analyses, including small, specialist studies, and negative studies. Publishing procedures are built around fully open peer review and continuous publication, publishing research online as soon as the article is ready.

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Introduction

Challenges

Solution

Results

About BMJ Open

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