A lot of wards have associate consultants schedule for their wards. At this juncture, they’re probably pretty experienced with their ward’s call (or shift) structure, rostering rules, and scheduling practice.
However, the transition from being a participant in the roster to being the one responsible for creating one can be challenging. This article aims to provide a comprehensive guide on how to set reasonable rules for your ward, ensuring fairness, efficiency, and staff satisfaction.
Understanding the Importance of Reasonable Rules
Before we dive into the nitty-gritty details, here are a few considerations for what a “reasonable rule” means:
- Complies with labour laws and regulations
- Workload distribution is fair and evenly distributed
- Ensures adequate staffing for patient care
- Prevent burnout and maintain staff well-being
- Minimize conflicts and complaints about “unfair rosters” among staff
The Balancing Act: Strict VS Flexible Rules
One of the primary challenges in setting ward rules is finding the right balance between strictness and flexibility. If you’re an associate consultant, you probably have experienced situations where the rules are either too rigid or too lax. For instance:
- A rule of “maximum 1 call per 3 days” is quite common in paediatric settings. However, it still might be too strict (and chur) for staff, because even after a full 24-hour call, they still need to work their day job as normal.
- However, if you relax the rule to, say, “maximum 1 call per 5 days”, then it may be too lax. This could lead understaffing in some cases, or excessive workload for other staff.
The key is to find a middle ground between these 2 extremities. Fortunately, you’ve been working in your ward for quite a few years and needless to say, you do have an idea of how frequent (or infrequent) shifts and calls should be. On that basis, you can adjust for other factors such as staff experience, ward requirements, and individual preferences.
Understanding Labour Regulations
Before setting rules, it is critical to be well-informed about relevant labour regulations. In Hong Kong, that means:
- Rest Days: A rest day is defined as a continuous period of more than or equal to 24 hours during which an employee can abstain from working. An employee employed under a continuous contract is entitled to not less than one rest day in every period of seven days.
- Appointment of Irregular Rest Days: You must inform your employees orally or in writing before the beginning of each month, in the form of a roster showing the appointed rest days for each employee.
- Substitution of Rest Days: You may substitute some other rest day with the consent of the employee, in which case it must be within the same month before the original rest day or within 30 days after it. You should also notify the employee about the substitution within 48 hours after the employee is required to work.
- Compulsory Work on Rest Days: Unless in unforeseen emergency, employees cannot be compelled to work on a rest day. If this happens, the employer should substitute some other rest day within 30 days after the original rest day, and notify the employee of the arrangement within 48 hours after the employee is required to work.
- Voluntary Work on Rest Days: Employees can work voluntarily on a rest day, but their compensation for such voluntary work is not legally enforcable.
- Working on Statutory Holidays: You must arrange an alternative holiday within 60 days before or after the holiday, and notify your employees. If a statutory holiday falls on a rest day, the employee should be granted a holiday on the next day which is not a statutory holiday, alternative holiday, substituted holiday, or a rest day.
- Paid Annual Leave (AL): An employee is entitled to annual leave with pay after having been employed under a continuous contract for every 12 months, and their entitlement to AL increases progressively from 7 to 14 days according to his length of service.
- Granting of AL: An employee shall take the paid AL within the following period of 12 months. If the employee is entitled to not more than 10 ALs, you can grant at most 3 days separately, the rest must be taken consecutively. If the employee is entitled to more than 10 ALs, at least 7 days must be taken consecutively, the rest can be taken separately.
- Maximum Work Hours: The Hospital Authority has been formulating strategies and implementation plans to reduce the doctors’ working hours in public hospitals to a level not exceeding 65 hours per week, but for specialties such as Paediatrics, Cardio-thoracic Surgery, Neurosurgery, etc. It is still a norm to work more than 65 hours per week.
These are the more relevant parts for roster scheduling. You can read up the full article in the Labour Department’s website.
Source: https://www.labour.gov.hk/eng/public/wcp/ConciseGuide/EO_guide_full.pdf, https://www.ha.org.hk/ho/dwr/ch5.pdf
Research on Work Hours and Performance
Numerous studies have explored the relationship between work hours, shift patterns, and various outcomes such as physical health, mental stress, and medical errors.
The general consensus is that calls and shifts affect employees’ health via the disruption of their circadian rhythm, which could lead to downstream effects such as stress. This is due to the disruption of hypothalamus-pituitary-adrenal axis causing excessive cortisol.
You’ve heard it countless times, but I’m citing this again: Among the doctors who worked more than 65 hours per week, 1 in 7 once fell asleep during surgery. 1 in 3 has had medical blunders due to overwork.
Understanding these research findings can help you create rules that not only comply with regulations, but also optimizes for your team members’ health and patient care.
Considering Seniority and Skill Mix
When setting rules for your ward, it is crucial to consider the different levels of seniority and skill mix among your staff. This ensures you have the right balance of experience and expertise on each shift, while allowing the interns to grow and learn with practice, promoting better patient care and staff development.
Example: The “Intern” to “3rd Call” Structure
In many wards, you might follow a structure ranging from “Intern” to “3rd Call”. In this case, it is important to avoid scheduling staff of the same intermediate level together.
For example, you might have some staff that are at the top of 1st Call, and crosses half to 2nd Call. In theory, you can schedule them in either 1st call slots or 2nd call slots, and both would do fine. However, you don’t want to have 2 staff who are of this same intermediate level take up both the 1st and 2nd call slot on the same day.
This is because these staff members cannot support each other — with the same level of expertise, if a problem is not solvable for one person, it is probably not solvable for the other person as well. It means you need to alert the 3rd Call. If this problem is at the level of the top for 2nd call, the 3rd call need not have been alerted.
This means that you are effectively 1 seniority level short.
Another example, I’ve helped a nursing war before, where they have seniorities of Advanced Practice Nurse (APN), Seniors, and Juniors. They had a combination constraint where APNs must not take shifts together, and Juniors cannot take shifts together. This means that junior nurses are either working with APNs or Seniors, ensuring adequate guidance for each night shift.
Rule suggestion: Ensure that each shift has a mix of seniority levels, with at least one staff member from a higher seniority level present to provide support and guidance.
Balancing Workload Across Seniority Levels
Different seniority levels often come with different responsibilities and workload expectations. For instance, the nursing ward we mentioned above also had different work regulations for seniorities.
Specifically, APNs only work 2 night shifts per month (they have a lot of staff so this is possible), and for every seniority, the number of shifts assigned to each member must be equal or differs by less than 1.
For example:
- APN: 1-2 shifts per month
- Senior Nurses: 3-4 shifts per month
- Junior Nurses: 6-7 shifts per month
Rule suggestion: Create separate rules or quotas for different seniority levels to ensure fairness within each group.
Ensuring Fairness and Transparency
One of the most challenging aspects of ward scheduling is ensuring fairness and transparency. This is crucial for maintaining staff morale and preventing conflicts.
Example: Perceived Manipulation of Shifts
You might encounter situations where staff members feel that shifts are being manipulated, such as a staff always being scheduled with some less competent interns.
This is particularly difficult because you often don’t want to point out it blatantly (it is fair that they’re incompetent as interns), and it is often omitted or goes unnoticed. However, in the long term, this perception can lead to resentment and conflicts within the team.
Rule suggestion:
- Make the scheduling process transparent by sharing the rules and allowing staff to review the schedule before finalization.
- Use scheduling software that can assign shifts while adhering to other rules: computers have no bias.
Fairness in Holiday and Weekend Shifts
Distributing holiday and weekend shifts fairly is often a point of contention amont staff members.
In the shorter term, you will want to distribute weekends fairly across staff, either by assigning them evenly, or assigning a particular number of weekend shift you want each person to take.
In the longer term, sometimes you also want to keep shifts fair for staff across holidays of a year. Say, if someone has taken up calls for Chinese New Year, they should deserve a leave in Easter. Some departments would designate statutory holiday calls/shifts at the start of the year, some schedule on the fly. As long as you keep them fair, both is ok.
Rule Suggestions:
- Create a rotating system for major holidays like CNY, Christmas, to ensure everyone gets a fair share of shifts over time.
- Designate a particular number of holiday or weekend shifts per month for each staff member
- Allow staff to request preferred holidays off in advance, but limit the number so that it is fair for others as well.
Dealing with Complex Preferences and Constraints
In some cases, especially in specialized settings, you may encounter very complex preferences and rules. For example, I once worked with a home healthcare service provider, where they need to send carers to different estates, when each “run” needs at least 1 driver, 1 staff with particular additional qualification, and different estates have preferred carers whom they’ve had experience with.
It is almost guaranteed that at least a few rules or preferences will need to be compromised.
Categorizing Rules and Preferences
To handle this complexity, it is helpful to categorize rules and preferences into different levels:
- Hard Constraints: These are non-negotiable rules that must be followed (e.g. minimum rest periods between shifts, maximum working hours per week).
- Soft Constraints: These are desirable rules that should be followed when possible, but can be broken if necessary (e.g. preferred carer).
- Optimization Targets: These are goals to strive for in the schedule, but not meeting them doesn’t make the schedule invalid (e.g. minimizing the imbalance of shifts across staff, spacing out shifts evenly across the month).
Rule suggestion: Clearly communicate to all staff members which rules fall into which category. This helps manage expectations and reduces conflicts when some preferences cannot be met.
Implementing Flexibility and Adaptability
While having clear roster scheduling rules is important, it is equally important to build in some flexibility to accommodate unexpected situations and changing needs.
Allow for Shift Swaps
You may create a system for staff to swap shifts, subject to approval to ensure that the swap doesn’t violate any hard constraints or significantly impact the skill mix on the shift.
In this case, you may also consider using a “single source of truth” — a place where every staff can get the most updated roster schedule, since if you change your rosters frequently, the traditional method of spreadsheets may have you end up with multiple versions, which may confuse staff when they want to reference back to the shift roster.
Regular Review and Adjustment of Rules
The needs of your ward and staff may change oer time. It is important to regularly review and adjust your rules to ensure they remain relevant and effective.
It is also important to survey your staff to make sure that their requirements are met, and foster a culture where they feel comfortable to report on any human errors on the roster that went unspotted by you.
Leveraging Technology for Rule Implementation
In today’s digital age, leveraging technology can greatly assist in implementing and maintaining complex scheduling rules.
Scheduling Software
Many advanced scheduling software solutions can handle complex rules and preferences. We’re not talking about the softwares where they let you fill in the empty slots manually. We’re talking about intellegent algorithms that can help you auto-fill in the scheduling slots.
Our work in 8 Hours belongs to the latter. We don’t think associate consultants and nursing managers need another fancy version of Excel. We think they need an algorithm to generate rosters for them automatically.
Here’s a brief overview of our software’s function:
- Auomatically generate schedules based on predefined rules
- Flag soft constraint violations, and report infeasibility of hard constraints clash with one another
- Optimize schedules to meet as many preferences as possible
- Provide analytics on schedule fairness and rule adherence.
You can invest in a quality scheduling software and train key staff members on its use. This can save significant time and reduce errors in the long run.
💡Tip: if you want to learn the basics of how to programmatically generate rosters, you can read my e-book here: https://8-hours.com.hk/e-book. If you’d like us to help you build the algorithm, you can contact us at https://8-hours.com.hk/contact.
Clear communication and staff involvement are crucial for the successful implementation of ward rules.
Explaining the Rationale
When introducing new rules or changes to existing ones, always explain the rationale behind them. This helps staff understand why certain rules are necessary and can increase buy-in.
Soliciting Feedback
Regularly seek feedback from staff about the scheduling rules and their impact. This can be done through anonymous surveys, open forum discussions, or one-on-one meetings with staff members.
It is important to implement a system for staff to provide ongoing feedback about scheduling rules and their implementation
Handling Exceptions and Special Cases
Even with the best-laid rules, there will always be exceptions and special cases that need to be addressed.
Creating an Exception Process
Develop a clear process for handling exceptions to the rules. You will need to consider:
- Who has the authority to approve exceptions
- What documentation is required
- How frequently exceptions can be made for an individual
As the saying goes: “if you didn’t document it it didn’t happen”. Documenting exceptions can not only protect you legally, but also allow you to review periodically to see if they indicate a need for rule adjustments.
Continuous Improvement and Adaptation
Setting ward rules is not a one-time task but an ongoing process of improvement and adaptation.
Data-Driven Decision Making
You can use data from your scheduling process to inform rule adjustments. Look at metrics such as:
- Number of rule violations
- Staff Satisfactions (if you do conduct a survey)
- Frequency of shift swaps or last-minute changes
- Patient Outcomes and Medical Error rates
Staying Informed about Best Practices
Keep yourself updated on the latest research and best practices in healthcare scheduling. Attend conferences, participate in professional forums, and network with other associate consultants to share ideas and experiences.
Conclusion
Setting reasonable rules for your ward is a complex but crucial task. It requires a deep understanding of your ward’s need, staff dynamics, and relevant regulations. It certainly helps that you’ve been working in your ward for years to get a feel of all of these aspects. By finding the right balance between structure and flexibility, considering various factors such as seniority and skill mix, ensuring fairness and transparency, and leveraging technology, you can create a set of rules that promote efficient operations, staff satisfaction, and optimal patient care.
Remember that the process of setting and maintaining ward rostering rules is ongoing. Regularly review, staff involvement, and a willingness to adapt are the key to long-term success. By approaching this responsibility with thoughtfulness and care, you can create a positive work environment that benefits both your staff and your patients.
Optimize Your Ward Scheduling with Expert Assistance
Our Scheduling Service
If you’re looking to implement an efficient, fair, and compliant ward roster scheduling system, we can help. Our team offers personalized algorithm development and web-based solutions tailored to your specific needs. Learn more about how we can transform your scheduling process at https://8-hours.com.hk.
Learn to Schedule with Program
If you want to try make your own rostering algorithm, you can learn it with our free e-book, “Programmatic Roster Scheduling”. This guide introduces you to the basics of using programming to create efficient and fair schedules. You will learn how to translate ward rules into code, automate repetitive tasks, and generate optimized rosters with ease. Because most doctors have little programming experience, I’ve written it for beginners in Python.