Automated rostering helps Mount Carmel Hospital maximise staff
2 December 2013
Mount Carmel Hospital in Dublin has replaced its traditional
paper-based system for producing staff rosters by implementing a
computerised workforce management system.
Mount Carmel has deployed the SMART e-rostering system from
Kronos across all four floors, starting on the busier wards on the
ground floor and finishing with the operating theatres and
outpatients department. The hospital has already noticed
considerable benefits in the utilisation of nursing staff. It now
has the ability to plan ahead and arrange cover for unplanned
changes which results in consistently high standards of patient
The major challenge Mount Carmel faced was instigating a
significant shift in culture by promoting the benefits of e-rostering.
The Hospital has loyal and long-standing staff who are proud of
their clinical excellence. However, as times have changed, there has
been far greater emphasis on helping ward sisters and nursing staff
understand the importance of using automated technology to produce
efficient rosters that tangibly support the smooth running of the
As a hospital reliant on a traditional paper-based system for
many years, providing easy-to-understand, quality hands-on training
whilst maintaining excellent patient care was an additional hurdle
to be overcome. The hospital also has a higher proportion of
part-time staff than is typically found within hospital
organisations, many of whom hold (historic) restrictive contracts of
employment, which presents further challenges for the implementation
The solution – a change in culture
Mount Carmel deployed the e-rostering system across all four
wards to support 210 nursing staff, manage complex shifts and
produce efficient rosters that maximise the talents of highly
skilled clinicians and provide fair rosters for everyone. Staff can
even access the system themselves (including remote accessing) to
request changes to their shifts, book holidays or report sickness
At the same time, the system has been sensitively configured and
installed to meet Ireland’s strict Trades Union policy of consulting
staff prior to changing shift patterns and rosters.
In line with Dr McCarley’s own pioneering Timeframe Analysis
methodology that maps a typical workload across the day and across
the week and flags up what and how many staff are needed whenever
there is a change in workload, the system can be fine-tuned to Mount
Carmel’s own schedule.
For example, patient demand typically changes during the course
of the day from lulls during night-time to intense bursts of
The successful implementation with hard evidence of positive
results, has been the catalyst for cultural change at Mount Carmel.
From a strong resistance to change, staff at all levels are
beginning to appreciate the benefits of e-rostering and look forward
to utilising other features provided by a suite of workforce
Next on the agenda is installing a patient acuity solution, Real
Time Hospital, to provide a 360 degree view of all staffing
requirements to minimise risk and maximise safety. It then plans to
centralise all e-rostering in the foreseeable future.
Putting patients first
Mount Carmel has become more efficient in its use of key
resources, meaning the most appropriate skills are allocated to the
right wards at the right time. In addition to properly identifying
workforce requirements (expressed in whole-time equivalents), it has
allowed for the proper identification of the specific skills and
expertise required within discreet service environments, based on
the typical patient population. The e-rostering system has also
improved the capacity for managers to redeploy nursing staff across
service environments as activity/acuity changes leading to a
reduction in the use of ‘bank’ nursing staff.
The Real Time Hospital acuity solution provides a continual,
comprehensive overview of the hospital rosters allowing managers to
quickly identify periods of either overstaffing or understaffing,
based on the predetermined minimum staffing requirements within each
area. This also improves management decision-making
In short, the system helps the hospital provide a truly
patient-based service where the patient’s well-being lies at the
heart of everything it does.
Time and cost savings
Mount Carmel has been able to prove the benefits of e-rostering
in real terms. Already, the hospital has saved significant amounts
of time through the more effective management of rosters, reducing
considerably the ‘overstaffing’ within many rosters. The time saved
has released clinical skills back into patient care, where it
matters most and where senior nurses excel.
The hospital has improved the equity in allocating staff to
shifts that attract a premium pay. The scoring system automatically
allocates the ‘premium’ shifts to staff that have the lowest score
ie staff that have had fewer premium shifts.
The automated link to the hospital payroll has removed the
requirement for managers to calculate premium payments for nursing
staff, eliminates the potential for errors and further reduced the
time required to manage the rostering process.
Better forward planning through analytics
The availability of accurate, real-time information has enabled
Mount Carmel to analyse their use and deployment of staff. Rather
than look through paper or spreadsheet records, managers can quickly
generate reports to identify the busiest times of day or year and
track holiday or sickness absence and plan future rosters
accordingly. They have also eliminated the requirement for storage
of paper records of ward rosters.
Mount Carmel expects to yield the following additional benefits:
- a greater focus on workforce planning and deployment,
minimising the requirement for reactive staff adjustment
- improved capacity to deliver coordinated experimental
learning for nursing staff;
- enhanced ability to monitor hours worked against contracted
time leading to a reduction in the requirement for time off in
- more effective control of expenditure both on permanent
staff and in the use of bank nursing .
Mount Carmel has plans to move towards centralised rostering in
the near future, so a core group of expert users will improve the
cost-effectiveness of rosters and enhance the deployment of staff
across all areas, rather than a traditional one-ward perspective.
This will give staff working on all four floors a clear view of
rostering across the whole organisation, allowing them to fully
utilise specific skills or address potential shortages on certain
wards quickly and efficiently. It will also eradicate the
duplication in ward management time, facilitate annual leave
planning and support the integration of timesheets and absences into
A centralised approach to e-rostering will depersonalise the
process for managers who have often built up a strong sense of
camaraderie with their staff. This will bring greater transparency
to the process and dictate greater equity in allocation of premium
working hours, making it fair for everyone.