The story of how the European working time directive was implemented successfully at Sheffield Teaching Hospitals Foundation Trust.
Following the introduction of the European working time directive on 1 August 2009, the maximum average hours of work for all training grade doctors was reduced from 58 hours (56 hours under New Deal) to 48 hours. As a legal requirement, this target has clearly defined measurable limits that will be subject to monitoring and audit, producing hard data.
The directive affects the whole of the NHS and incorporates risk management and clinical governance issues.
This article describes how Sheffield Teaching Hospitals NHS Foundation Trust took a partnership approach to produce an integrated project plan for the directive and summarises how the changes were then organised and implemented in order to fully comply with European legislation from 1 August 2009.
The largest FT in England
Sheffield Teaching Hospitals is the largest foundation trust in England and as such is a successful, well-managed service provider, run along increasingly commercial business lines. With this in mind, the following questions were asked when considering the European working time directive:
- How does directive fit into the service development strategy over the next one/three/five years?
- What contribution does the directive workforce plan make to realising profits?
- How does the directive link to modernising medical careers?
The trust is a complex organisation, covering five geographically separate sites. There are cultural and procedural differences between sites and across directorates and these were addressed simultaneously as the trust moved towards compliance with the legislation.
Integrated project plan
The trust completed its working time project between July 2007 and August 2009 and then conducted a comprehensive review of the project between September 2009 and March 2010.
The first stage involved a detailed audit of the original working hours of all training grade doctors. This was then mapped onto the directive’s requirements. Following this exercise an organisational chart was created clearly illustrating the original position in relation to the directive and highlighting those directorates required to make the largest or most significant changes.
On 31 July 2007, junior doctors were working 3,228 hours per week across the organisation more than the directive would allow. This was successfully reduced in stages between then and meeting the legal requirements that entered force on 1 August 2009.
At the outset, a series of meetings were held with all clinical directors and general managers (starting with the directorates required to make the largest or most significant changes) to discuss the results of the hours mapping exercise. Directorate plans/thinking on actions required were explored in detail and each specialty was encouraged to highlight constraints faced in meeting the directive in the context of the overall directorate business plan.
A detailed audit of workload and activity was then completed (targeted activity exercise) in conjunction with the directorates that were required to make the largest or most significant changes. This involves the use of barcode reader devices and statistical analysis with significant assistance from the nursing directorate.
All plans were assessed in the context of the financial implications for each directorate (financial modelling exercise) by working in conjunction with the finance directorate. The aim was to provide an approximate cost projection from 2009 onwards to model potential cost savings and identify where these savings may be best utilised.
Regular summary reports were collated and presented to the trust’s medical workforce project board, executive group, clinical management board and trust board, incorporating information from all the above exercises. Recommendations for further action/next steps were made within these reports.
Project management guidelines as defined in PRINCE2 were incorporated where appropriate in order to achieve effective project initiation, direction, control, delivery and completion.
Gantt charts were used in order to provide a visual illustration of progress, responsibility and milestones. These allocated tasks, responsibilities and set deadlines.
National Workforce Projects diagnostic tools and enabling strategies were utilised where appropriate. Learning from the national pilots was incorporated into the plan.
A comprehensive evidence based change management programme was developed incorporating recommendations from the most recent related research articles. All plans were considered at both strategic and operational level.
Junior doctor rotas were redesigned following guidelines published by Royal Colleges and where appropriate the BMA. Communication was improved by working closely with all relevant internal and external stakeholders.
It was made clear to all Directorates that they were responsible for developing their own individual solutions and ideas for discussion and sharing. A prescriptive approach was discouraged.
The European working time directive was seen as an opportunity for Sheffield Teaching Hospitals NHS Foundation Trust and not as a threat. A number of related issues were addressed as part of the project including the breaking down of silo working between sites, Directorates and roles in order to create a multi professional, competency based approach to service delivery.
The aim with this as with all change programmes was to maintain but ideally increase organisational productivity and efficiency. The changes required were also incorporated into overall long-term service and business plans.
Dr Jane Fitch is a healthcare management consultant and director at Hallmark Data Design firstname.lastname@example.org