Matt Morgan: Buying toilet rolls and writing rotas—is this really the best use of clinicians’ time?

Quality improvement schemes have so far been aimed at solving clinical and logistical problems, but have forgotten about the most important assetstaff

I’m staring at a screen filled with different coloured boxes, endless numbers and characters fighting for attention. As one number changes, another flashes to life. Although this has similarities to the patient monitors in the intensive care unit where I work, I am actually sitting at my desk. I’m writing yet another rota for twenty people spanning the next six months.

Teenagers across the land are not told when ticking “medicine” as a career that an in-depth knowledge of Excel macros is a key requirement for a doctor. Fifteen years of medical training seldom prepares you for the first time you tell a colleague that they are going to work Christmas Day this year. The truth is that I actually like my role of writing a complicated consultant rota. There is a simple satisfaction when all of the cells turn green after matching fifty different study leave requests in the same month to the clinical needs of a unit. Yet a part of me worries about whether this is really the best use of my time. Is it good for the NHS that hundreds of front line clinicians are doing what non-medical others could do better?

The NHS is the world’s fifth biggest employer spending over £2 billion every week. It employs 1.3 million people with a budget more than New Zealand’s entire gross domestic product. If it were a company, the competition commission would soon be knocking at its doors. Yet this shear scale which should be a winning factor, is often a weakness.

Before improvements in central procurement, even buying toilet rolls was devolved to individual hospitals leading to hundreds of different suppliers. Even my family of four people exploit economy of scale and bulk buy ours together. Yet the NHS was doing the equivalent of popping to the corner shop every day to buy a single roll. One hospital may pay £32 for 100 rolls while another £66 for the very same item. Although procurement is now slowly getting into gear, there are more pressing aspects of scale that should be developed.

Richard Branson said “if you look after your staff, they’ll look after your customers.” There is now finally appreciation of the negative effects that shift work, poor rostering, and disturbed sleep have on the health of healthcare staff. As the NHS spends 40% of its costs on staff, it makes sense to put staff wellbeing and efficient working at the centre of what it does. This in turn will lead to profound benefits for patients.

Why then, am I reinventing the wheel, making bespoke rotas for our staff, just like thousands of other doctors are doing every day wedged between their clinical work? Although, as a computer geek, I feel I am skilled at this task, I can never be as skilled as the combined knowledge of millions of staff delivered through a software package designed for a specific purpose. Why can’t we learn the lessons of efficient rostering that promotes good health and apply them across the biggest employer in Europe? This would in-turn promote better patient care.

It seems quality improvement schemes have so far been aimed at solving clinical and logistical problems, but have forgotten about the most important assetstaff. Using the sheer scale of the NHS to automate, improve, and offload these important tasks from front line clinicians will give them more time and energy to do what they do bestbe on the front line helping patients.

Matt Morgan, Honorary Senior Research Fellow at Cardiff University, Consultant in Intensive Care Medicine and Head of Research and Development at University Hospital of Wales, and an editor of BMJ OnExamination. He is on twitter: @dr_mattmorgan

Competing interests: None declared