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East Midlands Ambulance

East Midlands Ambulance Service Introduces Annualised Hours

From December 2004, East Midlands Ambulance Service Trust, (EMAS), was required to implement new ways of working under the Government's national Agenda for Change, (A4C), programme, and redesign employee roles to increase the focus on patient need and service delivery. It thus began an investigation into its emergency service workload demand to identify trends and evaluate the efficiency of its current shift patterns, and create a reduced working week of 37.5 hours for employees, with regular, unpaid, meal breaks within shifts.

The Need for Change

The Trust operates 38 ambulance stations in an area of over 2700 square miles, serving almost 3 million people. Each station is required to be on stand-by 24 hours a day, seven days a week, but have different, local operational demand profiles. Ambulance staff were working an average of between 39 and 42-hours per week, and there was dissatisfaction with the centrally-produced rosters, being inflexible and unable to simultaneously meet the needs of staff, the organisation and the ever-changing demand profiles. Staff were under-utilised during slack periods, but periods of high activity meant that meal breaks were often missed, or, service levels declined at these times, and, due to the nature of emergency calls, staff often experienced an unequal work-life balance. Daily, weekly and seasonal variations in demand occurred, but the rostered labour supply remained largely unchanged in comparison. Insufficient cover was especially a problem on Friday and Saturday nights, and Sunday afternoons and evenings, and staff sickness, holidays, training or other reasons for absence, meant that overall, the lack of employee capacity was increasing labour costs in terms of overtime and relief staff, as well as having a detrimental effect on patient service levels. Conversely however, at certain times, an overstaffing issue was also identified commensurate with relief provision for the cover of holidays, training, sickness and other absences.

The Solution

EMAS faced a major challenge of reform to satisfy staff, patient and organisational expectations and it required a rostering tool and method dynamic enough to be able to allocate staff based on predicted demand and make provision for unexpected variations and staff requests. An external consultancy was invited to work with the EMAS project team to review the potential for, and benefits of, demand-led working time change in the organisation, and by applying the annual hours theory, provided EMAS with a new perspective for its given scheduling situation and objectives for reform:

• To reorganise all A&E rosters to match current demand profiles
• To ensure staff work rosters based on 37.5 hrs per week, in line with A4C terms and conditions
• Improve capacity at key times of the day to improve performance target delivery.
• Accommodate, and effectively utilise, 300 additional staff within the new rosters
• Staff to influence the final design of the roster pattern, in line with resource requirements.
• Promote more flexibility around staff's working time commitments
• Encourage a team-based approach and accountability for roster planning and delivery

Detailed analysis of the A&E demand during a 20-week reference period and across all the ambulance stations, took careful account of a range of operational factors and contingencies, including the average job cycle time of 63 minutes, the types of demand experienced, non-patient carrying time and 'inefficiencies' such as vehicle refuelling, breakdown, maintenance and cleaning, as well as staff meal breaks. Overall, this provided a reliable picture of the requirement for staff hours, and an annual hours contract calculation, based on the A4C reduction in contracted hours, was applied to the demand profile to allocate staff according the peaks and troughs in demand activity.

Results

An important element of the reform process for EMAS was the need to improve staff satisfaction and motivation. Essential consultation with trade union officials introduced the system to staff, and by matching rosters to busy and quiet times, staff have gained more flexibility in their working hours. They also have less shifts to work per year, and self-managed rosters have been introduced at a local level. Paramedic team leaders now manage shift patterns and the allocation and monitoring of shifts, per station. Team members have flexibility regarding which shifts they work, providing that the team roster meets the final demand profile, and colleagues can also 'trade' between three and five shifts with each other, and work these hours either in advance or arrears to achieve additional time off, such as for a holiday.

Staff were given the option to retain a managed rota, with, for example, annual leave organised in the conventional manner and shift abstractions covered by relief staff, similar to the previous method of operation, and a number of stations took this option. However, their rosters still correspond with the demand patterns and meet the A4C target of 37.5 hours per week, and in consequence, EMAS has been able to operate with both systems, complementing each other to deliver a more dynamic cover level.

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