Web-based Anaesthesia Rota Management

[Grant]

Received this email from Suparna Das mid-October:

Re: Web-based departmental rotas

I'm a locum consultant anaesthetist at King's College Hospital, London.
Recently, while studying for a full-time MBA at Leeds Business School, I got interested in improving communications about changes in dept rotas using a web-based application & text messaging service.
Does SCATA know of any such application? Or else I'll develop it from scratch.

My reply :

Hi Suparna, thanks for your message.
I think the problem in the past has always been the limitations of the browser in terms of delivering a feature-rich environment for a rota-type of application.
With the advent of Web 2.0/CSS 2 and Ajax, I think the possibilities are now much greater and I think we'll start to see commercial products appearing.
Personally I would really like SCATA to take a hand in building a web-based system and making it available for free to departments in the UK.
Perhaps we could fund it from sales to non-UK departments, or indeed we could look for grant funding.
I've copied this to a few of my SCATA colleagues to get their thoughts.

Is anyone interested in starting a project to build a web-based anaesthesia/theatre rota management system ?

[Grant]

Madden_SCATA wrote:

Grant

I think Suparna has identified the big problem. Talking to my colleagues who deal with our weekly rota it seems that computerising the rota by itself would not solve their biggest headache. The problem is the constant changes to the rota once it has been printed and distributed. A web based solution with SMS messaging to all affected might just be the solution. I’d be very interested to see what others think.

[Grant]

Hi
There is a new Rota program which does exactly what you have suggested using web 2.0 technology. It allows access to an always up to date version of the Rota and sends out changes by Email and Text message. I think it is called Rotalife or something similar. More details later
Boris

[Grant]

Hi All
It is called CLWRota

From the Campbell-Lange workshop. It has been developed in conjunction with the Wythenshawe Hospital.

Rory Campbell-Lange is talking at the Scata conference and will be showing us his system.
Thanks

Boris

[pcooper]

Do you mean web-based app, LAN -accessible app or just computer with an internet connection ?
You can send SMS/email from a stand alone machine . Excel macros can send emails and I was doing it 3 years ago from a rota spreadsheet.

I saw the CLWRota at ASM. - PHP + PostgreSQL .

We use spinfusion. http://www.spinfusion.com - java app and jsp backend
there are also some standalone desktop apps around as well.

When i was a registrar 20 years ago in Sheffield, there was a guy doing an MSc in computer science modelling anaesthetic service delivery. (this is how I know that as a registrar I was doing 1800 cases a year). The main conclusion was that there was no real point in getting a computer to do the rota because it took as long putting the weekly changes in ( leave of various sorts, meetings, other requests) and then letting the machine do the rota , as it did actually doing the rota manually. I suspect things havent changed much in the interim. And then there is the fuzzy logic around lists as well. Computerising is useful for basic error-checking (duplicate entries etc) , but you don't need to buy an expensive product to do that. A computerised rota is an administrative tool.

What we actually bought the expertise to configure a web-accessible form that lets you put names in boxes. And the user interface is really really awful. but there again these things dont exist for the users.

Our troubleshooting is done by people gathering round the rota pinned to the noticeboard by the dept door, and someone with a pencil and an undo function ( eraser). We've thought about doing this on the computer in real time so it would be LAN accessible, but the technology , probably a touch screen, isnt affordable ATM and Health and Safety told us we couldnt do what we wanted where we wanted to (the corridor is too narrow). 3 people looking at a computer screen isnt the same ( weve tried).

There is too much crisis management around rotas and too many variables around the country for any sort of generic solution and the workflow isnt straightforward.

eg some are happy to be changed and will just grumble when they arrive - unless its a day when they have something they need to go to in the middle of the list and therefore have to have a reasonably experienced someone else with them (where will this be documented ? ) . Some insist on being asked. Some are intransigent b*****s and wont change unless other requirements are met.

how often can you wait for someone to pick up their email before you can confirm rota changes ?
have they picked it up
Have they read it but forgotten about it
have they read it but need to check things before replying
are they just not replying yet


Grafting SMS/Email onto existing systems shouldnt be too difficult

Just use the swiss army chainsaw of the internet
.
http://search.cpan.org/~eim/WWW-SMS-0.09/lib/WWW/SMS.pm
http://www.perlfect.com/articles/sendmail.shtml


perhaps what is needed is a common dataset and take it from there.
location, surgeon , surgical speciality
primary anaesthetist (how do you define primary)
other anaesthetist
skills required (eg can an SHO/SG do this list)

[danielhickmore]

Hi,
I think things have moved on a bit since 20 years ago. Have you considered anaesthetic rostering in isolation? All rostering in a healthcare organisation, or Trust has many dependencies on other specialisms and support staff, holistically. In addition, complex rules around contracts, working arrangement and more have to be considered, weighed balanced and taken in to account. I would be happy to discuss this with you as I work for Kronos, who have workforce management systems in 2,600 hospitals globally and rosters accross healthcare roles and functions. Daniel Hickmore, Healthcare Regional Manager, Kronos. 01189006866, [email protected].

[rorycl]

CLWRota, our web based Rota management system, was developed specifically for large anaesthetics departments. Although the rota is very much centred around anaesthetics it is proving to be useful for other departments as they can "look in" on the rota and help collaborate to ensure that it is an accurate register (although only certain members of the anaesthetics team can modify data).

The fact that the rota is centralised and always up-to-date is probably the most important single feature of the system. Other important apects of the system are the ability to manage recurrent activity flexibly and intuitively, while allowing for last-minute changes in an accurate manner. Naturally there are many other features, including mentoring and trainee solo list management, trainee training module support, oncall rota construction, email and text messaging alerts, comprehensive reports etc. etc.

The system was built over several years of development, staring with a long period of conceptual design with South Manchester. The conceptual "bones" of the system have so far been proven to be robust, thanks in large part to Drs Neil Braude and Nick Wisely at the Wythenshawe, and we are continuing to develop the system rapidly to meet the demands of new departments that we meet. There is some more info at http://clwrota.com.

The heart of CLWRota is procedural SQL, and we will be changing the frontend from PHP to Django for the next major version. We would be delighted to collaborate on future designs for the system (and in particular what sorts of data sets and reports departments are looking for). We'd like the system to be more extensible and open-ended, particularly in the area of extracting data.

If anyone would like to discuss this more in person we can do meet up at the SCATA conference in November, where I will be giving a short talk, or you can email me at [email protected].

Rory Campbell-Lange

[pcooper]

we have just started using one of these systems
Heres some comments from one of my colleagues ( reproduced with permission) . we used to do our rota with one person doing it whilst in theatre with a pen and paper and then an excel spreadsheet ( with suitable error cheking) and macros to store/analyse the data as to produce a one page sheet that went around. Now there is an administrator doing it
- less flexibility
- less responsive to changes
- less local ownership , so more p****d off people.


To give only one example, we have had a rota system imposed on us, with rigid rules about what activities may (or may not) follow a night on call. I am not so naïve as to believe that the Trust has spent, and continues to spend, a considerable amount of time and money on this software in order to make rostering easier for us (which it does not, this being an inelegant kludge*). It is all about increasing management's control over what we do and how we do it. The occupational psychology literature (and of course business practice by good private-sector employers) demonstrates repeatedly that reducing workers' autonomy makes them less flexible, less productive and more likely to resist change of any kind. Obsessive micromanagers are disinclined to tolerate heterogeneous systems, uniformity and compliance (or as they would prefer to put it, "consistency") being their preferred outcome. To change a system which works well and is "robust" (in the buzzword du jour), to one which is not demonstrably better simply in order to be "consistent" is a change which does not need to be made.


*kludge (noun), computing, colloq a botched or makeshift device or program which is unreliable or inadequate in function.

[pcooper]

( not that i regularly read the Guardian, you understand .......)
http://www.guardian.co.uk/commentisfree ... ing-report

"In every walk of life, the computer screen has become a professional comfort blanket................... It demotes the value of informal contact with colleagues. Provided the screen has been filled and the boxes ticked, officialdom regards itself as in the clear. Risk is eliminated not by personal application but by process."

PS im actually an enthousiast for this technology as well, but in the correct place in the correct way

[pcooper]

currently going through job-planning abetted by data from one of these things, I am now convinced they are a bad idea. Even though they may not start as such, it gives control to management , who then produce data to suit them in a format that suits them.
Im now convinced that, for the people 'at the coalface' computerised rostering software, that gives control to management , reduces flexibility and impairs you (or your) departments' abillity to tailor what you do to your immediate service issues are a very bad idea.

and im an enthousiast for this sort of stuff. !