1. PROFESSIONALISING ROTAS THE CURIOUS CASE OF THE “GOOD DOCTOR” Reem Al Soufi Consultant Lead for Rotas - NHS Grampian Aberdeen

2. How did I get involved?! EM Trainee 2008 - 2015 Rota “Master” 2012 - 2013 Scottish Clinical Leadership Fellowship 2014: Professionalism & Excellence in Scottish Medicine Group Professionalism Compliance Analysis Tool (PCAT) Consultant Lead for Rotas (98 of them!)

3. The Elephant Metaphor Chip & Dan Heath SWITCH: How to change when change is hard

4. Talking about change.. 1. What? 2. Why? 3. How?

5. What to change about Rotas? Rotas are designed with available numbers of doctors in training to provide service within the contractual limits of the EWTR and the ND     Rotas are designed to empower doctors in training to become Good Doctors

6. Define “Good Doctors”? “Good Doctors make the care of their patients their first concern, they are competent, keep their knowledge and skills up to date, establish and maintain good relationships with patients and colleagues, are honest and trustworthy, and act with integrity and within the law ” GMC – Professionalism in Action Rotas with Patient at the centre of design Team Cohesiveness & Compassion Quality of training: symbiosis between training and service Rota Monitoring Process Workload intensity allows timely breaks Good Rotas

7. Ask the trainees.. What aspects of your Rota are fostering “Good Medicine”? PCAT Professionalism Compliance Analysis Tool 24 recurring themes Bundled in 3 domains PCAT Professionalism Compliance Analysis Tool 24 recurring themes Bundled in 3 domains Patient Centredness Trainee Wellbeing Quality of Training

8. PCAT Patient-centrednessQuality of TrainingHealth & Wellbeing Adequacy of medical staffing Trainees involved in rota design Post night recovery > or = 48 hours Adequacy of nursing and AHP staffing Formal teaching time is protected Accessibility of study leave Timely release of rota > or = 6/52 Workload intensity Time for indirect and non-clinical tasks Healthy shift patterns (e.g circadian rhythm and max weekend frequency) Preparedness for changes in workload intensity Adequacy of supervision % OOH Continuity of care: Turnover of medical staff ‘Acting up’ SupportTeams synchronised on rota (team cohesiveness) Handover (time & quality) Mentorship StructureWellbeing @ work awareness Induction (time & quality) Formal teaching and planning for unique learning opportunities within the rota Flexibility of annual leave

9. PCAT as a Diagnostic Tool

11. PCAT

12. Why change? Medical Workforce Happy is the new Effective Quality Strategy & Workforce Visions 2020 ≈5500 Trainees on 900 rotas 5024.3 Consultants ≈5500 Trainees on 900 rotas 5024.3 Consultants Happier staff are more productive: 12% more! Oswald et al, Warwick Happier staff are more productive: 12% more! Oswald et al, Warwick Care & Compassion Quality & Teamwork Care & Compassion Quality & Teamwork Patient Centred, safe and effective care for all 70,905 trainees 65,965 hospital career grades 70,905 trainees 65,965 hospital career grades

13. How to Change Communication Diversify The Team Share Innovation Leadership with Compassion NES/HEE  Rota Masters Rota Master  Rota Masters NES/HEE  Rota Masters Rota Master  Rota Masters TPD, Service Lead, UOM and Trainee Rep Seek to understand, motivate and support Lothian CDF and Manchester CESAR Trainees, RCSPG Mentoring Scheme

14. Most wanted..

15. The Royal Infirmary of Edinburgh Model #BakingisCaring!

16. Recipe for changing Rotas 1. Clear aim yet flexible route map 2. Diverse team 3. Evidence-based 4. Compassion PCAT TPD, CD, UOM, TR, OHS Michael West (Teams) Aviation Would you want to work on that rota yourself?

17. PCAT in Department of “Challenge” somewhere North We need more Juniors! Juniors don’t want to take their breaks! EWTR is rubbish! We need to make trainees supernumerary! When I was a lad/lass…

18. PCAT Diagnostic Phase Handover: Timing and structure Handover: Timing and structure Induction: content and delivery Standardisation of the working environment Mapping of workload: adaptive rota and “LEAN” Trainee-led QI Projects with consultant support

19. Ownership.. “We will fix it for the next group of FYs!” Professionalism

20. THE CURIOUS CASE OF THE “HAPPY DOCTOR” Reem.alsoufi@nhs.net