The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust

Collinson Grant reviewed existing rostering policy alignment with acuity requirements and occupancy

The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust (RJAH) is a leading orthopaedic centre of excellence that has been in existence since 1900.  A specialist hospital with a reputation for innovation, the Trust provides a comprehensive range of musculoskeletal (bone, joint and tissue) surgical, medical and rehabilitation services; locally, regionally and nationally.

The hospital is on a single site in Oswestry, Shropshire, close to the border with Wales.  It has eight inpatient wards, including a private patient ward, ten operating theatres, and extensive outpatient and diagnostic facilities.

The Trust implemented a new digital rostering system and Mark Brandreth, the Chief Executive Officer, asked Collinson Grant to help review the effectiveness of its current rostering policy.  We worked closely with the managers and nursing teams to understand the existing policy and its use.  The review involved:

  • Interviews with the managerial team, ward managers and senior nurses.
  • Analysis of rostering, safe staffing, use of agency and bank staff, bed occupancy and day cases.
  • Review of existing acuity and booking management processes.
  • Ward observations to test the hypotheses created through data analysis.

Collinson Grant combined and analysed the data sources for a 12-month period before digital rostering was introduced.  We created hypotheses, which we tested through ward observations and interviews.  We then recommended improvements in efficiency for better use of resource and productivity.  The review showed some key principles for successfully rostering healthcare staff:

  • Accurate patient acuity information must be available in a timely manner in advance of admission to allow accurate rostering of staff against patient care.
  • Management information must be visible and timely. It should include performance measures (including commercial), bed capacity, safe staffing and staff availability.
  • Policies should focus on actual patient occupancy and acuity, not potential bed availability.
  • Consider cross-organisation rostering for essential roles, such as nurses.
  • Patient care pathways need to be clearly defined, visible and communicated throughout an organisation. The pathways should consider external influences, such as out of organisation patient referrals.
  • Policies and the objectives of the organisation must be clearly communicated to all users, managers and employees.

Mark Brandreth, Chief Executive Officer, commented:

“Collinson Grant worked well with front line staff and managers to produce an evidence based analysis that helps us better understand our own work.  This is really useful in making sure we are using our valuable resources well.”


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