Case Study: Good Call
How an independent review saved an on-call service
Overview
Sally* was an experienced director who had started a new role leading a busy team of 60 allied health professionals. The managers in her team were highly experienced, and the workers were qualified and engaged professionals.
All workers were required to participate in an on-call roster to support clients out of hours as needed. However, some workers voiced concerns about participating in this service. They asked Sally to hire other people to do the on-call work, but Sally wasn’t sure if that would fit her budget. Her managers suggested perhaps the workers’ professional confidence wasn’t sufficient and that more training would fix the problem.
Sally found the workers’ concerns contributed to low morale, decreased productivity, sick days, and higher turnover. She also found it difficult to recruit people to replace those who had left. It was becoming well-known that workers could get better conditions and more money in other organisations.
If Sally’s budget couldn’t cover the cost of fully staffing the on-call roster, she didn’t know what else she could do to attract and retain enough workers to support the service. So, Sally enlisted the help of the Guardian Actuarial team.
Key Issue
A solution was required to a complex rostering problem for 60 plus staff. On the surface, the key issues related to staff not wanting to do the ‘on call’ shifts. This ultimately turned out to be a false assumption and once the truth was revealed, a series of small but significant changes resolved the issue.
What was required to solve the problem?
Trustworthy insights on why the problem existed, options to solve the problem and data to support the decision, including ensuring their budget would cover the proposed solution.
Our Process
Initial session: Understanding the problem
First, we met with Sally to better understand the issues she faced. We then explored possible options to address these issues. Together, we agreed on a program that would clarify the issues and enable clear recommendations.
Focus groups: Capturing staff concerns
Next, we held confidential focus groups with different levels of staff. We met with the managers to understand what they thought should be done to address team members’ concerns. We then met with the workers (without their managers) to get a greater insight into the issues and hear their suggested solutions.
The focus groups allowed us to capture and refine what the managers and workers thought was and was not working with the on-call arrangements, as well as possible areas for improvement.
Surveys: Validating themes
We issued two online surveys (one for managers and one for workers) across all 60 staff members to validate the focus group themes and give all workers a chance to be heard.
By conducting focus groups before issuing the survey, we were able to keep the survey questions targeted and focused. We could test whether the themes that had emerged from the focus groups were shared by all workers and not just those who had attended the focus groups.
Data collection: Identifying the costs
In addition to collecting worker data, we gathered organisational-level data about the on-call roster. This helped us identify the hidden costs of this arrangement, such as “sleep leave”.
We examined various data, such as how often workers were called in while working on-call. This enabled us to identify trends in on-call duties based on time, day and month.
We also collected management accounting information to understand current staffing levels and costs. This allowed us to quantify overtime costs and the cost of hiring additional staff to complete the on-call work.
Data analysis: Problem-solving
Having collected quantitative and qualitative data, we analysed the focus groups, surveys and financial information to gain full clarity on why staff were concerned about working on the on-call roster. We also used this data to identify possible areas for improvement and quantified the costs of these opportunities.
Reporting: Presenting solutions
Finally, we presented to Sally our findings and recommendations via a report and summary infographic. We outlined:
How much after-hours work was required at which times and on what days.
The true cost of the on-call roster (including actual and hidden costs) and the risks to the organisation.
Opportunities to better support and address the concerns of on-call workers.
A strategic way forward
Our analysis estimated that hiring additional staff for the on-call roster would require a more than 300% increase in the budgeted cost of wages. This was far outside the organisation’s budget, so it was critical to address the workers’ concerns. As independent, confidential consultants, we were able to find out the true concerns of the staff and what they needed to address those issues.
Interestingly, although managers had suggested that a lack of professional confidence may have been at the heart of the problem, 77% of workers agreed with the survey statement, “I feel confident in my professional ability while I’m on call.” Workers also outlined many benefits of working on call, including the opportunity to enhance their professional skillset.
However, workers also identified important safety concerns, which they felt unable to articulate to their managers. Our review allowed Sally to address these safety concerns, resulting in more confident and safe workers while also reducing the risks to the organisation. Most of these improvements did not require any additional funding, as they could be delivered through existing resources.
Workers also told us they didn’t have sufficient access to managers for support and debrief while on call. As the on-call arrangements didn’t include a funded manager, the managers supported workers in their own time. This was unsustainable for managers and insufficient for workers. We estimated that implementing a dedicated on-call manager would increase the on-call budget by approximately 56%, which was significantly less than fully funding the roster at a 300%+ increase.
After implementing our recommendations, the on-call roster now works more efficiently and safely, and the budget has not blown out. Most importantly, Sally’s team of allied health professionals are more engaged, productive and happy in their work.
From
Lack of transparency, misunderstandings and a set of unidentified risks that were driving unhappy staff, misinformed managers and high staff turnover.
To
A well-resourced roster, happy staff and management, as well as mitigating previously unidentified risks that were putting the staff and organisation at risk.
*Names have been changed to protect client confidentiality.
