Surgical and Ambulatory Service Orthopaedic RMO Staffing Increase and Roster Impact Project / Brief Name: Orthopaedic RMO Staffing Increase and Roster Impact Release date: 31 July 2015 Version: Second Draft Print date: 31 July 2015 Status: Draft Consultation Paper Sign-Off Name and Position Date Signature Liz Hollier, Acting GM, S&AS Michael Rodgers, CoS, S&AS Matthew Walker, CD Orthopaedics Dale Shewan, OM, Orthopaedics 1
1 Glossary of Abbreviations DHB FTE MECA NZRDA RMO SMO HO District Health Board Full Time Equivalent Multi Employer Collective Agreement New Zealand Resident Doctors Association Resident Medical Officer Senior Medical Officer House Officer 2 Purpose The purpose of this document is to initiate a formal consultation process with staff who may be affected by a proposal to make changes to RMO staffing and rostering within Waitemata DHB s Othopaedic service. It is essential to emphasise that this is a proposal only. No final decisions will be made until all feedback has been considered. 3 Background The Orthopaedic service employs 17 Senior Medical Officers (SMO) and 3 Fellows. In addition, 10 registrars and 1 reliever registrar (4 SET positions and 7 Non SET positions) are employed within the service. These are organised into 5 teams with 8 House Surgeons reporting into each team, as below: Team SMO s Fellow Senior Registrar Junior Registrar House Officer Blue 3 1 1 1 1 Red 4 1 2 2 Black 4 1 1 1 2 Green 2 2 2 Red 3 1 1 1 In order to meet the increased demand for Orthopaedic services and to better apportion workload an additional 3.89 FTE SMO s have been appointed between 2013 and 2015. The number of registrars employed has stayed constant during this time. This is despite both elective and acute workloads having increased, whilst there has also been an increase in the acuity of patients and the time required in managing their complex care. Discharge Volumes Acute volumes have steadily risen by 18% since 2009. This increase is felt across the hospital system from the Emergency Department, operating theatres and ward occupancy. The registrars are responsible for the coordination of discharge planning from Emergency Department and from ward rounds. They also manage the urgent orthopaedic referrals during normal hours and after hours, including weekends. Electives 2
Elective volumes have increased by 57.9% since 2009. With ESC opening in 2014 the electives split between North Shore and ESC is roughly 50%. Registrars attend pre assessment clinics and support SMO s in outpatients clinics for patients having their surgery at both ESC, North Shore and Waitakaere hospital. Whilst the data shows that ESC have reduced the amount of electives treated at North Shore the overall work up to theatre for the ESC electives and the post-surgery follow ups for the ESC electives are undertaken by registrars. ** Please note: - 2015 are extrapolated volumes based on ytd performance It is expected that acute service volumes will continue to grow by at least 2% per annum. In March 2015, a business case for an additional 1.0FTE of RMO headcount was submitted to provide additional reliever resource. Approval was received for this additional position. 4 Current and Proposed Model 4.1 Current Model Current rosters are available from the RMO Centre and the run description is attached. 4.2 Proposed Model To support the increased workload within the Orthopaedic Service this additional 1.0fte RMO resource is being proposed. Whilst it will require no change to the current roster pattern, the additional resource is proposed to reduce the number of Long Days during the week and at the weekend and the number of nights allocated per Registrar. The new arrangements are not expected to see any change to the Run Category which will remain an A. 3
Our consultation process is open and we will consider any suggestions regarding this matter, therefore your thoughts on how this proposed roster will work with an additional reliever available are welcome, and alongside any other suggestions to improve the roster, will be considered as part of the consultation process. Based on this information, the following changes are proposed: An increase in the numbers of Orthopaedic Registrars from 11 to 12. There will be no change in the roster, but RMO s work schedules will reflect a reallocation of commitments i.e, the number of clinics and of theatre sessions they are currently required to attend, etc are proposed to be reduced. The number of on call shifts for the Orthopaedic RMO s is also proposed to be reduced. WDHB is a training hospital and with an additional RMO providing relief there will be increased opportunity for all registrars to be able to attend operating sessions. To provide clarity, a draft run description has been included in this document as attached in the Appendices. This should not be interpreted as the proposal being predetermined. Any suggested changes to the proposed model will be fully considered and where determined to be beneficial, will be included. To the best of our understanding, RMO training opportunities are not affected by the proposed changes. 5 Purpose / Benefit of Proposed Changes The main drivers for the proposed changes include: A better, more sustainable and equitable workload between teams. Reducing workload, by spreading the load therefore improving safety of Orthopaedic RMOs. Better support for the increased number of Orthopaedic SMOs in the service. The realisation that, if that the above were to be achieved by the increase in RMO resources, this would provide better care for our patients. The benefits of implementing the proposed changes include: The addition of another relieving RMO to the service would significantly improve and promote a more equitable workload over the current teams. The proposal increases the number of whole weekends off for the Orthopaedic Registrars affording them better quality time for rest and recreation. Across both Registrars and House Officers there would be little net change in remuneration from run categories if the proposed changes were implemented. All other RMOs would remain on the same run pay category. An additional registrar will provide cover to allow training commitments to be met and provide cover for annual leave to ensure staff can take a reasonable amount of leave when they require it. 4
6 Scope The run descriptions that will be affected by the change include: Registrar 7 Out of Scope Not applicable. 8 The current and proposed structures Current Structure 5
Proposed Structure 9 Consultation This consultation will be carried out over a period of two weeks, from 6 August 15 July 2015 and all stakeholders are invited to provide feedback electronically or if preferred via meetings, either group or individually, to discuss the proposal further. The service genuinely wants to hear from all stakeholders and no decisions have been made. The opinion of the affected staff is vital to making this work and both group and individual discussion will be sought. This document is to provide the basis for those discussions and all opinions will be taken into consideration before a final decision is made. Feedback may be provided on all or some aspects of the proposal. There is a feedback form appended to this document which you may wish to use. Feedback can be sent directly to Sue Brown, HR Manager, at sue.brown@waitematadhb.govt.nz. All feedback will be treated confidentially and will be collated and fed into the decision making process on an anonymised basis. 10 Support Services It is acknowledged that the changes proposed may be stressful for some people. The following resources are available: EAP Services Counselling is available through the WDHB funded Employee Assistance Program (EAPworks). This program is completely confidential. Employees using this service are not identified and we encourage you to contact the service to discuss any issues as a result of this proposed change. An 0800 number 0800 SELFHELP (0800 735 343) is staffed by EAPworks staff members and can be accessed 24 hr / 7 days 6
Occupational Health & Safety Support is also available from the Occupational Health team. The Occupational Health Team contact details are: Occ.health@waitematadhb.govt.nz or NSH - Telephone: 09-486 1491 Ex: 2829 WTH - Telephone: 09-839 0000 Ex: 6134 NZRDA NZRDA can be contacted as follows: Melissa Dobbyn delegate@nzrda.org.nz (09) 526 0280 11 Next Steps Timetable Activity Date Announcement of proposed structure 6 August 2015 Consultation period begins 6 August 2015 Consultation period ends 20 August 2015 Consideration and review of feedback 21 August 28 August 2015 Delivery of decisions 29 August 4 September 2015 Implementation 14 Dec 2015 7
12 Appendices Appendix A Feedback Template Name: Designation: Comments on proposal for change: Any other information you think is relevant and of value to consider in this process? 8
Appendix B Proposed Run Descriptions RUN DESCRIPTION POSITION: Registrar Orthopaedics DEPARTMENT: Orthopaedics PLACE OF WORK: North Shore Hospital. RESPONSIBLE TO: Clinical Director Orthopaedic Services, Operations Manager, Orthopaedics. FUNCTIONAL RELATIONSHIPS : PRIMARY OBJECTIVE: There are 3 Orthopaedic Fellows, 10 Orthopaedic Registrars and 2 relievers. (4 SET and 7 Non-SET) To facilitate the management of patients in the care of the Orthopaedics service. RUN RECOGNITION: That the run is accredited for the training of basic orthopaedic and advanced orthopaedic trainees. RUN PERIOD: 26 weeks Section 1: Responsibilities Area Clinical Duties & Work Schedule Responsibilities Responsible for the clinical assessment, investigation, diagnosis and treatment of patients admitted to the orthopaedic unit under the direction of the Specialist Consultant. To facilitate the safe and efficient management of patients under the care of the orthopaedic consultants, including patients admitted under the orthogeriatric model in wards 14 and 15. To assist the specialist consultants in the operating theatre as allowed by the acute roster, and carry out orthopaedic procedures as directed by them under their supervision. To be responsible for admission of elective orthopaedic patients from the waiting list, in consultation with the Specialist, and to assist with the Outpatient clinics at both North Shore Hospital and Waitakere Hospital under the direct supervision of the consultant. 9
Area Expected Results Responsibilities To keep the specialist on call informed about the acute admissions, particularly in the case of seriously ill patients. To assist the specialist consultants in the management of urgent referrals to the orthopaedic unit and supervise the management of these patients by the house surgeons. To provide afterhours cover for emergency referrals to the orthopaedic department and assist in the care of these patients. To carry out with the House Officer a daily ward round during ordinary hours and on Saturday where rostered on duty in order to oversee ongoing investigation and management of inpatients. To receive telephone calls from GP s for urgent referrals and discuss appropriately. A high standard of clinical care, including assessment, investigation, diagnosis and treatment will be provided for patients in the department. Clinical competence especially in emergency situations meets Waitemata District Health Boards requirements. Patient treatments will be accurately charted and progress notes kept up to date, ensuring discharge summaries are completed on the day of discharge of a patient, and the patient receives a copy. Actively participate in the department s developing quality assurance programme, including audit. Report significant patient events to the consultant under whom the patient has been admitted. The clinical well-being of patients is assured at all times, and care is delivered in a sensitive fashion, taking into account ethnic and other interests, and recognition of patient rights. Actively promote early, effective and appropriate discharge of patients, ensuring discharge summaries are completed on the day of discharge of a patient, and the patient receives a copy. Assist in operating theatre, developing expertise in orthopaedic procedures. Perform orthopaedic procedures under supervision of surgeons. Maintain a high quality of clinical management of Outpatients in collaboration with Specialist Consultants. Maintain effective interpersonal relationships with members of the multidisciplinary team, patients and relatives/whanau. Provide supervision, instruction and support to house officers on the team. Section 2: Training and Education Nature Protected Time Details The Registrar will attend weekly (unless attendance is required for an emergency) the: Grand Round Tuesday 1230 Conference Room 1. X-Ray/Radiology review meeting Wednesday 1030 a.m. Formal Teaching Round Friday morning 0800-1000 Registrars may be requested to present case summaries and topic reviews as agreed. 10
Section 3: Roster Hours Of Work Ordinary hours of work Monday to Friday 0730 1530 Acute Admitting Duty 0730 2300 Night Duty 2200 0800 Post Acute Rounds Saturday 0800 1600 Junior Registrar Nights will be rostered 1:7 Long day weekends (Saturday and Sunday) rostered 1:7 Registrars are rostered every alternate full weekend off duty. The Registrar reliever will perform the duties of the Registrar on nights and cover nights at a frequency of 1:7. Section 4: Performance appraisal Registrar The Registrar will: Ensure they arrange a formal meeting with their supervising consultant to assess and discuss their performance at the beginning of the attachment, and again at three and six months. If deficiencies are identified, the Consultant will identify these with the Registrar who should implement a corrective plan of action under the advice of their Consultant. Service The service will provide: an initial meeting between the Consultant and Registrar to discuss goals and expectations for the run, review and assessment times, and one on one teaching time. an interim assessment report on the Registrar three (3) months into the run, after discussion between the Registrar and the Consultant responsible for them; the opportunity to discuss any deficiencies identified during the attachment. The Consultant responsible for the Registrar will bring these to the Registrar s attention, and discuss and implement a plan of action to correct them; a final assessment report on the Registrar at the end of the run, a copy of which is to be sighted and signed by the Registrar. Section 5: Hours and Salary Category Average Working Hours Basic hours 40.0 Rostered additional hours (inc. nights, weekends & long days) 18.88 All other unrostered hours 13.59 Service Commitments The service together with RMO Support will be responsible for the preparation of any rosters. Total hours per week 72.47 11
Salary The salary for this attachment will be detailed as a category A. The Reliever Registrar will perform the duties of the Registrar on nights or leave. The Salary for these particular duties will be as detailed in a Category A++ run. WDHB Orthopaedic Registrar Run Description Effective 9 June 2014 Disclaimer: Please note that this run description is current at the time of publication, but is currently under review and may be subject to change. It is your responsibility to ensure that you have the most up to date version if you will be relying on the information enclosed. Please contact RMO Support for further information. 12