Leading on the implementation of a COVID junior doctor rota

McHale, G.; O’Reilly, N.

AimsWe developed and implemented a new Junior Doctor rota at a small DGH in London in the weeks approaching the peak of the COVID19 pandemic.In early March 2020, it became clear it would be necessary to increase junior doctor staffing in order to provide round-the-clock care for acutely unwell patients, while ensuring cover for staff sickness. Failure would result in significant strain on staff wellbeing and patient safety.MethodsWe assessed the challenge by discussing with colleagues, meeting the site medical director and joining calls with strategic leaders.Central hospital planning provided details of expected clinical need and acuity. Junior doctors were engaged in daily handover meetings and via instant messaging.We developed a rota covering all medical wards, increasing on-call and night staffing and ensuring adequate rest. We split the hospital into zones and organised colleagues into colour-coded teams. This provided team spirit and support in a difficult environment. Evident immediately were improvements in both perceptions of patient safety and morale.ResultsWe carried out a survey of colleagues. Of the approximately 60 colleagues involved, 37 responded to 21 questions. (A = Agree, SA = Strongly Agree, N = Neutral)Perceptions of safe ward staffing before and after rota introduction: 32% vs 86% (A/SA)Perceptions of safe on-call staffing before and after rota introduction: 24% vs 92% (A/SA)Adequate notice on COVID rota change: 73% (A/SA/N)Adequate consultation on COVID rota change: 92% (A/SA/N)Team-based rota pattern beneficial86% (A/SA)ConclusionsThis work identified the need for adequate consultation when changing working practices. Successful leadership requires the ability to communicate in difficult circumstances and to implement necessary change despite time pressures. The benefits of team-based work were clearly demonstrated and should be carried forward to maintain morale.