Achieving a balance between many competing interests when rostering health care professionals in our hospitals has always been problematic. It is self-evident that excessive working hours not only lead to sleep deprivation and fatigue but also create attendant risks for both patients and doctors — from an erosion of high-quality care to a negative impact on personal lives. In short, rostering is an administrative nightmare.
* Duff E, Hall L. $4m for 10 bureaucrats to do rosters as nurses go. The Sun-Herald (Sydney) 2009; 16 Aug: 7.
In the light of such difficulties, a recent media report claimed that New South Wales Health is considering a unique solution. The rostering of all nurses, junior doctors and allied health staff in hospitals is to be taken out of the hands of local managers and electronically centralised in a “Rostering Centre of Excellence” based in the Sydney suburb of Gladesville.* This proposed Centre is to employ 10 bureaucrats, earning an average of $100 000 a year, to micromanage hospital rosters from Broken Hill to Balmain! In addition to the $4 million allocated for these roles over 4 years, change management consultants will also be paid to help implement the new system across NSW.
This initiative smacks of desperation — an instinctive retreat to the customary bureaucratic, command and control, top-down approach to a problem that is endemic in any hospital which has to juggle fluid medical situations and a workforce subjected to constant stress. This begs the inevitable question: can a distant bureaucracy be an efficient substitute for in-house rostering? Is this simply another attempt at cost saving, which will serve to superimpose yet another layer of bureaucracy on an already overmanaged health care system? Or will such a Centre usher in a nightmarish scenario of Orwellian proportions?
Finally, there is an inherent irony in the proposed siting of this absurdly named “Rostering Centre of Excellence” in a location that, in another life, accommodated an asylum for troubled souls.
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