Executive Summary

The project final report is available to download here.

The WayWard project was a two-year study based at the University of Nottingham and funded by the Health Foundation. Its aim was to develop methods to enable the demands of ‘Out of Hours’ (OoH) care in hospitals to be studied at scale in order to provide clinicians and service managers with new forms of process management information to improve the safety, efficiency and quality of OoH care.

For years concerns have been raised over ‘Out of Hours’ (OoH) care in hospitals. Studies demonstrate drops in healthcare quality at night and on weekends, including significant increases in mortality. Demands of OoH working lower quality of life for staff and impact the costs of care through absenteeism and over-reliance on locums. Despite well documented effects, OoH care remains under-studied, due in part to practicalities of large scale manual studies in complex, geographically dispersed, and sensitive working environments.

The WayWard team collected four complementary sets of data in three UK hospitals, Nottingham City Hospital, Queens Medical Centre (Nottingham) and Aintree Hospital. At each site task logs, tracking data from individual doctors, direct observations of activity (‘shadowing’) and qualitative interview data were collected. During the project the team developed new methods for processing and analysing this data and worked in partnership with the Royal College of Physicians (RCP) to produce outputs which are of use to clinical staff, hospital managers and policy makers. These outputs include both academic outputs in peer reviewed journals and contributions to the RCP staff staffing working party which is due to report in 2018.

Results from the project include detailed analysis of the workload faced by clinicians working OoH, including the distribution of work over time. For example at all sites studied around 35% of the total workload undertaken out of hours is raised in the first 20% of the shift. Up to 45% of the workload created OoH may be more efficiently completed during the daytime, for example drug prescribing and cannulation / venepuncture. Activity data collected by the project found that 13% of a doctor’s time is spent searching for notes, equipment, other staff or patients in the OoH period.

Interviews revealed the varying nature of pressures felt by OoH staff. Clinical Support Workers seek to maintain efficient routines, steadily working through non-urgent tasks according to preferred routes around the hospital site. Coordinators (Nurse Clinicians) and Registrars are in a position of oversight and need to balance two distinct facets of their roles, managing clinical emergencies and organisational tasks interchangeably or simultaneously. Junior Doctors may struggle to complete tasks in a timely manner when there are complex care needs or large numbers of patients, and they do not necessarily know when and how to get help. These interviews also revealed that information flows among team members are complex and sometimes not well supported by the technological aids and system design.

United under the ‘WayWard’ brand, outputs from the project can be found on this website (http://wayward.wp.horizon.ac.uk/). The website contains links to academic outputs, computer code, white papers and project videos. The website is intended for academics, professional bodies and senior clinical staff interested in replicating and extending the methods used in the WayWard study. As such it has been advertised where opportunity arises at academic events and actively promoted by the University of Nottingham media team. The website will be hosted and maintained until at least 2021 by Horizon Digital Economy Research at the University of Nottingham.

The project final report summarises the activities and results obtained by the WayWard team and gives recommendations based on our findings and experiences.